Sexuality education is the lifelong process of building a strong foundation for sexual health

Sexuality education seeks to assist young people in understanding a positive view of sexuality, provide them with information and skills about taking care of their sexual health, and help them make sound decisions now and in the future.

Comprehensive sexuality education programs have four main goals:

1. to provide accurate information about human sexuality
2. to provide an opportunity for young people to develop and understand their values, attitudes, and beliefs about sexuality
3. to help young people develop relationships and interpersonal skills, and
4. to help young people exercise responsibility regarding sexual relationships, including addressing abstinence, pressures to become prematurely involved in sexual intercourse, and the use of contraception and other sexual health measures. 15 

Schools and communities are responsible for developing their own curricula and programs regarding sexuality education. Programs, therefore, vary widely. The following terms and definitions provide a basic understanding of the types of sexuality education programs that are currently offered in schools and communities.

1. Comprehensive Sexuality Education. Sexuality education programs that start in kindergarten and continue through twelfth grade. These programs include information on a broad set of topics related to sexuality and provide students with opportunities for developing skills as well as learning factual information.
2. Abstinence-based. HIV-prevention and sexuality education programs which emphasize the benefits of abstinence. They also include information about non-coital sexual behavior, contraception, and disease prevention methods. These programs are also referred to as abstinence-plus or abstinence-centered.
3. Abstinence-only. HIV-prevention and sexuality education programs which emphasize abstinence from all sexual behaviors. They do not include any information about contraception or disease prevention methods.
4. Abstinence-only-until-marriage. HIV-prevention and sexuality education programs which emphasize abstinence from all sexual behaviors outside of marriage. They do not include any information about contraception or disease- prevention methods. These programs typically present marriage as the only morally correct context for all sexual activity.

The National Guidelines Task Force, composed of representatives from 15 national organizations, schools, and universities, identified six key concept areas that should be part of any comprehensive sexuality education program: human development, relationships, personal skills, sexual behavior, sexual health, and society and culture.

The Task Force published the Guidelines for Comprehensive Sexuality Education, which includes information on teaching 36 sexuality-related topics in an age-appropriate manner.16 

The content of sexuality education varies depending on the community and the age of the students in the programs. Recent studies provide some insight into what is being taught in America’s classroom today.

1. In a national survey released by The Kaiser Family Foundation, 61% of teachers and 58 % of principals reported that their school takes a comprehensive approach to sexuality education described as teaching young people that they should wait to engage in sexual behavior but that they should practice “safer sex” and use birth control if they do not. In contrast, 33% of teachers and 34% of principals described their school’s main message as abstinence-only-until-marriage.17 
2. In the same survey, teachers reported covering the following topics in their most recent sexuality education course: HIV/AIDS (98%), abstinence (97%), STDs (96%), and the basics of reproduction (88%), birth control (74%), abortion (46%), and sexual orientation and homosexuality (44 %).18 
3. The Centers for Disease Control and Prevention's (CDC) Division of Adolescent and School Health has published School Health Education Profiles (SHEP) that summarizes results from 35 state surveys and 13 local surveys conducted among representative samples of school principals and health education coordinators. SHEP found that 97 % of health education courses required by states included information about HIV prevention, 94% included information about STD prevention, and 85% included information about pregnancy prevention.19 
4. Among those schools that required HIV education, 99% taught about HIV infection and transmission, 76 % taught about condom efficacy, and 48 percent taught how to use condoms correctly.20 
5. In addition, 96% of health education courses required by states taught skills to help students resist social pressures, 97% taught decision-making skills, and 90% taught communication skills.21 

RESEARCH ON SEXUALITY EDUCATION

Numerous studies and evaluations published in peer-reviewed literature suggest that comprehensive sexuality education is an effective strategy to help young people delay their involvement in sexual intercourse. Research has also concluded that these programs do not hasten the onset of sexual intercourse, do not increase the frequency of sexual intercourse, and do not increase the number of a partners sexually active teens have.

1. Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy, a report released by The National Campaign to Prevent Teen Pregnancy in 2001, identified successful teenage pregnancy prevention initiatives, including five sexuality/HIV education programs, two community service programs, and one intensive program that combined sexuality education, health care, and activities such as tutoring.

Emerging Answers concluded that sexuality and HIV education do not hasten sexual activity, that education about abstinence and contraception are compatible rather than in conflict with each other, and that making condoms available does not increase sexual behavior.22 

1. No Easy Answers, a report commissioned in 1997 by The National Campaign to Prevent Teen Pregnancy, reviewed both sexuality and HIV education programs. The report concluded that skills-based sexuality education—those programs that, among other things, teach contraceptive use and communications skills—can delay the onset of sexual intercourse or reduce the frequency of sexual intercourse, reduce the number of sexual partners, and increase the use of condoms and other contraception.

Further, the review concluded that sexuality and HIV education curricula that discuss abstinence and contraception do not hasten the onset of intercourse, do not increase the frequency of intercourse, and do not increase the number of a person’s sexual partners.23 

1. UNAIDS, Sexual Health Education Does Lead to Safer Sexual Behavior-UNAIDS Review, commissioned in 1997 by the Joint United Nations Programme on HIV/AIDS (UNAIDS), examined 68 reports on sexuality education from France, Mexico, Switzerland, Thailand, the United Kingdom, the United States, and various Nordic countries. The review found 22 studies that reported that HIV and/or sexual health education either delayed the onset of sexual activity, reduced the number of sexual partners, or reduced unplanned pregnancy and STD rates. The review also found that education about sexual health and/or HIV does not encourage increased sexual activity.

The authors concluded that good quality sexual health programs helped delay first intercourse and protect sexually-active youth from pregnancy and sexually transmitted diseases, including HIV.24 

Research has shown that effective programs share a number of common characteristics. The following list of these characteristics was developed by Doug Kirby, Ph.D, author of both Emerging Answers and No Easy Answers.

Effective programs:

1. focus narrowly on reducing one or more sexual behaviors that lead to unintended pregnancy or STDs/HIV infection
2. are based on theoretical approaches that have been successful in influencing other health-related risky behaviors
3. give a clear message by continually reinforcing a clear stance on particular behaviors
4. provide basic, accurate information about the risks of unprotected intercourse and methods of avoiding unprotected intercourse
5. include activities that address social pressures associated with sexual behavior
6. provide modeling and the practice of communication, negotiation, and refusal skills
7. incorporate behavioral goals, teaching methods, and materials that are appropriate to the age, sexual experience, and culture of the students
8. last a sufficient length of time to complete important activities adequately
9. select teachers or peers who believe in the program they are implementing and then provide training for those individuals25

To date, no published studies of abstinence-only programs have found consistent and significant program effects on delaying the onset of intercourse.

1. The National Campaign to Prevent Teen Pregnancy’s report titled Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy identifies successful teenage pregnancy-prevention initiatives but indicates that none are abstinence-only programs. The report indicates that evidence is not conclusive about such programs but that, thus far, the information in “not encouraging.” In fact, the report states that none of the evaluated abstinence-only programs “showed an overall positive effect on sexual behavior, nor did they affect contraceptive use among sexually active participants.”26 
2. Of the previous studies of abstinence-only programs, none have found consistent and significant program effects on delaying the onset of intercourse. At least one has provided strong evidence that the program did not delay the onset of intercourse. To date, there are six published studies of abstinence-only programs. None have found consistent and significant program effects on delaying the onset of intercourse. At least one has provided strong evidence that the program did not delay the onset of intercourse.
3. Proponents of abstinence-only-until-marriage programs often conduct their own in-house evaluations and cite them as proof that their programs are effective. Outside experts have found, however, that they are inadequate, methodologically unsound, or inconclusive based on methodological limitations.27 
4. The CDC’s Research to Classroom Project identifies curricula that have shown evidence of reducing sexual risk behaviors. A recent paper written by the White House Office of National AIDS Policy points out that “none of the curricula on the current list of programs uses an ‘abstinence-only’ approach.”28 

In recent years, many abstinence programs have begun to include pledge cards for students to sign promising to remain virgins until they are married. Recent research suggests that under certain conditions these pledges may help some adolescents delay sexual intercourse. For these adolescents, the pledge helped them delay the onset of sexual intercourse for an average of 18 months. The study, however, also found that those young people who took a pledge were less likely to use contraception when they did become sexually active.29 

GOVERNMENT’S ROLE IN SEXUALITY EDUCATION 

There is no federal law or policy requiring sexuality or HIV education. The federal government is explicit in its view that it should not dictate sexuality education or its content in schools. Four federal statutes preclude the federal government from prescribing state and local curriculum standards:

1. the Department of Education Organization Act, Section 103a
2. the Elementary and Secondary Education Act, Section 14512
3. Goals 2000, Section 314(b)
4. the General Education Provisions Act, Section 438

While the federal government does not have a policy about sexuality education and has never taken an official position on the subject, a number of federal programs have been instituted in recent years that provide funding for strict abstinence-only-until-marriage education.

1. In 1996, the federal government created an entitlement program, Section 510(b) of Title V of the Social Security Act, that funnels $50 million per year for five years into states. States that choose to accept Section 510(b) funds must match every four federal dollars with three state-raised dollars and then disperse the funds for educational activities.
2. Programs that accept the Section 510(b) funds must adhere to the following strict definition of “abstinence education”:
3. (A) has as its exclusive purpose, teaching the social, psychological, and health gains to be realized by abstaining from sexual activity;
4. (B) teaches abstinence from sexual activity outside marriage as the expected standard for all school age children;
5. (C) teaches that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems;
6. (D) teaches that a mutually faithful monogamous relationship in the context of marriage is the expected standard of human sexual activity;
7. (E) teaches that sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects;
8. (F) teaches that bearing children out of wedlock is likely to have harmful consequences for the child, the child’s parents, and society;
9. (G) teaches young people how to reject sexual advances and how alcohol and drug use increase vulnerability to sexual advances; and
10. (H) teaches the importance of attaining self-sufficiency before engaging in sexual activity.
11. Funding for abstinence-only-until-marriage education has increased nearly 3,000% since this federal entitlement program was created in 1996. 30 The federal government has since approved an additional 50 million dollars of funding for abstinence-only-until-marriage. Although these funds are not part of Section 510(b), programs must conform to the strict eight-point definition. In addition, these new funds are awarded directly to state and local organizations by the Maternal and Child Health Bureau through a competitive grant process instead of through state block grants as is the case for Section 510(b) funds.

States vary in their approach to sexuality education. Some mandate that schools provide sexuality education, others mandate that schools provide STD and/or HIV/AIDS education, and others mandate both. Some states, make no mandates at all while others make recommendations.

Among states that mandate sexuality education and/or STD and/or HIV/AIDS education, some include specific requirements or restrictions on the content of these courses while others leave these decisions to local communities. Even in those states where sexuality education is not mandated, certain requirements and restrictions are sometimes placed on those schools that opt to teach either sexuality education or STD and/or HIV/AIDS education.

There is a lack of uniformity in language used by states to enact mandates. This makes categorization difficult. For more detailed information about individual state mandates, contact your state legislature.

Sexuality education mandates.

1. Nineteen states, including the District of Columbia, require schools to provide sexuality education. (DE, DC, GA, IL, IA, KS, KY, MD, MN, NV, NJ, NC, RI, SC, TN, UT, VT, WV, WY)
2. Thirty-two states do not require schools to provide sexuality education. (AL, AK, AZ, AR, CA, CO, CT, FL, HI, ID, IN, LA, ME, MA, MI, MS, MO, MT, NE, NH, NM, NY, ND, OH, OK, OR, PA, SD, TX, VA, WA, WI)31 

Content requirements. Regarding sexuality education, content requirements for abstinence and contraception were examined. Many states also have mandates for the inclusion or prohibition of other information, such as information on puberty and sexual orientation.

1. Of the 19 states that require schools to provide sexuality education, three (IL, KY, UT) require schools that teach sexuality education to teach abstinence but do not require that they teach about contraception.
2. Of the 19 states that require schools to provide sexuality education, nine (DE, GA, NJ, NC, RI, SC, TN, VT, WV) require schools that teach abstinence to also teach about contraception.
3. Of the 32 states that do not require schools to provide sexuality education, 11 (AL, AZ, CO, FL, IN, LA, MI, MS, OK, SD, TX) require that curricula, when taught, must include information about abstinence but not about contraception. Of those 11 states, six (AL, FL, IN, LA, MS, TX) require that curricula, when taught, must include abstinence-only-until-marriage education.
4. Of the 32 states that do not require schools to provide sexuality education, five (CA, HI, MO, OR, VA) require that curricula, when taught, must provide information about abstinence and contraception. Of these five, three (CA, MO, VA) specify abstinence-only-until-marriage education.32 

STD/HIV education mandates.

1. Thirty-six states, including the District of Columbia, require schools to provide STD, HIV, and/or AIDS education. (AL, CA, CT, DE, DC, FL, GA, IL, IN, IA, KS, KY, MD, MI, MN, MO, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, UT, VT, WA, WV, WI, WY)
2. Fifteen states do not require schools to provide STD, HIV, and/or AIDS education.10 (AK, AZ, AR, CO, HI, ID, LA, ME, MA, MS, MT, NE, SD, TX, VA) 33 

Content requirements. For STD and/or HIV/AIDS education, content requirements for abstinence and prevention methods were examined.

1. Of the 36 states that require schools to provide STD, HIV, and/or AIDS education, two (IN, OH) require that such education also teach abstinence-only-until-marriage but do not require information about prevention methods.
2. Of the 36 states that require schools to provide STD, HIV, and/or AIDS education, 24 (AL, CA, DE, FL, GA, IL, KY, MI, MN, MO, NJ, NM, NY, NC, OK, OR, PA, RI, SC, TN, UT, VT, WA, WV) require that such education also teach about abstinence and methods of prevention. Of these 24 states, 12 (AL, CA, FL, GA, IL, MN, MO, NC, SC, TN, UT, WA) specify abstinence-only-until-marriage education.
3. Of the 15 states that do not require schools to provide STD, HIV, and/or AIDS education, four (AZ, LA, MS, TX) require that such education also teach abstinence but not prevention methods. Of these four, three (LA, MS, and TX) specify abstinence-only-until-marriage.
4. Of the 15 states that do not require schools to provide STD, HIV, and/or AIDS education, two (HI, VA) require that such programs, if taught, must also teach abstinence and methods of prevention. Virginia specifies abstinence-only-until-marriage.34 

SUPPORT FOR COMPREHENSIVE SEXUALITY EDUCATION 

Recent research shows that parents, teachers, and students consistently support sexuality education and that they want more rather than fewer topics included in these classes.

1. A 2000 study released by the Kaiser Family Foundation found that virtually all parents, teachers, principals, and students want some form of sexuality education taught in secondary school, and all overwhelmingly support teaching high school students a broad range of topics including birth control and safer sex. For middle and junior high school students, support is more divided; about half or more of students, parents, teachers, and principals favor teaching all aspects of sexuality education.35 
2. Parents surveyed wanted sexuality education to teach the following topics and skills: HIV/AIDS and others STDs (98%), the basics of pregnancy and birth (90%), how to deal with the pressure to have sex and emotional issues and consequences of being sexually active (94 %); how to talk with a partner about birth control and STDs (88%); how to use condoms (85 %); how to use and where to get other birth control (84 %); abortion (79%); and sexual orientation and homosexuality (76 %).36 
3. A third of parents (33 %) said they wanted their children to learn abstinence as the only option until marriage. However, many of the same parents also wanted their children to learn preventative skills such as how to use condoms and other birth control methods.37 
4. In addition, nearly three-quarters of parents (74 %) said that they wanted schools to present issues in a “balanced” way that represented different views in society.38 
5. When asked what they wanted to learn more about, students who had already had sexuality education classes named the following: knowing what to do in case of rape or sexual assault (55%); knowing how to deal with the emotional consequences of being sexually active (46%); knowing how to talk with a partner about birth control and STDs (46%); and knowing how to use or where to obtain birth control (40 %).39 

Numerous national polls find overwhelming public support for comprehensive sexuality education.

1. A national poll conducted by Hickman-Brown Research, Inc., in 1999 for SIECUS and Advocates for Youth found that 93% of all Americans support the teaching of sexuality education in high schools and 84% support sexuality education in middle/junior high schools.40 
2. A survey conducted by Peter D. Hart Research Associates, Inc., for the Children's Research and Education Institute in 1999 found that 66 % of registered voters are in favor of teaching sexuality education in the public elementary schools, 22% are negative about sexuality education in the public elementary schools, and 12% are neutral on the topic.41 
3. A recent Phi Delta Kappa/Gallup Poll, The Public's Attitudes Toward the Public Schools, found that 87 % of Americans favor including sexuality education in school curricula.42 

Numerous national and government organizations have expressed their support for comprehensive sexuality education.

1. Officials at the National Institutes of Health43, The Institute of Medicine44, the U.S. Centers for Disease Control and Prevention45, the White House Office on National AIDS Policy46, and the Surgeon General’s Office47 have all publicly supported sexuality education programs that included information about abstinence, contraception, and condom use.
2. Prominent public health organizations also support comprehensive sexuality education including the American Medical Association48, the American Academy of Pediatrics49, the American College of Obstetrics and Gynecology50, and the Society for Adolescent Medicine.51 
3. In fact, more than 127 mainstream national organizations focusing on young people and health issues including Advocates for Youth, Girls Inc., the National Association for the Advancement of Colored People, and the YWCA of the USA have joined together as the National Coalition to Support Sexuality Education committed to assuring comprehensive sexuality education for all youth in United States.

SIECUS provides numerous resources and services to help parents, educators, policymakers, media representatives, and the public understand issues related to sexuality education. SIECUS’ award-winning Web site (www.siecus.org) contains over 1,000 pages of information about sexuality and links to numerous organizations working in this area. SIECUS’ also produces fact sheets, bibliographies, and other publications designed to expand on the information available here visit our Web site or contact SIECUS for a publications catalogue. In addition, SIECUS’ Mary S. Calderone Library is one of a few libraries in the country dedicated to sexuality issues and is open to the public for assistance with research. The library now has over 20,000 books, journals, and curricula.

References 

1. National Guidelines Task Force, Guidelines for Comprehensive Sexuality Education, 2nd Edition, Kindergarten-12th Grade (New York: Sexuality Information and Education Council of the United States, 1996), p. 3.
2. Teen Today 2000, Liberty Mutual and Students Against Destructive Decisions/ Students Against Drunk Driving (Boston, MA, Students Against Drunk Driving, 2000).
3. T. R. Jordan, et al., “Rural Parents’ Communication with Their Teenagers about Sexual Issues,” Journal of School Health, vol. 70, no. 8, pp. 338-44.
4. The Henry J. Kaiser Family Foundation, Talking with Kids about Tough Issues: A National Survey of Parents and Kids, Questionnaire and Detailed Results (Menlo Park, CA: The Henry J. Kaiser Family Foundation, 2001) pp. 16-17.
5. T. R. Jordan, et al., “Rural Parents’ Communication with Their Teenagers About Sexual Issues.”
6. The Henry J. Kaiser Family Foundation, Talking with Kids about Tough Issues: A National Survey of Parents and Kids. 
7. Ibid.
8. T. R. Jordan, et al., “Rural Parents’ Communication with Their Teenagers About Sexual Issues.”
9. The Henry J. Kaiser Family Foundation, Talking with Kids about Tough Issues: A National Survey of Parents and Kids.
10. Teen Today 2000, Liberty Mutual and Students Against Destructive Decisions/ Students Against Drunk Driving. 
11. The Henry J. Kaiser Family Foundation, Talking with Kids about Tough Issues: A National Survey of Parents and Kids. 
12. Ibid., chart 4.
13. D. Whitaker and K. S. Miller, “Parent-Adolescent Discussions about Sex and Condoms: Impact on Peer Influences of Sexual Risk Behaviors,” Journal of Adolescent Research, March 2000, vol. 15, no. 2, pp. 251-73.
14. S. R. Beier, et al, “The Potential Role of an Adult Mentor in Influencing High-risk Behaviors in Adolescents,” Archives of Pediatrics & Adolescent Medicine, April 2000, vol. 154, pp 327-31.
15. National Guidelines Task Force, Comprehensive Sexuality Education, pp. 3, 5.
16. Ibid. pp. 7-10.
17. The Henry J. Kaiser Family Foundation, Sex Education in America: A View from Inside the Nation’s Classrooms, Chart Pack (Menlo Park, CA: The Henry J. Kaiser Family Foundation, 2000), chart 9.
18. Ibid, chart 10.
19. “Characteristics of Health Education Among Secondary Schools—School Health Education Profiles, 1996” Morbidity and Mortality Weekly Report, September 11, 1998, vol. 47, no. SS-4, pp. 1-31, table 4.
20. Ibid., table 12.
21. Ibid., p. 5.
22. D. Kirby, Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy (The National Campaign to Prevent Teen Pregnancy, May 2001).
23. D. Kirby, No Easy Answers (Washington: National Campaign to Prevent Teen Pregnancy, 1997)
24. “Sexual Health Education Does Lead to Safer Sexual Behaviour—UNAIDS Review” Press Release, Joint United Nations Programme on HIV/AIDS, October 22, 1997.
25. D. Kirby, “What Does the Research Say about Sexuality Education/” Educational Leadership, Oct. 2000, p. 74.
26. D. Kirby, Emerging Answers, “Summary,” p. 8.
27. C. Bartels, et.al, Federally Funded Abstinence-only Sex Education Programs: A Meta-Evaluation. Paper presented at the Fifth Biennial Meeting of the Society for Research on Adolescence, San Diego, CA, February 11, 1994;
    B.Wilcox, et.al., Adolescent Abstinence Promotion Programs: An Evaluation of Evaluations. Paper predsnted at the Annual Meeting of the American Public Health Association, New York, NY, November 18, 1996.
28. Office of National AIDS Policy. The White House, Youth and HIV/AIDS 2000: A New American Agenda (Washington, DC: Government Printing Office, 2000), p.14.
29. P. Bearman and H. Brückner, "Promising the Future: Virginity Pledges as they Affect Transition to First Intercourse," American Journal of Sociology, vol. 106, no. 4 (2001).
30. C. Dailard, “Fueled by Campaign Promises, Drive Intensifies to Boost Abstinence-Only Education Funding,” The Guttmacher Report on Public Policy, vol. 3, no. 2, April 2000.
31. National Abortion and Reproductive Rights Action League Foundation (NARAL), Who Decides? A State-by-State Review of Abortion and Reproductive Rights (Washington, DC: NARAL, the NARAL Foundation, January 2001).
32. Ibid.
33. Ibid.
34. Ibid.
35. The Henry J. Kaiser Family Foundation, Sex Education in America: A View from Inside the Nation’s Classrooms, p. 32.
36. Ibid., chart 12.
37. Ibid., chart 14.
38. Ibid., p. 30.
39. Ibid., chart 15.
40. SIECUS/Advocates for Youth Survey of Americans’ Views on Sexuality Education (Washington, DC: Sexuality Information Council of the United States, and Advocates for Youth, 1999).
41. Teaching Sex Education in the Public Elementary Schools, phone survey, Peter D. Hart Research Associates, Inc., February 20-26,1999.
42. “The 30th Annual Phi Delta Kappa/Gallup Poll of the Public’s Attitudes Toward Public Schools,” Phi Delta Kappa, September 1998, p. 54.
43. National Institutes of Health, Consensus Development Conference Statement (Rockville, MD: The Institutes, 1997).
44. Institute of Medicine, Committee on Prevention and Control of Sexually Transmitted Diseases T. R. Eng, W. T. Butler, editors., The Hidden Epidemic: Confronting Sexually Transmitted Diseases (Washington, DC: Government Printing Office, 2001).
45. Centers for Disease Control and Prevention, statement of Dr. Lloyd Kolbe, director, Division of Adolescent and School Health, June 1998.
46. Office of National AIDS Policy, The White House, Youth and HIV/AIDS 2000: A New American Agenda (Washington, DC: Government Printing Office, 2001).
47. D. Satcher, The Surgeon General’s Call to Action to Promote Sexual Health and Responsible Sexual Behavior (Washington, DC: U.S. Government Printing Office, 2001).
48. Council on Scientific Affairs, American Medical Association, Report 7 of the Council on Scientific Affairs: Sexuality Education, Abstinence, and Distribution of Condoms in Schools (Chicago, IL: American Medical Association, 1999).
49. American Academy of Pediatrics, “Policy Statement: Condom Availability for Youth,” Pediatrics, vol. 95, 1995, pp. 281-85.
50. American College of Obstetrics and Gynecology, Committee on Adolescent Health Care-Committee Opinion, 1995.
51. Society for Adolescent Medicine, Position Statements and Resolutions: Access to Health Care for Adolescents, March 1992.