United States Government Accountability Office

GAO Testimony 

Before the Committee on Oversight and 

Government Reform, House of 

Representatives

ABSTINENCE EDUCATION

Assessing the Accuracy and 

Effectiveness of Federally 

Funded Programs 

Statement of Marcia Crosse 

Director, Health Care 

For Release on Delivery

Expected at 10:00 a.m. EDT 

Wednesday, April 23, 2008 

 

GAO-08-664T 
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

April 23, 2008

ABSTINENCE EDUCATION

Assessing the Accuracy and Effectiveness of 

Federally Funded Programs

Highlights of GAO-08-664T, a testimony 

before the Committee on Oversight and 

Government Reform, House of 

Representatives 

Among the efforts of the

Department of Health and Human

Services (HHS) to reduce the

incidence of sexually transmitted 

diseases and unintended 

pregnancies, the agency provides

funding to states and organizations

that offer abstinence-until-marriage

education. 

GAO was asked to testify on the

oversight of federally funded 

abstinence-until-marriage 

education programs. This

testimony is primarily based on 

Abstinence Education: Efforts to

Assess the Accuracy and 

Effectiveness of Federally Funded 

Programs, GAO-07-87 (Oct. 3, 

2006). In this testimony, GAO

discusses efforts by (1) HHS and 

states to assess the scientific 

accuracy of materials used in

abstinence-until-marriage 

education programs and (2) HHS,

states, and researchers to assess 

the effectiveness of abstinenceuntil-marriage education programs. 

GAO also discusses a Public Health

Service Act requirement regarding

medically accurate information 

about condom effectiveness. 

GAO focused on the three main 

federally funded abstinence-untilmarriage programs and reviewed 

documents and interviewed HHS 

officials in the Administration for 

Children and Families (ACF) and 

the Office of Population Affairs 

(OPA). To update certain

information, GAO contacted 

officials from ACF and OPA. 

Efforts by HHS and states to assess the scientific accuracy of materials used 

in abstinence-until-marriage education programs have been limited. As of 

October 2006, HHS’s ACF—which awards grants under two programs that 

account for the largest portion of federal spending on abstinence education—

did not review its grantees’ education materials for scientific accuracy, nor did 

it require grantees of either program to do so. Not all states that receive 

funding from ACF had chosen to review their program materials for scientific 

accuracy. OPA reviewed the scientific accuracy of grantees’ proposed 

education materials, and any inaccuracies found had to be corrected before 

those materials could be used. The extent to which federally funded 

abstinence-until-marriage education materials are inaccurate was not known, 

but OPA and some states reported finding inaccuracies. GAO recommended 

that the Secretary of HHS develop procedures to help assure the accuracy of 

abstinence-until-marriage education materials. An ACF official reported that 

ACF is currently implementing a process to review the accuracy of 

Community-based grantees’ curricula and has required those grantees to sign 

assurances that the materials they propose using are accurate. The official

also reported that, in the future, state grantees will have to provide ACF with 

descriptions of their strategies for reviewing the accuracy of their programs.

As of August 2006, HHS, states, and researchers had made a variety of efforts 

to assess the effectiveness of abstinence-until-marriage education programs, 

but a number of factors limit the conclusions that can be drawn about the 

programs’ effectiveness. ACF and OPA have required their grantees to report 

on various outcomes used to measure program effectiveness. To assess the

effectiveness of its grantees’ programs, ACF has analyzed national data on 

adolescent birth rates and the proportion of adolescents who report having 

had sexual intercourse. Additionally, 6 of the 10 states in GAO’s review 

worked with third-party evaluators to assess the effectiveness of abstinenceuntil-marriage programs in their states. However, the conclusions that can be

drawn are limited because most of the efforts to evaluate program 

effectiveness have not met certain minimum criteria that experts have 

concluded are necessary for such assessments to be scientifically valid. 

Additionally, the results of some efforts that do meet such criteria have varied.

While conducting work for its October 2006 report, GAO identified a legal 

matter that required the attention of HHS. Section 317P(c)(2) of the Public 

Health Service Act requires certain educational materials to contain medically 

accurate information about condom effectiveness. GAO concluded that this 

requirement would apply to abstinence education materials prepared and 

used by federal grant recipients, depending on their substantive content, and 

recommended that HHS adopt measures to ensure that, where applicable, 

abstinence education materials comply with this requirement. The fiscal year

2007 program announcement for the Community-based Program provides 

information about the applicability of this requirement, and future State and 

Community-based Program announcements are to include this information. 

To view the full product, including the scope 

and methodology, click on GAO-08-664T. 

For more information, contact Marcia Crosse 

at (202) 512-7114 or crossem@gao.gov. 
Mr. Chairman and Members of the Committee 

I am pleased to be here today as you examine federally funded abstinenceuntil-marriage education programs. Reducing the incidence of sexually 

transmitted diseases (STD) and unintended pregnancies among 

adolescents has been an important objective of the Department of Health

and Human Services (HHS). Among its efforts to do so, HHS funds 

abstinence-until-marriage education programs. These programs are 

delivered by a variety of entities, including schools, human service 

agencies, and faith-based organizations. Studies have raised concerns 

about the accuracy of the educational materials that are incorporated into 

these programs, as well as the effectiveness of the programs themselves. 

My remarks today are primarily based on our October 2006 report on the 

oversight of federally funded abstinence-until-marriage programs, 

Abstinence Education: Efforts to Assess the Accuracy and Effectiveness 

of Federally Funded Programs (GAO-07-87).1

 In that report, we 

recommended that the Secretary of Health and Human Services develop

procedures to help assure the accuracy of such materials. Today, I will 

discuss findings from our report on (1) efforts by HHS and states to assess

the scientific accuracy of materials used in abstinence-until-marriage 

programs, and (2) efforts by HHS, states, and researchers to assess the 

effectiveness of abstinence-until-marriage education programs as well as 

updates on selected information. I will also discuss a legal matter that 

came to our attention during the course of our work regarding the 

applicability of section 317P(c)(2) of the Public Health Service Act to 

Abstinence Education programs. We recommended in a letter dated 

October 18, 2006, that HHS adopt measures to ensure that, where 

applicable, abstinence-until-marriage education materials comply with the 

requirement that educational materials specifically designed to address 

STDs contain medically accurate information about condom effectiveness 

in preventing the STDs the materials were designed to address.2

 1

GAO, Abstinence Education: Efforts to Assess the Accuracy and Effectiveness of 

Federally Funded Programs, GAO-07-87 (Washington, D.C.: Oct. 3, 2006). This report is

available online at http://www.gao.gov. 

2

42 U.S.C. § 247b-17(c)(2) (2000); see GAO, Abstinence Education: Applicability of Section

317P of the Public Health Service Act, B-308128 (Washington, D.C.: Oct. 18, 2006). This 

letter is available online at http://www.gao.gov.

Page 1 GAO-08-664T
For our assessment of the accuracy and effectiveness of abstinence-untilmarriage education programs, we focused our review on the three main 

federally funded abstinence-until-marriage programs: the Abstinence 

Education Program (State Program), the Community-Based Abstinence 

Education Program (Community-Based Program), and the Adolescent 

Family Life (AFL) Program. The State Program and the Community-Based 

Program are both administered by HHS’s Administration for Children and 

Families (ACF); AFL is administered by HHS’s Office of Population Affairs 

(OPA). According to HHS, funding for the three abstinence-until-marriage 

programs was about $165 million in fiscal year 2007. 

In order to describe the efforts to assess the scientific accuracy of 

program materials, we reviewed published reports, program 

announcements, Federal Register notices, agency Web sites, and other 

documents related to abstinence-until-marriage education. We did not 

assess the criteria used to determine the scientific accuracy of education

materials or the quality of the reviews. We interviewed officials from ACF 

and OPA. We also interviewed officials from the 10 states that received the 

largest share of federal funding (together accounting for 51 percent of the 

total funding in fiscal year 2005) through the State Program for abstinenceuntil-marriage education.3

To describe efforts by HHS, states, and researchers to assess the 

effectiveness of abstinence-until-marriage education programs, we 

focused on efforts that examined the extent to which these programs 

achieved their program goals. In general, these goals include teaching 

adolescents to abstain from sexual activity until marriage in order to avoid 

unintended pregnancies, STDs, and related health problems. As part of our 

review, we compared these efforts to the design characteristics that 

experts have identified as important for a scientifically valid study of 

 3

The 10 states that received the largest share of funding in fiscal year 2005 through the 

State Program were Arizona, Florida, Georgia, Illinois, Louisiana, Michigan, New York, 

North Carolina, Ohio, and Texas. 

Page 2 GAO-08-664T
program effectiveness.4

 We reviewed journal articles and other published

reports, agency budget submissions, program announcements, agency and 

grantee performance reports, Federal Register notices, agency Web sites, 

and other documents related to abstinence-until-marriage education.5

 We 

also interviewed officials from ACF, OPA, the Centers for Disease Control 

and Prevention (CDC), the National Institutes of Health (NIH), the Office 

of the Assistant Secretary for Planning and Evaluation (ASPE), and 

10 states that received the largest share of federal funding for abstinenceonly education through the State Program in fiscal year 2005. We focused

our review on efforts to assess the scientific accuracy of materials and the 

effectiveness of the programs during fiscal year 2006. We conducted this 

work from October 2005 through September 2006 and during April 2008 in

accordance with generally accepted government auditing standards. Those 

standards require that we plan and perform the audit to obtain sufficient, 

appropriate evidence to provide a reasonable basis for our findings and 

conclusions based on our audit objectives. We believe that the evidence 

obtained provides a reasonable basis for our findings and conclusions 

based on our audit objectives. 

To assess the applicability of section 317P(c)(2) of the Public Health 

Service Act to abstinence-until-marriage education programs, we reviewed 

the statute, pertinent legislative history, and relevant program guidance. In

addition, we solicited the views of HHS officials on this issue. 

In summary, we found that efforts by HHS and states to assess the 

scientific accuracy of materials used in abstinence-until-marriage 

education programs had been limited. ACF did not review its grantees’ 

education materials for scientific accuracy and did not require that 

 4

See Douglas Kirby, Emerging Answers: Research Findings on Programs to Reduce Teen

Pregnancy (Washington, D.C.: National Campaign to Prevent Teen Pregnancy, 2001). The

experts identifying the design characteristics of a scientifically valid study for the National 

Campaign to Prevent Teen Pregnancy were drawn from institutions that include the 

National Institutes of Health, the Medical Institute for Sexual Health, the Alan Guttmacher 

Institute, the Institute for Research and Evaluation, and various universities. See David

Satcher, The National Consensus Process on Sexual Health and Responsible Sexual

Behavior: Interim Report (Atlanta: Morehouse School of Medicine, 2006). The panel

convened by former Surgeon General David Satcher included experts from a variety of

organizations, including the Medical Institute for Sexual Health, the Alan Guttmacher 

Institute, and the American Academy of Pediatrics. In addition, characteristics of a 

scientifically valid study have been identified by other experts in the field of evaluation 

research. For example, see Carol H. Weiss, Evaluation (Upper Saddle River: Prentice Hall, 

1998). 

5

For a more detailed description of our literature review methodology, see GAO-07-87. 

Page 3 GAO-08-664T
grantees of either the State Program or the Community-Based Program do 

so. In addition, not all states that received funding through ACF’s State 

Program chose to review their program materials for scientific accuracy.

Five of the 10 states in our review conducted such reviews. In contrast to 

ACF, OPA did review the scientific accuracy of AFL grantees’ proposed 

educational materials and any inaccuracies found had to be corrected 

before the materials could be used. While we reported that the extent to 

which federally funded abstinence-until-marriage education materials are 

inaccurate was not known, in the course of their reviews OPA and some 

states reported that they had found some inaccuracies in abstinence-untilmarriage education materials. For example, one state official described an

instance in which abstinence-until-marriage materials incorrectly 

suggested that HIV can pass through condoms because the latex used in 

condoms is porous. To address concerns about the scientific accuracy of 

materials used in abstinence-until-marriage programs, we recommended 

that the Secretary of HHS develop procedures to help assure the accuracy

of such materials, and HHS agreed to consider this recommendation. In 

April 2008, an ACF official reported that, in response to our 

recommendation, ACF began requiring in fiscal year 2007 that communitybased grantees sign written assurances that the materials they propose 

using are accurate. This official also reported that, starting in fiscal year 

2008, grantees of the State Program will also be required to sign these 

written assurances. In addition, this official reported that ACF is 

implementing a process to review the accuracy of the proposed curricula 

of fiscal year 2007 Community-based grantees. The ACF official reported 

that the curricula will be reviewed by a research analyst to ensure that all 

statements are referenced to source documents, and then by a healthcare

professional who will compare the information in the curricula to 

information in the source documents. The official also reported that, in the 

future, ACF will require states to provide the agency with descriptions of 

their strategies for reviewing the accuracy of their abstinence-untilmarriage education programs. 

HHS, states, and researchers have made a variety of efforts to assess the 

effectiveness of abstinence-until-marriage education programs; however, a 

number of factors limit the conclusions that can be drawn about the 

effectiveness of abstinence-until-marriage education programs. To assess 

the effectiveness of their abstinence-until-marriage education programs, 

ACF and OPA have required their grantees to report on various outcomes. 

For example, as of fiscal year 2006, states that received funding through 

the State Program were required to report annually on four measures of 

the prevalence of adolescent sexual behavior in their state, such as the 

rate of pregnancy among adolescents aged 15 to 17 years. To assess the 

Page 4 GAO-08-664T
effectiveness of both its State and Community-Based Programs, ACF also 

analyzed trends in adolescent behavior, as reflected in national data on

birth rates among teens and the proportion of surveyed high school 

students reporting that they have had sexual intercourse. OPA required 

grantees of the AFL Program to develop and report on outcome measures

that demonstrated the extent to which grantees’ programs are having an 

effect on program participants. Further, 6 of the 10 states in our review 

that received funding through the State Program worked with third-party 

evaluators to assess the effectiveness of abstinence-until-marriage 

education programs in their states. Several factors, however, limit the 

conclusions that can be drawn about the effectiveness of abstinence-untilmarriage education programs. Most of the efforts to evaluate the 

effectiveness of abstinence-until-marriage education programs that we 

described in our report did not meet certain minimum criteria—such as 

random assignment of participants and sufficient follow-up periods and 

sample sizes—that experts have concluded are necessary in order for 

assessments of program effectiveness to be scientifically valid. 

During the course of our work on abstinence-until-marriage education, we

identified a legal matter that required the attention of HHS. Section 

317P(c)(2) of the Public Health Service Act requires educational materials 

specifically designed to address STDs to contain medically accurate 

information about condom effectiveness in preventing the diseases the 

educational materials are designed to address. We concluded that this 

requirement would apply to abstinence-until-marriage education materials 

prepared by and used by federal grant recipients, depending upon the 

substantive content of those materials. In other words, in materials 

otherwise meeting the statutory criteria, HHS’ grantees are required to 

include information on condom effectiveness, and that information must 

be medically accurate. At the time of our review, an ACF official reported 

that materials prepared by abstinence-until-marriage education grantees 

were not subject to section 317P(c)(2). Therefore, we recommended in a

letter dated October 18, 2006, that HHS reexamine its position and adopt

measures to ensure that, where applicable, abstinence-until-marriage 

education materials comply with this requirement. The fiscal year 2007 

Community-Based Program announcement states that mass produced 

materials that as their primary purpose are specifically about STDs are 

required to contain medically accurate information regarding the 

effectiveness or lack of effectiveness of condoms in preventing the STDs 

the educational materials are designed to address. An ACF official also 

told us that future State and Community-Based Program announcements 

would include this language. 

Page 5 GAO-08-664T
Statistics reported by CDC show that many high school students engage in 

sexual behavior that places them at risk for unintended pregnancy and 

STDs. In 2005, 46.8 percent of high school students reported that they have 

had sexual intercourse, with 14.3 percent of students reporting that they 

had had sexual intercourse with four or more persons. CDC also has 

reported that the prevalence of certain STDs—including the rate of 

chlamydia infection, the most frequently reported STD in the United 

States—peaks in adolescence and young adulthood. 

Background 

At the time of our 2006 report, HHS’s strategic plan included the objectives 

to reduce the incidence of STDs and unintended pregnancies and to 

promote family formation and healthy marriages. These two objectives 

supported HHS’s goals to reduce the major threats to the health and wellbeing of Americans and to improve the stability and healthy development 

of American children and youth. Abstinence-until-marriage education 

programs were one of several types of programs that supported these 

objectives. The State Program, the Community-Based Program, and the 

AFL Program provide grants to support the recipients’ own efforts to 

provide abstinence-until-marriage education at the local level. These 

programs must comply with the statutory definition of abstinence 

education (see table 1).6

 6

42 U.S.C. § 710(b)(2). This definition is also referred to as the A-H definition. This statutory

provision defines abstinence education for purposes of the State Program. Annual 

appropriations acts and program announcements have extended this definition to the

Community-Based and AFL Programs. See, e.g., Departments of Labor, Health and Human 

Services, and Education, and Related Agencies Appropriations Act, 2006, Pub. L. No. 109-

149, 119 Stat. 2833, 2855-56. 

Page 6 GAO-08-664T
Table 1: Definition of Abstinence Education

Abstinence education refers to an educational or motivational program that: 

A. has, as its exclusive purpose, teaching the social, psychological, and health gains 

to be realized by abstaining from sexual activity; 

B. teaches abstinence from sexual activity outside marriage as the expected standard

for all school age children; 

C. teaches that abstinence from sexual activity is the only certain way to avoid out-ofwedlock pregnancy, sexually transmitted diseases, and other associated health 

problems; 

D. teaches that a mutually faithful monogamous relationship in context of marriage is 

the expected standard of human sexual activity; 

E. teaches that sexual activity outside of the context of marriage is likely to have 

harmful psychological and physical effects; 

F. teaches that bearing children out-of-wedlock is likely to have harmful 

consequences for the child, the child’s parents, and society;

G. teaches young people how to reject sexual advances and how alcohol and drug 

use increases vulnerability to sexual advances; and 

H. teaches the importance of attaining self-sufficiency before engaging in sexual 

activity. 

Source: Social Security Act, § 510(b)(2) (codified at 42 U.S.C. § 710(b)(2)).

The State Program, administered by ACF, provides funding to its 

grantees—states—for the provision of abstinence-until-marriage education 

to those most likely to have children outside of marriage.7

 States that 

receive grants through the State Program have discretion in how they use 

their funding to provide abstinence-until-marriage education. Funds are 

allotted to each state that submits the required annual application based 

on the ratio of the number of low-income children in the state to the total

number of low-income children in all states. States are required to match 

every $4 they receive in federal money with $3 of nonfederal money and 

are required to report annually on the performance of the abstinence-untilmarriage education programs that they support or administer. In fiscal 

year 2007, 40 states, the District of Columbia, and 3 insular areas were 

awarded funding. 

 7

Funds are also provided through the State Program to the District of Columbia and insular 

areas, which include U.S. territories and commonwealths. In this statement, we refer to 

U.S. territories and commonwealths as “insular areas.” When we refer to “states,” we are

referring to all grantees of the State Program—including states, insular areas, and the

District of Columbia. 

Page 7 GAO-08-664T
The Community-Based Program, which is also administered by ACF, is 

focused on funding public and private entities that provide abstinenceuntil-marriage education for adolescents from 12 to 18 years old. The 

Community-Based Program provides grants for school-based programs, 

adult and peer mentoring, and parent education groups. For fiscal year 

2007, 59 grants were awarded to organizations and other entities. Grantees 

are required to report to ACF, on a semiannual basis, on the performance 

of their programs. 

The AFL Program also supports programs that provide abstinence-untilmarriage education.8

 Under the AFL Program, OPA awards competitive 

grants to public or private nonprofit organizations or agencies, including 

community-based and faith-based organizations, to facilitate abstinenceuntil-marriage education in a variety of settings, including schools and 

community centers. In fiscal year 2007, OPA awarded funding to 36 

grantees. Grantees are required to conduct evaluations of certain aspects 

of their programs and report annually on their performance. 

Five organizational units located within HHS—ACF, OPA, CDC, ASPE, and 

NIH—have responsibilities related to abstinence-until-marriage education. 

ACF and OPA administer the three main federal abstinence-until-marriage 

education programs. CDC supports abstinence-until-marriage education at 

the national, state, and local levels. CDC, ASPE, and NIH are sponsoring 

research on the effectiveness of abstinence-until-marriage programs. 

 8

See 42 U.S.C. § 300z et seq. In this statement, when we use the term AFL Program, we are 

referring only to the abstinence-until-marriage component of the AFL Program. The AFL 

Program also supports other projects for pregnant and parenting adolescents, their infants, 

male partners, and family members. The purpose of these projects is to improve the 

outcomes of early childbearing for teen parents, their infants, and their families. 

Page 8 GAO-08-664T
In October 2006 we reported that efforts by HHS and states to assess the 

scientific accuracy of materials used in abstinence-until-marriage 

education programs had been limited.

9

 ACF—whose grants to the State 

and Community-Based Programs accounted for the largest portion of 

federal spending on abstinence-until-marriage education—did not review

its grantees’ education materials for scientific accuracy and did not require 

grantees of either program to review their own materials for scientific 

accuracy. In addition, not all states funded through the State Program 

chose to review their program materials for scientific accuracy. In contrast

to ACF, OPA reviewed the scientific accuracy of grantees’ proposed 

educational materials and corrected inaccuracies in these materials. 

Federal and State 

Efforts to Assess the 

Scientific Accuracy of 

Materials Used in

Abstinence-untilMarriage Education 

Programs Have Been 

Limited 

ACF Neither Reviewed Nor 

Required Grantees to 

Review Program Materials 

for Scientific Accuracy, 

Although Some State 

Grantees Had Conducted 

Such Reviews 

As of October 2006, there had been limited efforts to review the scientific 

accuracy of educational materials used in ACF’s State and CommunityBased Programs—the two programs that accounted for the largest portion 

of federal spending on abstinence-until-marriage education. ACF did not 

review materials for scientific accuracy in either reviewing grant 

applications or in overseeing grantees’ performance. Prior to fiscal year 

2006, State Program and Community-Based Program applicants were not 

required to submit copies of their proposed educational materials with 

their applications. While ACF required grantees of the Community-Based 

Program—but not the State Program—to submit their educational 

materials with their fiscal year 2006 applications, ACF officials told us that 

grantee applications and materials were only reviewed to ensure that they

addressed all aspects of the scope of the Community-Based Program, such 

as the A-H definition of abstinence education.10 Further, documents 

provided to us by ACF indicated that the agency did not review grantees’ 

educational materials for scientific accuracy as a routine part of its 

oversight activities. In addition, ACF also did not require its grantees to 

review their own materials for scientific accuracy.

While not all grantees of the State Program had chosen to review the 

scientific accuracy of their educational materials, officials from 5 of the 

10 states in our review reported that their states chose to do so. These five

states used a variety of approaches in their reviews. For example, some 

 9

See GAO-07-87. 

10HHS officials told us that if ACF finds inaccurate statements during this more general 

review process or if inaccuracies are brought to their attention at any time during the grant 

period, ACF officials work with the grantees to take corrective action. 

Page 9 GAO-08-664T
states contracted with medical professionals—such as nurses, 

gynecologists, and pediatricians—to serve as medical advisors who review 

program materials and use their expertise to determine what is and is not

scientifically accurate. One of the states required that all statistics or 

scientific statements cited in a program’s materials be sourced to CDC or a 

peer-reviewed medical journal. Officials from this state told us that if 

statements in these materials could not be attributed to these sources, the 

statements were required to be removed until citations were provided and 

materials were approved.

As a result of their reviews, officials from two of the five states reported 

that they had found inaccuracies. One state official cited an instance 

where materials incorrectly suggested that HIV can pass through condoms 

because the latex used in condoms is porous. State officials who have 

identified inaccuracies told us that they informed their grantees of 

inaccuracies so that they could make corrections in their individual 

programs. Some of the educational materials that states reviewed were 

materials that were commonly used in the Community–Based Program. 

While there had been limited review of materials used in the State and 

Community-Based Programs, grantees of these programs had received

some technical assistance designed to improve the scientific accuracy of 

their materials. For example, ACF officials reported that the agency 

provided a conference for grantees of the Community-Based Program in 

February 2006 that included a presentation focused on medical accuracy.

OPA Reviewed Materials 

Used by AFL Program 

Grantees for Scientific 

Accuracy 

As of 2006, in contrast to ACF, OPA reviewed for scientific accuracy the 

educational materials used by AFL Program grantees, and it did so before 

those materials were used. OPA officials said that after grants were 

awarded, a medical education specialist (in consultation with several parttime medical experts) reviewed the grantees’ printed materials and other 

educational media, such as videos. OPA officials explained that the 

medical education specialist must approve all proposed materials before 

they are used. On many occasions, OPA grantees had proposed using—

and therefore OPA has reviewed—materials commonly used in the 

Community-Based Program. For example, an OPA official told us that the

agency had reviewed three of the Community-Based Program’s commonly 

used curricula and was also currently reviewing another curriculum 

commonly used by Community-Based Program grantees. 

Page 10 GAO-08-664T
OPA officials stated that the medical education specialist had occasionally 

found and addressed inaccuracies in grantees’ proposed educational 

materials. OPA officials stated that these inaccuracies were often the 

result of information being out of date because, for example, medical and 

statistical information on STDs changes frequently. OPA addressed these 

inaccuracies by either not approving the materials in which they appeared 

or correcting the materials through discussions with the grantees and, in

some cases, the authors of the materials. In fiscal year 2005, OPA 

disapproved of a grantee using a specific pamphlet about STDs because 

the pamphlet contained statements about STD prevention and HIV 

transmission that were considered incomplete or inaccurate. For example, 

the pamphlet stated that there was no cure for hepatitis B, but the medical 

education specialist required the grantee to add that there was a 

preventive vaccine for hepatitis B. In addition, OPA required that a grantee 

correct several statements in a true/false quiz—including statements about 

STDs and condom use—in order for the quiz to be approved for use. For 

example, the medical education specialist changed a sentence from “The 

only 100% effective way of avoiding STDs or unwanted pregnancies is to

not have sexual intercourse.” to “The only 100% effective way of avoiding

STDs or unwanted pregnancies is to not have sexual intercourse and 

engage in other risky behaviors.” 

While OPA and some states had reviewed their grantees’ abstinence-untilmarriage education materials for scientific accuracy, these types of 

reviews have the potential to affect abstinence-until-marriage education 

providers more broadly, perhaps creating an incentive for the authors of 

such materials to ensure they are accurate. As of October 2006, the 

company that produced one of the most widely used curricula used by 

grantees of the Community-Based Program had updated its curriculum. A 

representative from that company stated that this had been done, in part, 

in response to a congressional review that found inaccuracies in its 

abstinence-until-marriage materials. 

To address concerns about the scientific accuracy of materials used in 

abstinence-until-marriage education programs, we recommended that the 

Secretary of HHS develop procedures to help assure the accuracy of such

materials used in the State and Community-Based Programs.11 We 

recommended that in order to provide such assurance, the Secretary could 

consider alternatives such as (1) extending the approach currently used by 

 11See GAO-07-87. 

Page 11 GAO-08-664T
OPA to review the scientific accuracy of the factual statements included in 

abstinence-until-marriage education to materials used by grantees of 

ACF’s Community-Based Program and requiring grantees of ACF’s State 

Program to conduct such reviews or (2) requiring grantees of both 

programs to sign written assurances in their grant applications that the 

materials they propose using are accurate. In its written comments on a 

draft of our report, HHS stated that it would consider requiring grantees of 

both ACF programs to sign such written assurances to the accuracy of 

their materials. In April 2008, an ACF official reported that, in response to 

our recommendation, ACF began requiring in fiscal year 2007 that 

community-based grantees sign written assurances that the materials they 

propose using are accurate. This official also reported that, starting in 

fiscal year 2008, grantees of the State Program will also be required to sign 

these written assurances. In addition, this official reported that ACF is 

implementing a process to review the accuracy of the proposed curricula 

of fiscal year 2007 Community-based grantees. The ACF official reported 

that the curricula will be reviewed by a research analyst to ensure that all 

statements are referenced to source documents, and then by a healthcare

professional who will compare the information in the curricula to 

information in the source documents. The official also reported that, in the 

future, ACF will require states to provide the agency with descriptions of 

their strategies for reviewing the accuracy of their abstinence-untilmarriage education programs. 

HHS, states, and researchers have made a variety of efforts to assess the 

effectiveness of abstinence-until-marriage education programs; however, a 

number of factors limit the conclusions that can be drawn. ACF and OPA 

have required their grantees to report on various outcomes used to 

measure the effectiveness of grantees’ abstinence-until-marriage education 

programs. To assess the effectiveness of the State and Community-Based 

Programs, ACF has analyzed national data on adolescent birth rates and 

the proportion of adolescents who report having had sexual intercourse. 

As of October 2006, other organizational units within HHS were funding 

studies designed to assess the effectiveness of abstinence-until-marriage 

education programs in delaying sexual initiation, reducing pregnancy and 

STD rates, and reducing the frequency of sexual activity. Despite these 

efforts, several factors limit the conclusions that can be drawn about the 

effectiveness of abstinence-until-marriage education programs. Most of the 

efforts to evaluate the effectiveness of abstinence-until-marriage education 

programs that we reviewed have not met certain minimum criteria that 

experts have concluded are necessary in order for assessments of program 

effectiveness to be scientifically valid, in part because such designs can be 

A Variety of Efforts 

Were Made to Assess 

the Effectiveness of 

Abstinence-untilMarriage Education 

Programs, but a 

Number of Factors 

Limit the Conclusions 

That Can Be Drawn 

Page 12 GAO-08-664T
expensive and time-consuming to carry out. In addition, the results of 

some efforts that meet the criteria of a scientifically valid assessment have 

varied. 

HHS, States, and 

Researchers Have Made a 

Variety of Efforts to Assess 

the Effectiveness of 

Abstinence-until-Marriage 

Education Programs 

ACF has made efforts to assess the effectiveness of abstinence-untilmarriage education programs funded by the State Program and the 

Community-Based Program. One of ACF’s efforts has been to require 

grantees of both programs to report data on outcomes, though the two 

programs have different requirements for the outcomes grantees must 

report.12 As of fiscal year 2006, State Program grantees were required to 

report annually on four measures of the prevalence of adolescent sexual 

behavior in their states, such as the rate of pregnancy among adolescents 

aged 15 to 17 years, and compare these data to program targets over 

5 years. States also were required to develop and report on two additional 

performance measures that were related to the goals of their programs.13

Also as of fiscal year 2006, ACF required Community-Based Program 

grantees to develop and report on outcome measures designed to 

demonstrate the extent to which grantees’ community-based abstinenceuntil-marriage education programs were accomplishing their program 

goals.14 In addition to outcome reporting, ACF required grantees of the 

Community-Based Program to report on program “outputs,” which 

measure the quantity of program activities and other deliverables, such as

the number of participants who are served by the abstinence-untilmarriage education programs. 

 12This reporting is a part of ACF’s efforts to collect evaluative information about these 

programs. These efforts include both performance measurement—the ongoing monitoring

and reporting of program accomplishments toward pre-established goals—and program 

evaluation—individual systematic studies to assess how well a program is working. 

13For example, in fiscal year 2002, state grantees developed such measures as the 

percentage of teens surveyed who show an increase in participating in structured activities 

after school hours; the percentage of live births to women younger than 18, fathered by

men age 20 and older; the percentage of program participants proficient in refusal skills; 

the percentage of high school students who reported using drugs or alcohol before

intercourse; and the percentage of high school students who had sexual intercourse for the

first time before age 13. 

14The fiscal year 2006 program announcement for the Community-Based Program provided 

examples of outcome measures that grantees could use, including increased knowledge of

the benefits of abstinence, the number of youths who commit to abstaining from premarital

sexual activity, and increased knowledge of how to avoid high-risk situations and risk 

behaviors. 

Page 13 GAO-08-664T
As of October 2006, OPA also had made efforts to assess the effectiveness 

of the AFL Program. Specifically, OPA required grantees of the AFL 

Program to develop and report on outcome measures, such as

participants’ knowledge of the benefits of abstinence and their reported 

intentions to abstain from sexual activity, that were used to help 

demonstrate the extent to which grantees’ programs were having an effect

on program participants. To collect data on outcome measures, OPA 

required grantees to administer, at a minimum, a standardized 

questionnaire to their program participants, both when participants begin 

an abstinence-only education program and after the program’s completion. 

OPA officials told us that they were planning to aggregate information 

from certain questions in the standardized set of questionnaires in order to 

report on certain performance measures as part of the agency’s annual

performance reports; the agency expected to begin receiving data from 

grantees that were using these questionnaires in January 2007.

To help grantees measure the effectiveness of their programs, both ACF 

and OPA required that grantees use independent evaluators and have

provided assistance to grantees in support of their program evaluation 

efforts. ACF and OPA required their grantees to contract with third-party 

evaluators, such as university researchers or private research firms, who 

were responsible for helping grantees develop the outcome measures they 

were required to report on and monitoring grantee performance against 

those measures. Unlike ACF, OPA required that these third-party 

evaluations incorporate specific methodological characteristics, such as 

control groups of individuals that did not receive the program and 

sufficient sample sizes to ensure that any observed differences between 

the groups were statistically valid. Both ACF and OPA have provided 

technical assistance and training to their grantees in order to support 

grantees’ own program evaluation efforts. 

ACF also analyzed trends in adolescent behavior, as reflected in national

data on birth rates among teens and the proportion of surveyed high 

school students reporting that they have had sexual intercourse.15 ACF 

used these national data as a measure of the overall effectiveness of its 

State and Community-Based Programs, comparing the national data to

 15Data on teen birth rates and adolescents’ reported sexual behavior are contained in the 

National Vital Statistics System and the Youth Risk Behavior Surveillance System, 

respectively. The former is a national data set of public health statistics reported by states 

to CDC, and the latter is a national data set based on nationwide surveys administered to 

high school students by CDC.

Page 14 GAO-08-664T
program targets. In its annual performance reports, the agency has 

summarized the progress being made toward lowering the rate of births to 

unmarried teenage girls and the proportion of students (grades 9-12) who 

report having ever had sexual intercourse. 

Some states have made additional efforts to assess the effectiveness of 

abstinence-until-marriage education programs. Specifically, we found that 

6 of the 10 states in our review that received funding through ACF’s State 

Program had made efforts to conduct evaluations of selected abstinenceuntil-marriage programs in their state. All 6 of the states worked with 

third-party evaluators, such as university researchers or private research 

firms, to perform the evaluations, which in general measured self-reported 

changes in program participants’ behavior and attitudes related to sex and 

abstinence as indicators of program effectiveness. Four of these states had 

completed third-party evaluations as of February 2006, and the results of 

these studies varied.16 Among those 4 states, 3 states required the 

abstinence programs in their state to measure reported changes in 

participants’ behavior as an indicator of program effectiveness—both at 

the start of the program and after its completion. The 3 states required 

their programs to track participants’ reported incidence of sexual 

intercourse. Additionally, 2 of the 4 states required their programs to track 

biological outcomes, such as pregnancies, births, or STDs. In addition, 6 of 

the 10 states in our review required their programs to track participants’ 

attitudes about abstinence and sex, such as the number of participants 

who make pledges to remain abstinent. 

Besides ACF and OPA, other organizational units within HHS have made

efforts to assess the effectiveness of abstinence-until-marriage education 

programs. As of 2006, ASPE was sponsoring a study of the CommunityBased Program and a study of the State Program. The study of the State 

Program was conducted by Mathematica Policy Research, Inc.

(Mathematica) and completed in 2007. It examined the impact of five 

programs funded through the State Program on participants’ attitudes and 

 16See, for example, LeCroy & Milligan Associates, Inc., Abstinence Only Education 

Program: Fifth Year Evaluation Report, a report prepared for the Arizona Department of

Health Services (2003); Patricia Goodson et al., Abstinence Education Evaluation: Phase 

6, a report prepared for the Texas Department of State Health Services (2005); MGT of

America, Evaluation of Georgia Abstinence Education Programs Funded Under Title V, 

Section 510, a report prepared for the Georgia Department of Human Resources (2005);

Thomas E. Smith, It’s Great to Wait: An Interim Evaluation, a report prepared for the 

Florida Department of Health (2001). 

Page 15 GAO-08-664T
behaviors related to abstinence and sex.17 Like ASPE, CDC has made its 

own effort to assess the effectiveness of abstinence-until-marriage 

education by sponsoring a study to evaluate the effectiveness of two 

middle school curricula—one that complies with abstinence-untilmarriage education program requirements and one that teaches a 

combination of abstinence and contraceptive information and skills. The 

agency expects to complete the study in 2009. Likewise, NIH has funded 

studies comparing the effectiveness of education programs that focus only 

on abstinence with the effectiveness of sex education programs that teach 

both abstinence and information about contraception. As of October 2006,

NIH was funding five studies, which in general were comparing the effects 

of these two types of programs on the sexual behavior and related 

attitudes among groups of either middle school or high school students. 

In addition to the efforts of researchers working on behalf of HHS and 

states, other researchers—such as those affiliated with universities and 

various advocacy groups—have made efforts to study the effectiveness of 

abstinence-until-marriage education programs. This work includes studies 

of the outcomes of individual programs and reviews of other studies on 

the effectiveness of individual abstinence-until-marriage education 

programs. In general, research studies on the effectiveness of individual 

programs have examined the extent to which they changed participants’ 

demonstrated knowledge of concepts taught in the programs, declared 

intentions to abstain from sex until marriage, and reported behavior 

related to sexual activity and abstinence. As of October 2006, the efforts to 

study and build a body of research on the effectiveness of most 

abstinence-until-marriage education programs had been under way for 

only a few years, in part because grants under the two programs that 

account for the largest portion of federal spending on abstinence-untilmarriage education—the State Program and the Community-Based 

Program—were not awarded until 1998 and 2001, respectively.

 17The five abstinence-until-marriage education programs studied were My Choice, My

Future! in Powhatan, Virginia; ReCapturing the Vision in Miami, Florida; Teens in Control 

in Clarksdale, Mississippi; Families United to Prevent Teen Pregnancy in Milwaukee,

Wisconsin; and Heritage Keepers in Edgefield, South Carolina. 

Page 16 GAO-08-664T
Most of the efforts of HHS, states, and other researchers to evaluate the 

effectiveness of abstinence-until-marriage education programs included in

our review have not met certain minimum criteria that experts have 

concluded are necessary in order for assessments of program 

effectiveness to be scientifically valid. In an effort to better assess the 

merits of the studies that have been conducted on the effectiveness of 

sexual health programs—including abstinence-until-marriage education 

programs—scientific experts have developed criteria that can be used to 

gauge the scientific rigor of these evaluations. The reports of two panels of 

experts,18,19 as well as the experts we interviewed in the course of our 

previous work, generally agreed that scientifically valid studies of a 

program’s effectiveness should include the following characteristics: 

Several Factors Limit the 

Conclusions That Can Be 

Drawn about the 

Effectiveness of 

Abstinence-until-Marriage 

Education Programs 

• An experimental design that randomly assigns individuals or schools to 

either an intervention group or control group, or a quasi-experimental 

design that uses nonrandomly assigned but well-matched comparison 

groups. According to the panel of scientific experts convened by the 

National Campaign to Prevent Teen Pregnancy, experimental designs or 

quasi-experimental designs with well-matched comparison groups have at

least three important strengths that are typically not found in other 

studies, such as those that use aggregated data: they evaluate specific 

programs with known characteristics, they can clearly distinguish between 

participants who did and did not receive an intervention, and they control 

for other factors that may affect study outcomes. According to scientific 

experts, studies that include experimental or quasi-experimental designs 

should also collect follow-up data for a minimum number of months after 

subjects receive an intervention. In addition, experts have reported that 

studies should have a sample size of at least 100 individuals for study 

results to be considered scientifically valid. 

• Studies should assess or measure changes in biological outcomes or 

reported behaviors instead of attitudes or intentions. According to 

scientific experts, biological outcomes—such as pregnancy rates, birth 

rates, and STD rates—and reported behaviors—such as reported initiation

and frequency of sexual activity—are better measures of the effectiveness 

 18See Kirby. This panel included experts from NIH, the Medical Institute for Sexual Health,

the Alan Guttmacher Institute, the Institute for Research and Evaluation, and various

universities. 

19See Satcher. This panel included experts from a variety of organizations, including the

Medical Institute for Sexual Health, the Alan Guttmacher Institute, and the American 

Academy of Pediatrics. 

Page 17 GAO-08-664T
of abstinence-until-marriage programs, because adolescent attitudes and 

intentions may or may not be indicative of actual behavior. 

Many of the efforts by HHS, states, and other researchers that we 

identified in our review lack at least one of the characteristics of a 

scientifically valid study of program effectiveness. Most of the efforts to 

assess the effectiveness of these programs have not used experimental or 

quasi-experimental designs with sufficient follow-up periods and sample 

sizes. For example, ACF used, according to ACF officials, grantee 

reporting on outcomes in order to monitor grantees’ performance, target 

training and technical assistance, and help grantees improve service 

delivery. However, because the outcomes reported by grantees have not 

been produced through experimentally or quasi-experimentally designed 

studies, such information cannot be causally attributed to any particular 

abstinence-until-marriage education program. Further, none of the state 

evaluations we reviewed that had been completed included randomly 

assigned control groups. Similarly, some of the journal articles that we 

reviewed described studies to assess the effectiveness of abstinence-untilmarriage programs that also lacked at least one of the characteristics of a 

scientifically valid study of program effectiveness. In these studies, 

researchers administered questionnaires to study participants before and

after they completed an abstinence-until-marriage education program and 

assessed the extent to which the responses of participants changed.20

These studies did not compare the responses of study participants with a 

group that did not participate in an abstinence-until-marriage education 

program. 

Like the lack of an experimental or quasi-experimental design, not 

measuring changes in behavioral or biological outcomes among 

participants limits the conclusions that can be drawn about the 

effectiveness of abstinence-until-marriage education programs. Most of the 

efforts we identified in our review used reported intentions and attitudes 

in order to assess the effectiveness of abstinence-until-marriage programs. 

For example, as of 2006, neither ACF’s community-based grantees nor 

OPA’s AFL grantees were required to report on behavioral or biological

outcomes, such as rates of intercourse or pregnancy. Similarly, the journal 

articles we reviewed were more likely to use reported attitudes and 

 20See, for example, S. M. Fitzgerald et al., “Effectiveness of the Responsible Social Values 

Program for 6th Grade Students in One Rural School District,” Psychological Reports, 

vol. 91 (2002), and J. E. Barnett and C. S. Hurst, “Abstinence Education for Rural Youth: An

Evaluation of the Life’s Walk Program,” The Journal of School Health, vol. 73, no. 7 (2003). 

Page 18 GAO-08-664T
intentions—such as study participants’ reported attitudes about premarital 

sexual activity or their reported intentions to remain abstinent until 

marriage—rather than their reported behaviors or biological outcomes to 

assess the effectiveness of abstinence-until-marriage programs. 

According to scientific experts, HHS, states, and other researchers face a 

number of challenges in applying either of these criteria. According to 

these experts, experimental or quasi-experimental studies can be 

expensive and time-consuming to carry out, and many grantees of 

abstinence-until-marriage education programs have insufficient time and 

funding to support these types of studies. Moreover, it can be difficult for 

researchers assessing abstinence-until-marriage education programs to 

convince school districts to participate in randomized intervention and 

control groups, in part because of sensitivities to surveying attitudes, 

intentions, and behaviors related to abstinence and sex. Similarly, experts, 

as well as state and HHS officials, have reported that it can be difficult to

obtain scientifically valid information on biological outcomes and sexual

behaviors. For example, experts have reported that when measuring a 

program’s effect on biological outcomes—such as reducing pregnancy

rates or birth rates—it is necessary to have large sample sizes in order to 

determine whether a small change in such outcomes is the result of an 

abstinence-until-marriage education program. 

Among the assessment efforts we identified are some studies that meet the 

criteria of a scientifically valid effectiveness study. However, results of 

these studies varied, and this limits the conclusions that can be drawn 

about the effectiveness of abstinence-until-marriage education programs. 

Some researchers have reported that abstinence-until-marriage education 

programs have resulted in adolescents reporting having less frequent 

sexual intercourse or fewer sexual partners.21 For example, in one study of

middle school students, participants in an abstinence-until-marriage 

education program who had sexual intercourse during the follow-up 

period were 50 percent less likely to report having two or more sexual 

partners when compared with their nonparticipant peers.22 In contrast, 

 21See E. A. Borawski et al., “Effectiveness of Abstinence-only Intervention in Middle School 

Teens,” American Journal of Health Behavior, vol. 29, no. 5 (2005). See also T. L. St. Pierre 

et al., “A 27-Month Evaluation of a Sexual Activity Prevention Program in Boys & Girls

Clubs Across the Nation,” Family Relations, vol. 44, no. 1 (1995). 

22See Borawski et al., “Effectiveness of Abstinence-only Intervention in Middle School 

Teens,”. 

Page 19 GAO-08-664T
other studies have reported that abstinence-until-marriage education 

programs did not affect the reported frequency of sexual intercourse or 

number of sexual partners.23 For example, one study of middle school 

students found that participants of an abstinence-until-marriage program 

were not less likely than nonparticipants at the 1 year follow-up to report 

less frequent sexual intercourse or fewer sexual partners.24 Experts with 

whom we spoke emphasized that there were still too few scientifically 

valid studies completed as of 2006 that could be used to determine 

conclusively which, if any, abstinence-until-marriage programs are 

effective. 

We identified two key studies that experts anticipated would meet the 

criteria of a scientifically valid effectiveness study. Experts and federal 

officials we interviewed stated that they expected the results of these two 

federally funded studies to add substantively to the body of research on 

the effectiveness of abstinence-until-marriage education programs. One of 

these key studies—the final Mathematica report, contracted by ASPE, on

the State Program—has been completed.25 In this report, the researchers 

found that youth who participated in the abstinence-until-marriage 

education programs were no more likely than control group youth to have 

abstained from sex, and among those who reported having had sex, they 

had similar numbers of sexual partners and had initiated sex at the same 

average age. The youth in abstinence-until-marriage education programs 

also were no more likely to have engaged in unprotected sex than control 

group youth. The second key study we identified is CDC’s research on 

middle school programs, which is still ongoing. In addition, since October

2006, a third key report was released, presenting the 2007 analysis of the 

 23See N. G. Harrington et al., “Evaluation of the All Stars Character Education and Problem 

Behavior Prevention Program: Effects on Mediator and Outcome Variables for Middle 

School Students,” Health Education & Behavior, vol. 28, no. 5 (2001). See also J. B.

Jemmott III, L. S. Jemmott, and G. T. Fong, “Abstinence and Safer Sex HIV Risk-Reduction 

Interventions for African American Adolescents: A Randomized Controlled Trial,” Journal 

of the American Medical Association, vol. 279, no. 19 (1998). 

24See Harrington et al., “Evaluation of the All Stars Character Education and Problem 

Behavior Prevention Program: Effects on Mediator and Outcome Variables for Middle 

School Students.” 

25See Trenholm at al., Impacts of Four Title V, Section 510 Abstinence Education

Programs: Final Report, a report prepared for ASPE, 2007. According to several scientific 

experts, Mathematica’s study is an important one, in part because of its sound design: the

study randomly assigns and compares control groups with groups receiving abstinenceuntil-marriage education and uses surveys to follow up with program participants for 

several months after their completion of a program. 

Page 20 GAO-08-664T
National Campaign to Prevent Teen and Unplanned Pregnancy of the

available research on abstinence-until-marriage education programs. This 

report stated that studies of abstinence programs have not produced 

sufficient evidence of effectiveness, and that efforts should be directed 

toward further evaluation of these programs.26

During the course of our work on abstinence-until-marriage education, we

identified a federal statutory provision—section 317P(c)(2) of the Public 

Health Service Act—relevant to the grants provided by HHS’s State 

Program, Community-Based Program, and AFL Program.27 This provision 

requires that educational materials prepared by HHS’s grantees, among 

others, that are specifically designed to address STDs, contain medically 

accurate information regarding the effectiveness or lack of effectiveness 

of condoms in preventing the diseases the materials are designed to 

address. 

At the time of our review, an ACF official reported that materials prepared 

by abstinence-until-marriage education grantees were not subject to 

section 317P(c)(2). However, we concluded that this requirement would 

apply to abstinence-until-marriage education materials prepared by and 

used by federal grant recipients, depending upon the substantive content 

of those materials. In other words, in materials specifically designed to 

address STDs, HHS’s grantees are required to include information on 

condom effectiveness, and that information must be medically accurate. 

Therefore, we recommended in a letter dated October 18, 2006, that HHS 

reexamine its position and adopt measures to ensure that, where 

applicable, abstinence education materials comply with this requirement.28

Statutory 

Requirement to 

Include Information 

on Condom 

Effectiveness Would 

Apply to Certain 

Abstinence-untilMarriage Education 

Materials 

 26See Douglas Kirby, Emerging Answers 2007: Research Findings on Programs to Reduce 

Teen Pregnancy and Sexually Transmitted Diseases (Washington D.C.: National 

Campaign to Prevent Teen and Unplanned Pregnancy, 2007).

2742 U.S.C. § 247b-17(c)(2). Section 317P(c)(2) states that “. . . educational and prevention 

materials prepared and printed . . . for the public and health care providers by the Secretary

(including materials prepared through the Food and Drug Administration, the Centers for 

Disease Control and Prevention, and the Health Resources and Services Administration) or

by contractors, grantees, or subgrantees thereof, that are specifically designed to address 

STDs . . . shall contain medically accurate information regarding the effectiveness or lack 

of effectiveness of condoms in preventing the STD the materials are designed to address. 

Such requirement only applies to materials mass produced for the public and health care

providers, and not to routine communications.” 

28See GAO, B-308128, Oct. 18, 2006. 

Page 21 GAO-08-664T
In a letter to us dated January 16, 2007, ACF responded that it would take 

steps to “make it clear to grantees that when they mass produce materials 

that as a primary purpose are specifically about STDs those materials are 

required by section 317P(c)(2) of the Public Health Service Act to contain

medically accurate information regarding the effectiveness or lack of 

effectiveness of condoms in preventing the sexually transmitted disease 

the materials are designed to address.” The fiscal year 2007 CommunityBased Program announcement states that mass produced materials that as

their primary purpose are specifically about STDs are subject to this 

requirement. The announcement also states that mass produced materials 

are considered to be specifically designed to address STDs if more than 

50 percent of the content is related to STDs. An ACF official also told us 

that future State and Community-Based Program announcements would 

include this language.29

Mr. Chairman, this completes my prepared remarks. I will be happy to 

answer questions you or other Committee Members may have.

For further information regarding this testimony, please contact 

Marcia Crosse at (202) 512-7114 or crossem@gao.gov. Contact points for 

our Offices of Congressional Relations and Public Affairs may be found on

the last page of this statement. Major contributors to this report were 

Kristi Peterson, Assistant Director; Kelly DeMots; Cathleen Hamann; 

Helen Desaulniers; and Julian Klazkin. 

Contact and 

Acknowledgments 

 29OPA reported that, as a matter of policy, it has required since 1993 that AFL Program

materials that include information regarding STDs contain medically accurate information 

regarding the effectiveness or lack of effectiveness of condoms in preventing the STDs 

addressed in the materials. Further, OPA reported that, since November 2006, OPA has

taken additional steps to inform grantees about OPA’s policy and the need to be compliant 

with the requirements of Section 317P(c)(2) of the Public Health Service Act. 

(290699) Page 22 GAO-08-664T
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