programs most frequently as being "very effective" sources of information on STDs (EDK Associates, 1995). Factors affecting the acceptance and effectiveness of school-based programs include community norms related to the appropriateness of the inclusion of certain topics in school curricula and the knowledge of teachers about, and attitudes towards, issues related to STDs. It is important to recognize that there is substantial heterogeneity in teacher and community attitudes towards how health curricula should deal with these topics. Competing demands on time and resources, political and religious attitudes, and beliefs about the effects of the teaching of such topics on children's attitudes and behavior vary tremendously. It is important to be aware of, and address when feasible, such factors that might inhibit the implementation of effective programs.
A significant barrier to implementation of effective school-based interventions is inadequate support for dissemination of such programs. To address this issue, the "Research to Classroom Project," sponsored by the Division of Adolescent and School Health, CDC, is the largest federal program to disseminate school-based curricula for reducing sexual risk behaviors. Under this program, the CDC identifies curricula that have been evaluated and shown to be effective in reducing specific risky behaviors and meet other selection criteria, and then provides resources, including training and technical assistance, to ensure that such curricula are disseminated on a national level.
Condom Availability in Schools. To address barriers to adolescent condom usage, approximately 431 schools in 50 school districts in 21 states have condom availability programs as part of HIV and STD prevention efforts, primarily in large urban public high schools (Kirby and Brown, 1996). Ninety-two percent of schools that made condoms available are high schools; these high schools represent only 2.2 percent of all public high schools in the United States (Kirby and Brown, 1996). The 50 school districts with condom availability programs represent only 0.3 percent of all U.S. high school districts. In 1994, there were a total of 9,573 middle schools, 20,059 high schools, and 14,881 school districts in the United States (U.S. Department of Education, National Center for Education Statistics, 1995). Massachusetts, New York State, and the District of Columbia are the only states or jurisdictions to recommend that their schools consider condom availability for students as part of a comprehensive HIV prevention program (NARAL Foundation, 1995). In addition, Los Angeles, New York City, and other cities have mandated condom availability in high schools as part of a comprehensive effort to prevent HIV infection (Kirby and Brown, 1996). In 1992, a survey of superintendents or their designees of 299 middle and high school districts found that only 8 percent of middle and high school students are in districts that have approved condom distribution programs (Leitman et al., 1993). Of schools with condom distribution programs in place, students were not given access to condoms before grade 9. Most districts with approved programs were located in the East and West and in areas with a large proportion of students