Twenty years ago, Mosack was a full-time homemaker with three children. She volunteered at a Cleveland-area crisis pregnancy center where she says she was struck by the number of girls "coming in pregnant and saying, 'But I used a condom.' "

"When you hear 13- or 14-year-olds repeatedly saying [that], you start to assess whether or not we're giving the right message. A number of us at the center said we need to look around at what kind of education these kids are getting. And the message they were getting was the 'Safe Sex' message," she says. "That message wasn't working."

Mosack switched her volunteer efforts from crisis pregnancies to abstinence-before-marriage education.

Mosack knows her critics accuse her of hating sex and "being like one of those church ladies from Saturday Night Live," she says, her voice high and tight, her lips pursed in imitation. "I don't hate sex. In fact, the other day I told my husband I was sick of thinking about sex, writing about sex and talking about sex. I just wanted to have sex," she says, laughing.

"If we're the 'Just Say No' ladies, are [the comprehensive sex proponents] 'Just Say Maybe?' Maybe if I have a condom; maybe if mom and dad aren't home?"

Mosack views sex as a risky teen behavior, and she argues that abstinence is the only way to reduce a teen's risk to zero.

"The message has become a message that 'protected sex' is 'appropriate sex,'" continues Mosack. "As a society we seem to get caught up in the debate and forget what the real issue is - adolescent health."

Operation Keepsake instructors spend a lot of time discussing sexual activity in terms of STDs, broken hearts, negative emotions and what each gender wants from a relationship. These themes show up repeatedly in the program's middle- and high-school curriculums. Operation Keepsake is writing a curriculum for grades four, five and six.

Mosack believes that "explaining to teens what makes the opposite sex tick helps them protect their hearts."

"As old-age as this sounds, we are finding that girls and boys do, in fact, view sex differently," says Dr. Elaine Borawski, assistant professor of epidemiology and biostatistics and director for the Center for Health Promotion Research at Case Western Reserve University.

Abstinence programs often are criticized for "not working" because there's no data supporting their success, says Borawski. But there have been no rigorous evaluations done on abstinence-before-marriage programs as there have been on comprehensive sex programs, so no one knows, aside from anecdotally, whether they work, she says.

That will change. In April 2002, the NIH awarded Borawski and her team $1.5 million to study Operation Keepsake's middle-school curriculum over four years. They will follow two consecutive groups of students participating in the curriculum, beginning in seventh grade and ending when they graduate from eighth grade.

Borawski says the NIH is interested in middle-schoolers because the students are at "the age of initiation, when kids are really starting to think about having sex and when their opportunities to have sex begin to occur."

"Our point is to ask, 'What works?'" says Borawski. And what works is determined, she says, when data shows an intervention has changed a child's thought process to no longer participate in that high-risk behavior following that particular intervention.

Comprehensive sex curriculums have gone through rigorous testing for decades. The CDC refers to five of those curriculums as "Programs That Work." Such testing has not yet taken place on abstinence-before-marriage programs, of which Borawski estimates there are hundreds of such curriculums being taught throughout the country, with perhaps a dozen different ones being taught in Ohio.

The beauty of the ongoing debate, Borawski says, is that health educators in most districts are presenting abstinence and comprehensive sex classes. "Sometimes, Operation Keepsake is coming in one door while the comprehensive sex folks are going out the other door," she says.

"Based on the short-term results, Operation Keepsake seems to have an impact," says Borawski, "but so do the other programs. It seems to be particularly effective for those who have not had sex yet - especially the girls. The results are showing that Operation Keepsake's message is not only reducing teens' participation in casual sex, but also reducing the number of sexual partners," Borawski says.

What seems to make Operation Keepsake effective is not that it is telling kids to not have sex, says Borawski, but that they don't have to have sex. And it is "telling kids they're being valued and that they need to value themselves."

"Maybe that's what's been missing?" she asks.

When Barbara Sullivan steps into a seventh-grade classroom to begin the second day of "abstinence until marriage" class in this Euclid Catholic school, she notices that someone has already written Operation Keepsake's motto on the board.

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