and instruction regarding STDs, unintended pregnancy, and methods for preventing both. As reviewed in Chapter 4, such instruction does not increase sexual activity among adolescents. Because information is a necessary but not always sufficient condition for behavior change, interventions and policies to facilitate development of behavioral skills are also necessary.

To prevent STDs among adolescents, it is necessary to provide them with accurate, comprehensive information and give them instruction in ways to implement healthy sexual behaviors. As discussed in Chapter 3, adolescents experience a large information gap regarding STDs. Surveys show that they receive much of their information regarding sexuality and STDs from their peers, the mass media, or other unreliable sources of information rather from their parents or health care professionals. Studies cited in Chapter 4 show that many school-based programs and mass media education campaigns are effective in improving knowledge about STDs and in promoting healthy sexual behaviors. Therefore, the committee believes that school-related programs (including school-based and school-linked programs) and mass media campaigns should comprise two major components of an effective prevention strategy for adolescents.

Although school-based prevention programs should be a major means for preventing risky sexual behaviors among adolescents, it is not realistic to expect that such programs will be successful in all situations or that they will be effective in isolation. This is because such programs cannot control other influences on adolescent health behaviors, such as the mass media and peer and community norms regarding sexual behavior. In addition, the wide variability in the quality of and support for school-based programs in communities is a barrier to effectiveness of programs. Therefore, as with other interventions proposed by the committee, school-based programs must be implemented along with individual- and community-based interventions to promote healthy sexual behaviors. In evaluating school-based programs and other behavioral interventions to prevent STDs, it should be recognized that the outcomes of interest (e.g., reduction in STDs, reduction in risky sexual behaviors) are influenced by factors other than the intervention being studied. Therefore, evaluations of program effectiveness should account for other influences that exist under real world conditions.

Clinical services for adolescents need to be more accessible for reasons outlined in Chapter 3. Adolescents are one of the age groups least likely to have health insurance coverage: they infrequently present to regular health care facilities, and confidentiality is a major concern for them. In addition, the cost of health services may be a significant barrier. Many adolescents are seen at routine exams, including physical examinations for participation in sports, in school-related and family planning clinics, and by primary care professionals. Clinicians should utilize these and other appropriate clinical encounters to educate all and screen sexually active adolescents for STDs. For example, all adolescents should be counseled regarding methods to protect against STDs when prescriptions for

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