Addressing the Changing Needs of the Next Generation:

CDC's Role in Preventing HIV Infection Among Young Americans Through School Health Programs

Developing Prevention Skills for a Lifetime of Health

Just like their peers in other countries, young Americans lay the pattern for behaviors that will have significant impact -- positive or negative -- on their overall health for the rest of their lives. CDC works to help children and youth develop the knowledge, skills, attitudes, and behaviors that will help keep them healthy life-long.

HIV Prevention Is a Top Priority

It is estimated that half of all new HIV infections in the U.S. -- about 40,000 annually -- are among people younger than 25. Prevention activities/interventions -- beginning well before young adulthood -- are desperately needed to stem this tide. (For more information on HIV/AIDS prevention and youth, see the companion fact sheet, Developing Health Skills for a Lifetime: CDC's Role in Preventing HIV Infection Among Young Americans.)

In 1987, CDC launched a national program to help schools and other youth-serving agencies deliver effective HIV-prevention health education in schools and other youth-serving agencies. The impact of these efforts is assessed through applied surveillance and evaluation research, which is provided to communities to help them best address their unique local HIV/AIDS needs.

CDC puts prevention tools into the hands of education agencies in every state, the District of Columbia, American Samoa, Guam, Marshall Islands, Northern Mariana Islands, Puerto Rico, Virgin Islands, and 18 large U.S. cities. CDC provides financial support and translates biomedical and behavioral research into practical interventions, so that schools and other agencies serving youth can implement effective HIV prevention education for youth. Major activities include training teachers, developing and disseminating educational materials, and monitoring and evaluating program activities.

Local Solutions To Local Problems

The foundation of all CDC's HIV prevention programs is that those closest to the problem are best able to solve it, equipped with needed tools. CDC's role is to provide those tools. Consistent with that belief, CDC does not mandate or endorse any specific curriculum for HIV prevention. The specific scope and content of school health programs are locally determined and consistent with parental and community values. CDC's role is to identify curricula that have credible evidence of reducing health risk behaviors among youth and to provide resources to ensure that the interventions, including training, are available for those who want to use them.

To help schools develop quality locally determined HIV prevention education programs, CDC also supports 28 national organizations that are leaders in promoting school health education, 3 demonstration centers that train policymakers and program managers, and directors of training in each funded state, territory, and city. These three efforts help diffuse trained tacticians equipped with the latest behavioral and biomedical science nationwide.

CDC also supports "comprehensive school health" programs in thirteen states. A unique synthesis of state health and education departments, comprehensive school health education is a planned, sequential, approach that integrates important health topics such as HIV, STDs, unintended pregnancy, tobacco, nutrition, and physical activity for all students in kindergarten (age 6) through high school (age 18). This holistic approach to health is founded on the knowledge that health behaviors do not co-exist independently -- that a youngster's ability to resist peer pressure and social influences to smoke are integrally related to the ability to say no to risky sexual activity. Comprehensive, cohesive health education strengthens young people's health skills in all areas.

Continuous Improvement To Better Target Prevention Programs

Central to CDC's work are its continuing efforts to evaluate and improve program effectiveness and to develop surveillance systems for measuring risk behaviors among young people. In 1993, as part of the Youth Risk Behavior Surveillance System, CDC conducted a national school-based Youth Risk Behavior Survey (YRBS) among a representative sample of 16,296 high school students in grades 9-12. Data summarized from the survey are used by local communities to develop programs that target the most prevalent high-risk behaviors.

Using this and other information, CDC develops and disseminates guidelines for effective school health programs and policies. CDC staff provide technical assistance to communities in evaluating HIV/STD prevention programs and comprehensive school health programs. Evaluation assistance is available in policy assessment, curriculum assessment, staff development, student outcomes, and related health education topics to each funded state or local education agency.

Five-year trends from the YRBS show both a leveling of sexual risk behavior rates and increased condom use. From 1990 through 1995 no significant change was detected in the percentage of high school students who reported ever having had sex, having four or more partners, or having intercourse in the 3 months prior to the survey. In contrast, overall condom use at last intercourse was up significantly, from 46% in 1990 t o 53% in 1995. Female and African-American students posted the largest increases in condom use. While increased condom use is encouraging, YRBS findings indicate that more must be done to help young people delay initiation of sexual activity and reduce risky sexual behavior. CDC will continue to work with national, state, and local agencies to design, develop, deliver, and evaluate community-level prevention programming.

School Health Programs Presentations in Vancouver


Five-Year Trends in HIV Risk Behaviors Among Youth, Janet Collins.


Evaluating School-Based HIV/AIDS Education Efforts: A Systematic Approach to Improving Program Quality, Stephen W. Banspach.

School Condom Availability Programs in the United States, Nancy Brener.

Building an Infrastructure in the Nation's Schools for Addressing Major Health Problems, Including AIDS, Peter Cortese.

Designing Culturally Appropriate Theory-Based Behavioral Interventions: The Antigua Schools Project, Aisha Gilliam.

Setting Priorities for HIV Prevention Programs in School, Pete Hunt.

HIV Education in the United States -- How Good Is It? Laura Kann.

Initiation of Sexual Intercourse: Ages and Trends, Ellen Sogolow.

HIV Infection and U.S. College Students: How Great is the Risk? Charles W. Warren.

Research to Classroom: Selecting and Disseminating Educational Programs that Reduce HIV Risk Behaviors Among Adolescents, Susan Wooley.