When many adults talk about adolescence, they often invoke depictions of “teens these days” whose lives are sex-crazed and drug-filled. Ironically, these same adults often support prevention programs that are ineffective. In this article, I present two of the prevention myths that are adapted from the book Great Myths of Adolescence (Jewell et al. 2019) and a CSICon presentation (Hupp 2018).
Sex Prevention Pseudoscience: Infant Simulator Dolls
About 38 percent of high school students in the United States anonymously acknowledge that they have had sexual intercourse (Center for Disease Control and Prevention 2019). Although high, this percentage has actually been on the decline and is not nearly as high as many alarmists would have us believe (see Best and Bogle 2014 for a discussion of the hype). That said, it’s no surprise that schools have become interested in trying to prevent teen pregnancies. “When we started the Baby Think It Over Program three years ago, we were averaging three pregnancies per year,” expressed a junior high school teacher, adding, “This past school year no pregnancies were reported” (Realityworks 2004). The Baby Think It Over program mentioned in the testimonial has been more recently branded as the RealCare Baby program, and it’s similar to another competing product called the Ready-Or-Not Tot. More generically, these products are referred to as infant simulator dolls.
These products look like any other baby doll, but they come with enhanced technology. For example, when a doll cries, the computer inside keeps track of the students’ attempts to feed the doll or change its diaper. The dolls are also able to monitor if they’re being handled too roughly (e.g., shaken) or exposed to unsafe environments (e.g., cold temperatures). Teachers are also able to set the level of difficulty provided by the doll’s temperament. Students typically take care of the doll for several days and nights in a row, and teachers can access the data kept by the dolls to give the student feedback and perhaps a grade. These dolls are usually embedded within programs that include lessons (e.g., information about infant care) and exercises (e.g., finding out how much diapers cost).
Infant simulator dolls have been prominently and positively featured on television shows such as Saved by the Bell and Hannah Montana, and they are viewed favorably by the public. In our research, 50–53 percent of college students believed that “Taking care of an infant simulator doll increases abstinence” (Jewell and Hupp, manuscript in preparation). In a study of parent perceptions of a program using the dolls, 90 percent of the participants indicated that they would recommend that a friend use an infant simulator doll with their teen (Price et al. 1999). In another sign of public support for infant simulator dolls, according to the company, the RealCare Baby program is currently being used by two-thirds of school districts in the United States (Realityworks 2016). Is this wide use of this preventative approach warranted?
There have been several studies of infant simulator dolls, and one of the studies with the best research design is by Sally A. Brinkman et al. (2016). Researchers in Australia randomized fifty-six high schools such that half of the schools served as the prevention group with their students completing the Virtual Infant Program (VIP), centered on infant simulator dolls, and the other half of the schools served as the comparison group with their students receiving their standard health education curriculum. Both groups had over 1,000 female participants (ages thirteen to fifteen) who were contacted again years later at age twenty. During this later time period, 8 percent of the group that received the VIP program had given birth, and this was compared to 4 percent of the comparison group that had given birth. The VIP group also had more abortions (9 percent) than the control group (6 percent). Taken together, the students who were in the program using infant simulator dolls were significantly more likely to get pregnant. Other studies fail to show that infant simulator dolls change behavior in teens (e.g., Out and Lafreniere 2001).
In fact, no studies show an actual change in sexual behavior or pregnancy outcome in a direction favorable to infant simulator dolls. Moreover, in addition to the Australian study showing that adolescent girls were more likely to get pregnant if they cared for the doll, other research has demonstrated a potentially harmful effect of the dolls. For example, in one study 12 percent of students reported wanting to be teen parents before caring for an infant simulator doll, and this increased to 15 percent of the teens wanting to be teen parents after caring for the doll. Thus, it is possible that infant simulator dolls are actually harmful rather than helpful. In addition to the potential harm possibly experienced by some teens, the dolls also cost the school a lot of money that could be used for more effective programming.
Drug Prevention Pseudoscience: The D.A.R.E. Program
Drug Abuse Resistance Education (D.A.R.E.) is a universal prevention program, which means that it’s offered to all the children in a particular school grade; it is not a selected or indicated prevention program that would be just for students who are at greater risk or show early signs of substance use. Police officers visit schools to implement D.A.R.E. lessons to children in fifth or sixth grade once a week for about seventeen weeks. In addition to covering topics such as changing beliefs about drugs, the program has lessons dedicated to teaching assertiveness and healthy ways to manage stress. D.A.R.E. has also sought to decrease violence and prevent youth from joining gangs, typically ending with a graduation ceremony and certificate.
The program began in 1983 in Los Angeles, and since then it has really taken off. D.A.R.E. can currently be found in about 75 percent of American school districts across all fifty states, and it’s taught in over fifty additional countries (D.A.R.E. America 2014). In short, millions of children receive D.A.R.E. each year, and a lot of people believe it works. In our own research, 40–44 percent of students agreed with the statement that “D.A.R.E. prevents teen drug use” (Jewell and Hupp, manuscript in preparation).
From the beginning, the developers of D.A.R.E. did little to investigate its effectiveness, but when researchers began investigating the program’s effects it did not fare very well. In one of the best studies of D.A.R.E., researchers randomly assigned elementary schools to an experimental group who received D.A.R.E. from a police officer or to a comparison group receiving a curriculum of “whatever the health teachers decided to cover concerning drug education in their classes” (Lynam et al. 1999, 591). Ten years later, the researchers paid participants to report about their drug use on a questionnaire. Results demonstrated that there were no differences between the D.A.R.E. group and the comparison group on drug use for alcohol, cigarettes, marijuana, or illicit drugs. Moreover, peer pressure resistance was no better for the D.A.R.E. group, and self-esteem was significantly lower for students who had been in D.A.R.E., a finding that the investigators attributed to chance.
Quite a few other studies have demonstrated similar results regarding D.A.R.E.’s effectiveness. One meta-analysis combined the data from eleven studies on D.A.R.E. (including the ten-year follow-up discussed above) that were published between 1991 and 2002 (West and O’Neal 2004). The results of this meta-analysis again confirmed that D.A.R.E. was ineffective at preventing drug use.
Recognizing that D.A.R.E. was ineffective, the organization attempted to develop a new curriculum called Take Charge of Your Life for students in seventh grade, with a booster in ninth grade. Shockingly, however, research showed that students in the treatment schools actually ended up being more likely to use alcohol and cigarettes than students in the comparison group during the follow-up (Sloboda et al. 2009). This version of the program was quickly abandoned after it continued to show weak results (Singh et al. 2011).
Rather than giving up on D.A.R.E. or trying to develop another new curriculum, the organization began searching for a program that was already effective. They found a program called Keepin’ It REAL (Refuse, Explain, Avoid, & Leave), comprising ten lessons delivered by teachers of students in seventh grade (Hecht et al. 2003). Largely designed for Latino students, most of the studies demonstrated mixed results of Keepin’ It REAL with the Latino samples (Hecht et al. 2006; Marsiglia et al. 2005; Warren et al. 2006). However, these early studies of Keepin’ It REAL included some limitations. For example, they were all based on self-report and did not include follow-up measurements after the immediate post-intervention measurement. However, there were enough initial positive results to prompt D.A.R.E. to officially adopt the Keepin’ It REAL program in 2009. It is important to note that the original Keepin’ It REAL curriculum is not the same curriculum that is used by D.A.R.E. Developers combined aspects of the program with the original D.A.R.E. curriculum, and they also created another version for elementary school that captured the same market as the original D.A.R.E. program (Caputi 2015).
The adoption of Keepin’ It REAL, which had mixed research support, gave D.A.R.E. program administrators some confidence, and an article in Scientific American was even titled “The New D.A.R.E. Program—This One Works” (Nordrum 2014). However, it is a bit of a stretch to assert that this “new D.A.R.E.” works because the new D.A.R.E. version of Keepin’ It REAL has not been investigated. One big difference between the original version of Keepin’ It REAL and the D.A.R.E. version is that the latter uses police officers instead of school teachers. In addition, Keepin’ It REAL has little evidence of effectiveness beyond the Latino samples in its research. Moreover, when the developers of Keepin’ It REAL previously attempted to adapt their program for fifth grade, it fared no better than a comparison group (Hecht et al. 2008).
Conclusion
Many of the popular ways that we attempt to promote healthy choices in adolescents do not work. Fortunately, we have some other good options. For example, research supports the use of comprehensive sex education (Bennett and Assefi 2005). In addition, prevention programs, such as Life Skills Training, have shown promise in preventing adolescent drug use (Botvin and Griffin 2004). In other good news, adolescent sexual activity and most types of drug use have been declining over the past few decades (Arnett 2018). Thus, good progress is being made, but as always there is more to be done—ideally with methods shown to be effective.
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