Recent statistics from 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 ever had sexual intercourse, with 14.3 percent of students reporting that they had had sexual intercourse with four or more persons. The likelihood of ever having sexual intercourse varied by grade, with the highest rate among 12th grade students (63.1 percent) and the lowest rate among 9th grade students (34.3 percent). 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. According to CDC, in 2004 the chlamydia rates among adolescents 15 to 19 years old (1,579 cases per 100,000 adolescents) and young adults 20 to 24 years old (1,660 cases per 100,000) were each more than twice the rates among all other age groups. HHS’s current strategic plan includes the objectives to reduce the incidence of STDs and unintended pregnancies and to promote family formation and healthy marriages. These two objectives support HHS’s goals to reduce the major threats to the health and well-being of Americans and to improve the stability and healthy development of American children and youth, respectively. Abstinence-until-marriage education programs are one of several types of programs that support these objectives. The three main federal abstinence-until-marriage education programs— 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). 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. States that receive grants through the State Program have discretion in how they use their funding to provide abstinence-until-marriage education. Some require that organizations apply for funds and use them to administer abstinence- until-marriage education programs. Others may directly administer such programs. At their discretion, states may also provide mentoring, counseling, and adult supervision to adolescents to promote abstinence from sexual activity until marriage. The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 established the State Program, and states were awarded grants beginning in fiscal year 1998. 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-until-marriage education programs that they support or administer. In fiscal year 2005, 47 states, the District of Columbia, and 3 insular areas were awarded funding. The Community-Based Program, which is also administered by ACF, is focused on funding public and private entities that provide abstinence- until-marriage education for adolescents from 12 to 18 years old, with the purpose of creating an environment within communities that supports adolescent decisions to postpone sexual activity until marriage. The Community-Based Program provides grants for school-based programs, adult and peer mentoring, and parent education groups. The Community- Based Program first awarded grants in fiscal year 2001. Grantees of the Community-Based Program are selected through a competitive process and are evaluated according to several criteria, such as the extent to which they have demonstrated that a need exists for abstinence-until-marriage education for a targeted population or in a specific geographic location. Grantees are required to report to ACF, on a semiannual basis, on the performance of their programs. For fiscal year 2005, 63 grants were awarded to organizations and other entities. The AFL Program supports programs that provide abstinence-until- marriage education. The primary purpose of these programs is to find effective means of reaching preadolescents and adolescents before they become sexually active in order to encourage them to abstain from sexual activity and other risky behaviors. 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 abstinence-until-marriage education in a variety of settings, including schools and community centers. Established in 1981, the AFL Program began awarding grants in fiscal year 1982. AFL Program grantees include school districts, youth development groups, and medical centers. Grant applicants are evaluated based on several criteria, such as the extent to which they provide a clear statement of mission, goals, measurable objectives, and a reasonable method for achieving their objectives. Grantees are required to conduct evaluations of certain aspects of their programs and report annually on their performance. As of August 2006, OPA funded 58 abstinence-until-marriage education programs, and most of these were focused on reaching young adolescents from the ages of 9 to 14. Funding provided by HHS for abstinence-until-marriage education programs has increased steadily since 2001 (see table 2). For the three main programs combined—the State Program, the Community-Based Program, and the AFL Program—the amount of agency funding increased from about $73 million in fiscal year 2001 to about $158 million in fiscal year 2005. Nearly all of this increase was for the Community-Based program; funding under this program increased by about $84 million from fiscal years 2001 through 2005. In fiscal year 2005, agency funding for the Community-Based Program constituted the largest share of the total funding (about 66 percent) for the three main programs combined. Within each of the three main abstinence-until-marriage education programs, the amount of individual grants varied. In fiscal year 2005, the State Program’s annual grants ranged from $57,057 to $4,777,916 and the median annual grant amount was $569,675. That same year, the Community-Based Program’s annual grants ranged from $213,276 to $800,000 and the median grant amount was $642,250. In fiscal year 2006, the AFL Program’s annual grants ranged from $95,676 to $300,000 and the median grant amount was $225,000. 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. ACF is responsible for federal programs that promote the economic and social well-being of families, children, individuals, and communities. ACF administers and provides oversight of both the State Program and the Community-Based Program by, among other things, awarding grants, providing training and technical assistance to grantees, and requiring annual performance reporting from grantees. ACF has been responsible for the State Program since June 2004 and the Community-Based Program since October 2005. HRSA previously administered these programs. OPA has responsibility for advising the Secretary of HHS on a wide range of reproductive health topics, including adolescent pregnancy and family planning. The office is also responsible for administering programs that provide services for pregnant and parenting teens and prevention programs, such as abstinence-until-marriage education programs. OPA administers and provides oversight of the AFL Program by awarding grants, providing training and technical assistance to grantees, and requiring annual performance reporting from grantees. CDC is primarily responsible for the prevention and control of infectious and chronic diseases, including STDs. CDC provides funding to state and local education agencies in their efforts to support comprehensive school health education and HIV/STD prevention education programs, and CDC officials told us that some of these are focused on abstinence. CDC also provides funding to several state education agencies to implement various abstinence projects, such as collaboration-building among agencies to increase the impact of their efforts to encourage abstinence. Further, CDC develops tools to assist state and local education agencies with their health education programs. CDC provides funding to several national organizations to build the capacity of abstinence-until-marriage education providers. Organizations’ activities include, but are not limited to, the development and distribution of educational materials. CDC is also sponsoring research on the effectiveness of an abstinence-until-marriage education program. ASPE advises the Secretary of HHS in several areas, including policy development in health, human services, data, and science. ASPE is responsible for the development of policy analyses and it conducts research and evaluation studies in several areas, including the health of children and adolescents. ASPE is currently sponsoring research on the effectiveness of abstinence-until-marriage education programs. NIH is the primary federal agency that conducts and supports medical and behavioral research among various populations, including children and adolescents. NIH is currently sponsoring research on the effectiveness of abstinence-until-marriage education programs. Efforts by HHS and states to assess the scientific accuracy of materials used in abstinence-until-marriage education programs have been limited. ACF—which awards grants to two programs that account for the largest portion of federal spending on abstinence-until-marriage education—does not review its grantees’ education materials for scientific accuracy and does not require grantees of either program to review their own materials for scientific accuracy. In addition, not all states funded through the State Program have chosen to review their program materials for scientific accuracy.