student health (Emihovich and Herrington, 1993). The report on the first year, produced by Florida State University, was based on student surveys and site visits to 12 counties. All of the grantees had a designated health room in the school and the evaluation found heavy utilization rates, primarily for physical complaints, physical examinations, and minor injuries. The evaluation also stated that school-reported pregnancy rates had declined in some of the schools, but the data presented appeared to be estimates and were not validated. However, one comment from the report is interesting: "The most dramatic shift occurred at Glades Central High School in Palm Beach where the pregnancy rate dropped almost 73 percent. This project is also the only one where students can obtain prescriptions for contraceptives at the school and where there is a family practice physician available three days a week" (Emihovich and Herrington, 1993).

The first evaluation of the California Healthy Start initiative presents data on 40 different grantees, including eight youth service programs, five of which are school-based clinics. The report showed that adolescent clients of programs with the explicit goal of reducing teen pregnancy had significant reductions in the rate of initiation of sexually activity and an increase in the rate of reliable contraceptive use (Wagner et al., 1994). Among teenagers in pregnancy prevention programs, about 45 percent were sexually active at the end of the first six-month follow-up period, a significant 23 percent decrease from the proportion at intake (77 percent). Youth service programs showed large gains in linking clients to sources of health care.

An evaluation of the Teen Choice program showed that students were generally at high risk of pregnancy (Inwood House, 1987). In addition to demonstrating positive changes in knowledge and attitudes, participants were shown to have significantly improved their use of contraception following their group experiences and to have maintained these practices over time. Strengths of the program cited by the evaluators included that the program was convenient, students are respected, and although abstinence is encouraged, contraceptive use is recommended for those who choose not to abstain.

Other High-Risk Behaviors

At Lincoln High School in Denver, Colorado, a student who commits a drug offense can enter into a treatment contract for seven sessions at the school-based clinic rather than be suspended from the school. This component has resulted in an 80 percent reduction in suspensions (Bureau of Primary Health Care, 1993).

The Healthy Start data from California showed that in school-based

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