THE McDERMOTT REPORT : 4 A Guide for Parents A REVIEW OF HAWAII MIDDLE SCHOOL SEX EDUCATION PROGRAMS IN USE August 12th, 2015 The Office of Representative Bob McDermott Hawaii State Capitol 415 South Beretania Street, Room 330 Honolulu, HI 96813 Phone: (808) 586-9730 Fax: (808) 586-9738 repmcdermott@capitol.hawaii.gov 1 The images that follow were taken for DOE programs. 2 3 4 Table of Contents Bob McDermott’s Executive Summary ........................................................................................................................................ 6 1.0 – Introduction............................................................................................................................................................................ 9 2.0 – The Sex Education Battle .................................................................................................................................................... 12 3.0 – The “Other” Middle School Curricula ............................................................................................................................... 15 3.1 – Brief Backgrounds of the Curricula .................................................................................................................................. 15 3.2 – A Note on Usage ............................................................................................................................................................... 17 4.0 – Medical Accuracy ................................................................................................................................................................ 18 4.1 – Ambiguous Anatomy ......................................................................................................................................................... 18 4.2 – Equivalence of Different Types of Sex ............................................................................................................................... 18 4.3 – Homosexuality; Bisexuality ............................................................................................................................................... 21 4.4 – Gender Ambiguity ............................................................................................................................................................. 25 4.5 – Teaching Boys and Girls: Together or Separate? ............................................................................................................. 28 4.6 – Condom Limitations .......................................................................................................................................................... 29 4.7 – Health Risks ...................................................................................................................................................................... 34 4.8 – Abstinence and Marriage .................................................................................................................................................. 36 4.9 – Reproduction; Pregnancy ................................................................................................................................................. 42 5.0 – Age Appropriate? ................................................................................................................................................................ 45 5.1 – Legal Ramifications Relating to Age ................................................................................................................................. 45 5.2 – Too Much Information, Too Soon? ................................................................................................................................... 48 5.3 – “Rational” Youth .............................................................................................................................................................. 49 5.4 – Not “Everyone” is Having Sex.......................................................................................................................................... 53 5.5 – Warnings Against Predators ............................................................................................................................................. 54 6.0 – Ethical Considerations......................................................................................................................................................... 56 6.1 – Abortion ............................................................................................................................................................................ 56 6.2 – Abortifacients .................................................................................................................................................................... 57 6.3 – Parental Rights ................................................................................................................................................................. 59 7.0 – Legal Concerns ..................................................................................................................................................................... 63 7.1 – Previous Court Cases........................................................................................................................................................ 63 7.2 – How the State Might be Liable to Families ....................................................................................................................... 63 8.0 – Conclusion ............................................................................................................................................................................ 65 5 Bob McDermott’s Executive Summary McDermott Report 4 We have reviewed all the current Abstinence Based Sexuality Education programs currently in use by the State of Hawaii Department of Education. For purposes of this report we are only reviewing middle school programs because at this grade level some of these children are as young 11 years old. Because children at this age are probably most susceptible to social engineering, we wanted to provide parents a tool that they could use when evaluating their child’s program. Unfortunately, only one program, the HealthTeacher (“1999-2006” version) gets our mere “nod” of approval and for this reason we strongly recommend parents take full advantage of the DOE’s “opt out” forms and remove their children from the other medically inaccurate and age inappropriate courses. Here are our ratings: HealthTeacher (“1999-2006” version) Making a Difference! Draw the Line, Respect the Line Family Life and Sexual Health (F.L.A.S.H.) Pono Choices (Pono Choices is not included in this review as we covered it thoroughly in McDermott report's 1 and 2, posted at www.ohanapolicygroup.com for public inspection. Pono Choices is a Research Project and the worst of the curriculum reviewed.) All other programs have, in our estimation, varying degrees of inaccuracies, omissions, or misleading assertions and we simply cannot in good conscience, recommend them. It is worth noting that HealthTeacher was the oldest of all the programs we reviewed and hence, did not appear to have the same type of political correctness that can be found in nearly all of the other programs we reviewed. Furthermore, while we would like to be able to inform parents as to which schools currently use HealthTeacher as their sex education curriculum, we can’t. Unfortunately, sex ed is among the many things our bungling DOE does not keep track of so we are advising parents to contact their keiki’s school themselves. Because parents are busy juggling the demands of work and paying the bills, they are putting their trust in the schools when it comes to education. When it comes to a health course, too many parents assume that the schools are providing medically accurate, age appropriate, reproductionoriented lessons to their children. After reviewing these curricula, we believe this trust is misplaced and recommend parents be on guard when it comes to what is being passed off as sex “education.” 6 Over the last thirty years we have seen a remarkable shift in sexuality education – away from a biology-based study and instead toward one that is more oriented towards a sexual lifestyles behavior guide. This was exacerbated with the advent of the Affordable Care Act or “Obama Care” and the push for a very leftist approach to sexuality education though Health and Human Services (HHS) grants. Planned Parenthood, the nation’s largest provider of sex education and fetal body parts, has been a leader in this “new approach to sexuality.” According to Planned Parenthood, anything goes (e.g., anal sex, anilingus, bondage and sadomasochism, gender bending, etc.) and everything is okay as long as it is done with “respect.” Any sort of moral judgment is not allowed. If fact, these programs that are being widely promoted today go so far as to omit the devastating risk profiles associated with anomalous behaviors. One will not find anywhere in these so-called “comprehensive programs” the escalated risks of oral cancer associated with fellatio nor will one find information regarding the deadly and exponentially increased risks of participating in anal sex. Perhaps most striking of all is the fact these programs victimize young girls. Sex is sexist. Granted, we may not like to hear that, but it is a fact. It is young girls who will bear the brunt of the damage done by these programs. The misleading and incomplete information given regarding the “protection” condoms provide in the case of HPV and chlamydia is criminal. Young girls may think, “Well my partner always wore a condom, so I am safe.” Then one day she wakes up and wonders why she suddenly has these unsightly vaginal warts because she knows her boyfriend always wore a condom. Or when she is twenty-four years old, married and wants to start a family. Imagine her surprise when she discovers that she is sterile because chlamydia has irrevocably damaged her fallopian tubes. At this point, the damage is done and it’s permanent. Nowhere in any of these programs are the concepts of love, chastity, nor fidelity mentioned. The once common mantra of a “long term monogamous relationship” has vanished. Inexplicably, long-term monogamous relationships are no longer stressed nor mentioned. Now, terms like “perceived gender identity” and “gender fluidity” are clouding the minds of youngsters. There is no right or wrong now in sex ed. We have slipped backward into a pool of ripe moral decay and parents were never asked their opinion. Some of these programs even encourage teachers to promote the LBGTQ lifestyle in a positive fashion. We shall continue to fight and hold the State accountable to follow the law, which requires “medically accurate and age appropriate information.” Right now, they are falling short in both areas. According to the left – If you have same sex marriage; then you must teach same sex scenarios and anal sex on par with male-female reproduction, while omitting the elevated risks of these aberrant behaviors! Anything less, is bigoted in their view. The inmates are now in control of the asylum. We recommend parents take advantage of the current “opt out” policy and be pro-active in removing your children from sex ed programs that are inconsistent with your family’s values. 7 Bob McDermott State Representative Note: This is the 4th in a series of reports. Our Primary researcher has been the indefatigable Paul Kanoho, Esq. His work is bullet proof and meticulously researched. Paul is extraordinarily talented possessing a keen intellect and passion for excellence. Also, of help has been Mrs. Susan Duffy who has provided golden nuggets of information along the way. Of course, my Office Manager, Mr. Keith Rollman is always ready to lend a hand in these efforts and jumps in as needed. 8 1.0 – Introduction In January of 2014, our legislative office released “The McDermott Report,” subtitled: “The ‘Pono Choices’ Curriculum: Sexualizing the Innocent.” That report criticized the Hawaii State Department of Education (DOE) for its use of the University of Hawaii’s sexual education curriculum, Pono Choices, which was designed for 11 to 13 year-old middle school students. The report noted the fact that the ideologically biased, age-inappropriate curriculum was medically inaccurate regarding basic human anatomy. Pono Choices also normalized anal sex, while failing to warn students of the extreme dangers of anal sex. Monogamy was not clearly presented as a superior way of life over casual sex. Pono Choices also failed to disclose the shortcomings of condoms against diseases like HPV and herpes, and failed to teach students about the stages of human reproduction. Age of consent laws were ignored, and children were not given any warning about adult sexual predators. Further, parents received woefully inadequate notice about the more controversial aspects of the curriculum.1 Later in the year, the DOE announced that it was convening a “working group” of so-called “stakeholders” to review Pono Choices.2 The working group subsequently released a report,3 while the DOE simultaneously released an implementation report.4 In August of 2014, our office released “The McDermott Report Part II,” subtitled: “Pono Choices: The Credibility Gap Widens.” This report responded to the DOE’s working group and implementation reports, and also gave additional background information on the flawed process under which Pono Choices came into being.5 In September of 2014, the DOE announced that “a revised version of Pono Choices was reviewed and approved.” The most drastic change, arguably, came in the form of consent: Up until that announcement, parents were required to affirmatively “opt out” if they did not want their children to receive sexual education in the public schools.6 Under a new regulation change, BOB MCDERMOTT & PAUL KANOHO, THE MCDERMOTT REPORT—THE ‘PONO CHOICES’ CURRICULUM: SEXUALIZING THE INNOCENT 2 (2014). 2 Press Release, Hawaii State Department of Education, DOE Convenes Working Group to Review Pono Choices (Feb. 21, 2014), available at http://www.hawaiipublicschools.org/ConnectWithUs/MediaRoom/PressReleases/Pages/DOE-convenes-workinggroup-to-review-Pono-Choices.aspx. 3 HAWAII STATE DEPARTMENT OF EDUCATION STAKEHOLDER REVIEW PANEL, PONO CHOICES CURRICULUM FEBRUARY-MAY 2014 (2014), available at http://www.hawaiipublicschools.org/DOE%20Forms/PonoChoicesPanelReport.pdf. 4 HAWAII STATE DEPARTMENT OF EDUCATION, IMPLEMENTING SEXUAL HEALTH EDUCATION: BACKGROUND AND ACTIONS FOR IMPROVEMENT, (2014), available at http://www.hawaiipublicschools.org/DOE%20Forms/PonoChoicesImplementationReport.pdf. 5 BOB MCDERMOTT ET AL, THE MCDERMOTT REPORT PART II—PONO CHOICES: THE CREDIBILITY GAP WIDENS 3 (2014). 6 Press Release, Hawaii State Department of Education, DOE Approves Revised Pono Choices Sexual Health Curriculum (Sept. 4, 2014), available at 1 9 parents would need to “opt in” into order to enroll their students into any public school sexual education curriculum.7 Some things, however, did not change: The same press release stated that for Pono Choices, the anus would be listed as part of the “genital area.”8 On April 16, 2015, Joe S. McIlhaney, Jr., M.D., an obstetrician/gynecologist and founder of the Medical Institute of Sexual Health, teamed up with Rep. McDermott to give an informative live presentation on the status of Hawaii’s sex education. To coincide with this presentation, this legislative office released “The McDermott Report Part III,” subtitled: The Indoctrination of Our Children (Forced Acceptance of Unhealthy Behaviors).” That report highlighted the disturbing advancement of House Bill 459 in the Hawaii State Legislature,9 as well as a proposed amendment to a Hawaii Board of Education (BOE) policy regarding sex education.10 Social engineers, who wished to advance “comprehensive” sexuality education in Hawaii public schools, championed both H.B. 459 and the proposed BOE policy change.11 Eventually, the social engineers won. On the one hand, H.B. 459 did not become a statutory law.12 However, on June 16, 2015, the BOE abandoned its abstinence-based sex education policy.13 The policy change also requires parents to once again affirmatively “opt out” if they do not want their children to participate in public school sex education.14 The Office of Rep. McDermott has prepared this new report, “The McDermott Report Part IV.” Given that Pono Choices is only one of several curricula that the DOE has approved for middle school students attending public schools, this Report summarizes and evaluates the contents of those other curricula, which are currently: Draw the Line, Respect the Line Family Life and Sexual Health (F.L.A.S.H.) Health Teacher Making a Difference! http://www.hawaiipublicschools.org/ConnectWithUs/MediaRoom/PressReleases/Pages/DOE-approves-revisedPono-Choices-sexual-health-curriculum.aspx. 7 Hawaii State Department of Education Regulation #2210.1 (2014), available at http://www.hawaiipublicschools.org/ConnectWithUs/FAQ/Pages/Parent-opt-out-for-child.aspx. 8 Hawaii State Department of Education, supra note 6. 9 H.B. 459, 28th Leg., 2015 Sess. (Haw. 2015), available at http://capitol.hawaii.gov/measure_indiv.aspx?billtype=HB&billnumber=459&year=2015. 10 Agenda Item V.A., Discussion on Student Achievement Committee recommendation concerning Board Policy 103.5 Sexual Health Education, HAW. BOARD OF EDUC., (Apr. 21, 2015), http://www.hawaiiboe.net/Meetings/Notices/Documents/2015-0421%20GBM/GBM_04212015_SAC%20recommendation%20103.pdf. 11 BOB MCDERMOTT, THE MCDERMOTT REPORT PART III—THE INDOCTRINATION OF OUR CHILDREN (FORCED ACCEPTANCE OF UNHEALTHY BEHAVIORS) 2 (2014). 12 See A Bill For An Act Relating to Health, H.B. 459, 2015 Sess. (Haw. 2015), http://www.capitol.hawaii.gov/measure_indiv.aspx?billtype=HB&billnumber=459. 13 Nanea Kalani, School Board Makes Sex Education Mandatory, HONOLULU STAR-ADVERTISER, June 17, 2015, http://www.staradvertiser.com/newspremium/20150617_School_board_makes_sex_education_mandatory.html. 14 Jessica Terrell, Hawaii Public Schools Must Offer Sex Education, Board Decides, HONOLULU CIV. BEAT (June 16, 2015), http://www.civilbeat.com/2015/06/hawaii-public-schools-must-offer-sex-education-board-decides. 10 Positive Prevention15 While all of the curricula have varying degrees of positive aspects, we believe that with the notable exception of Health Teacher, the others are significantly flawed. We therefore recommend that parents consider taking full advantage of the “opt out” option. To assist parents so as to help them understand why we are not sold on these programs. We have provided specific page references when we have found notable examples of positive or flawed content. For the best context, readers should view this Report as a supplement to this Office’s previous three “McDermott Reports,” which are available upon request. Further, while we hope this Report is a helpful resource for all parents, we also encourage parents to read the curricula for themselves. The materials can and should be available from the DOE for parental review and inspection, given the requirements of Hawaii’s Uniform Information and Practices Act, which is found in Chapter 92F of the Hawaii Revised Statutes.16 15 HAWAII STATE DEPARTMENT OF EDUCATION, SEXUAL HEALTH EDUCATION IN HAWAII—FACT SHEET 7–9 (n.d.), available at http://www.hawaiipublicschools.org/DOE%20Forms/Health%20and%20Nutrition/Sexual%20Health%20Education %20Fact%20Sheet.pdf (last visited July 7, 2015). 16 HAW. REV. STAT. §§ 92F-1—92F-43 (2014), available at http://www.capitol.hawaii.gov/hrscurrent/Vol02_Ch0046-0115/HRS0092F/HRS_0092F-.htm. 11 2.0 – The Sex Education Battle The people on the different sides in the Hawaii sex education debate are part of a bigger historical picture in America. Child development expert and educator David Elkind observes: Early sex education was meant primarily to correct misinformation. This emphasis . . . continued well into the 1950s when sex education—considered as ‘preparation for marriage and family’—was most often part of home economics courses. By then, the sex education curriculum had expanded to include information about the dangers of venereal diseases and premarital pregnancy. In addition, some aspects of sexual anatomy and its functions were taught in courses on human biology. Such material, however, was reserved for junior and senior high school students.17 Sociologist Kristin Luker observes that, before the 1960’s: Outside of a few “sex radicals” whose opinions did not have much effect on mainstream American opinion, individuals, despite their own practices, agreed in principle that sex before marriage was wrong for both men and women . . . . Sex education in public schools was often . . . expansive, diffuse, and usually uncontroversial family life education . . . .18 At the time, even the mere proposition of conducting a national study on the sexual practices of unmarried women was unthinkable, and even “homophile” organizations that attempted to curb anti-homosexual discrimination did not call for the “acceptance” of homosexuality as a “lifestyle.”19 As time went on, however, a problematic shift started to emerge—away from marriage, family, monogamy, and heterosexuality. One man who was eager to help in this shift was Alfred C. Kinsey. He claimed that “10 per cent of the males are more or less exclusively homosexual . . . for at least three years between the ages of 16 and 55. This is one male in ten in the white male population.”20 It should be noted, however, that his male research subjects—25% of whom were prison or former prison inmates—were hardly representative of the overall U.S. adult male population.21 Kinsey also claimed that orgasm “has been observed in boys of every age from 5 months to adolescence.”22 It is disputed how Kinsey and his team collected information regarding young children. Paul Gebhard, formerly of the Kinsey Institute, claims that “that information about child sexuality came from childhood memories of some interview subjects and 17 DAVID ELKIND, THE HURRIED CHILD: GROWING UP TOO FAST TOO SOON 63 (Da Capo Press, 25th Anniversary ed. 2007) (1981). 18 KRISTIN LUKER, WHEN SEX GOES TO SCHOOL: WARRING VIEWS ON SEX—AND SEX EDUCATION—SINCE THE 1960’S 62 (2006). 19 Id. at 70. 20 ALFRED C. KINSEY ET AL., SEXUAL BEHAVIOR IN THE HUMAN MALE 651 (1948). 21 JUDITH REISMAN ET AL., KINSEY, SEX, AND FRAUD 9 (1990). 22 KINSEY ET AL., supra note 20, at 177. 12 from interviews with teachers and a small group of pedophiles.”23 It is also alleged, however, that the information was gained from adults who were performing sexual acts on children for the purpose of the study.24 Notably, the Kinsey Institute was willing to forego some funding in order to accommodate the financial needs of Sexuality Information and Education Council of the United States (SIECUS). As former SIECUS President Mary Calderone, M.D., announced: Few people realize that the great library collection of what is now known as the Kinsey Institute in Bloomington, Indiana, was formed very specifically with one major field omitted—sex education. This was because it seemed appropriate, not only to the Institute but to its major funding source, the National Institute of Mental Health, to leave this area for SIECUS to fill.25 In light of this, Professor Judith Reisman and her colleagues warn us: “The connection between Kinsey and Calderone must be taken literally.”26 True to form, a subsequent SIECUS President wrote about how she and her colleagues “fantasized” about a national “petting project” for teens. She advocated the following: A partial list of safe sex practices for teens could include: Talking Flirting Dancing Hugging Kissing Necking Massaging Caressing Undressing each other Masturbation alone Masturbation in front of a partner Mutual masturbation Teens could surely come up with their own list of activities. By helping teens explore the full range of safe sexual behaviors, we may help to raise a generation of adults that do not equate sex with intercourse, or intercourse with vaginal orgasm, as the goal of sex. Rather, we can help teens understand that sex is more than intercourse and that 23 Andrew Welsh-Huggins, Conservative Group Attacks Kinsey Data on Children, HERALD-TIMES, Sept. 6, 1995, http://www.heraldtimesonline.com/stories/1995/09/06/archive.19950906.b0c15bb.sto. 24 REISMAN ET AL., supra note 21, at 46. 25 Mary Calderone, In My Opinion, SIECUS REP., May-July 1982, at 6, 6, available at http://www.siecus.org/_data/global/images/SIECUS%20Reports/10-5.pdf. 26 REISMAN ET AL., supra note 21, at 37. 13 abstinence from intercourse does not mean abstinence from all intimate expression.27 A more recent SIECUS publication advocates telling children as young as five that “[t]ouching and rubbing one’s own genitals to feel good is called masturbation,”28 and recommends that nine year-olds learn that “[g]ender identity refers to a person’s internal sense of being male, female, or a combination of these.”29 Dr. Calderone was also a former Medical Director of Planned Parenthood.30 That organization performed 327,653 abortions in 2013.31 It was also listed as a “partner” for the Pono Choices curriculum.32 Another like-minded organization, Advocates for Youth, has been pushing for sex education to start in Kindergarten.33 Today, individuals who support abstinence and advocate caution regarding sex and sex education risk being labeled as unenlightened. Miriam Grossman, M.D., a psychiatrist who has been critical of SIECUS and Planned Parenthood, has noted that those organizations “claim neutrality and successfully portray the conflict as religious right versus medical facts, hicks versus Harvard.” Dr. Grossman, however, notes the irony: The “hicks” have science “in their corner.”34 The Report that you are now reading will show how this fact is relevant to the debate over sex education in Hawaii. 27 Debra W. Haffner, Safe Sex and Teens, SIECUS REP., Sept./Oct. 1988, at 9, 9, available at http://www.siecus.org/_data/global/images/SIECUS%20Reports/17-1.pdf. 28 NATIONAL GUIDELINES TASK FORCE, GUIDELINES FOR COMPREHENSIVE SEXUALITY EDUCATION 51 (3rd ed. 2004), available at http://www.siecus.org/_data/global/images/guidelines.pdf. 29 Id. at 31. 30 History, SIECUS, http://www.siecus.org/index.cfm?fuseaction=Page.viewPage&pageId=493 (last visited June 30, 2015). 31 Susan Berry, Planned Parenthood Annual Report: All About Abortions and Profits, BRIETBART.COM (Jan. 1, 2015), http://www.breitbart.com/texas/2015/01/01/planned-parenthood-annualreport-all-about-abortions-and-profits. 32 Pono Choices Partners, PONO CHOICES, http://www.cds.hawaii.edu/ponochoices/pono-choices-partners (last visited July 7, 2015). 33 Children and HIV/AIDS, ADVOCATES FOR YOUTH, http://advocatesforyouth.org/for-professionals/lessonplans-professionals/2406 (last visited July 7, 2015). 34 MIRIAM GROSSMAN, YOU’RE TEACHING MY CHILD WHAT?: A PHYSICIAN EXPOSES THE LIES OF SEX EDUCATION AND HOW THEY HARM YOUR CHILD 6 (2009). 14 3.0 – The “Other” Middle School Curricula 3.1 – Brief Backgrounds of the Curricula Draw the Line, Respect the Line We reviewed the following three stages of this curriculum: Grade 635 Grade 736 Grade 837 One of the curriculum’s authors, Douglas Kirby, “completed a seminal study on the impact of school-based health centers while working at The Center for Population Options (now Advocates for Youth).”38 The curriculum is intended to be used for each student throughout all three grades, and the content for each grade is different. The Grade 6 curriculum provides no information to students about sex, except that the instructor is to explain to students that he or she “will be teaching 5 lessons that will help them learn how to protect themselves and others from pregnancy, HIV and other diseases you can get from sex,” and further, that “these lessons won’t be talking about sex directly, but students will learn to set limits and stick with their limits.”39 For this reason, this Report will not be evaluating the Grade 6 book. Some of the curriculum’s developers also co-authored a study, which claims that Draw the Line, Respect the Line had a positive impact on boys, who delayed sexual initiation for up to one year after completing the course of the program. Parents should note, however, that the curriculum had no impact on the sexual activity of girls.40 Family Life and Sexual Health (F.L.A.S.H.) We reviewed the following three versions of this curriculum: Grades 4-641 Grades 7-842 35 BARBARA MARIN ET AL., DRAW THE LINE, RESPECT THE LINE: SETTING LIMITS TO PREVENT TEEN PREGNANCY, GRADE 6 (2003) [hereinafter MARIN ET AL., DTL GRADE SIX]. 36 KARIN COYLE ET AL., DRAW THE LINE, RESPECT THE LINE: SETTING LIMITS TO PREVENT TEEN PREGNANCY, GRADE 7 (2003) [hereinafter COYLE ET AL., DTL GRADE SEVEN]. 37 BARBARA MARIN ET AL., DRAW THE LINE, RESPECT THE LINE: SETTING LIMITS TO PREVENT TEEN PREGNANCY, GRADE 8 (2003) [hereinafter MARIN ET AL., DTL GRADE EIGHT]. 38 Honoring Dr. Douglas Kirby, ETR.ORG, http://www.etr.org/more-about-doug-kirby (last visited July 7, 2015). 39 MARIN ET AL., DTL GRADE SIX, supra note 35, at 13. 40 Research Evidence for Draw the Line/Respect the Line, TEEN PREGNANCY PREVENTION EVIDENCE REV., http://tppevidencereview.aspe.hhs.gov/pdfs/DrawtheLine-RespecttheLine.pdf (last updated May 31, 2012). 41 ELIZABETH “BETH” REIS ET AL., 4/5/6 F.L.A.S.H.: A CURRICULUM IN FAMILY LIFE AND SEXUAL HEALTH FOR GRADES 4, 5 AND 6 (2005) [hereinafter REIS ET AL., 4/5/6 F.L.A.S.H.]. 42 ELIZABETH “BETH” REIS ET AL., 7/8 F.L.A.S.H.: A CURRICULUM IN FAMILY LIFE AND SEXUAL HEALTH FOR GRADES 7 AND 8 (2006) [hereinafter REIS ET AL., 7/8 F.L.A.S.H.]. 15 Special Education (for special needs students in both Middle School and High School)43 Robert Bidwell, M.D., of the Kapiolani Medical Center for Women and Children is listed as a contributor.44 He is openly homosexual, has an adopted son,45 and has testified in court that children of gay parents would benefit by same-sex marriage.46 All three versions of the F.L.A.S.H. curriculum include several organizations on a list of “Selected Reliable Resources” in their appendices. The listed organizations include (among others): Advocates for Youth, Planned Parenthood Federation of America, and SIECUS.47 HealthTeacher We evaluated the version of the curriculum that was designed for middle school students. The printing that the DOE made available to us has copyright date of “1999-2006,” and contains nine lessons related to sexuality. Sex is only one of many health topics that HealthTeacher covers. In fact, most of the curriculum covers other issues, including hygiene, marijuana, alcohol, and gambling.48 This Report will have several positive comments about this version of HealthTeacher. Parents should be aware, however, that updates to the curriculum have been made since the publication of the “1999-2006” version. We do not know if or when the DOE will transition to a newer version. Making a Difference! This curriculum is intended for both middle school and high school students.49 We reviewed the version that the DOE’s Curriculum and Instruction Branch possesses, which is “4.1.”50 One of its developers, Konstance A. McCaffree, has served on the board of directors of SIECUS.51 The curriculum’s other developers helped to co-author a study. The results of that study claimed that 43 JANE STANGLE ET AL., SPECIAL EDUCATION F.L.A.S.H.: A CURRICULUM IN FAMILY LIFE AND SEXUAL HEALTH FOR MIDDLE & HIGH SCHOOL STUDENTS WITH SPECIAL NEEDS (2006) [hereinafter STANGLE ET AL., SPECIAL EDUCATION F.L.A.S.H.]. 44 REIS ET AL., 4/5/6 F.L.A.S.H., supra note 41, at ii; REIS ET AL., 7/8 F.L.A.S.H., supra note 42, at unnumbered page entitled “Medical Review”; STANGLE ET AL., SPECIAL EDUCATION F.L.A.S.H., supra note 43, at unnumbered page entitled “Medical Review.” 45 Catherine E. Toth, Gay and Lesbian Families, HONOLULU ADVERTISER, Nov. 18, 2001, http://the.honoluluadvertiser.com/article/2001/Nov/18/oh/oh01a.html. 46 B.A. Robinson, Same-Sex Parenting: Expert Testimony Before a Hawaiian Court, RELIGIOUSTOLERANCE.ORG, http://www.religioustolerance.org/hom_pare1.htm (last updated Jan. 5, 2002). 47 REIS ET AL., 4/5/6 F.L.A.S.H., supra note 41, Appendix F, at 1; REIS ET AL., 7/8 F.L.A.S.H., supra note 42, Appendix F, at 1; STANGLE ET AL., SPECIAL EDUCATION F.L.A.S.H., supra note 43, Appendix F, at 1. 48 ANITA DAVIS ET AL., HEALTHTEACHER: TEACHING HEALTH CONCEPTS AND SKILLS, MIDDLE SCHOOL (1999-2006) [hereinafter DAVIS ET AL., HEALTHTEACHER MIDDLE]. 49 Evidence-Based Programs: Making a Difference!, SELECT MEDIA, http://www.selectmedia.org/programs/difference.html (follow “Overview” hyperlink) (last visited June 30, 2015). 50 LORETTA SWEET JEMMOTT ET AL., MAKING A DIFFERENCE!: AN EVIDENCE-BASED, ABSTINENCE APPROACH TO TEEN PREGNANCY, STD AND HIV PREVENTION (4th ed., 2nd prtg. 2012) [hereinafter JEMMOTT ET AL., MAKING A DIFFERENCE!]. 51 Id. at iv. 16 three months after taking the course, students were significantly less likely to report having had sexual intercourse. However, there were no statistically significant differences between the behaviors of course participants and a control group during six-month and twelve-month followups.52 A poster used in Making a Difference! was the cause of controversy in a Kansas middle school in 2014, due to a poster that asked: “How do people express their sexual feelings?” Some of the listed answers included benign terms, such as “holding hands,” to more provocative terms, such as “grinding and oral sex.”53 Positive Prevention We evaluated the following two versions of this curriculum: Level A (Middle School and Junior High School)54 Special Populations.55 The latter version is intended for “moderate to low function populations.”56 The Special Populations education curriculum places the websites of several organizations on a list of “Resources for Teens.” Some of the named resources include sites for Advocates for Youth, Planned Parenthood, and the Gay Straight Alliance Network.57 3.2 – A Note on Usage Readers of this Report may ask a natural question: “Which DOE schools use what curricula?” To that, we give an honest answer: “We don’t know.” We attempted to obtain this information from the DOE’s Curriculum and Instruction Branch, but that office did not have that information. Honolulu Civil Beat confirmed that the DOE does not keep track of this information at the statewide level.58 52 Research Evidence for Making a Difference! (MAD), TEEN PREGNANCY PREVENTION EVIDENCE REV., http://tppevidencereview.aspe.hhs.gov/pdfs/makingadifference.pdf (last updated May 31, 2012). 53 Melissa Treolo, Shawnee Mission School District Offers No Decision Yet on Sex-Ed Poster, THE MIRROR (Feb. 25, 2014), http://www.tonganoxiemirror.com/news/2014/feb/25/shawnee-mission-school-district-offers-nodecision. 54 KIM ROBERT CLARK ET. AL., POSITIVE PREVENTION: HIV/STD EDUCATION FOR AMERICA’S YOUTH, LEVEL A; FOR MIDDLE SCHOOL AND JUNIOR HIGH SCHOOL (2004) [hereinafter CLARK ET. AL, POSITIVE PREVENTION LEVEL A]. 55 KIM ROBERT CLARK ET. AL., POSITIVE PREVENTION PLUS: SEXUAL HEALTH EDUCATION FOR SPECIAL POPULATIONS (2012) [hereinafter CLARK ET. AL, POSITIVE PREVENTION SPECIAL]. 56 Id. at xvi. 57 Id. at 99. 58 Jessica Terrell, In Hawaii, Sex Education Is Confusing—Even for Those in Charge, HONOLULU CIV. BEAT (Apr. 29, 2015), http://www.civilbeat.com/2015/04/in-hawaii-sex-education-is-confusing-even-for-those-incharge. 17 4.0 – Medical Accuracy As we have noted, Hawaii state-funded sex education, by law, must be medically accurate.59 How do the “other curricula” fare? 4.1 – Ambiguous Anatomy In the Grades 4-6 version of the F.L.A.S.H curriculum, students learn of the reproductive system and the process of human reproduction. Oddly enough, the anus is listed on a page listing body parts of reproductive anatomy, even though the curriculum also indicates that those body parts are not actually part of the reproductive system.60 The Grades 7-8 version61 and the Special Education version62 of F.L.A.S.H present similar ambiguities. Instructors of the Positive Prevention Special Education curriculum have the option of giving students additional information, including a listing that places the anus as part of reproductive anatomy.63 Unlike these sexual education curricula, the classic Gray’s Anatomy—now in its 40th edition— draws a clear and science-based distinction regarding the body parts that are actually responsible in the process of the creation of new life—and the anus is not listed as one of them.64 4.2 – Equivalence of Different Types of Sex Looking at some of the curricula, one might walk away with a view that all sex is created equal. For example, the Grade 8 version of the Draw the Line, Respect the Line curriculum states that “HIV can be passed when people have sexual intercourse (vaginal, anal or oral).”65 The Grades 7-8 of version F.L.A.S.H. states that “[t]he majority of HIV infections in the United States are spread through unprotected anal or vaginal sex.”66 It also places anal sex and vaginal sex with a condom at the same “risk level.”67 Yet while people might engage in anal sex and oral sex, only vaginal sex is specifically designed for human reproduction. Science is showing that there are adverse consequences to experimentation. 59 HAW. REV. STAT. § 321-11.1 (2014), available at http://www.capitol.hawaii.gov/hrscurrent/Vol06_Ch0321-0344/HRS0321/HRS_0321-0011_0001.htm. 60 REIS ET AL., 4/5/6 F.L.A.S.H., supra note 41, Lesson 11 at 3, 4, 10, 11, Lesson 12 at 6. 61 REIS ET AL., 7/8 F.L.A.S.H., supra note 42, at Lessons 6 & 7 at 13-15. 62 STANGLE ET AL., SPECIAL EDUCATION F.L.A.S.H., supra note 43, Lesson 16, at 3, 11, 13. 63 CLARK ET. AL, POSITIVE PREVENTION SPECIAL, supra note 55, at 69, 81. 64 GRAY’S ANATOMY 1261–1304 (Susan Standring ed., Churchill Livingstone Elsevier, 40th ed. 2008) (1858). 65 MARIN ET AL., DTL GRADE EIGHT, supra note 37, at 115, 133. 66 REIS ET AL., 7/8 F.L.A.S.H., supra note 42, Lesson 23, at 9. 67 Id. Lesson 23, at 10. 18 A 2010 study of HIV statistics in the International Journal of Epidemiology found the respective risks of HIV transmission through different types of sexual activity.68 That same year, AIDS Map highlighted the most glaring aspect of that study: That the risk of HIV transmission from receptive anal sex may be eighteen times greater than during vaginal intercourse.69 Why is anal sex so risky? AIDS Map explains that it all comes down to biology: Anal sex without using a condom is one of the highest-risk activities in terms of HIV transmission, because the tissue inside the rectum is made up of cells that are very susceptible to HIV. The rectal tissue is also very delicate and so can be easily damaged, which also creates a route for HIV transmission.70 One report chillingly discloses: “Several STIs, once thought to be on the verge of extinction, have recently reemerged. This change is thought to be partially related to an increase in STIs of the anus and rectum.”71 We further note that the FDA has not approved any condom for use during anal sex.72 When anal sex is practiced among heterosexuals, it tends to be an indicator of misogyny. During an annual medical exam, one young lady told Dr. McIlhaney that “she was ‘trying to engage in anal sex’ even though it was causing significant pain and discomfort. Why? It was what her boyfriend wanted.”73 One study found that “[f]emale respondents with a history of trauma related to sexual experiences (i.e., they felt forced to have sex) were at greater risk than were their peers of engaging in anal intercourse.”74 There’s also bad news for those who practice oral sex: According to a report published by the American Dental Association, “study findings have linked oral HPV infection with a history of open-mouthed kissing and oral sex.”75 Another source reports: “Patients who had a lifetime number of 6 or more oral-sex partners were 3.4 times [that is, 340%] more likely to have 68 Rebecca F. Baggaley et. al, HIV Transmission Risk through Anal Intercourse: Systematic Review, MetaAnalysis and Implications for HIV Prevention, 39 INT’L J. EPIDEMIOLOGY 1048 (2010), available at http://ije.oxfordjournals.org/content/39/4/1048.full.pdf+html. 69 Roger Pebody, HIV Transmission Risk during Anal Sex 18 times Higher than during Vaginal Sex, AIDS MAP (June 28, 2010), http://www.aidsmap.com/HIV-transmission-risk-during-anal-sex-18-times-higher-thanduring-vaginal-sex/page/1446187. 70 Sexual Transmission of HIV, AIDS MAP, http://www.aidsmap.com/Sexual-transmission-ofHIV/page/1255053 (last visited July 1, 2015). 71 Roland Assiet. al, Sexually Transmitted Infections of the Anus and Rectum, 20 WORLD J. GASTROENTEROLOGY 15262, 15262 (2014), available at http://www.wjgnet.com/1007-9327/pdf/v20/i41/15262.pdf. 72 David Heitz, FDA: Condoms Not Approved for Anal Sex, IMSTLLJOSH.COM (Apr. 30, 2014), http://www.imstilljosh.com/fda-condoms-not-approved-anal-sex; Judith Reisman, Condoms Never FDA-Approved for Sodomy, WORLD NET DAILY (Mar. 14, 2014), http://www.wnd.com/2014/03/condoms-never-fda-approved-forsodomy. 73 JOE S. MCILHANEY ET. AL., GIRLS UNCOVERED: NEW RESEARCH IN WHAT AMERICA’S SEXUAL CULTURE DOES TO YOUNG WOMEN 77 (2011). 74 Celia M. Lescano et. al, Correlates of Heterosexual Anal Intercourse Among At-Risk Adolescents and Young Adults, 99 AM. J. PUB. HEALTH 1131, 1134 (2009), available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2679800/pdf/1131.pdf. 75 Jennifer L. Cleveland et. al, The Connection Between Human Papillomavirus and Oropharyngeal Squamous Cell Carcinomas in the United States: Implications for Dentistry, 142 J. AMER. DENTAL ASS’N 915, 920 (2010), available at http://jada.ada.org/article/S0002-8177(14)62066-3/pdf. 19 oropharyngeal cancer.”76 Ironically, even as the rate of oral cancer from smoking is declining, oral sex resulting from HPV is also increasing. Further, it is predicted that by 2020, “the number of HPV-positive OPSCCs [oropharyngeal squamous cell carcinomas] is expected to surpass the number of cervical cancers . . . .”77 The Making a Difference! curriculum repeats the phrase, “oral, anal, and vaginal sex” several times throughout the curriculum, as if all three activities were the same.78 It also tells instructors to “[e]mphasize that abstaining from oral sex, anal sex, and vaginal intercourse can prevent pregnancy and STDs, including HIV.”79 While this is a correct statement, it is not, as we have shown, a complete statement. The curriculum also briefly states that “anal sex increases your chances of getting HIV,” but fails to state the actual risk.80 The Special Populations version of the Positive Prevention curriculum states: “Sexual intercourse is often defined as the insertion of an erect penis into a vagina (in a male-female relationship). However, the definition of intercourse may also include oral intercourse (penis in mouth) among female-male, male-male, female-female or varied sex partners.”81 The textbook treats different types of sexual activity as if they were they posed the same level of risk, by stating: “The four fluids (blood, semen, vaginal fluids and breast milk) . . . can transmit HIV into the bloodstream via four body openings (mouth, genitals, anus, broken skin).”82 By their language, the above-mentioned curricula expose young children (some as young age eleven) to the topics of anal and oral sex, while, at time same time, being less than forthright about the harmful health risks associated with those behaviors. Dr. Grossman comments: When sex educators teach that HIV can be transmitted by ‘any exchange of body fluids—blood, semen, vaginal secretions, and breast milk,’ when they say infection can occur via vaginal, oral, or anal intercourse, and when they claim, ‘Anyone can get HIV,’ their message is technically accurate. The problem is, however, that the various ‘anyones’ have vastly different risks—some would say million-fold differences, depending on their behavior. It’s like saying, ‘Lung cancer can be caused by radon, asbestos, tobacco, and air pollution.’ The statement is correct, but 80 percent of lung cancers are due to tobacco, and a person smoking four packs a day of unfiltered Camels is at much greater risk than someone living in Los Angeles’s polluted air, and everyone would agree he needs to know that.83 76 Catharine Paddock, Oral Sex Increases Throat Cancer Risk Scientists Say, MEDICAL NEWS TODAY (May 10, 2007), http://www.medicalnewstoday.com/articles/70495.php. 77 Anil K. Chaturvedi et. al, Human Papillomavirus and Rising Oropharyngeal Cancer Incidence in the United States, 29 J. CLINICAL ONCOLOGY 4294, 4297 (2011), available at http://jco.ascopubs.org/content/29/32/4294.full.pdf+html. 78 See JEMMOTT ET AL., MAKING A DIFFERENCE!, supra note 50, at 45, 66, 67, 93, 99, 100, 113. 79 Id. at 45. 80 Id. at 123. 81 CLARK ET. AL, POSITIVE PREVENTION SPECIAL, supra note 55, at xiii 82 Id. at 335-337. 83 GROSSMAN, YOU’RE TEACHING MY CHILD WHAT?, supra note 34, at 93-94. 20 The Level A version of the Positive Prevention curriculum mentions both anal and oral sex; yet, it is somewhat of an improvement. While it does not mention the enhanced risks associated with oral sex, it does disclose some of the increased risk associated with anal sex: [U]nprotected (without a condom) anal sex (intercourse) is considered to be very risky behavior. It is possible for either sex partner to become infected with HIV during anal sex. HIV can be found in the blood semen, pre-seminal fluid, or vaginal fluid of a person infected with the virus. In general, the person receiving the semen is at greater risk of getting HIV because the lining of the rectum is thin and may allow the virus to enter the body during anal sex. However, a person who inserts his penis into an infected partner is also at risk because HIV can enter through the urethra (the opening tip of the penis) or through small cuts, abrasions, or open sores on the penis. Not having (abstaining from) sex is the most effective way to avoid HIV. If people choose to have anal sex, they should use a latex condom. Most of the time, condoms work well. However, condoms are more likely to break during anal sex than during vaginal sex. Thus, even with a condom, anal sex can be very risky. A person should use generous amounts of water-based lubricant in addition to the condom to reduce the chances of the condom breaking.84 We should note that the HealthTeacher curriculum focuses a great percentage of its time on penile-to-vaginal intercourse. It mentions anal and oral sex about once,85 but there does not seem to be an overt attempt to draw equivalency between penile-to-vaginal intercourse and oral sex or anal sex. Given that their children might not be ready for the other curricula, parents may prefer this curriculum, at least regarding this particular topic. 4.3 – Homosexuality; Bisexuality Several of the curricula treat homosexuality as just another lifestyle. The Grades 4-6 version of F.L.A.S.H encourages the optional classroom use of a video called That’s a Family, which “tells the stories, in their own words, of children in families with parents of different races or religions, divorced parents, a single parent, gay or lesbian parents, adoptive parents or grandparents as guardians.”86 The Special Education version of F.L.A.S.H utilizes the same video.87 The Grades 4-6 version of F.L.A.S.H also presents some confusion regarding sexuality in this passage: A person may have crushes on people of their own sex, the other sex or both. It may or may not predict how they will feel when they’re grown. That is, really liking someone of a different sex doesn’t necessarily mean you will eventually figure out that you are 84 CLARK ET. AL, POSITIVE PREVENTION LEVEL A, supra note 54, at 79. DAVIS ET AL., HEALTHTEACHER MIDDLE, supra note 48, at 233. 86 REIS ET AL., 4/5/6 F.L.A.S.H., supra note 41, Lesson 2, at 3. 87 STANGLE ET AL., SPECIAL EDUCATION F.L.A.S.H., supra note 43, Lesson 5, at 3. 85 21 heterosexual (straight). And, likewise, really liking someone of your own sex doesn’t necessarily mean you will eventually figure out that you are gay or lesbian. It often takes time to figure out. There’s no rush.88 An appendix item in the Making a Difference! curriculum provides instructors with optional role-playing scenarios and games, intended to address “needs that may emerge in the group.”89 Several of them involve both lesbians and homosexual males. One scenario involves “Diane,” who has been previously “sexually active with guys; sometimes unprotected.” Diane is interested in having sex with Lauren, but Lauren wants to abstain.90 The Special Populations version of the Positive Prevention curriculum has taken an even more overtly politically correct route. Its introductory materials state: Gay-Straight Alliance Network has reviewed this curriculum guide and helped the Red Cross make updates to ensure that 1) the curriculum is inclusive of the sexual health information needs of LGBTQQI youth, 2) the terminology used is inclusive of LGBTQQI youth, and 3) the curriculum does not have a heterocentric bias, that is a bias towards heterosexual relationships as the only valid or normal relationships.91 The same version of Positive Prevention also claims that “high quality relationships” can occur in many “configurations,” including same-sex partnerships.92 The Special Populations defines “family” to include close friends and same-sex partners.93 An appendix item tells instructors to avoid the term “homosexual, as it is a dated term that focuses on only sex rather than love and relationships.”94 Interestingly enough, the curriculum places no prohibition against the use of the term “heterosexual.” Instructors are told: “It is important to understand that, in most situations, behavior that is appropriate for opposite sex couples is also appropriate for same-sex couples.”95 Further, it is not enough for instructors to merely teach—they are encouraged to become activists. They are told to “Come Out as a Public Ally: Make sure your library has LGBT friendly, age appropriate books and resources.”96 These “gay-friendly” messages attempt to hide an inconvenient truth: As a public health matter, homosexuals and bisexuals tend to be a greater risk for STD’s than the general population. Men who have sex with men comprise about 75% of those with syphilis.97 Further, while not everyone who contracts HIV is a homosexual, statistics from the Centers for Disease Control and Prevention show that: 88 REIS ET AL., 4/5/6 F.L.A.S.H., supra note 41, Lesson 9, at 6. JEMMOTT ET AL., MAKING A DIFFERENCE!, supra note 50, at 211. 90 Id. at 214-217. 91 CLARK ET. AL, POSITIVE PREVENTION SPECIAL, supra note 55, at xxxiii. 92 Id. at 306. 93 Id. at 190. 94 Id. Appendix C at 3. 95 Id. Appendix C at 10. 96 Id. Appendix C at 11. 97 CENTERS FOR DISEASE CONTROL AND PREVENTION, CDC FACT SHEET: 2013 NATIONAL DATA FOR CHLAMYDIA, GONORRHEA, AND SYPHILIS 2 (2014), available at http://www.cdc.gov/nchhstp/newsroom/docs/STDTrends-508.pdf. 89 22 Gay, bisexual, and other men who have sex with men (MSM) represent approximately 2% of the United States population, yet are the population most severely affected by HIV. In 2010, young gay and bisexual men (aged 13-24 years) accounted for 72% of new HIV infections among all persons aged 13 to 24, and 30% of new infections among all gay and bisexual men. At the end of 2011, an estimated 500,022 (57%) persons living with an HIV diagnosis in the United States were gay and bisexual men, or gay and bisexual men who also inject drugs.98 This disproportionate risk has natural consequences for the blood donors. Recently, the Food and Drug Administration announced a reversal of the ban that prohibits homosexual men from donating blood. Yet the FDA policy introduced a caveat: No male who has engaged in sex with another male within one year prior to donating blood would be permitted to donate blood.99 With regard to women who have sex with women, Dr. Grossman notes: You are probably aware that girls are not getting HIV from sex with other girls; femaleto-female HIV transmission is extremely rare. They’re getting it the same way straight girls do: from HIV positive boys. Lesbian and bisexual girls and women are as likely as heterosexuals to report experiences with males. Most significantly in terms of HIV risk, they are more likely to report sex with a gay or bisexual man and more likely to engage in unprotected intercourse. This is worth repeating. Females who are not exclusively heterosexual are more likely to have unprotected intercourse with a gay or bisexual male.100 It has been shown that about only 8% of women who have sex with women have never had sex with a man.101 Further, a report in the American Journal of Public Health found: Lesbian girls were more than 3 times as likely as their heterosexual peers to report using alcohol or drugs and failing to use pregnancy prevention during their most recent sexual encounter. Bisexual girls were almost 3 times more likely than heterosexual girls to report 2 or more lifetime sexual partners. Girls with both male and female partners were almost 3 times as likely as girls with male partners only to report using alcohol or drugs during their most recent sexual encounter. In all comparisons, the direction and significance of effects were similar regardless of sexual orientation dimension (sexual identity or partner gender) . . . . In summary, regardless of sexual orientation dimension, 98 HIV/AIDS: Gay and Bisexual Men, CENTERS FOR DISEASE CONTROL AND PREVENTION, http://www.cdc.gov/hiv/group/msm/index.html (last updated July 8, 2015). 99 Blood Donor Deferral, FOOD AND DRUG ADMIN., http://www.fda.gov/forpatients/illness/hivaids/safety/ucm117929.htm (last updated Feb. 5, 2015). 100 GROSSMAN, YOU’RE TEACHING MY CHILD WHAT?, supra note 34, at 142. 101 Shirley K. Chan et al., Likely Female-to-Female Sexual Transmission of HIV — Texas, 2012, 63 CENTERS FOR DISEASE CONTROL AND PREVENTION MORBIDITY AND MORTALITY WKLY. REP. 209, 211 (2014), available at http://www.cdc.gov/mmwr/pdf/wk/mm6310.pdf. 23 sexual minority girls reported riskier sexual behaviors than did their heterosexual peers.102 Given the noted health risks, one would assume that the curricula that mention alternative lifestyles would also mention the health risks associated with homosexuality and bisexuality. Several of the curricula, however, fail in this regard. It appears that their authors would rather have us believe that HIV is an equal opportunity disease. The Special Populations version of the Positive Prevention curriculum states that: “HIV can infect anyone who participates in risk behavior regardless of their race, sex, or sexual orientation.”103 A game in an appendix section of Making a Difference! ponders: Isn’t AIDS a gay disease? No. AIDS, a result of the infection, is caused by a virus (HIV). Anyone can get HIV through the exchange of blood, vaginal fluid, or breast milk with an infected person. Like anyone else, men who have sex with men are at risk only if they engage in activities that include the exchange of these fluids.104 The above statement fails to mention that semen can carry HIV as well.105 The Grades 7-8 version of the F.L.A.S.H curriculum is a little more accurate regarding risks. It recommends that the teacher tell the students: Some of you think this class won’t be relevant to you because you are straight (heterosexual) and you think that HIV is only a disease of gay (homosexual) men . . . . Know that if your partner had HIV it wouldn’t make the slightest difference what sex he or she was; you would still be at risk. But the fact is the majority of HIV cases in the U.S. are in gay and bisexual men. It’s also a fact that a lot of lesbian and bisexual young women are at risk because they have sex at some point with a guy friend who may be gay.106 An Appendix item in the Special Populations version of Positive Prevention claims that “sexual orientation is not something that a person can change.”107 Any serious discussion of sexuality cannot blindly accept the idea that sexual orientation cannot change. A 10-year longitudinal study found: “Among women, 1.36% with a heterosexual identity changed, 63.63% with a homosexual identity changed, and 64.71% with a bisexual identity changed. Among men, 0.78% 102 Rachel G. Riskind et. al, Sexual Identity, Partner Gender, and Sexual Health Among Adolescent Girls in the United States, 104 AM. J. PUB. HEALTH 1957, 1961 (2014), available at http://search.ebscohost.com/login.aspx?direct=true&AuthType=cookie,ip,cpid&custid=s4800244&db=aph&AN=98 254739&site=ehost-live. 103 CLARK ET. AL, POSITIVE PREVENTION SPECIAL, supra note 55, at 314. 104 JEMMOTT ET AL., MAKING A DIFFERENCE!, supra note 50, at 273. 105 Viral Load in Semen, AIDS MAP, http://www.aidsmap.com/Viral-load-in-semen/page/1322890 (last visited July 5, 2015). 106 REIS ET AL., 7/8 F.L.A.S.H., supra note 42, Lesson 23, at 5. 107 CLARK ET. AL, POSITIVE PREVENTION SPECIAL, supra note 55, Appendix B, at 33. 24 with a heterosexual identity changed, 9.52% with a homosexual identity changed, and 47.06% with a bisexual identity changed.”108 Psychologist Nicholas Cummings is a past president of the American Psychological Association. He believes that “[g]ays and lesbians have the right to be affirmed in their homosexuality,” and stands by his vote to remove homosexuality from the APA’s list of mental disorders. On the other hand, he has also been successful in helping homosexuals who wish to change their orientation, and finds that “contending that all same-sex attraction is immutable is a distortion of reality.”109 Several studies have been conducted regarding homosexuals who are part of pairs of twins. No reliable study has shown that every homosexual twin has a homosexual twin.110 Even a study that showed a high concordance of 52% of homosexuality among identical twins was affected by the fact that the authors of the study sought volunteers through advertisements placed in homosexual-friendly publications.111 The version of HealthTeacher that we reviewed does not mention homosexuality or bisexuality. 4.4 – Gender Ambiguity Males and females are different. Nature made us this way. Educator and family therapist Michael Gurian observes: In order for the human species to survive, this divergence of sex roles was necessary. . . . Females had to be better at verbal skills than males; males had to be better at spatials and more physically aggressive. . . .Both the brain and its hormones—which are catalysts for brain activity—came to differ with gender. The differences existed (as they still do) even in utero . . . . 112 Several of the curricula, however, want to challenge biology and nature. The Grade 8 version of the Draw the Line, Respect the Line curriculum tells a story of characters named “Chris” and “J.” One character wants to give the other a hickey, but the other doesn’t want one.113 The genders of the two characters are unclear. 108 Steven E. Mock & Richard P. Eibach, Stability and Change in Sexual Orientation Identity Over a 10Year Period in Adulthood, 41 ARCHIVES SEXUAL BEHAV. 641, 645 (2012), available at http://ioa126.medsch.wisc.edu/findings/pdfs/1153.pdf. 109 Nicholas A. Cummings, Sexual Reorientation Therapy Not Unethical: Column, USA TODAY, July 30, 2013, http://www.usatoday.com/story/opinion/2013/07/30/sexual-reorientation-therapy-not-unethicalcolumn/2601159. 110 See William Byne & Bruce Parsons, Human Sexual Orientation: The Biologic Theories Reappraised, 50 ARCHIVES GEN. PSYCHIATRY 228, 229 (1993), available at http://www.researchgate.net/profile/William_Byne/publication/14760555_Human_sexual_orientation._The_biologi c_theories_reappraised/links/0c960533ca1e5df789000000.pdf. 111 Id. at 230. 112 MICHAEL GURIAN ET AL., BOYS AND GIRLS LEARN DIFFERENTLY: A GUIDE FOR TEACHERS AND PARENTS 39 (2001). 113 MARIN ET AL., DTL GRADE EIGHT, supra note 37, at 139. 25 Making a Difference! presents far more “gender neutral” role playing scenarios.114 For example, in a scenario with two students named “Justice” and “Angel,” the following summarizes what the character “Justice” is facing: You do not want to have sexual intercourse at this point in your life and you told Angel your feelings about it . . . . You’ve gotten back from another groping session at the movies and Angel tells you that you have to decide whether you’re down to be a couple or what.115 The Level A version of the Positive Prevention curriculum makes a point in its Introduction of stating that the curriculum’s “[l]anguage. . .is gender-neutral and nonspecfic to sexual orientations, so that the emphasis is placed on personal responsibility as perceived by each student, independent of sexual biases or stereotypes.”116 The Special Populations version has the same Introduction language.117 The Special Populations version of Positive Prevention introduces students to the concept of “gender identity,” that is, “whether a person sees herself or himself as female.”118 During a lesson on condom use, the curriculum informs instructors: “Language should also be genderneutral, referring to ‘sexual partners’ rather than a man and a woman.”119 An appendix item states: “Gender identity refers to a person’s internal sense of being male, female, or something in between.120 An appendix item cautions instructors: “Remember not to allow gender stereotypes or norms to unnecessarily impact your responses to students who are LGBT.”121 Playing with gender is not a game. We note the warning from Paul McHugh, M.D., a former psychiatrist from Johns Hopkins University: We at Johns Hopkins University—which in the 1960s was the first American medical center to venture into “sex-reassignment surgery”—launched a study in the 1970s comparing the outcomes of transgendered people who had the surgery with the outcomes of those who did not. Most of the surgically treated patients described themselves as “satisfied” by the results, but their subsequent psycho-social adjustments were no better than those who didn’t have the surgery. And so at Hopkins we stopped doing sex-reassignment surgery, since producing a “satisfied” but still troubled patient seemed an inadequate reason for surgically amputating normal organs.122 114 E.g. JEMMOTT ET AL., MAKING A DIFFERENCE!, supra note 50, at 172, 174, 191, 194, 196-197, 199, 204- 205. 115 Id. at 191. CLARK ET. AL, POSITIVE PREVENTION LEVEL A, supra note 54, at xiii. 117 CLARK ET. AL, POSITIVE PREVENTION SPECIAL, supra note 55, at xvi. 118 Id. at 37, 41. 119 Id. at 236. 120 Id. Appendix C at 3. 121 Id. Appendix C at 10. 122 Paul McHugh, Transgender Surgery Isn’t the Solution, WALL ST. J., June 12, 2014, http://www.wsj.com/articles/paul-mchugh-transgender-surgery-isnt-the-solution-1402615120. 116 26 Gender differences are very real. Biology is not politically correct. As educator and family therapist Steve Biddulph summarized: Some gender differences between boys and girls do begin to appear early on. Here are just a few discoveries researchers have made: • Boy babies are less aware of faces. • Girl babies have a much better sense of touch. • The retinas in the back of boys’ eyes are differently made, so they see more movement, and less color and texture. • Boys grow faster and stronger, yet they are more troubled by separations from their mother. • Boys in toddlerhood move around more and occupy more space. • Boys like to handle and manipulate objects more, and build high buildings out of blocks, while girls prefer low-rise. • At preschool boys tend to ignore a new child who arrives in the group, while girls will notice and befriend him or her.123 The idea that boys and girls tend to have different tastes is unthinkable to the excessively politically correct crowd. But biology gets in the way, as neuroscientists Sandra Aamodt and Sam Wang commented: One of our colleagues, who was dedicated to freeing her kids from traditional gender expectations, bought a doll for her son and trucks for her daughter. She gave up her quest after she found the boy using the doll to pound in a nail and the girl pretending that the trucks were talking to each other.124 Louann Brizendine, M.D., one of whose patients attempted a similar failed “experiment” on the patient’s three and one-half year-old daughter, explains: There is no unisex brain. She [the daughter] was born with a female brain, which came complete with its own impulses. Girls arrive already wired as girls, and boys arrive already wired as boys. Their brains are different by the time they’re born, and their brains are what drive their impulses, values, and their very reality.125 Perhaps most notably, “[m]en, quite literally, have sex on their minds more than women do . . . . Males have double the brain space and processing power devoted to sex as females.”126 123 STEVE BIDDULPH, WHY BOYS ARE DIFFERENT—AND HOW TO HELP THEM BECOME HAPPY AND WELLBALANCED MEN 14-15 (Ten Speed Press, 3rd ed. 2013) (1998). 124 SANDRA AAMODT & SAM WANG, WELCOME TO YOUR CHILD’S BRAIN: HOW THE MIND GROWS FROM CONCEPTION TO COLLEGE 63 (2011). 125 LOUANN BRIZENDINE, THE FEMALE BRAIN 12 (2006). 126 Id. at 91. 27 Speaking on gender differences, Dr. Grossman rejects political correctness, and notes that “the most powerful messages our kids get [about gender and behavior] are not from their environment. They are from their hypothalamus, ovaries, and testes . . . . To deny these forces of nature in the interest of promoting specific social agendas is an unethical and hazardous blunder.127 4.5 – Teaching Boys and Girls: Together or Separate? Do you want your daughter to be learning about her period when a bunch of boys are present? If the teacher asks students if they have any honest questions about biology, will your daughter feel comfortable enough to raise her hand, knowing that some of the boys in the background will snicker at the mere mention of a “period” or “breast”? Educator and family therapist Michael Gurian suggests that at least some single-sex groupings during sex education courses should be made, “so that sensitive and difficult areas can be covered without members of either sex shutting down or resorting to attention-getting devices with the other sex.”128 The evaluators of the Draw the Line, Respect the Line curriculum, during a study, offered “boys’ day” and “girls’ day” to separate the sexes, which were “aimed at students who might feel uncomfortable asking a question in a mixed-gender group.”129 The curriculum, however, gives no guidance to the instructor regarding when boys and girls should be separated, with the exception of small single-sex discussions groups for the evaluation of a previous day’s HIVpositive speaker.130 The Grades 4-6 version of the F.L.A.S.H. curriculum states: Using Coed or Single-Gender Groups Probably the ideal is a combination: one lesson, perhaps #9 or 10, single-gender and the rest coed. The advantage of single-gender lessons is that students may be somewhat more comfortable asking questions aloud. One advantage of coed lessons is that mutual respect and understanding develop, instead of an aura of mystery and illicitness...there is less need to tease or “gossip” on the playground, since everyone has heard the same things. Also we model that men and women, parents and children of both genders, can talk together. In any case, consult your principal and your district’s guidelines if you are not sure which to do.131 The Grades 7-8 version of the F.L.A.S.H. curriculum consistently combines boys and girls. Students work in pairs or trios, for example, to review what they’ve learned about HIV.132 The GROSSMAN, YOU’RE TEACHING MY CHILD WHAT?, supra note 34, at 53. GURIAN ET AL., supra note 112, at 289. 129 COYLE ET AL., DTL GRADE SEVEN, supra note 36, at 5; MARIN ET AL., DTL GRADE EIGHT, supra note 127 128 37, at 5. 130 MARIN ET AL., DTL GRADE EIGHT, supra note 37, at 77. REIS ET AL., 4/5/6 F.L.A.S.H., supra note 41, at 8. 132 REIS ET AL., 7/8 F.L.A.S.H., supra note 42, Lesson 23, at 4. 131 28 curriculum also utilizes the term “wet dream” during its puberty lesson133 and addresses masturbation during a discussion on touching and abstinence.134 The Special Education curriculum addresses masturbation as well.135 During the HealthTeacher curriculum’s instruction on sexual anatomy, the menstrual cycle, and sperm production, the text instructs teachers to divide boys and girls to complete paperwork.136 The Making a Difference! curriculum encourages a “talk circle” between all students (regardless of gender) at the end of each module, where they can “discuss their thoughts and feelings.”137 The curriculum also teaches boys and girls—at the same time—about body changes as breast development and penis development.138 The Level A version of the Positive Prevention curriculum states that for small group discussions, “it is sometimes appropriate to team boys against girls, for example when exploring attitudes toward dating and sex.”139 In one lesson, it is recommended that boys and girls be separated from each other into small groups to discuss reasons for abstaining from sex.140 Unfortunately, any public school that separates boys and girls for sex education might face a lawsuit from the leftist American Civil Liberties Union. Incredibly, the ACLU has likened single-sex arrangements to racial segregation.141 Perhaps this is why the curricula do not emphasize the separation of the sexes. (Ironically, not too long ago, leftist feminists protested Mills College’s proposed plan to admit men as undergraduates.142 The protests, in part, were based on the notion that a coeducation setting would shortchange women.143) 4.6 – Condom Limitations Latex (natural rubber) condoms can reduce the risk of both pregnancy and the spread of some sexually transmitted diseases. They do, however, have their limitations. To what extent do the curricula discuss condoms, and how? 133 Id. Lesson 2, at 11. Id. Lessons 12 & 13, at 6. 135 STANGLE ET AL., SPECIAL EDUCATION F.L.A.S.H., supra note 43, Lesson 17, at 5. 136 DAVIS ET AL., HEALTHTEACHER MIDDLE, supra note 48, at 135, 176. 137 JEMMOTT ET AL., MAKING A DIFFERENCE!, supra note 50, at 35. 138 Id. at 57. 139 CLARK ET. AL, POSITIVE PREVENTION LEVEL A, supra note 54, at xxiv. 140 Id. at 147. 141 More Public Schools Splitting Up Boys, Girls, IDAHO PRESS TRIB., July 9, 2012, http://www.idahopress.com/news/local/more-public-schools-splitting-up-boys-girls/article_dc73c2c0-c984-11e186a9-001a4bcf887a.html. 142 Jennifer Bermon, 25 Years Ago: When Mills College Students Rallied to Keep It a Woman’s Institution, MS. MAG, May 4, 2015, http://msmagazine.com/blog/2015/05/04/25-years-ago-when-mills-collegestudents-rallied-to-keep-it-a-womans-institution. 143 Jorie Lueloff, Coed Classes Shortchange Women, CHI. TIMES, June 6, 1990, http://articles.chicagotribune.com/1990-06-06/news/9002160205_1_mills-college-mills-students-mills-women; Larry Gordon, Mills College Will Begin Admitting Men, L.A. TIMES, May 4, 1990, http://articles.latimes.com/199005-04/news/mn-118_1_mills-college. 134 29 The Grade 8 version of Draw the Line, Respect the Line claims that condoms “can be 98% effective in preventing HIV, other STD, and pregnancy, but only if they are used correctly and consistently—every time a person has sex.”144 Condoms are listed one of the “choices so you don’t get STD.”145 The Grades 7-8 version of F.L.A.S.H. states that “Condoms are very good protection against most STDs (the ones spread by semen and vaginal fluid).”146 The curriculum lists abstinence, monogamy, and the consistent use of condoms as “[t]he best (most certain) ways people can protect themselves and their partners from getting or giving” a sexually transmitted disease.”147 The curriculum does not give any estimates on the effectiveness or failure rates of condoms in preventing HIV.148 The Special Education version of that curriculum discusses condoms and how they may prevent disease.149 The Level A version of the Positive Prevention curriculum states that the latex male condom is “very good protection against HIV” and that it “reduces the risk of other STD’s.”150 It also states: Couples who used latex condoms consistently and correctly experienced a 98%-100% success rate in preventing the transmission of HIV. Couples who used condoms inconsistently or incorrectly still experienced an 85%-90% success rate in preventing the transmission of HIV.151 The Making a Difference! curriculum discusses male and female condoms as barrier methods which help prevent STDs and pregnancy.152 It also carries a mixed message on condoms to instructors: Some [student] participants may correctly assert that condoms can be used to reduce the risk of sexually transmitted diseases, including HIV, and pregnancy. Acknowledge the accuracy of this assertion, but emphasize the fact that abstinence is the best and most effective way to eliminate the possibility of sexually transmitted diseases, including HIV, and pregnancy. Don’t bash condoms or provide exaggerated information on failure rates.153 So while the curriculum states that it emphasizes abstinence on the one hand, and anticipates that questions about condoms may be asked, it fails to provide guidance regarding what is an “exaggerated” failure rate. 144 MARIN ET AL., DTL GRADE EIGHT, supra note 37, at 88. Id. at 129. 146 REIS ET AL., 7/8 F.L.A.S.H., supra note 42, Lesson 5, at 3. 147 Id. Lesson 4, at 9, 12. 148 Id. Lesson 21, at. 9. 149 STANGLE ET AL., SPECIAL EDUCATION F.L.A.S.H., supra note 43, Lesson 26, at 6. 150 CLARK ET. AL, POSITIVE PREVENTION LEVEL A, supra note 54, at 81, 141. 143. 151 Id. at 138. 152 JEMMOTT ET AL., MAKING A DIFFERENCE!, supra note 50, at 221. 153 Id. at 115. 145 30 The Grade 8 version of Draw the Line, Respect the Line states that it is a “common misperception that condoms contain ‘holes’, and that HIV can pass through the holes. Laboratory studies show that intact latex condoms provide a continuous barrier to microorganisms, including HIV.”154 The Grades 7-8 version of F.L.A.S.H. states, in bold letters: “NO DISEASES TRAVEL THROUGH LATEX OR POLYURETHANE.”155 On the other hand, the Special Populations version of Positive Prevention states that 0% to 2% of latex condoms have factory defects.156 The Level A version of that curriculum states that “up to 2% of the time there may be manufacturer defects (holes) in the latex.” That version, however, is describing a latex glove.157 So, do latex and/or polyurethane condoms have holes? The FDA website states: The FDA works with condom manufacturers to help ensure that the latex and polyurethane condoms you buy are not damaged. Manufacturers “spot check” their condoms using a “water-leak” test. FDA inspectors do a similar test on sample condoms they take from warehouses. The condoms are filled with water and checked for leaks. An average of 996 of 1000 condoms must pass this test.158 Given the FDA’s current standards regarding manufacturer defects, four out of every one thousand latex and polyurethane condoms might fail the “water-leak” test—that is, if a condom manufacturer does not voluntarily hold itself to a higher standard than what the FDA requires. Condom manufacturer Durex claims of its products: “If the sample [condom] fails any of the tests, the whole batch is rejected!”159 Condom manufacturer Trojan claims that it also submits every single condom to electronic testing.160 If a condom does fail the water-leak test, there is a risk of some exposure to HIV. Even condoms that are not defective (and therefore considered “intact”) still have pores that can theoretically allow a virus to pass through. However, due to the low infectivity of the HIV-1 virus, the pores of “intact” condoms are very unlikely to transmit an amount of the HIV virus capable of causing infection.161 154 MARIN ET AL., DTL GRADE EIGHT, supra note 37, at 87. REIS ET AL., 7/8 F.L.A.S.H., supra note 42, Lesson 4, at 6. 156 CLARK ET. AL, POSITIVE PREVENTION SPECIAL, supra note 55, at 235. 157 CLARK ET. AL, POSITIVE PREVENTION LEVEL A, supra note 54, at 137. 158 Condoms and Sexually Transmitted Diseases, U.S. FOOD & DRUG ADMIN., http://www.fda.gov/ForPatients/Illness/HIVAIDS/ucm126372.htm (last updated Jan. 15, 2015). 159 What Quality Tests Do Durex Condoms Through?, DUREX.COM, http://www.durex.com/enlat/askdurex/faq%27s/pages/whatqualitytestsdodurexcondomsgothrough.aspx (last visited July 3, 2015). 160 How are TROJAN Brand Condoms Manufactured?, TROJANCONDOMS.COM, http://www.trojancondoms.com/resources/faqs.aspx (last visited July 3, 2015). 161 Ronald F. Carey et al., Implications of Laboratory Tests of Condom Integrity, 26 SEXUALLY TRANSMITTED DISEASES 216, 219 (1999), available at http://bit.ly/1EkRk7S. 155 31 So the good news is that, while condoms are not as effective as abstinence (which can never fail), non-defective condoms can help to reduce the risk of HIV infection. The bad news, however, is that condoms are not effective if they are used incorrectly.162 They may also break163 or slip.164 Further, their effectiveness is dramatically diminished if they are used inconsistently.165 The fact of the matter is that condoms are not always used consistently. Condom consistency actually decreases among adolescents who are older, have sex more frequently, and who are in longer sexual relationships. Further, adolescents who engage in casual sex are less likely to use a condom the first time they have sex.166 During a Grade 8 Draw the Line, Respect the Line in-class condom demonstration, students are informed that “sometimes can condoms break (2 or 3 out of 100 times) during sexual intercourse, usually because people don’t know how to use them correctly.”167 Other curricula fail to provide such information. Sources vary regarding actual latex condom breakage rates during penile to vaginal intercourse; one study states a rate of 0.2%,168 while another has 3.3%.169 The Making a Difference! curriculum informs instructors: “The facilitator should note that some individuals may have a latex allergy or develop awareness of a latex allergy in the future. It is appropriate to consistently remind participants that polyurethane condoms are an effective alternative condoms if allergies are present.”170 The other curricula do not mention latex allergies. Some studies have shown that some synthetic condoms (such as those made of polyurethane, orstyrene, ethylene, butylene, and styrene) have higher breakage rates than natural latex condoms. The risk ranges from 264%171 to 800%172 as high as the risk one takes when using a latex condom. Even if condoms are used consistently, they may give users a false sense of security. A review of multiple studies of condom use among heterosexuals shows that, even among consistent 162 Fact Sheet for Public Health Personnel, CENTERS FOR DISEASE CONTROL AND PREVENTION, http://www.cdc.gov/condomeffectiveness/latex.html (last updated Mar. 25, 2013). 163 Ronald F. Carey et al., supra note 161, at 219-220. 164 Condom Fact Sheet In Brief, CENTERS FOR DISEASE CONTROL AND PREVENTION, http://www.cdc.gov/condomeffectiveness/brief.html (last updated Mar. 25, 2013). 165 See supra note 162. 166 Jennifer Manlove et al., Condom Use and Consistency Among Male Adolescents in the United States, 43 J. ADOLESCENT HEALTH 325, 332 (2008), available at http://www.jahonline.org/article/S1054-139X(08)001869/pdf. 167 MARIN ET AL., DTL GRADE EIGHT, supra note 37, at 83. 168 Terri L. Walsh et al., Evaluation of the Efficacy of a Nonlatex Condom: Results from a Randomized, Controlled Clinical Trial, 35 PERSP. ON SEXUAL REPROD. HEALTH 79, 83 (2003), available at http://www.guttmacher.org/pubs/journals/3507903.pdf. 169 Ann Duerr et al., Assessing Male Condom Failure and Incorrect Use, 38 SEXUALLY TRANSMITTED DISEASES 580, 582 (2011), available at http://bit.ly/1LiZu5R. 170 JEMMOTT ET AL., MAKING A DIFFERENCE!, supra note 50, at v. 171 Maria F. Gallo, Nonlatex Versus Latex Male Condoms for Contraception, COCHRANE DATABASE SYSTEMATIC REVIEWS, no. 1, 2006, at 1, 6, available at http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003550.pub2/pdf. 172 Terri L. Walsh et al., supra note 168, at 85. 32 condom users, the effectiveness rate of preventing HIV transmission was “approximately 80.2%, but may be as low as 35.4% or as high as 94.2%.”173 Further, condoms are less useful at preventing the spread of some STD’s. Several of the curricula fail to fully disclose these risks. Consistent condom users can reduce the risk of transmitting herpes, but their risk is reduced by only about 30% when compared to non-condom users.174 The Grade 7 version of the Draw the Line, Respect the Line curriculum tells of a story that implies that condom use would have prevented a fictional character from getting HPV.175 The Grade 8 version of the curriculum merely states that condoms “may help prevent HPV.”176 Yet the Centers for Disease Control and Prevention (CDC) website notes that “HPV can infect areas that are not covered by a condom - so condoms may not give full protection against getting HPV.”177 One study showed that consistent condoms use reduces the risk of transmitting HPV, but the risk was only cut by only 46% when compared to sex without a condom.178 The Grades 7-8 version of F.L.A.S.H. discloses that condoms may not protect against HPV, since they may not cover the infected area.179 The Special Education version of that curriculum, however, does not clarify that condoms may not protect against HPV. HealthTeacher discloses that genital warts (HPV) can be transmitted by skin to skin contact, even without sexual intercourse. It also states that “[p]ersons who choose to be sexually active can protect themselves from HIV/STD by using condoms correctly and consistently.”180 However, it does not clarify that HPV can be transmitted even when a condom is used. Another report shows that even when condoms are used both correctly and consistently during every act of heterosexual penile to vaginal intercourse, sex with a condom reduced the risk of transmitting Chlamydia, Gonorrhea, and Trichomoniasis by only about 40% when compared to sex without a condom.181 The curricula might benefit by the addition of such a disclosure, 173 Susan C. Weller & Karen R. Davis-Beaty, Condom Effectiveness in Reducing Heterosexual HIV Transmission (Review), COCHRANE DATABASE SYSTEMATIC REVIEWS, no. 1, 2002, at 1, 6, available at http://apps.who.int/rhl/reviews/langs/CD003255.pdf. 174 Emily T. Martin et. al, A Pooled Analysis of the Effect of Condoms in Preventing HSV-2 Acquisition, 169 ARCHIVES INTERNAL MED. 1233, 1237 (2009), available at http://archneur.jamanetwork.com/data/Journals/INTEMED/9903/ioi90031_1233_1240.pdf. 175 COYLE ET AL., DTL GRADE SEVEN, supra note 36, at 131, 133. 176 MARIN ET AL., DTL GRADE EIGHT, supra note 37, at 88. 177 Genital HPV Infection - Fact Sheet, CENTERS FOR DISEASE CONTROL AND PREVENTION, http://www.cdc.gov/std/hpv/stdfact-hpv.htm (last updated Feb. 23, 2015). 178 Christine M. Pierce Campbell et. al, Consistent Condom Use Reduces the Genital Human Papillomavirus Burden Among High-Risk Men: The HPV Infection in Men Study, 208 SEXUALLY TRANSMITTED DISEASES 373, 377 (2013), available at http://jid.oxfordjournals.org/content/208/3/373.full.pdf+html. 179 REIS ET AL., 7/8 F.L.A.S.H., supra note 42, Lesson 4, at 6. 180 DAVIS ET AL., HEALTHTEACHER MIDDLE, supra note 48, at 233. 181 Richard A Crosby et. al, Condom Effectiveness Against Non-Viral Sexually Transmitted Infections: A Prospective Study Using Electronic Daily Diaries, 88 SEXUALLY TRANSMITTED INFECTIONS 484, 488 (2012), available at http://sti.bmj.com/content/88/7/484.full.pdf+html. 33 especially since a 2009 study shows that 24.1% of U.S. female adolescents aged 14 to 19 have one of these diseases.182 As we noted earlier, the FDA has not approved of condoms for use during anal sex.183 Among all of the curricula that bring up the topic of anal sex, none of them mention that fact. Further, according to AIDS Map, the results of a recently-released report regarding men who have anal sex with men show that “there was no significant difference in HIV acquisition rates between men reporting they ‘never’ used condoms in the previous six months and men reporting they ‘sometimes’ used them.” Even among the consistent condom users, condoms were only 70.5% effective in preventing HIV transmittal during anal sex.184 4.7 – Health Risks Some of the curricula give helpful information regarding these threats to health. Yet some of the information is either incorrect or incomplete. The Grades 7-8 version of F.L.A.S.H. states that HIV, Syphilis, Hepatitis B and C, and HPV are life threatening. It discloses that the HPV vaccine doesn’t protect against all types of HPV. The curriculum also classifies Chlamydia, gonorrhea, pelvic inflammatory disease, genital herpes, and cytomegalovirus as serious diseases.185 The curriculum states that Chlamydia can be cured, but that it also may not show symptoms.186 HealthTeacher states that Chlamydia187 and gonorrhea188 usually have no symptoms among women. A Making a Difference! appendix item discloses that for Chlamydia and gonorrhea, many people never have any symptoms.189 The appendix also discloses that some people with herpes “do not have any symptoms,” and that “you do not have to have sexual intercourse” to get herpes or HPV.190 Yet the curriculum also states that “body rubbing/massaging, mutual masturbation” are “effective against HIV and some other STDs as long as bodily fluids are not exchanged.”191 182 Sara E. Forhan et. al, Prevalence of Sexually Transmitted Infections Among Female Adolescents Aged 14 to 19 in the United States, 124 PEDIATRICS 1505, 1507 (2009), available at http://pediatrics.aappublications.org/content/124/6/1505.full.pdf+html. 183 See supra note 72. 184 Gus Cairns, CDC Researchers Publish Estimate of Effectiveness of Condom Use in Anal Sex, AIDS MAP (December 19, 2014), http://www.aidsmap.com/CDC-researchers-publish-estimate-of-effectiveness-ofcondom-use-in-anal-sex/page/2930716. 185 REIS ET AL., 7/8 F.L.A.S.H., supra note 42, Lesson 4, at 4. 186 Id. Lesson 4, at 5, 6. 187 DAVIS ET AL., HEALTHTEACHER MIDDLE, supra note 48, at 237. 188 Id. at 239. 189 JEMMOTT ET AL., MAKING A DIFFERENCE!, supra note 50, at 249. 190 Id. at 243-244. 191 Id. at 275. 34 What is not made clear, however, is that HPV can be transmitted by the skin-to-skin contact that is involved with mutual masturbation.192 The same is true for herpes.193 The Positive Prevention Special Populations curriculum lists Chlamydia, gonorrhea, syphilis, and public lice (Crabs) as “treatable but repeatable.” It discloses that Chlamydia and gonorrhea, if left untreated, can cause permanent damage to the reproductive system and sterility.194 It is true that Chlamydia can be treated with antibiotics. However, antibiotics might not be able to make the disease go away completely. The disease is very persistent—possibly because even after treatment with antibiotics, the disease can survive in the gastrointestinal tract.195 Further, the scar that Chlamydia leaves behind can interfere with a fertilized egg and may disrupt it from implanting in the uterus.196 None of this is described in the curricula we reviewed. Yet this information has profound implications for any girl who wants to be a mother someday. A person infected with Chlamydia will often exhibit no symptoms.197 The need for abstinence until adulthood is all the more urgent. Dr. McIlhaney, an infertility specialist, saw with his own eyes the impacts of these disease, and how they destroyed some young women’s dreams of motherhood: “Many of his patients required his care because the women had been infected with Chlamydia when in high school or college. Almost none had known of the infection. Almost none were aware that their sexual involvement when young could result in infertility later.”198 Young girls are not told that they may be too young to have sex, given that their biology makes them vulnerable to HPV. As noted in Missouri Medicine: Another factor that can increase the susceptibility of female adolescents to HPV infection includes the physiologically large cervical transformation zone, or “immature cervix, “ that is undergoing active squamous metaplasia. The thinly layered columnar epithelium appears to be especially vulnerable to HPV, and allows the virus direct access to the basal epithelial cells through a wound or abrasion. Early age of first intercourse may be related to increased HPV acquisition, not only because of the potential for 192 Laurel A. Mills et. al, Sexually Related Behaviors as Predictors of HPV Vaccination Among Young Rural Women, 20 J. WOMEN’S HEALTH 1909, 1910 (2011), available at http://online.liebertpub.com/doi/pdf/10.1089/jwh.2011.3000. 193 AM. MED. ASS’N., FAMILY MEDICAL GUIDE 456, 482 (4th ed. 2004) (1982). 194 CLARK ET. AL, POSITIVE PREVENTION SPECIAL, supra note 55, at 273-275. 195 Roger G. Rank & Laxmi Yeruva, Hidden in Plain Sight: Chlamydial Gastrointestinal Infection and Its Relevance to Persistence in Human Genital Infection, 82 INFECTION & IMMUNITY 1362, 1369 (2014), available at http://iai.asm.org/content/82/4/1362.full.pdf. 196 Astrid Hjelholt et. al, Tubal Factor Infertility is Associated with Antibodies against Chlamydia Trachomatis Heat Shock Protein 60 (HSP60) but not Human HSP60, 26 INFECTION & IMMUNITY 2069, 2069 (2011), available at http://humrep.oxfordjournals.org/content/26/8/2069.full.pdf+html. 197 Chlamydia - CDC Fact Sheet, CENTERS FOR DISEASE CONTROL AND PREVENTION, http://www.cdc.gov/std/Chlamydia/stdfact-Chlamydia.htm (last updated Dec. 16, 2014). 198 JOE S. MCILHANEY ET. AL., supra note 73, at 42. 35 higher numbers of sexual partners, but because young adolescents are much more likely to have this large area of metaplasia at the transformation zone.199 Dr. Grossman puts this matter in layperson’s terms: [T]he cervix of a teen has a central area called the transformation zone. Here the cells are only one layer thick. The transformation zone is largest at puberty, and it slowly shrinks as the cervix matures. The thin folds of fragile, single cells are transformed pro progressively into a thick, flat shield with many layers. The “T-zone” can be seen during a routine pelvic exam. It makes the cervix look like a bull’s eye, which is fitting, because it’s exactly where the bugs want to be . . . . It’s difficult, if not impossible, to get through the many layers of the mature cervix. But penetration of the transformation zone’s single layer is a cinch, making this area of the cervix prime real estate for genital infections. This is one of the reasons for our current pandemic of genital infections in teen girls.200 Based on this, Dr. Grossman asserts that “girls should be advised to delay sexual behavior... . Not for moral reasons, and not for emotional . . . but for medical reasons alone.”201 4.8 – Abstinence and Marriage BOE Policy No. 2110, “ABSTINENCE-BASED EDUCATION POLICY”, in place from September of 1995 until June of 2015, stated in full: In order to help students make decisions that promote healthy behaviors, the Department of Education shall instruct students that abstention from sexual intercourse is the surest and most responsible way to prevent unintended pregnancies, sexually transmitted diseases such as HIV/AIDS, and consequent emotional distress. The abstinence-based education program shall: a. support abstention from sexual intercourse and provide skill development to continue abstention; b. help youth who have had sexual intercourse to abstain from further sexual intercourse until an appropriate time; and c. provide youth with information on and skill development in the use of protective devices and methods for the purpose of preventing sexually transmitted diseases and pregnancy.202 199 Melissa L. Lawson, Human Papillomavirus Infection in Adolescent and Young Women, 105 MO. MED. 42, 43 (2008), available at http://www.msma.org/docs/communications/MoMed/HPV%20in%20Adolescent%20and%20Young%20Women.pd f. 200 GROSSMAN, YOU’RE TEACHING MY CHILD WHAT?, supra note 34, at 77. 201 Id. at 80. 202 HAW. BOARD EDUC. POL’Y No. 2110 (1995), available at http://www.hawaiiboe.net/policies/2100series/Pages/2110.aspx. 36 BOE Policy 103.5, “SEXUAL HEALTH EDUCATION” which passed in June of 2015, replaces BOE Policy No. 2110. The new policy states in full: In order to help students make decisions that promote healthy behaviors, the Department of Education shall provide sexual health education to include age appropriate, medically accurate, health education that: (1) Includes education on abstinence, contraception, and methods of infection prevention to prevent unintended pregnancy and sexually transmitted infection, including human immunodeficiency virus; (2) Helps students develop relationships and communication skills to form healthy relationships that are based on mutual respect and affection and are free from violence, coercion and intimidation; (3) Helps students develop skills in critical thinking, problem solving, decision making and stress management to make healthy decisions about sexuality and relationships; (4) Encourages student to communicate with their parents, guardians and/or other trusted adults about sexuality; and (5) Informs students of available community resources. Instruction will emphasize that abstention from sexual intercourse is the surest way to prevent unintended pregnancies, sexually transmitted infections such as HIV/AIDS, and consequent emotional distress. A description of the curriculum utilized by the school shall be made available to parents and shall be posted on the school’s website prior to the start of any instruction. A student shall be excused from sexual health instruction only upon the prior written request of the student’s parent or legal guardian. A student may not be subject to disciplinary action, academic penalty or other sanction if the student’s parent or legal guardian makes such written request.203 The very concept of abstinence is sometimes ridiculed in our culture. According the authors of Girls Uncovered, “[a] number of women in their mid-twenties (one a bank vice president) transferred their medical care to [Dr. Joe McIlhaney] because their previous doctors had actually made fun of them for being virgins.”204 Yet a study commissioned by the U.S. Dept. of Health and Human Services found that 71% of parents and 53% of teens agreed that it was against their values to have sexual intercourse before marriage.205 Abstinence isn’t just about moralism or Bible-thumping; it is about a child’s overall well-being. The earlier a girl starts to have sex, the less likely she is to use contraceptives consistently later in life.206 Early sexual activity may also be a sign of (though perhaps not the cause of) HAW. BOARD EDUC. POL’Y No. 103.5 (2015), available at http://www.hawaiipublicschools.org/DOE%20Forms/Health%20and%20Nutrition/BOE103_5_061615.p f. 204 JOE S. MCILHANEY ET. AL., supra note 73, at 113. 205 LAUREN OLSHO ET AL., NATIONAL SURVEY OF ADOLESCENTS AND THEIR PARENTS: ATTITUDES AND OPINIONS ABOUT SEX AND ABSTINENCE 51 (2009), available at http://www.acf.hhs.gov/sites/default/files/fysb/20090226_abstinence1.pdf . 206 Brianna M. Magnusson et. al, Early Age at First Intercourse and Subsequent Gaps in Contraceptive Use, 21 J. WOMEN’S HEALTH 73, 75 (2012), available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3283439/pdf/jwh.2011.2893.pdf. 203 37 depression.207 One study found that schools that adopted abstinence curricula showed an increase in higher student passing rates for a state math achievement examination.208 Further, sociology professor Sinikka Elliott’s research suggests that: [A]bstinence is appealing to parents less for its moral message than its promise of psychological, physical, and financial well-being. That is, despite their ambivalence, many parents promote abstinence because they hope it will keep their children safe and safeguard their futures. . . .First, parents think sex (by which they mean heterosexual intercourse) is enormously risky--resulting in innumerable negative physical, emotional, and financial consequences....Second, in addition to emphasizing the dangerous consequences of sex, the parents articulated a view of teenagers as vessels of raging hormones who lack the capacity to approach sex responsibly.209 Unfortunately, Professor Elliott’s study also found that “most of the parents professed that sexual abstinence until marriage (or adulthood) is what they would prefer for their children, but also a belief that this is probably not realistic.” For example, one self-described non-religious parent “uses the language of abstinence until marriage in discussing sex with her son because, despite her belief that it is unrealistic and that her son will not abstain until he is married, she does not know what else to tell him.”210 These parents’ lack of confidence in their ability to lead their own children, however, is ill-founded. Parental attitudes about sex can and do have an impact on the sexual behavior of their children. One report showed: “Adolescents whose parents wanted them to be over 18 when they first have sex had lower odds of having had sex.”211 This echoes an earlier report’s statement: “Parents and families whose adolescent children feel connected to them and those who are perceived by the adolescent as disapproving of their teens being sexually active provide some protection from early sexual intercourse. Disapproval of adolescent contraception protects teens from early sexual involvement as well as from pregnancy.”212 Another report found that for parents who conveyed restrictive values regarding intercourse, their children were more likely to delay 207 Luanne K. Jamieson & Terrance J. Wade, Early Age of First Sexual Intercourse and Depressive Symptomatology among Adolescents, 48 J. SEX RES. 450, 457 (2011), available at http://search.ebscohost.com/login.aspx?direct=true&AuthType=cookie,ip,cpid&custid=s4800244&db=aph&AN=62 666680&site=ehost-live. 208 Kenneth F. Ferraro & Karis A. Pressler, Do Abstinence Education Programs Influence High-School Academic Performance? 26 AMER. J. HEALTH STUD. 230, 233 (2011), available at http://www.researchgate.net/profile/Kenneth_Ferraro/publication/265491279_DO_ABSTINENCE_EDUCATION_ PROGRAMS_INFLUENCE_HIGHSCHOOL_ACADEMIC_PERFORMANCE/links/54d0e1d40cf298d6566940fe.pdf. 209 Sinikka Elliott, “If I Could Really Say that and Get Away with It!”: Accountability and Ambivalence in American Parents’ Sexuality Lessons in the Age of Abstinence, 10 SEX EDUC. 239, 243 (2010), available at http://search.ebscohost.com/login.aspx?direct=true&AuthType=cookie,ip,cpid&custid=s4800244&db=aph&AN=52 288419&site=ehost-live. 210 Id. at 245. 211 Monica A. Longmore et. al, Parenting and Adolescents’ Sexual Initiation, 71 J. MARRIAGE FAM. 969, 977 (2009), available at http://facweb.northseattle.edu/lchaffee/PSY100/Journal%20Articles/Longmore%20et%20al%202009.pdf. 212 ROBERT W. BLUM & PEGGY MANN RINEHART, REDUCING THE RISK: CONNECTIONS THAT MAKE A DIFFERENCE IN THE LIVES OF YOUTH 20 (1997), available at http://files.eric.ed.gov/fulltext/ED412459.pdf. 38 intercourse. On the other hand, for parents who endorsed contraceptive use, their children were less likely to delay intercourse.213 Yet another study shows that adolescents whose parents disapproved of sex were less likely to initiate both oral sex and vaginal sex.214 Adolescents who perceive that their mothers’ approved of sexual activities are less likely to delay sexual activity.215 A father’s disapproval about adolescent sexual behavior can delay or reduce sexual behavior in their children.216 Unfortunately, many parents and their children don’t talk about the crucial issues. One study found that teens more likely to talk to their best friends than their own parents about condom use. Further, only 26% of teens spoke with their parents about all of the following topics: Using condoms, using other birth control, the risk of STD’s, the risk of HIV/AIDS, the risk of pregnancy, and abstinence.217 Parents can help prevent the initiation of adolescent sex through monitoring. One study showed: “Among the [adolescent] respondents who had had intercourse, 91% said that the last time had been in a home setting, including their own home (37%), their partner’s home (43%), and a friend’s home [12%] . . . . “218 Further, abstinence education can have a positive impact. A 2008 study of seventh-grade students in Virginia found that students who took an abstinence education course were only 46% as likely as their peers to lose their virginity after one year.219 With all this in mind, how do the curricula in Hawaii DOE schools measure up in terms of promoting abstinence? The Grade 8 version of the Draw the Line, Respect the Line curricula asks (but does not firmly answer): What are you going to do now to prevent HIV, other STD and unplanned pregnancy in your life? Will you choose to kiss, but not go any further? Will you decide it’s OK to 213 Alison Parkes et. al, Is Parenting Associated with Teenagers’ Early Sexual Risk-Taking, Autonomy And Relationship with Sexual Partners?, 43 PERSP. ON SEXUAL AND REPROD. HEALTH 30, 35 (2011), available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437472/pdf/psrh0043-0030.pdf. 214 Melina Bersamin et. al, Parenting Practices and Adolescent Sexual Behavior: A Longitudinal Study, 70 J. MARRIAGE FAMILY 97, 105-106 (2008), available at https://www.deepdyve.com/lp/wiley/parenting-practicesand-adolescent-sexual-behavior-a-longitudinal-ydBuyI4d93. 215 Hyeouk Hahm et al., Longitudinal Effects of Perceived Maternal Approval on Sexual Behaviors of Asian and Pacific Islander (API) Young Adults, 37 J. YOUTH ADOLESCENCE 74, 79 (2007), available at http://www.bu.edu/awship/files/2013/10/longitudinal-effects.pdf. 216 Vincent Guilamo-Ramos et. al, Paternal Influences on Adolescent Sexual Risk Behaviors: A Structured Literature Review, 130 PEDIATRICS e1313, e1323 (2012), http://pediatrics.aappublications.org/content/130/5/e1313.full.pdf+html 217 Laura Widman et. al, Sexual Communication Between Early Adolescents and Their Dating Partners, Parents, and Best Friends, 51 JOURNAL OF SEX RES. 731, 734 (2014), available at http://mitch.web.unc.edu/files/2013/10/Widman-et-al-2014-JoSR.pdf. 218 Deborah A. Cohen et. al, When and Where Do Youths Have Sex? The Potential Role of Adult Supervision, 110 PEDIATRICS e66, 3 (2014), http://pediatrics.aappublications.org/content/110/6/e66.full.pdf+html. 219 Stan E Weed et al., An Abstinence Program’s Impact on Cognitive Mediators and Sexual Initiation, 32 AMER. J. HEALTH BEHAV. 60, 70 (2008), available at http://www2.cortland.edu/centers/character/images/sex_character/StanWeed_AbstinProgram_CogMediators_SexIni tiation.pdf. 39 touch above the waist but not below? Will you choose not to have sex until you are older and married? Will you choose to use condoms every time if you decide to have sex?220 A lesson in the Grades 4-6 version of the F.L.A.S.H curriculum discusses condom use. Before that discussion is reached, the curriculum recommends that instructors tell their students the following: The only 100% safe way to protect yourself from HIV is not to use injection drugs at all ever and to practice sexual abstinence . . . . Sexual intercourse, when two people are older and love each other very much, is an important part of most people’s lives. It’s a way to show strong affection, and it’s also the way to make babies. It’s very private and personal and special. Decisions about sex are very complicated. They are really adult decisions. When young people try to make sexual decisions, things often don’t go right. Sex is worth waiting for until you’re an adult.221 A lesson in the Grades 7-8 version of F.L.A.S.H states: The best (most certain) ways people can protect themselves and their partners from getting or giving an STD are: Not having oral, anal, or vaginal sex (This is called abstinence and it is safest.) Only having sex with one other person, who only has sex with them, ever. (In a marriage or a long-term partner relationship where they have had years to build trust.) Using a condom every time they have sex.222 Another section of that curriculum recommends that teachers discourage teen pregnancy by inviting an adult speaker “who made a conscious decision to delay parenting until at least age 20” to speak to the students. The curriculum encourages asking such a speaker such questions as “What made you decide to wait until you were older to have a baby?” and “Were there things you were looking for in a partner that you didn’t find until you were older? Like what?”223 A lesson in the F.L.A.S.H Special Education curriculum recommends that teachers tell students the following: In our culture, many people think it is best to wait to have sexual intercourse until you are an adult. They think that having sex is not safe for children or teenagers. Some believe adults should wait until they are married to have sex. They think it’s wrong to have sex unless you are married, even if you’re grown. Others think it’s wrong unless you are in love. But almost all think it’s important to wait until you are an adult. Really 220 MARIN ET AL., DTL GRADE EIGHT, supra note 37, at 20. REIS ET AL., 4/5/6 F.L.A.S.H., supra note 41, Lesson 17, at 6. 222 REIS ET AL., 7/8 F.L.A.S.H., supra note 42, Lessons 10 & 11, at 4. 223 Id. Lesson 4, at 9. 221 40 think hard about your feelings and beliefs and those of your family, before you make up your mind about sex. I would really encourage you to discuss this with your family or a trusted adult.224 Another lesson in that curriculum states that abstinence is the only 100% effective way to prevent the spread of STD’s.225 The HealthTeacher curriculum instructs teachers to “[s]tress the percentage of students who are not sexually active.”226 The curriculum discloses: “Sexual activity involves physical and emotional risks and responsibilities better managed when students are older or in a more stable relationship.”227 It also states that “mutual monogamy” is a safe behavior.228 The curriculum also addresses some of the feelings that children go through after their parents divorce.229 There are enclosed scripts are about achieving nonsexual goals—like fundraising for camp230 and preparing for a career.231 The curriculum notes that goal-setting “can provide motivation to avoid early sexual behavior and the risks that accompany it, including unintended pregnancy, HIV infection, and other sexually transmitted diseases (STDs).”232 The First Module of the Making a Difference! curriculum states goals and learning objectives.233 None of the goals mention abstinence until marriage, or even abstinence until adulthood. The curriculum further states: Sexual arousal can make your palms sweaty, your heart beat faster, or make you feel like there are butterflies in your stomach. Boys may experience erections, and girls may feel warm and tingly in their genital area. Sexual emotions can be strong and confusing. These feeling are normal. However, what you do about them is important! The proud and responsible thing to do is to take time to get know your feelings. You do not have to have sex.234 “You do not need to have sex” is hardly a ringing recommendation for abstinence. The curriculum also states that “[i]t’s NOT a good idea to HAVE sex until you are prepared to have sex with respect and responsibility.”235 Instead of informing young students when they will be prepared when they reach a clear landmark (such as marriage, or attainment of financial 224 STANGLE ET AL., SPECIAL EDUCATION F.L.A.S.H., supra note 43, Lesson 22, at 2. Id. Lesson 25, at 3. 226 DAVIS ET AL., HEALTHTEACHER MIDDLE, supra note 48, at 212. 227 Id. at 213. 228 Id. at 249. 229 Id. at 135. 230 Id. at 191. 231 Id. at 203. 232 Id. at 193. 233 JEMMOTT ET AL., MAKING A DIFFERENCE!, supra note 50, at 31, 50-51. 234 Id. at 56. 235 Id. at 64. 225 41 independence during adulthood), the curriculum leaves a noticeable canyon of ambiguity. Students are even encouraged to “brainstorm” on the benefits of sex versus abstinence.236 What if a twelve year-old girl believes she might be “prepared” to have sex with “respect and responsibility” with her sixteen year-old boyfriend? Students and parents should heed the words of Dr. Grossman: How old should one be to start having sex? This is not a complex question requiring lengthy elaboration. Sex is for adults—both in years and maturity. When sex educators believe there’s no right or wrong answer to this question, when they say, “you must decide what’s right for you,” they are negligent.237 Further, while the Making a Difference! curriculum discusses bad reasons for having sex—such as, “to get back at your parents,”238—the curriculum gives scant attention to the good reasons for and benefits of abstaining. The Level A version of the Positive Prevention curriculum states that the use of condoms and other STD prevention methods are better and safer than no protection at all. However, abstinence is the only truly “safe” option and other methods are not equal to abstinence.239 As we see, some of the “pro-abstinence” messages of the above-mentioned curricula are halfhearted. This problem is exacerbated when we explore other parts of the curricula in Section 5.3 of this Report. Plainly stated, it is easier for an abstinence message to become lost given the mixed message of the curricula as a whole. Though we are not saying that only conservatives believe in abstinence, it is likely that some of the mixed messages from the curricula result, in part, from a left-of-center philosophy. Professor Donna Frietas, who describes herself as “leftleaning,” complains: “Our society suffers from a lack of serious reflection on what practicing abstinence might look like, and how the many ways of living abstinence might benefit a broad segment of the young adult population.”240 Yet while she tries to champion abstinence, she also redefines it to include “temporary abstinence” for adults.241 4.9 – Reproduction; Pregnancy In the Grades 4-6 version of the F.L.A.S.H. curriculum, students learn, in reasonably significant detail, how a fertilized egg develops into a newborn baby.242 The curriculum recommends, as an optional step, the use of fetal models.243 The Grades 7-8 version of the curriculum takes students through the stages of reproduction.244 236 Id. at 70-71. MIRIAM GROSSMAN, NEW YORK CITY SEXUALITY EDUCATION REPORT 13 (2012), available at http://www.miriamgrossmanmd.com/wp-content/uploads/2012/11/sex_ed_report.pdf. 238 Id. at 59. 239 CLARK ET. AL, POSITIVE PREVENTION LEVEL A, supra note 54, at xii. 240 DONNA FREITAS, THE END OF SEX: HOW HOOKUP CULTURE IS LEAVING A GENERATION UNHAPPY, SEXUALLY UNFULFILLED, AND CONFUSED ABOUT INTIMACY 152 (2013). 241 Id. at 154 242 REIS ET AL., 4/5/6 F.L.A.S.H., supra note 41, Lesson 14, at 6-7. 243 Id. Lesson 13, at 1. 244 REIS ET AL., 7/8 F.L.A.S.H., supra note 42, Lessons 7 & 8, at 1-25. 237 42 The Special Education version of F.L.A.S.H. also covers human reproduction, and encourages instructors to make use of the NOVA film The Miracle of Life.245 Drawings of the full development of a baby are shown.246 However, the curriculum lacks terms like “zygote” and “embryo.” The Special Education version of Positive Prevention discusses the male and female reproductive organs.247 On the other hand, the actual stages of pregnancy are omitted. Most of the other curricula devote little to no time to the stages of reproduction. Dr. Grossman remarks: Sex ed provides kids with pages and pages of information about contraception and abortion, leading them to believe that in a zillion years, when they do want to get pregnant, all that’s necessary is to stop—stop taking the pill, stop using the diaphragm, and stop wearing a condom. Pull the goalie and let the babies roll. Easy, right? Try telling that to the hordes of women seeking treatment at fertility centers all over the country. Many of them can’t conceive because they waited too long.248 The authors of a fertility book warn: “Women whose eggs are older make embryos that are more likely to be chromosomally abnormal. That can mean no pregnancy at all, miscarriage, or birth defects.”249 Freezing eggs can be costly.250 Further, “what often happens is that long before [a woman’s] egg supply runs out, the eggs get depleted or damaged along the way, leading to decreased fertility. . . .”251 Further, the authors advise women that “your fertility begins to decline in your twenties, then continues on a steady downward slope all through your thirties.”252 Boys and men may need to heed the restrictions of age as well. Some studies have found that a man’s sperm decreases in both quality and quantity as he ages past thirty-four or forty.253 The lower-quality sperm of a father over the age of forty may increase the likelihood that his offspring may suffer a disability.254 245 STANGLE ET AL., SPECIAL EDUCATION F.L.A.S.H., supra note 43, Lesson 19, at 3. Id. Lesson 20, at 5-6. 247 CLARK ET. AL, POSITIVE PREVENTION SPECIAL, supra note 55, at xiii. 248 GROSSMAN, YOU’RE TEACHING MY CHILD WHAT?, supra note 34, at 123. 249 KYRA PHILLIPS & JAMIE GRIFO, THE WHOLE LIFE FERTILITY PLAN: UNDERSTANDING WHAT AFFECTS YOUR FERTILITY TO HELP YOU GET PREGNANT WHEN YOU WANT TO 145 (2015). 250 Id. at 146. 251 Id. at 6. 252 Id. at 7. 253 Joao Batista A. Oliveira et al., The Effects of Age on Sperm Quality: An Evaluation of 1,500 Semen Samples, 18 JBRA ASSISTED REPRODUCTION 34, 38-39 (2014), available at http://www.jbra.com.br/media/trab/arq_238; Bronte A. Stone et. al, Age Thresholds for Changes in Semen Parameters in Men, 100 FERTILITY & STERILITY 952, 955 (2013), available at http://www.fertstert.org/article/S0015-0282(13)00687-0/pdf. 254 Michael Zitzmann, Effects of Age on Male Fertility, 27 BEST PRAC. & RES.: CLINICAL ENDOCRINOLOGY & METABOLISM 617, 620 (2013), available at https://www.deepdyve.com/lp/elsevier/effects-of-age-on-malefertility-GIZ899EbJT. 246 43 Ironically, most of the curricula that we reviewed discuss anal sex repeatedly—but never spend any time informing students that there may be an upper age limit on when they can mother or father their own biological children. 44 5.0 – Age Appropriate? As we have noted, Hawaii state-funded sex education, by law, must be age appropriate. That, is, it must be “suitable to a particular age or age group based on developing cognitive, emotional, and behavioral capacity typical for that age or age group.”255 How do the “other curricula” fare? 5.1 – Legal Ramifications Relating to Age Under Hawaii law, a person (regardless of age) commits the offense of sexual assault in the first degree (a class A felony) if he sexually penetrates a child aged thirteen or younger. The consent of the minor is irrelevant. A person also commits the same offense if the minor is age fourteen or fifteen, the suspect is at least five years older than the minor, and the suspect is not legally married to the minor.256 Further, under Hawaii law, a person (regardless of age) commits the offense of sexual assault in the third degree (a class C felony) if he makes sexual contact with a child aged thirteen or younger. Again, the consent of the minor is irrelevant. A person also commits the same offense if the minor is age fourteen or fifteen, the suspect is at least five years older than the minor, and the suspect is not legally married to the minor.257 Further, Hawaii law recognizes the offense of “Continuous sexual assault of a minor under the age of fourteen years.” This is a class A felony, which one commits when (1) the suspect resides with the minor or has recurring access to the minor, AND (2) the suspect engages in three or more acts of sexual penetration or sexual contact with a minor aged thirteen or younger.258 “Sexual penetration” is defined as: (1) Vaginal intercourse, anal intercourse, fellatio, deviate sexual intercourse, or any intrusion of any part of a person’s body or of any object into the genital or anal opening of another person’s body; it occurs upon any penetration, however slight, but emission is not required. As used in this definition, “genital opening” includes the anterior surface of the vulva or labia majora; or (2) Cunnilingus or anilingus, whether or not actual penetration has occurred. 259 “Sexual contact” means: 255 HAW. REV. STAT. § 321-11.1 (2014), available at http://www.capitol.hawaii.gov/hrscurrent/Vol06_Ch0321-0344/HRS0321/HRS_0321-0011_0001.htm. 256 HAW. REV. STAT. § 707-730 (2014), available at http://www.capitol.hawaii.gov/hrscurrent/Vol14_Ch0701-0853/HRS0707/HRS_0707-0730.htm. 257 HAW. REV. STAT. § 707-732 (2014), available at http://www.capitol.hawaii.gov/hrscurrent/Vol14_Ch0701-0853/HRS0707/HRS_0707-0732.htm. 258 HAW. REV. STAT. § 707-733.6 (2014), available at http://www.capitol.hawaii.gov/hrscurrent/Vol14_Ch0701-0853/HRS0707/HRS_0707-0733_0006.htm. 259 HAW. REV. STAT. § 707-700 (2014), available at http://www.capitol.hawaii.gov/hrscurrent/Vol14_Ch0701-0853/HRS0707/HRS_0707-0700.htm. 45 . . . . any touching, other than acts of “sexual penetration”, of the sexual or other intimate parts of a person not married to the actor, or of the sexual or other intimate parts of the actor by the person, whether directly or through the clothing or other material intended to cover the sexual or other intimate parts.260 Under Hawaii law, a minor who participates in “sexting” of a nude image of any minor is committing a petty misdemeanor.261 According to a book on teen pregnancy, “[a]bout 18%-24% of girls who began to have sex younger than at the age of 14 say that it was involuntary and 27% characterized their first sexual experience as unwanted.”262 Most minor-aged females who have engaged in sexual behavior at age 14 or younger regret doing so, as they believe that they were too young at the time.263 Given the above information, how well do the curricula do at informing students that underage sexual activity may be the wrong thing to do, or even illegal? The Grade 7 version of Draw the Line, Respect the Line contains a role-playing scenario in which an adult teacher plays the role of “Samuel.” Another character, “Elena,” is to be played by “the other teacher, classroom aide, or prepared students volunteer.”264 The scenario script is as follows: Samuel and Elena meet at a party. They dance and talk together. Some couples have gone upstairs to make out. Elena takes Samuel’s hand to go upstairs, but he doesn’t really want to go. Elena (Helper): Let’s go upstairs. Samuel (Teacher): No, I don’t want to go upstairs. Elena (Helper): Don’t you like me? Samuel (Teacher): Yes, I like you. I just don’t want to go upstairs. Elena (Helper): Why not? Everyone else is. Samuel (Teacher): Let’s keep dancing instead. I like the way you dance. Elena (Helper): Sure, let’s dance.265 260 Id. HAW. REV. STAT. § 712-1215.6 (2014), available at http://www.capitol.hawaii.gov/hrscurrent/Vol14_Ch0701-0853/HRS0712/HRS_0712-1215_0006.htm. 262 NAOMI B. FARBER, ADOLESCENT PREGNANCY: POLICY AND PREVENTION SERVICES 16 (2nd ed. 2009) (2003). 263 Sian Cotton et. al., Adolescent Girls’ Perceptions of the Timing of Their Sexual Initiation: “Too Young” or “Just Right”?, 34 J. ADOLESCENT HEALTH 453, 455 (2004), available at https://www.deepdyve.com/lp/elsevier/adolescent-girls-perceptions-of-the-timing-of-their-sexual-initiationNhdrBKTsJB; Susan L. Rosenthal et al., Heterosexual Romantic Relationships and Sexual Behaviors of Young Adolescent Girls, 21 J. ADOLESCENT HEALTH 238, 241 (1997), available at https://www.deepdyve.com/lp/elsevier/heterosexual-romantic-relationships-and-sexual-behaviors-of-youngZXv347AYRx. 264 COYLE ET AL., DTL GRADE SEVEN, supra note 36, at 52. 265 Id. at 119. 261 46 The curriculum gives no explanation as to why a grown adult should be roleplaying with a 12 year-old student in such a capacity—given that “Elena” wants to “make out” and possibly have sex with “Samuel.” The Grade 8 version of that curriculum includes a scenario with a 16 year-old boy and 13 yearold girl. They are alone at his house, and they kiss romantically. The boys anticipates, in his mind, that they might have sex. At that moment, however, his mother walks in. The curriculum suggests that the boy and girl might be going too far because of his age, but there is no outright warning about the problem of possible legal consequences.266 F.L.A.S.H references the topic of the age of consent in the appendices of the Grades 4-6,267 Grades 7-8,268 and Special Education269 versions of the curriculum. However, the subject is not presented as a main part of the curriculum. The Making a Difference! curriculum asks students to ponder: “Why do you think some teens your age are having sex?”270 The curriculum also presents a case study: Jolie is 13 and Malik is 16 . ...When Malik asks Jolie about having sex with him, Jolie doesn’t know what to say. She really wants to wait until she’s older and maybe even engaged . . . . Jolie and Malik are making out on the couch at his house. His parents won’t be home for a while. Things begin to get hot and heavy. They both are very sexually excited. How can Jolie avoid having sexual intercourse?271 This curriculum fails to warn students against the propriety of being alone and unsupervised with another teenager of the opposite sex. More incredibly, however, the curriculum also fails to notice that Malik, according to the law in some states, is about to commit statutory rape/sexual assault. Since Jolie is only thirteen, Hawaii law states that she cannot legally consent to sexual penetration.272 Contrast that omission to the discussion that that curriculum provides regarding sexting. The curriculum does mention that “there may be legal actions. Some states consider it a juvenile offense to sext, both for the recipient and the sender.”273 We note that although Making a Difference! discourages sexting, some parents might question the wisdom of introducing children as young as 11 years old to the topic. Though statistics vary, it appears that a very low number of children aged 13 and younger have engaged in sexting—perhaps as low as 4%.274 266 MARIN ET AL., DTL GRADE EIGHT, supra note 37, at 44, 45, 143. REIS ET AL., 4/5/6 F.L.A.S.H., supra note 41, Appendix C, at 4. 268 REIS ET AL., 7/8 F.L.A.S.H., supra note 42, Appendix C, at 4. 269 STANGLE ET AL., SPECIAL EDUCATION F.L.A.S.H., supra note 43, Appendix C, at 4. 270 JEMMOTT ET AL., MAKING A DIFFERENCE!, supra note 50, at 43, 58. 271 Id. at 108. 272 HAW. REV. STAT. § 707-730 (2014), available at http://www.capitol.hawaii.gov/hrscurrent/Vol14_Ch0701-0853/HRS0707/HRS_0707-0730.htm. 273 JEMMOTT ET AL., MAKING A DIFFERENCE!, supra note 50, at 138. 274 Luke Gilkerson, Sexting Statistics: What Do the Surveys Say?, COVENANT EYES (Jan. 20, 2012), http://www.covenanteyes.com/2012/01/10/sexting-statistics-what-do-the-surveys-say. 267 47 The Special Populations version of the Positive Prevention curriculum briefly addresses California law for the age of consent, which is the age of 18 in that state.275 An appendix item discusses statutory rape in more detail; however, it appears that that discussion is for reference purposes only, and is not intended for classroom instruction.276 None of the other curricula mention age of consent issues. 5.2 – Too Much Information, Too Soon? Child development expert David Elkind is concerned about the fact that many schools “reflect the contemporary bias toward having children grow up fast.”277 He observes: “Sex education in schools, given at even younger ages and without clear-cut theoretical or research justification, is another way in which some contemporary schools are encouraging their pupils to grow up [too] fast.”278 He reasons: Inevitably . . . the conviction that “earlier [sex education] is better,” which so dominates today’s educational climate, means that such programs will be and are being used with preteen and young teenagers who may be given more information than they want or need. The real question is not whether sex education should be provided in the schools but, rather, whether what is offered in the name of sex education is meaningful and useful to the age groups for whom it is provided. Unfortunately, the answer is often “no,” and many young people are exposed to programs and information that reflect adult anxieties about teenage sexuality much more than the very real concerns and anxieties experienced by the young people to whom the programs are directed.279 The Grades 4-6 version of the F.L.A.S.H. curriculum informs students about puberty.280 Among other matters, it includes information that men may ejaculate during masturbation, during a sexual touch with a partner, or during a “wet dream.”281 The Special Education version of the curriculum presents an account of a heterosexual couple that has been dating for three years, and they decide to have sex without using a condom. The male character transmits gonorrhea to the female character, but they “temporarily abstain” from sex, and receive medication for treatment.282 The curriculum does not make clear the ages of the characters, nor does it explain why it is playing with the definition of the word “abstain.” The HealthTeacher curriculum is milder. It explains how boys and girls attitudes change about each other during puberty.283 It also acknowledges that it is normal for adolescents to be curious about sex.284 During an instruction on sexual anatomy, the curriculum provides drawings and 275 CLARK ET. AL, POSITIVE PREVENTION SPECIAL, supra note 55, at 453. Id. Appendix A, at 29-30 277 ELKIND, supra note 17, at 49. 278 Id. at 66. 279 Id. at 65. 280 REIS ET AL., 4/5/6 F.L.A.S.H., supra note 41, Lesson 9, at 1. 281 Id. at 5. 282 STANGLE ET AL., SPECIAL EDUCATION F.L.A.S.H., supra note 43, Lesson 25, at 4-6. 283 DAVIS ET AL., HEALTHTEACHER MIDDLE, supra note 48, at 151. 284 Id. at 155. 276 48 computer-generated models—not photographs—of sexual organs.285 Yet the drawings are comparable to what one might find in an encyclopedia, and are neither unnecessarily graphic nor provocative. The Making a Difference! curriculum directs the instructor to ask these boys and girls: “How Do People Express Their Sexual Feelings?” The curriculum anticipates some of the answers that the students might give, including such answers as “kissing”, “holding hands”, and “talking”, as well as “oral sex”, “masturbation”, “sexual fantasy”, “anal sex”, “vaginal intercourse”, and “grinding.”286 And just in case students miss a few, the curriculum directs instructors to place a poster on the wall, which includes those terms.287 The Level A version of Positive Prevention provides optional, digital color photographs—not drawings—of the effects of various sexual transmitted diseases on the human body. Some of the photographs show actual genitalia and private parts. The curriculum cautions instructors to “get administrative approval” before these photographs are shown to students.288 The Special Education version of that curriculum discusses the male and female reproductive organs and condom usage. During the discussion, drawings are presented of the sexual anatomy. The drawings are somewhat cartoony, including one image of an ejaculation. The drawings are very poor in quality, and lack the straightforward, non-provocative professional detail and attention to scale that one usually finds in Gray’s Anatomy or an encyclopedia set.289 5.3 – “Rational” Youth Neurobiologist Semir Zeki comments that “the all-engaging passion of romantic love is mirrored by a suspension of judgment or a relaxation of judgmental criteria by which we assess other people.” He adds: “Love is often irrational because rational judgments are suspended or no longer applied with the same rigour.”290 Do the authors of the sex education curricula take this irrationality into account when addressing teenage sexual behavior? The Grade 7 version of Draw the Line, Respect the Line directs instructors to read a story about a party out loud. It has a “Sad” ending, as well as an alternate “New Movie Ending”: [Sad Ending] Marco took Tina’s hand and started to go up the stairs . . . . Tina and Marco went into the bedroom. Soon they were lying in bed, kissing and touching. They didn’t really talking about having sex. It just happened. After they did it, Tina and Marco found their friends and went home. 285 Id.at 165, 171, 183. JEMMOTT ET AL., MAKING A DIFFERENCE!, supra note 50, at 65. 287 Id. at 65-66. 288 CLARK ET. AL, POSITIVE PREVENTION LEVEL A, supra note 54, at 59. 289 CLARK ET. AL, POSITIVE PREVENTION SPECIAL, supra note 55, at 61-67, 71-73, 77-79, 229-232, 409-412. 290 Semir Zeki, The Neurobiology of Love, 581 FEBS LETTERS 2575, 2577 (2007), available at http://cmb.duke.edu/sites/default/files/5D-3.pdf. 286 49 [New Movie Ending] Tina and Marco found the bedroom and were lying on the bed, kissing and touching. Even though it felt very good, both Tina and Marco began feeling more uncomfortable. They both realized that they didn’t want to have sex right now. So they stopped. Then they found their friends and went home.291 The intent of this activity is to “enable students to identify, discuss and personalize immediate and short-term consequences of having sex or not having sex, with an emphasis on emotional consequences.”292 Later, the curriculum revisits the story and suggests (but does not firmly say so) that Tina and Marco would have been better off avoiding a situation where parents are not home, where the house is dark, and where there is alcohol.293 Instructors ask Grade 7 boys and girls this question: “How do you think most people feel talking about sex?”294 Students are also asked to read stories out loud, such as the following, which reads in part: James feels this incredible surge of sexual energy. He wraps his arms around Alana and lies down on top of her. He thinks this is probably the most exciting moment in his entire life. Alana likes kissing James. It feels good to be close to him. She lets him start touching her body. She feels excited, and her stomach feels all mixed up from it. James really like Alana. Touching her feels great. He wonders if now is the right time to actually have sex, but he also wonders if he might be pressuring Alana. Then he thinks: “This must feel as good to her as it does to me. Otherwise, she’d tell me. Right?” Alana wonders what James is expecting from her . . . . She wants to be close to James, and she know she and James could have sex right now, but she doesn’t think it’s what she wants.295 The Grade 8 version of Draw the Line, Respect the Line tells a story of “Herman uses a condom.” Herman is 19 and his girlfriend Kiva is 18. He attempts to have intercourse with her while using a condom. However, he bungles his attempts, and either breaks them or uses them inside out. Before continuing with intercourse, he throws multiple condoms away.296 The scenario (correctly) implies that throwing away of each condom after each bungle is appropriate. The curriculum, however, also assumes that the 13 year-olds who hear this story will have the maturity—during the heat of passion—to be willing to correct their mistakes, until they “get it right.” Making a Difference! includes role-playing scenarios, including this Valentine’s Day scenario: Person 1: . . . . We’ve been dating for a while, I love you, and I’m ready. 291 COYLE ET AL., DTL GRADE SEVEN, supra note 36, at 101. Id. at 29. 293 Id. at 37. 294 Id. at 17. 295 Id. at 99 . 296 MARIN ET AL., DTL GRADE EIGHT, supra note 37, at 159, 161, 163. 292 50 Person 2: Well, I’m not. I love you but I’m not ready to sleep with you. I know you are the person that I want to be with, but I also know that I need you to be understanding and patient. I want to sleep with you but only when I’m absolutely sure—when I’m not scared or in doubt. Person 1: Well, I don’t want to feel like I’m pressuring you to do something that you don’t want to. It’s important that you’re sure. So, I guess I’ll wait until you are ready. Person 2: Thanks for understanding baby. I love you so much and I’m really glad that you are willing to hold on for a bit.297 In the course of in-class games, the instructor tells students, in the guise of promoting abstinence, that a young couple can engage in activities such as masturbation, kissing, massaging, and having fantasies, and grinding as alternatives to actual intercourse.298 The Special Populations version of the Positive Prevention curriculum contains “pressure lines,” to which students are directed to say “no.” A sample line is: “Come with me to this great party. There are not going to be any parents and one of the guys is bringing beer.”299 Yet on the other hand, the curriculum also presents a scenario in which two characters are on the brink of having sex. One character is reluctant to use a condom; the other character (the students in the class) are directed to say: “I want us to be safe and use a condom—or else no sex!” The curriculum calls this “condom negotiation.”300 While the above role-playing scenarios seem to favor abstinence, the curricula make a faulty assumption: That children as young as eleven years old are rational enough to determine when they are ready. Another faulty assumption: That kids, once they start kissing or massaging their partners, won’t be tempted to proceed to intercourse. The authors of some of the curricula also appear to believe that teenagers will be able to plan rationally, and, if they do have sex, take the time to put on condoms properly. But how can instructors expect teens will “plan” to use condoms when most teens who have had sex did not “plan” to do so? One publication found that “65% of teenagers report that their first sexual experience was unplanned; 21% state that although not planned, it was not unexpected; only 15% report that their first sexual experience was planned.”301 Dr. Grossman states the matter quite bluntly: [T]he premise for teaching “safe sex” is based entirely on the assumption that teens can think through complex issues, plan ahead, and consider consequences. “Reasoning, judgment and decision-making,” the very things they’re still developing, are precisely the skills teens must have to determine their “readiness” for a “mature sexual 297 JEMMOTT ET AL., MAKING A DIFFERENCE!, supra note 50, at 81-82. Id. at 99, 124. 299 CLARK ET. AL, POSITIVE PREVENTION SPECIAL, supra note 55, at 177. 300 Id. at 415-417. 301 George Loewenstein & Frank Furstenberg, Is Teenage Sexual Behavior Rational?, 21 J. APPLIED SOC. PSYCHOL. 957, 982 (1991), available at http://www.cmu.edu/dietrich/sds/docs/loewenstein/TeenageSexualBehRational.pdf. 298 51 relationship.” How, in light of the insights this young century has brought us about teen risk-taking and decision-making, can sex educators still tell kids, “only you know when you’re ready,” and instruct parents to “respect” their teen’s decision? .... Sorry, you may have all the good intentions in the world, but even if you provide all the information, and teach all the skills, you can’t bank on producing a sexually responsible teen. The wiring isn’t finished. The circuits aren’t complete. The driver is unskilled, and only one thing will help: time.302 Unlike other curricula, HealthTeacher more clearly instructs students on how to avoid being alone with a significant other, by not accepting an invitation of a girlfriend or boyfriend who “wants you to come to his/her house after school.”303 Teens do not think like adults, and they should not be treated as such. Two forms of impulsive behavior (“temporal discounting” and the surprisingly-scientific term “acting-without-thinking”) work against teens, and help bring about early sexual debut.304 Even teens kissing alone while parents and guardians are away can be in a hazardous situation. Kissing may very well be “an adaptive courtship strategy that functions as a mate-assessment technique, a means of initiating sexual arousal and receptivity, and a way of maintaining a bonded relationship.”305 In other words: Kissing can lead to sex, either immediately or in the long run. If an unmarried teen or child is insistent on having sex, the answer is not for his or her parents to throw up their hands and say, “Oh well, I guess you know what’s best. Here’s a condom.” Instead, Dr. Grossman takes a stand: “If...nothing adults do has any impact, the answer is still not birth control; it’s crisis intervention by a team of mental health professionals.”306 Several of the curricula also have students practice giving others advice. The Grade 7 version of Draw the Line, Respect the Line teaches students how to answer such questions as: “I don’t want to have sex. What can I tell her if she wants to do it? What else could I say?”307 The Grade 8 version of that curriculum asks students to ponder answering: “What are the most important things about condoms that you would tell your brother or sister?”308 The Grades 7-8 version of F.L.A.S.H. encourages students to write “skits,” including “advice” skits with such topics as: “You ask a friend how you can get more information about STDs,” or they “You see a friend’s STD medicine and wonder if you have the same thing and if the pills GROSSMAN, YOU’RE TEACHING MY CHILD WHAT?, supra note 34, at 76. DAVIS ET AL., HEALTHTEACHER MIDDLE, supra note 48, at 225. 304 Atika Khurana et. al., Early Adolescent Sexual Debut: The Mediating Role of Working Memory Ability, Sensation Seeking, and Impulsivity, 48 DEVELOPMENTAL PSYCHOL. 1416, 1416 (2012). 305 Susan M. Hughes et. al, Sex Differences in Romantic Kissing Among College Students: An Evolutionary Perspective, 5 EVOLUTIONARY PSYCHOL. 612, 628 (2007), available at http://www.epjournal.net/articles/sexdifferences-in-romantic-kissing-among-college-students-an-evolutionaryperspective/getpdf.php?file=EP05612631.pdf. 306 GROSSMAN, YOU’RE TEACHING MY CHILD WHAT?, supra note 34, at 206. 307 COYLE ET AL., DTL GRADE SEVEN, supra note 36, at 177. 308 MARIN ET AL., DTL GRADE EIGHT, supra note 37, at 85. 302 303 52 would work. Your friend knows that using his or her pills would be dangerous.”309 Another “advice” scenario states in part: Your cousin is in a relationship with someone and told you they’re having sex. They haven’t ever used a condom because your cousin says the person doesn’t have any diseases and looks clean. And your cousin says condoms break anyway . . . . What could you say or do to help your cousin reduce the risk—to help your cousin not get HIV or another STD?310 A Making a Difference! role-play activity encourages students to give “advice” to others by role-playing in a sex call-in show. Students are asked to give answers to such questions as: “I keep hearing that teens my age are getting diseases. Is oral sex safe? How do we protect ourselves from diseases?”311 The Level A version of Positive Prevention introduces several hypothetical scenarios in the form of letters asking an advice columnist for help In one scenario, an unnamed character asks the inclass students to come on over to “spend the night” even though parents won’t be home. Students are asked how they would refuse such an invitation—in order to completely avoid a compromising situation.312 The HealthTeacher curriculum instructs students on how to give other students advice on avoiding sex.313 A hypothetical student asks: I have been going with Jordan for three months now . . . . When we are together, we can’t keep our hands off each other . . . . Lately, we’ve talked about having sex. I’m sure just about everybody at school has already had sex. I really can’t think of any good reasons to wait. I want to show Jordan how much I care. What do you think?314 Although some of the curricula (like the Positive Prevention and HealthTeacher examples above) instruct the student “advisor” to recommend abstinence, none of the curricula explain why the heavy burden of providing such advice should fall on the shoulders of an 11 year-old child in the first place. Further, in the real world, it is always possible that the “advisor” student may get into an extended debate, and the “advisee” student may win over the “advisor” student—and even persuade the “advisor” student to engage in sex. 5.4 – Not “Everyone” is Having Sex The curricula (except HealthTeacher) seem intent on teaching children aged 13 and under the ins and outs of sex. The authors of the curricula appear to be under the impression that most children are going to have sex. 309 REIS ET AL., 7/8 F.L.A.S.H., supra note 42, Lesson 5, at 4. Id. Lessons 12 & 13, at 6. 311 JEMMOTT ET AL., MAKING A DIFFERENCE!, supra note 50, at 149. 312 CLARK ET. AL, POSITIVE PREVENTION LEVEL A, supra note 54, at 169. 313 DAVIS ET AL., HEALTHTEACHER MIDDLE, supra note 48, at 213. 314 Id. at 217. 310 53 David Elkind observes: “In the early 1960’s about 10 percent of teenage girls and some 25 percent of teenage boys were sexually active.”315 But while teen sexual activity has risen since then, a report from the Centers for Disease Control and Prevention, the percentage of females between the ages of 15 to 19 who engaged in sex dropped from 51% to 43%, while the corresponding statistic for boys dropped from 60% to 42%.” The same report also found: For both male and female teenagers, a significantly smaller percentage were sexually experienced if: - they lived with both parents when they were aged 14 - their mothers had their first birth at age 20 or over - the teenager’s mother was a college graduate - the teenager lived with both of her/his parents.316 More importantly, students in Hawaii are more likely to abstain from sex than students in the rest of the country as a whole. Only 5% of Hawaii students under the age of 13 have engaged in sex. Further, 63% of Hawaii high school students have never had sexual intercourse.317 5.5 – Warnings Against Predators The Grades 4-6 version of F.L.A.S.H. warns students about sexual abuse from adult predators. The curriculum warns against letting people touch their private parts, except when appropriate, as in a doctor’s visit.318 It rightfully instructs students to make a report when they are victims of inappropriate touching from adults, even when such adults ask children to keep such incidents “secret.”319 The Grades 7-8 version addresses predatory behavior, and tells students that they have a right “never to be touched in a sexual or affectionate way without your permission” as well as the right “never to be touched in an exploitive way.” It also presents, as an example of inappropriate behavior, an instance where an uncle enters a minor’s room when the minor is changing clothes.320 It advises victims of sexual assault to call the police or Child Protective Services.321 The Special Education curriculum warns children of exploitation from adults, and the need to report when students are threatened by inappropriate touching.322 The Special Populations version of Positive Prevention recommends avoiding risky/dangerous situations like “dark alleys and parking lots,” “hitchhiking,” or “being alone on a date with an 315 ELKIND, supra note 17, at 18. GLADYS MARTINEZ ET AL., TEENAGERS IN THE UNITED STATES: SEXUAL ACTIVITY, CONTRACEPTIVE USE, AND CHILDBEARING, 2006-2010 NATIONAL SURVEY OF FAMILY GROWTH 6 (2011), available at http://www.cdc.gov/nchs/data/series/sr_23/sr23_031.pdf. 317 Hawaii Adolescent Reproductive Health Facts, U.S. DEP’T HEALTH HUM. SERVICES, http://www.hhs.gov/ash/oah/adolescent-health-topics/reproductive-health/states/hi.html (last updated Nov. 13, 2014). 318 REIS ET AL., 4/5/6 F.L.A.S.H., supra note 41, Lesson 7, at 3. 319 Id. Lesson 7, at 5. 320 REIS ET AL., 7/8 F.L.A.S.H., supra note 42, Lesson 20, at 4. 321 Id. Lesson 20, at 6. 322 STANGLE ET AL., SPECIAL EDUCATION F.L.A.S.H., supra note 43, Lesson 15, at 3-4. 316 54 older person.” It wants students to refuse when “a stranger asks” them to “go with them.”323 The curriculum also informs instructors that if a girl claims she is having sex with an older man, then the teacher should contact law enforcement or social services.324 Yet that curriculum’s warning against predators rings somewhat hollow when one considers the philosophical perspective of the authors of the curriculum. An appendix item claims that: “[f]rom the time we are born, we are sexual beings . . . .”325 The same item goes on to tell us that infants are interested in sex: Infancy through 3 years old. Infants and young children find great pleasure in bodily sensations and exploration. Fascination with genitals is quite normal during this period and should not be discouraged or punished by parents or caregivers.326 323 CLARK ET. AL, POSITIVE PREVENTION SPECIAL, supra note 55, at 171. Id. Appendix D, at 34. 325 Id. Appendix B, at 22. 326 Id. Appendix B, at 27. 324 55 6.0 – Ethical Considerations 6.1 – Abortion The Grades 7-8 version of F.L.A.S.H. names abortion as a possible response to an unplanned pregnancy.327 The Special Populations version of Positive Prevention does the same.328 Neither curriculum mentions the possible mental health consequences that a woman may suffer after she chooses an abortion. New Zealand researchers, led by Professor David M. Fergusson, analyzed data from a twenty-five-year period: This study produced evidence consistent with the view that in young women, exposure to abortion was associated with a detectable increase in risks of concurrent and subsequent mental health problems. This conclusion is based on the following lines of evidence: 1. On the basis of concurrently assessed data . . . young women reporting abortions had elevated rates of mental health problems when compared with those becoming pregnant without abortion and those not becoming pregnant. 2. These associations persisted after extensive control for a range of confounding factors, suggesting a possible causal linkage between exposure to abortion and mental health problems . . . . 3. To examine the direction of causation, a prospective analysis was conducted in which exposure to abortion by age 21 was used to predict subsequent mental health problems .... That analysis showed that even following control for confounding factors, exposure to abortion prior to age 21 was associated with increased risks of later mental health problems. In general, these results are consistent with the view that exposure to abortion was associated with increased risks of mental health problems independently of confounding factors. The study estimates suggested that those who were not pregnant or those becoming pregnant but not having an abortion had overall rates of mental disorders that were between 58% and 67% of those becoming pregnant and having an abortion.329 Ironically, the professor has no pro-life bias. He has stated: “I remain pro-choice. I am not religious. I am an atheist and a rationalist. The findings did surprise me, but the results appear 327 REIS ET AL., 7/8 F.L.A.S.H., supra note 42, Lessons 10 & 11, at 12, Lesson 14, at 3. CLARK ET. AL, POSITIVE PREVENTION SPECIAL, supra note 55, at 262. 329 David M. Fergusson et. al, Abortion in Young Women and Subsequent Mental Health, 47 J. CHILD PSYCHOL. & PSYCHIATRY 16, 22 (2006), available at http://www.unav.edu/departamento/preventiva/files/file/aborto_psych_JChildPsych2006_Fergusson.pdf. 328 56 to be very robust because they persist across a series of disorders and a series of ages.”330 He also stated: “If we were talking about an antibiotic or an asthma risk, and someone reported adverse reactions, people would be advocating further research to evaluate risk . . . . I can see no good reason why the same rules don’t apply to abortion.”331 Notably, he sought to publish the study because it would be “scientifically irresponsible” not to do so.332 If a pro-choice atheist finds it fit to address potential psychological effects of abortion, why can’t the sex education curricula do the same if and when they discuss abortion? 6.2 – Abortifacients Connected to the issue of abortion is a debate regarding when “conception” even occurs. The Grades 4-6 version of F.L.A.S.H. states: Fertilization is what you call it when a sperm cell enters an egg . . . . After the egg is fertilized, it will take a week or so to finish traveling down the tube into the uterus, where it will nest. That’s called implantation. The combination of fertilization and implantation is what we call conception, meaning a pregnancy has begun.333 Similarly, the Grades 7-8 version of that curriculum teaches that “fertilization + implantation = conception.”334 The American Congress of Obstetricians and Gynecologists (ACOG) takes the position that conception does not occur until after implantation.335 Ironically, however, a 2011 survey shows that 57% of obstetricians/gynecologists disagree with that position.336 The Merck Manual states that pregnancy “begins when an egg is fertilized by sperm,”337 and equates conception with fertilization.338 In their book filled with amazing ultrasound images of a baby developing in the womb, two Harvard radiology professors unambiguously write that the first trimester of pregnancy “begins with a single microscopic fertilized egg.”339 Gray’s Anatomy agrees that pregnancy begins at fertilization,340 while pictures from a British Museum (Natural History) 330 The 7:30 Report (Australian Broadcasting Corporation television broadcast Mar. 1, 2006), available at http://www.abc.net.au/7.30/content/2006/s1541543.htm. 331 Greg Tourelle, Abortion Raises Depression Risk, Say NZ Researchers, N.Z. HERALD, Jan. 4, 2006, http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10362363. 332 Ruth Hill, Abortion Researcher Confounded By Study, N.Z. HERALD, Jan. 5, 2006, http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10362476. 333 REIS ET AL., 4/5/6 F.L.A.S.H., supra note 41, Lesson 12, at 3. 334 REIS ET AL., 7/8 F.L.A.S.H., supra note 42, Lessons 8 & 9, at 15, 21. 335 Press Release, ACOG Statement on “Personhood” Measures (Feb. 10, 2012), available at http://www.acog.org/About-ACOG/News-Room/News-Releases/2012/Personhood-Measures. 336 Grace S. Chung et. al, Obstetrician-Gynecologists’ Beliefs About When Pregnancy Begins, 206 AM. J. OBSTETRICS & GYNECOLOGY 132.e1, 132.e3 (2012), http://www.ajog.org/article/S0002-9378(11)02223-X/pdf. 337 MERCK MANUAL OF MEDICAL INFORMATION 1434 (Mark H. Beers ed., 2nd ed. 2003) (2000). 338 Id. at 1800. 339 PETER M. DOUBILET ET AL., YOUR DEVELOPING BABY: CONCEPTION TO BIRTH 7 (2008). 340 GRAY’S ANATOMY, supra note 64, at 167. 57 exhibit declare (both visually and literally) that the moment of fertilization is “when a new life comes into being.”341 Due to the disagreement among OB/GYNs over definitions, the author of a study in The Journal of Maternal-Fetal & Neonatal Medicine suggested that, for the sake of informed consent of the women who use birth control, that the ACOG reconsider its definition of “conception” and “pregnancy.”342 Given this background: Do the sex education curricula that provide information about birth control also address the risks that some methods may pose to a fertilized egg that has not yet implanted? The Grades 7-8 version of F.L.A.S.H. discusses emergency contraception, as well as DepoProvera (which is injected), Implanon (which is an implant), the patch, the Mirena IUD, and the vaginal ring.343 The Special Education version of the curriculum teaches students, among other methods, about IUD’s and Plan B.344 The Level A version of Positive Prevention states that products such as Depo-Provera and Nuvaring prevent pregnancy.345 The Special Populations version mentions Emergency Contraception, NuvaRing, Plan B, the Pill, and Implanon as birth control methods.346 A fertilized egg normally implants in the endometrium, which is the lining of the uterus.347 The above-mentioned curricula do not inform students that the manufacturers of these products caution that the use of the products may make changes to the endometrium and/or prevent implantation. For example, the manufacturer of Plan B states that: Plan B One-Step is believed to act as an emergency contraceptive principally by preventing ovulation or fertilization (by altering tubal transport of sperm and/or ova). In addition, it may inhibit implantation (by altering the endometrium). It is not effective once the process of implantation has begun.348 The website of the manufacturer of Nuvaring states: 341 STEPHEN PARKER, LIFE BEFORE BIRTH: THE STORY OF THE FIRST NINE MONTHS 2 (1979). Joseph A. Spinnato, Informed Consent and the Redefining of Conception: A Decision Ill-Conceived?, 7 J. MATERNAL-FETAL & NEONATAL MED. 264, 264 (1998). 343 REIS ET AL., 7/8 F.L.A.S.H., supra note 42, Lesson 14, at 3, 5, 8. 344 STANGLE ET AL., SPECIAL EDUCATION F.L.A.S.H., supra note 43, Lesson 23, at 3-4. 345 CLARK ET. AL, POSITIVE PREVENTION LEVEL A, supra note 54, at 143. 346 CLARK ET. AL, POSITIVE PREVENTION SPECIAL, supra note 55, at 201-207. 347 Implantation: Reproduction Physiology, ENCYCLOPÆDIA BRITANNICA, http://www.britannica.com/EBchecked/topic/284036/implantation (last updated Dec. 15, 2014). 348 DURAMED PHARMACEUTICALS, INC., HIGHLIGHTS OF PRESCRIBING INFORMATION 4 (2009) (1982), available at http://www.planbonestep.com/pdf/PlanBOneStepFullProductInformation.pdf. 342 58 Although the primary effect of this action is inhibition of ovulation, other alterations include changes in the cervical mucus (which increase the difficulty of sperm entry into the uterus) and the endometrium (which reduce the likelihood of implantation).349 The manufacturer of the Mirena IUD states that: Studies of Mirena and similar LNG IUS prototypes have suggested several mechanisms that prevent pregnancy: thickening of cervical mucus preventing passage of sperm into the uterus, inhibition of sperm capacitation or survival, and alteration of the endometrium.350 The manufacturers of Implanon,351 Depo-Provera ,352 “the Pill,”353 and “the Patch”354 make similar disclosures. An appendix item in the Making a Difference! curriculum provides instructors with additional information, intended to address “needs that may emerge in the group.”355 The curriculum discusses the use of Paraguard IUDs, Mirena IUDs, “the Pill,” “the Patch,” Depo-Provera, and Implanon. While the curriculum discloses that Paraguard IUDs “make it very hard for fertilized eggs to attach to the wall of the uterus”,356 there is no disclosure of the possibility that that same interference may occur when the other birth control methods are used. 6.3 – Parental Rights As we demonstrated in Section 4.8 of this Report, parental attitudes and instructions can have a substantial effect on the sexual behavior of their children. Given the crucial roles of mothers and fathers, any sex education curriculum that fails to inform parents of its content, or that helps create a divide between children and parents, is putting family integrity—and student health—at risk. So how do the curricula fare? The Making a Difference! curriculum tells students: “When people share private information in this group, it should be kept private . . . . We will not talk about any personal information we hear in this group.”357 Similarly, the Grades 7-8 version of F.L.A.S.H imposes this rule: “Protecting one’s own and other peoples’ privacy means not sharing very personal issues in the 349 MERCK & CO., INC., HIGHLIGHTS OF PRESCRIBING INFORMATION 14 (2012) (2001), available at http://www.merck.com/product/usa/pi_circulars/n/nuvaring/nuvaring_pi.pdf. 350 BAYER HEALTHCARE PHARMACEUTICALS INC., HIGHLIGHTS OF PRESCRIBING INFORMATION 17 (2014) (2000), available at http://labeling.bayerhealthcare.com/html/products/pi/Mirena_PI.pdf. 351 MERCK & CO., INC., HIGHLIGHTS OF PRESCRIBING INFORMATION 18 (2014) (2001), available at http://www.merck.com/product/usa/pi_circulars/i/implanon/implanon_pi.pdf. 352 PFIZER INC., HIGHLIGHTS OF PRESCRIBING INFORMATION 13 (2015) (1959), available at http://labeling.pfizer.com/ShowLabeling.aspx?id=522. 353 JANSSEN PHARMACEUTICALS, INC., ORTHO TRI-CYCLEN LO TABLETS (NORGESTIMATE/ETHINYL ESTRADIOL) 1 (2010) (1998), available at https://www.thepill.com/sites/default/files/pdf/OTC_LO_PI_-03H268.pdf. 354 JANSSEN PHARMACEUTICALS, INC., HIGHLIGHTS OF PRESCRIBING INFORMATION 25 (2014) (2001), available at http://www.orthoevra.com/sites/default/files/assets/OrthoEvraPI.pdf. 355 JEMMOTT ET AL., MAKING A DIFFERENCE!, supra note 50, at 211 356 Id. at 221-222. 357 Id. at 38. 59 large group, not using names or relationships when you talk about personal issues, and not quoting classmates outside of class.”358 The Special Education version of F.L.A.S.H tells the instructor that “a gentle reminder [to students] that discussion is private and confidential may prevent catastrophes and confusion.”359 The Special Populations version of Positive Prevention directs students to maintain confidentiality during class sessions.360 While the above instructions may be intended to stop hurtful on-campus gossip, the curricula do not clarify to students that they still have a right to tell their own parents about what they learned about in school. Further, if the personal information being shared in class is that embarrassing— why are the curricula assuming that 11 to 13 year-old children are mature enough to exchange such information in class in the first place? The Grade 8 version of Draw the Line, Respect the Line tells students (who are likely about 13 years old) that condoms “are available at markets, drugstores, and family planning and STD clinics. They also may be available in vending machines or at some schools. Anyone can buy condoms, regardless of age or gender.”361 While this is true (except for the fact that DOE schools are not allowed to distribute condoms362), the curriculum does not instruct students that they should—for their own safety—talk to their parents first. The authors fail to notice that while a student might have the means to purchase condoms, the students probably won’t have the means to pay for medical treatments that may be necessary if a condom breaks—and Mom and Dad will be the ones responsible for finding ways to foot those bills. The Special Education version of F.L.A.S.H., directs instructors to tell students: “Discuss places where condoms can be purchased – a pharmacy, a grocery store, a vending machine. They can be found at some clinics for free.”363 Again, parents are left out of the picture. The Special Education edition of F.L.A.S.H. also gives students the option to work on worksheets with and to be in contact with a “trusted adult” to “talk to privately and honestly if they had questions, concerns, or problems about growing up”—including matters of sexuality. The trusted adult need not be a parent. It is not even necessary that the “trusted adult” be a family member or even a household member. The “trusted adult” is to be given a form letter that explains that the exercises are to “reinforce classroom learning,” “share information,” and “find out what your young adult is thinking about, or worrying about, regarding growing up.”364 The Grades 4-6365 and the Grades 7-8366 versions of F.L.A.S.H contain similar language. Nowhere in the F.L.A.S.H curricula does one find any indication that a parent needs to be informed when a student chooses a non-parental, non-familial “trusted adult.” 358 REIS ET AL., 7/8 F.L.A.S.H., supra note 42, Lesson 1, at 3. STANGLE ET AL., SPECIAL EDUCATION F.L.A.S.H., supra note 43, at 5. 360 CLARK ET. AL, POSITIVE PREVENTION SPECIAL, supra note 55, at 3. 361 MARIN ET AL., DTL GRADE EIGHT, supra note 37, at 87. 362 HAW. BOARD EDUC. POL’Y No. 2245 (1994), available at http://www.hawaiiboe.net/policies/2200series/Pages/2245.aspx. 363 STANGLE ET AL., SPECIAL EDUCATION F.L.A.S.H., supra note 43, Lesson 26, at 6. 364 Id. Lesson 2, at 5-7. 365 REIS ET AL., 4/5/6 F.L.A.S.H., supra note 41, at 12. 366 REIS ET AL., 7/8 F.L.A.S.H., supra note 42, at 13. 359 60 One letter to the trusted adult in the Special Education F.L.A.S.H curriculum poses questions for discussion between the student and the adult, such as “What is our home rule about me touching my own body? What about touching my genitals? Where in our house is that okay?”367 Draw the Line, Respect the Line instructors are encouraged to have office hours to be available to talk to students. There is no guidance on what types of conversations would be appropriate or inappropriate.368 F.L.A.S.H instructors are also encouraged to give students access to talk to them privately about questions.369 The Grades 7-8 version of F.L.A.S.H assigns students to ask librarians, counselors, “natural helpers” (trained peers), or doctors some questions about their services.370 Students are not directed to make their parents a part of the conversation. The questions include: If a student came to you with a possible sexually transmitted infection, what would you do? If a student came to you with a pregnancy question, what would you do? If a student came to you with a birth control question, what would you do? 371 In the Level A version of Positive Prevention, students are instructed how they can be tested for HIV. Steps included in the process are: Call [the clinic] for information. Visit the clinic Talk to a counselor Body fluid sample and/or a visual examination You may need to return to the clinic Review the results, make plans372 Steps such as “Reach out to your parents” and “Seek parental instruction” are conspicuously absent. This is hazardous. As Dr. Grossman cautions: “Allowing a teen to make health decisions in a closed room with her provider undermines and weakens the parent-child relationship. PP [Planned Parenthood] does that with this approach.”373 The Grade 7 and Grade 8 versions of Draw the Line, Respect the Line contain a suggested parental notification letter. The most controversial issue that the letter mentions is that the program “helps students learn ways to prevent HIV infection, other sexually transmitted disease 367 368 STANGLE ET AL., SPECIAL EDUCATION F.L.A.S.H., supra note 43, Lesson 2, at 8. COYLE ET AL., DTL GRADE SEVEN, supra note 36, at 23; MARIN ET AL., DTL GRADE EIGHT, supra note 37, at 35. 369 REIS ET AL., 4/5/6 F.L.A.S.H., supra note 41, at 12, 14; REIS ET AL., 7/8 F.L.A.S.H., supra note 42, at 13; STANGLE ET AL., SPECIAL EDUCATION F.L.A.S.H., supra note 43, at 16. 370 REIS ET AL., 7/8 F.L.A.S.H., supra note 42, Lesson 15, at 3. 371 Id. Lesson 15, at 6. 372 CLARK ET. AL, POSITIVE PREVENTION LEVEL A, supra note 54, at 149, 186, 188. 373 GROSSMAN, YOU’RE TEACHING MY CHILD WHAT?, supra note 34, at 207. 61 (STD), and pregnancy. The lessons emphasize that choosing not to have sex is the safest choice.”374 The Level A version of Positive Prevention contains sample parent notification letters.375 None of the letters are very specific about any of the controversial aspects of the curriculum. The guidelines to teachers for parent meetings tells teachers to “[s]hare sample lessons and activities with parents.”376 However, the guidelines to not specify what lessons and activities should be shared. The Special Populations version of the curriculum has similar parent notification letters.377 The “trusted adult” concept for F.L.A.S.H is not fully explained in the curriculum’s parental notification letters. The letters also fails to summarize the controversial content of the curriculum.378 In contrast to the other curricula, HealthTeacher leans toward transparency. It informs instructors: “When teaching sensitive subjects such as reproductive health, it is essential to follow state and district guidelines for notification of parents and to provide opportunities for community members to preview materials.”379 374 COYLE ET AL., DTL GRADE SEVEN, supra note 36, at 7; MARIN ET AL., DTL GRADE EIGHT, supra note 37, at 7. 375 CLARK ET. AL, POSITIVE PREVENTION LEVEL A, supra note 54, Appendix B, at 3, 5. Id. Appendix B, at 7. 377 CLARK ET. AL, POSITIVE PREVENTION SPECIAL, supra note 55, at 5-10. 378 REIS ET AL., 4/5/6 F.L.A.S.H., supra note 41, Appendix A, at 1; REIS ET AL., 7/8 F.L.A.S.H., supra note 42, Appendix A, at 1; STANGLE ET AL., SPECIAL EDUCATION F.L.A.S.H., supra note 43, Appendix A, at 1. 379 DAVIS ET AL., HEALTHTEACHER MIDDLE, supra note 48, at 175. 376 62 7.0 – Legal Concerns Given the issues with some of the curricula, should the State be concerned about possible legal challenges from parents? 7.1 – Previous Court Cases On the one hand, it may appear that there is little that parents can do within the judicial system. Some courts have taken the position that once children are enrolled in public schools, a parent does not have a right to control content of curriculum.380 The Ninth Circuit Court of Appeals ruled against a family that complained about a survey that was administered to their children. Some of the questions were related to sex. The court ruled that the United States Constitution “does not vest parents with the authority to interfere with a public school’s decision as to how it will provide information to its students or what information it will provide, in its classrooms or otherwise.”381 (The Federal Ninth Circuit includes Hawaii.382) A federal district court in Connecticut reviewed a public school’s decision to give a student failing grade for not attending a sexual health education class. The student’s parent had objected to the class due to the fact the content conflicted with the family’s religious beliefs. The court sided with the school. The court found the “health” requirement was a legitimate state interest that would survive a constitutional challenge. The only option the court left the parent was to place the child in a private school or homeschool the child, even though “the options of private school or home schooling may be unrealistic.”383 The Supreme Court of Hawaii has also ruled that as long as parents have a right to withdraw their children from sex education, the privacy rights and free exercise rights of parents are not violated.384 7.2 – How the State Might be Liable to Families On the other hand, as we have demonstrated, several of the curricula are not medically accurate and not age appropriate, in spite of the requirements of the Hawaii Revised Statutes. The sex education batter is no longer merely about beliefs or feelings; this is about saving lives and disease prevention. Parents should not have to “opt-opt” their children from curricula that provide medically inaccurate, age-inappropriate information. 380 E.g., Brown v. Hot, Sexy & Safer Prod., Inc., 68 F.3d 525, 533-534 (1st Cir. 1995); Myers v. Loudoun Cnty. Sch. Bd., 500 F. Supp. 2d 539, 545 (E.D. Va. 2007). 381 Fields v. Palmdale Sch. Dist., 427 F.3d 1197, 1206 (9th Cir. 2005). 382 What is the Ninth Circuit?, USCOURTS.GOV, http://www.ca9.uscourts.gov/judicial_council/what_is_the_ninth_circuit.php (last visited July 9, 2015). 383 Leebaert ex rel. Leebaert v. Harrington, 193 F.Supp.2d 491, 501 (D. Conn. 2002). 384 Medeiros v. Kiyosaki, 478 P. 2d 314, 316-319 (Haw. 1970). 63 In 2012, the ACLU filed a lawsuit on behalf of the American Academy of Pediatrics, the Gay Straight Alliance Network, and two parents. The plaintiffs complained against the abstinencefocused sex education curricula that the Clovis Unified School District in California was using at the time. The plaintiffs claimed, among other allegations, that the curricula were medically inaccurate.385 The plaintiffs dropped the lawsuit in 2014, after the School District made changes.386 Nevertheless, a California court awarded plaintiffs’ attorneys’ fees.387 In its decision, the court also asserted that “access to medically and socially appropriate sexual education is an important public right.”388 Whatever the merits (or lack of merit) of the curricula used in Clovis, this remains clear: As we have demonstrated in this Report, no one can assume that a curriculum that minimizes the importance of abstinence is automatically medically accurate or age-inappropriate. Arguably then, given the deficiencies of some of the curricula in the State of Hawaii, the DOE is denying children access to effective education. Ironically, the ideological left’s lawsuit in Clovis may very inspire the dismantling of the libertine sex education in Hawaii. (Disclaimer: We note that this Report cannot and should not serve as a substitute for legal advice. Therefore, it is up to the State and the DOE to review such matters with their own legal counsel. On the other side of the coin, parents who wish to pursue legal action should probably seek assistance from a private attorney.) 385 Teresa Watanabe, Clovis Unified District Sued Over Abstinence-Only Sex Education, L.A. TIMES, Aug. 22, 2012, http://articles.latimes.com/2012/aug/22/local/la-me-sex-ed-20120822. 386 Grace Rubenstein, ACLU: Clovis School District Has Fixed ‘Abstinence-Only’ Sex-Ed Curriculum, KQED NEWS (Feb. 26, 2014), http://ww2.kqed.org/news/2014/02/26/127740/aclu-forced-clovisschool-district-fix-sex-education. 387 Hannah Furfaro, Sex Education for Students a Public Right, Judge Rules in Clovis Unified Case, FRESNO BEE, May 14, 2015, http://www.fresnobee.com/news/local/education/article21013362.html. 388 Brent Bozell, The ‘Science’ of Sex Education, TOWNHALL.COM (May 22, 2015), http://townhall.com/columnists/brentbozell/2015/05/22/the-science-of-sex-education-n2002396/page/full. 64 8.0 – Conclusion As we have seen, there are negative and positive aspects to the curricula reviewed in this report. In short summary: HealthTeacher is the most modest of the curricula. It has less “shock value,” and parents will likely have the least objections. However, it lacks information about the stages of human reproduction. We also again note that the version that we reviewed might be replaced in the schools. All three versions of F.L.A.S.H. go through the stages of reproduction in respectful detail. Other portions of the curriculum, however, may give parents pause. The Special Populations version of Positive Prevention appears to be the curriculum that is most likely to “push the envelope.” Yet while it brings up sensitive topics (like anal sex), it fails to bring up all the consequences of those topics. Students are facing increased departures from reasonable sex education. And it gets worse as students get older: Words of caution are replaced with words of libertinism. Even the respected Yale University hosted a “Sex Week,” which featured a lecture from a porn producer on the business of pornography.389 But for now, parents of DOE middle school children must take charge of their children’s sexual education. Such parents may wish to consider the following steps (among others): Affirmatively “opt out” your children from sex education if their schools do not offer curricula that meet your standards. Make contact with local community groups that offer alternative sex education programs. Keep open the gates of communication with your children’s teachers about the curricula at their schools. We know there are many fine teachers who, regardless of their own worldviews, are more than willing to engage with and respect the wishes of parents and guardians. During the legislative session (which starts in January of every year), sign up at the State of Hawaii Legislative Website at http://capitol.hawaii.gov for hearing notices regarding bills that will be heard before the House and Senate Committees on Education. Submit testimony, and speak from the heart. Email the Board of Education at boe_hawaii@notes.k12.hi.us to make a request for notices regarding future BOE meetings. Most importantly: Love and “be there” for your kids. 389 NATHAN HARDEN, SEX AND GOD AT YALE: PORN, POLITICAL CORRECTNESS, AND A GOOD EDUCATION GONE BAD 34 (2012). 65