1. health plans should review billing or claims-processing procedures to ensure that they preserve confidentiality of services;
  2. the National Committee for Quality Assurance and other organizations that accredit health plans should ensure that a health plan's ability to ensure confidential access to STD-related services is appropriately assessed;
  3. state and local health professional organizations should disseminate information regarding the importance of maintaining patient confidentiality to their members; and
  4. the Academy of Pediatrics and other health professional organizations should educate pediatricians and other clinicians who provide health services to adolescents regarding the negative impact of parental notification for STD-related services.
Expanding School-Based Programs

Schools are critical venues for STD prevention activities. Survey data show overwhelming public support for school-based HIV/STD education programs. Studies cited in Chapter 4 show that school-based education programs are effective in improving knowledge regarding STDs, delaying adolescent initiation of sexual intercourse, and increasing use of condoms. Most teenagers indicate that the school is their primary source of information regarding STDs; this indicates that other sources of information are lacking.

Scientific studies and evaluations of school-based programs for STD prevention do not support the contention that such programs encourage students to have sex. Unfortunately, these programs have become highly controversial and efforts to provide STD-related education outside the home have been consistently resisted by certain groups. The committee recognizes that some parents and interested groups have sincere, deeply held personal beliefs regarding sex and STD education in schools that prevent them from supporting such programs. However, the committee believes that the scientific evidence presented in Chapter 4 in support of school-based educational programs for STD prevention is strong; that adolescence is the critical period for adopting healthy behaviors; and that school is one of the few available venues for reaching adolescents.

The committee believes that it is important to distinguish opposition to school-based programs and other STD prevention efforts that are primarily based on religious and personal beliefs from that based on systematic evaluations of program effectiveness or scientific research. Understanding the underlying reasons for such opposition can help communities resolve differences. Because of the controversial nature of the issue, health departments and other agencies and organizations desiring to implement a school-based STD prevention program should work closely with school administrators, health educators, teachers, parents, and students throughout the planning and implementation process.

Surveys cited in Chapter 4 show that many states specifically require schools



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