This article is adapted from The Cleveland Plain Dealer Magazine

Mary Anne Mosack loves sex. She just doesn't want your teenagers having it before they're married.

Mosack is executive director of Operation Keepsake, a nonprofit "Abstinence Before Marriage" organization whose representatives have been in public and private middle- and high-school classrooms across Northeast Ohio for the past 15 years talking about sex - or, actually, talking about not having sex.

Operation Keepsake received $577,000 from the federal government in 2002, and will continue to receive federal money through 2004 to subsidize organizational costs. President Bush, who supports the abstinence-before-marriage message, poured $73 million into Special Projects of Regional and National Significance (SPRANS), which funds organizations such as Operation Keepsake.

To receive money, an organization must meet the government's strict criteria, including teaching that "sexual activity outside the context of marriage is likely to have harmful psychological and physical effects" and that "a mutually faithful monogamous relationship in the context of marriage is the expected standard of human sexual activity."

The Bush administration hopes to eventually boost abstinence spending to $135 million - up from $60 million in 1998 - fulfilling a campaign promise to spend as much on abstinence as teen family-planning programs.

Sex education has been a hot-button topic for more than 30 years, when the subject was first taught in schools. In the 1970s, health educators sought to curb the rise in teen pregnancy by teaching adolescents about reproductive health, hoping knowledge of how everything works would be prevention enough.

The 1980s brought an awareness of HIV/AIDS, and to meet that challenge, a shift to "Safe Sex," which included teaching adolescents how to use condoms to prevent the spread of HIV/AIDS and sexually transmitted diseases (STDs).

In the late 1990s, after a 2001 National Institutes of Health (NIH) study reported that condoms offer some protection against HIV/AIDS and some protection from gonorrhea for males, but did not protect against other STDs for both males and females, science caught up with sex education classes and the curriculum changed to "Safer Sex." In response to the report, the Centers for Disease Control (CDC) deleted its condom fact sheet from its official government Web site.

The debate among educators, scientists and some government administrators about what should be taught has never ceased. Some say leave sex education to the parents; others want abstinence taught. And then there's "the other side," as Mosack calls it, which prefers that students be given as much information as possible - a comprehensive sexual curriculum that includes abstinence and contraceptive information, as well as in-depth instruction in how to use contraceptives and where to obtain them.

Studies regarding what parents want do not agree. A 1995 study by the Kaiser Foundation found that 80 percent of parents polled would prefer their children learn both abstinence and information about contraception. A recent survey by Zogby International concluded in February that a majority (69 percent of parents of kids in fourth through seventh grade) want schools to teach their children the basics of sex education, but disapprove of the more explicit contraceptive guidance commonly used in comprehensive sex-education classes.

Both abstinence-before-marriage and comprehensive sex proponents take credit for CDC stats that report the number of high-schoolers who say they have had sexual intercourse dropped from 54 percent in 1991 to 46 percent in 2001.

Both sides also take credit for the drop in teen pregnancies. The comprehensive sex side contends the drop is because more teens opt for injectable contraceptives, as well as an increase in teen condom use. A study published in last month's Adolescent and Family Health journal determined that abstinence is the primary reason for the decline in pregnancies among teens.

That doesn't mean teenagers aren't having sex. The CDC reports that more than half of high school seniors still lose their virginity before graduation.

No one will deny that sexual activity among teens is a problem. It's just that no one can agree on the solution.

Until four years ago, Operation Keepsake was known as Responsible Social Values Program of Greater Cleveland (RSVP). Mosack changed the name because of the confusion between her organization and others using the same acronym. Mosack says she chose the word "Operation" because of its "militancy sound, like Operation Desert Storm," and included "Keepsake" because of its definition. "Something that's kept as valuable or precious in remembrance of the giver, which gives a good representation of how we view sexuality."

Her large hazel eyes turn steely as she adds, "I think we need to mobilize seriously and deliberately to dismantle the myth of safe sex to keep our students healthy."

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.

"DECISIONS DETERMINE DESTINY" she reads out loud. "Thank you to whoever wrote that."

She hands two girls and two boys equal chunks of different-colored Play-Doh. Sullivan then pairs them off.

"Hazel and Felix are sooooo in love," Sullivan says, reminding the class that the reason she's changed the names of the kids is so no one will make fun of them later.

"They think they're ready to have sexual intercourse." She asks one couple to squish their Play-Doh together - which they do, staring at the multicolored clay to avoid eye contact with one another. The girls blush. One boy twists his foot and grinds it absentmindedly into the floor. The rest of the class is sniggering. The classroom teacher has to stand and ask the youngsters to quiet down.

"But now a new guy moves in and Hazel breaks up with Felix because she wants to start dating Dudley." Sullivan asks the children up front to separate their Play-Doh. When they can't, Sullivan grabs the chunk from Hazel's hand and mashes Dudley's blue piece into the yellow-and-red-tinged chunk.

"Every time you have sex with someone, you give a part of yourself away that you can never get back. You're linked together, just like this Play-Doh," Sullivan says. "And every time you have sex with someone, your risk of getting an STD goes way up."

With the Play-Doh front and center on her lectern, Sullivan tells the kids that when she was their age, she had to worry about only two STDs. "Now there are over 25 significant STDs and some are at epidemic levels." She explains the difference between an STD that is bacterial and one that is viral and then begins to systematically go through the signs, symptoms and manifestations of chlamydia, gonorrhea, syphilis, genital herpes, genital warts, HIV and hepatitis B.

The snickering has stopped, replaced by "Eewwws" and "That's soooo gross." Sullivan hands out "STD Discussion Sheets" that must be taken home and signed by the students' parents.

Critics of abstinence-until-marriage programs have complained of their tendency to be fear-based, relying on scaring kids from sex by describing the nitty-gritty of STDs. Borawski, of Case Western, says that's not necessarily a bad thing.

"I would say that a good chunk of all the sexual interventions have a bit of fear," she says. For a while, scientists were saying fear-based interventions didn't work. "But now there's been a push back toward them because some of us are saying, 'You know, fear works a little bit.'

"If you tell kids, 'If you do this once, you're going to get this STD,' that's lying to them," she says, comparing that technique to the days of the Reefer Madness movie, when kids were told if they smoked marijuana once they'd go crazy. "Fear tactics have to be realistic."

Kids will quickly reject messages that don't ring true. "The diseases you can get scared me because they said that condoms don't even work," says a 13-year-old eighth-grader at a middle school on Cleveland's near East Side. "But the rest of the class was really stupid.

"Nowadays more people are getting divorced than staying together. So say you save yourself and you get married when you're 26 and then you're divorced because he cheated on you and then you just gave yourself to someone who cheated on you," she says, admitting that's what happened to her mom.

"They make it sound like if I have sex one time it's going to ruin my whole life. That I'm not going to have a house. I'm not going to have any kids or a car. They make it sound like that," she says before she quietly admits she's sexually active and that her heart has been broken. Her eyes fill with tears.

"He told me he loved me. He's already seeing somebody else."

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