drug use) that takes into account cognitive, affective, cultural, and neurophysiological variables; studies on direct effects of intoxicants on self-regulatory mechanisms; and studies regarding maintenance of behavior change.

The committee agrees with the above assessments and recommends that general areas of additional research in STD prevention include behavioral, biomedical, and operational research. In addition, the committee recommends that the following specific topics be studied: determinants of sexual behavior and sustained behavior change on an individual and community level; determinants of initiation of sexual intercourse among adolescents; influence of social and other community-related factors on risk of STDs; interventions to improve condom use and reduce high-risk behaviors; effectiveness of sexual risk behavior assessment and counseling; biomedical interventions that do not rely primarily on individual behavior, such as vaccines; female-controlled prevention methods; cost-effectiveness of preventive interventions, including partner notification and treatment techniques; methods for preventing STDs among disenfranchised populations; interventions for preventing STDs among persons of all sexual orientations; and methods to measure prevention program effectiveness.

Therefore, the committee makes the following recommendation:

• The National Institutes of Health and the CDC should continue to support and expand both basic and applied research in STD prevention. Research results should be made widely available and should be used by government agencies, public and private health programs, and health professional organizations to improve STD prevention services.

Although women bear the larger burden of disease associated with STDs, the most effective means for preventing transmission of STDs during intercourse (i.e., the male condom) is largely dependent on the behavior of men. Except for the female condom, there are no female-controlled methods that are sufficiently protective against STDs. Additional methods of protection over which women have greater control need to be made available, and additional effective mechanical and chemical methods for protection against STDs need to be developed. Dual protection (i.e., use of one method to protect against pregnancy and one method to protect against STDs) is important because, as discussed in Chapter 4, no single method of preventing STDs or pregnancy confers the maximum level of protection for both conditions.

Therefore, the committee makes the following recommendation:

• The National Institutes of Health, the Food and Drug Administration, and pharmaceutical, biotechnology, and medical device companies should collaboratively develop effective female-controlled methods for preventing