Validation of a new in vitro Sun Protection Factor method to include a wide range of sunscreen product emulsion types.

In 2017, Cosmetics Europe performed a double-blinded ring test of 24 emulsion-type sunscreen products, across 3 in vivo test laboratories and 3 in vitro test laboratories, using a new candidate in vitro SPF test method. Based on the results of this work, an article was published showing how data derived from a new lead candidate method conform to new International Standards (ISO) acceptance criteria for alternative SPF test methods (Any alternative method should consider the matrix effect and if required, specify the matrix applicability of the method; Criterion 1a: Systematic differences between methods should be negligible: 95% of all individual results of an alternative method are within the range of ±2× reproducibility standard deviation of the in vivo method, that is overall bias must be below 0.5× reproducibility standard deviation of the in vivo method; Criterion 1b: Measurement uncertainty of an alternative method should be below the measurement uncertainty of the in vivo method. Candidate method predicted values must fall within the full 'funnel' (SPF 6-50+) limits proposed by Cosmetics Europe (derived from the same minimum test design, that is using the ISO24444 Method to measure at least 24 products across at least 3 laboratories using at least 5 test subjects/laboratory, in a blinded fashion).). Of the 24 sunscreen products tested, the majority of emulsions were of the oil-in-water (O/W) type, whereas only one was water-in-oil (W/O) and there were no products with a mineral-only sun filter system. In order to confirm the scope of this method, therefore, a new study was conducted that included 73 W/O (12 mineral + organic, 44 mineral only and 17 organic only) and 3 O/W mineral-only, emulsion-type sunscreen products (a total of 76 new sunscreen products). When combined with the previous 24 products (tested in 3 different laboratories), this yielded a new data set comprising a total of 100 emulsion-type sunscreen products, with SPF values ranging from 6 to 50+ (with a total of 148 data points). These products were tested using the double-plate in vitro SPF test method and compared with the ISO TC217/WG7 acceptance criteria for alternative SPF test methods. Over 95% of paired in vitro: in vivo SPF values lay within the upper and lower limits of the ISO acceptance criteria funnel, with no bias. This new in vitro SPF test method, therefore, meets the minimum requirements for an alternative SPF test method to ISO24444:2010, for emulsion-type sunscreen products (which make up the majority of marketed sunscreen products).

En 2017, Cosmetics Europe a réalisé un ring test en double aveugle de 24 produits de protection solaire de type émulsion, dans 3 laboratoires de test in vivo et 3 laboratoires de test in vitro, en utilisant une nouvelle méthode de test SPF in vitro. Sur la base des résultats de ces travaux, un article a été publié montrant comment les données dérivées de cette nouvelle méthode sont conformes aux nouveaux critères d'acceptation des normes internationales (ISO) pour les méthodes de test SPF alternatives. Sur les 24 produits de protection solaire testés, la majorité des émulsions étaient du type huile dans l'eau (H / E), tandis qu'un seul était de l'eau dans l'huile (E / H) et il n'y avait aucun produit contenant uniquement des minéraux. Afin de confirmer cette méthode, une nouvelle étude a donc été menée comprenant 73 produits E/ H (12 produits contenant des filtres minéraux + organiques, 44 produits contenant des filtres minéraux uniquement et 17 produits contenant des filtres organiques uniquement) et 3 produits H / E contenant des filtres minéraux uniquement, tous de type émulsion (donc un un total de 76 nouveaux produits de protection solaire). Combiné aux 24 produits précédents (testés dans 3 laboratoires différents), cela a donné un nouvel ensemble de données comprenant un total de 100 produits de protection solaire de type émulsion, avec des valeurs SPF allant de 6 à 50+ (avec un total de 148 points de données) . Ces produits ont été testés à l'aide de la méthode de test SPF in vitro double approche et comparés aux critères d'acceptation de l'ISO TC217 / WG7 pour les méthodes alternatives du SPF in vivo. Plus de 95% des valeurs de SPF appariées in vitro: in vivo se situent dans les limites supérieure et inférieure de l'entonnoir des critères d'acceptation ISO, sans biais. Cette nouvelle méthode de test SPF in vitro, par conséquent, répond aux exigences minimales d'une méthode de test SPF alternative à ISO24444: 2010, pour les produits de protection solaire de type émulsion (qui constituent la majorité des produits de protection solaire commercialisés).

Fresh or Frozen Embryo Transfer in In Vitro Fertilization: An Update.

The past decade has witnessed a rapid increase in the number of frozen-thawed embryo transfer (FET) cycles. Several factors have contributed to the increase in FET cycles, including improvement in culture media, vitrification, and an increase in preimplantation genetic testing of embryos. However, the accelerated trend in FET cycles also suggests that FET may be preferred over fresh embryo transfer. The current review explores the factors that have influenced this practice shift toward preferential FET and why this shift may be premature.

Anti-inflammatory / anti-oxidant activity of ingredients of sunscreen products? Implications for SPF.

OBJECTIVE: The Sun Protection Factor (SPF) of sunscreen products is derived from testing in vivo their ability to prevent erythema ("sunburn"). Recently, certain articles have raised concerns that sunscreen products may actively suppress erythema via anti-inflammatory / anti-oxidant (AI/AO) activity. These articles reason that this may result in a higher labelled SPF value than that provided by the efficacy of the UVR filters alone, giving consumers a "false sense of security". On the other hand, since inflammatory processes are known to play a role in the mechanisms of photodamage / skin cancer induction and propagation, AI/AO activity may provide valuable incremental photoprotective benefit (provided that there is no interference with visible erythema). The objective of these studies, therefore, was to investigate the potential of AI/AO ingredients to suppress UVR-induced erythemal response in human skin, in vivo. METHODS: In vivo studies with SPF30 sunscreen formulations containing a variety of AI/AO ingredients were performed according to the International Standard ISO24444:2010 method. While ISO24444:2010 requires assessment of erythema at 20 ± 4h post-irradiation, an additional assessment at 5 h post-irradiation was also used to determine potential delay in erythema development. RESULTS: None of the formulations, containing a variety of AI/AO ingredients, influenced SPF determination in comparison to the vehicle formulation. CONCLUSION: Our in vivo results demonstrate that commonly-used AI/AO ingredients, at concentrations typically used in sunscreen products, neither influence SPF value nor delay erythemal response, i.e., the measured SPF reflects the true photoprotective capacity of the product.

OBJECTIF: Le facteur de protection solaire (SPF) des produits de protection solaire est dérivé de tests in vivo servant à déterminer leur capacité à prévenir un érythème (« coup de soleil ¼). Récemment, certains articles ont soulevé des inquiétudes en insinuant que les produits de protection solaire pourraient activement faire disparaître un érythème par le biais d'une activité anti-inflammatoire/anti-oxydante (AI/AO). Ces articles soutiennent que cela pourrait impliquer une valeur déclarée du SPF plus élevée que celle fournie par l'efficacité des filtres RUV à eux seuls, donnant ainsi une « fausse impression de sécurité ¼ aux consommateurs. D'autre part, étant donné que les processus inflammatoires sont réputés jouer un rôle dans les mécanismes de photo-altération/d'induction et de propagation du cancer de la peau, l'activité AI/AO pourrait apporter un précieux bénéfice photo-protecteur amplifié (à condition qu'il n'y ait aucune interférence avec un érythème visible). L'objectif de ces études était, par conséquent, d'étudier le potentiel des ingrédients contribuant à l'activité AI/AO à faire disparaître la réponse érythémateuse induite par les RUV dans la peau humaine, in vivo. MÉTHODES: Des études in vivo avec des formules de produits solaires à SPF30 contenant une variété d'ingrédients contribuant à l'activité AI/AO ont été effectuées conformément à la méthode correspondant à la norme internationale ISO24444:2010. Bien que l'ISO24444:2010 nécessite l'évaluation de l'érythème à 20 _ 4 heures post-irradiation, une évaluation supplémentaire à 5 heures post-irradiation a également été utilisée pour déterminer l'éventuel délai d'apparition d'un érythème. RÉSULTATS: Aucune des formules, contenant une variété d'ingrédients contribuant à l'activité AI/AO, n'a influencé la détermination du SPF par comparaison à la formule véhicule. CONCLUSION: Nos résultats in vivo démontrent que les ingrédients contribuant à l'activité AI/AO fréquemment utilisés, aux concentrations généralement utilisées dans les produits de protection solaire, n'influencent pas la valeur du SPF, pas plus qu'ils ne retardent la réponse érythémateuse, autrement dit, le SPF mesuré reflète la véritable capacité photo-protectrice du produit.

Validation of an in vitro sun protection factor (SPF) method in blinded ring-testing.

OBJECTIVE: The objective of this work was to investigate the utility of a new in vitro SPF test method in blinded ring-testing, against new ISO acceptance criteria. METHODS: Twenty four blinded, commercial, emulsion-type, primary sunscreen products, covering the full range of labelled SPF in Europe (SPF6 - 50+), were tested by three test institutes using the current ISO24444:2010 In Vivo SPF Test Method and simultaneously by three separate test laboratories using a new candidate in vitro SPF test method, developed under the leadership of Cosmetics Europe (CE). The resulting relationship between in vitro SPF and in vivo SPF values was then compared with acceptance criteria developed recently by the International Standards (ISO) TC217/WG7 Sun Protection Test Methods Working Group. RESULTS: Analysis of the mean inter-laboratory in vitro and mean inter-institute in vivo SPF values revealed a strong correlation between in vitro and in vivo values, with a Pearson correlation coefficient of r2  = 0.88 (P < 0.0001), a slope of 1.01 and a non-significant intercept (-1.48; P = 0.62). When these data were compared to the new ISO WG7 acceptance criteria, method bias was found to be extremely low and over 95% of the coupled data lay within the model 'funnel' (defined by upper and lower confidence intervals). CONCLUSION: In conclusion, the results of blinded ring testing and comparison to new ISO WG7 acceptance criteria indicate that a new in vitro SPF test method meets (and exceeds) these minimum criteria and is an interesting candidate for possible deployment as an industry test methodology.

4-n-butylresorcinol, a highly effective tyrosinase inhibitor for the topical treatment of hyperpigmentation.

BACKGROUND: Hyperpigmentary disorders like melasma, actinic and senile lentigines are a major cosmetic concern. Therefore, many topical products are available, containing various active ingredients aiming to reduce melanin production and distribution. The most prominent target for inhibitors of hyperpigmentation is tyrosinase, the key regulator of melanin production. Many inhibitors of tyrosinase are described in the literature; however, most of them lack clinical efficacy. METHODS: We were interested in evaluating the inhibition of skin pigmentation by well-known compounds with skin-whitening activity like hydroquinone, arbutin, kojic acid and 4-n-butylresorcinol. We compared the inhibition of human tyrosinase activity in a biochemical assay as well as inhibition of melanin production in MelanoDerm skin model culture. For some compounds, the in vivo efficacy was tested in clinical studies. RESULTS: Arbutin and hydroquinone only weakly inhibit human tyrosinase with a half maximal inhibitory concentration (IC(50)) in the millimolar range. Kojic acid is 10 times more potent with an IC(50) of approximately 500 µmol/L. However, by far the most potent inhibitor of human tyrosinase is 4-n-butylresorcinol with an IC(50) of 21 µmol/L. In artificial skin models, arbutin was least active with an IC(50) for inhibition of melanin production > 5000 µmol/L. Kojic acid inhibited with an IC(50) > 400 µmol/L. Interestingly, hydroquinone inhibited melanin production in MelanoDerms with an IC(50) below 40 µmol/L, probably due to a mechanism different from tyrosinase inhibition. Again, 4-n-butylresorcinol was the most potent inhibitor with an IC(50) of 13.5 µmol/L. In vivo efficacy of 4-n-butyl-resorcinol was confirmed in clinical studies. Subjects with age spots on the forearm treated twice daily two age spots with a formula containing 4-n-butylresorcinol and two control age spots with the corresponding vehicle. Within 8 weeks, 4-n-butylresorcinol reduced visibly the appearance of age spots, while the control spots showed no improvement. A second study showed that 4-butylresorcinol was more effective than 4-hexylresorcinol and 4-phenylethylresorcinol. CONCLUSION: The present in vitro and in vivo data prove the high inhibitory capacity of 4-n-butylresorcinol on human tyrosinase activity, exceeding by far the potency of hydroquinone, arbutin and kojic acid. The resulting clinical improvement of skin hyperpigmentations reveals 4-n-butylresorcinol as a very valuable active compound for the management of pigmentation disorders.

The revised COLIPA in vitro UVA method.

A multicentred study derived from the COLIPA in vitro UVA method was performed to assess the influence of test conditions on UVA protection factor (UVAPF) values in terms of amplitude, reproducibility between laboratories and correlation with in vivo UVA results. Eight products with a range of in vivo UVAPF from three to 29 were used. Two different types of plates, namely high-roughness (5 µm) and low-roughness (2 µm) plates, were used with a different application rate for each (1.3 mg cm(-2) and 0.75 mg cm(-2) respectively). The UVR dose applied to both plate types followed the same principle as the original test (1.2 J. cm(-2)  × UVAPF0). Strong, significant correlations between in vitro and in vivo UVAPF values were observed for both plate types (Pearson correlation > 0.9, P ≤ 0.01). The correlation and slope obtained with the low-roughness plates confirmed the previous results obtained by COLIPA. Across all laboratories, higher UVAPF values were obtained on the high-roughness plates (P < 0.01). Reproducibility of UVAPF values between laboratories was comparable between the two plate roughness values (low roughness, COV = 8%; high roughness, COV = 12%). Considering the in vitro/in vivo comparisons, a regression slope of 0.83 was observed for the low-roughness plates, in comparison with a value of 1.05 for the high-roughness plates. The accuracy of the method was improved, therefore, with the use of the high-roughness plates. With a constraint to recommend the use of only one plate type in the COLIPA UVA in vitro Test, the high-roughness plate was selected on an on-going basis to limit variability of results and to provide better accuracy with in vivo data.

Optimal lead follicle size for human chorionic gonadotropin trigger in clomiphene citrate and intrauterine insemination cycles: an analysis of 1,676 treatment cycles.

OBJECTIVE: To identify the optimal lead follicle size for hCG trigger in clomiphene citrate (CC)-intrauterine insemination (IUI) cycles. DESIGN: Retrospective cohort study. SETTING: University-affiliated center. PATIENT(S): Patients <40 years of age with ovulatory dysfunction or unexplained infertility undergoing their first CC-IUI cycle. INTERVENTION(S): Ovulation induction, hCG trigger, and IUI. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate (CPR) was the primary outcome and was plotted against lead follicle size in increments of 1 mm. Odds ratios with 95% confidence intervals for associations between lead follicle size and CPR were calculated from a multivariable logistic regression model. A receiver operating characteristic (ROC) curve was generated for CPR as a function of lead follicle size. RESULT(S): 1,676 cycles were included. The overall CPR was 13.8% (232/1,676). There was no difference in baseline demographics or ovulation induction parameters of patients who did or did not conceive. The odds of clinical pregnancy were 2.3 and 2.2 times higher with lead follicle sizes of 21.1-22.0 mm and >22.0 mm, respectively, compared with the referent category of 19.1-20.0 mm. Lead follicle size was an independent predictor of CPR, even after accounting for confounders. A lead follicle size of 22.1 mm corresponded to a sensitivity and specificity of 80.1% and 90.4% for clinical pregnancy, respectively, with an area under the ROC curve of 0.89. CONCLUSION(S): hCG administration at a lead follicle size of 21.1-22.0 mm is associated with higher odds of clinical pregnancy in patients undergoing their first CC-IUI cycles for ovulatory dysfunction or unexplained infertility.

Weapon-carrying, physical fighting, and fight-related injury among U.S. adolescents.

INTRODUCTION: Access to firearms and other weapons has been cited as an important factor contributing to the rise in violence-related injury among adolescents in the United States. METHODS: Data from the Youth Risk Behavior Survey supplement to the 1992 National Health Interview Survey were analyzed to examine relationships among weapon-carrying, physical fighting, and fight-related injury among U.S. adolescents aged 12-21 years (N = 10,269). Adjusted odds ratios (OR) were used to describe the association of weapon-carrying during the past 30 days with physical fighting and fight-related injury during the past 12 months. RESULTS: Weapon-carrying (15%) and physical fighting (39%) were common among adolescents. One out of 30 (3.3%) adolescents reported receiving medical care for fight-related injuries. Controlling for demographic characteristics, youth who carried weapons were more likely than those who did not to have been in a physical fight (OR = 3.3). The association between weapon-carrying and physical fighting was stronger among females (OR = 5.0) than among males (OR = 2.9), but did not vary significantly by age, race/ethnicity, or place of residence (urban, suburban, rural). Controlling for frequency of physical fighting and demographics, adolescents who carried a handgun (OR = 2.6) or other weapon (OR = 1.6) were more likely than those who did not carry a weapon to have had medical care for fight-related injuries. CONCLUSIONS: Among adolescents, weapon-carrying is associated with increased involvement in physical fighting and a greater likelihood of injury among those who do fight. Efforts to reduce fight-related injuries among youth should stress avoidance of weapon-carrying.

Building the capacity of schools to improve the health of the nation. A call for assistance from psychologists.

During the past several years, about two dozen major reports have called for the nation to reconceive and regenerate its school health programs. Proposals to reform health, education, and social services have included means to improve such programs. This article (a) identifies the leading causes of mortality and morbidity in the United States, (b) delineates 6 categories of behavior established during youth that contribute to these causes, (c) outlines ways in which a modern school health program might prevent such behaviors and address critical health and social problems among students, (d) describes practical research and development strategies that are being established to help schools implement effective school health programs, and (e) suggests how psychologists might help improve these programs.

The sodium hydroxide erosion assay: a revision of the alkali resistance test.

Burckhardt proposed the alkali resistance method as a means of assessing the integrity of the stratum corneum barrier in 1947. Researchers after Burckhardt largely found the test unreliable and nonreproducible; it therefore fell into disuse worldwide. We have upgraded the procedure by exposing the skin to 1.0 M sodium hydroxide under strictly specified conditions for successive 1-min periods until the emergence of the first erosions, revealed by staining with nitrazine yellow. Histology showed that the erosions were follicular and limited to the epidermis. The test was highly reproducible and repeatable. We demonstrated the usefulness of the test in the following ways: (1) the erosion time increased with aging, correlating with a thickened horny layer; (2) as few as five Scotch tape strippings greatly decreased the erosion time, although transepidermal water loss was only slightly increased; (3) slight damage to the horny layer by a 24-h exposure to 0.01% sodium lauryl sulfate sharply reduced the erosion time; (4) the erosion time decreased after daily open applications for 3 weeks of clobetasol propionate, corresponding to the thinned horny layer; (5) daily applications of petrolatum increased the erosion time. This new version of the alkali resistance test, renamed the sodium hydroxide erosion assay, promises to be a useful tool for studying the horny layer barrier in healthy and diseased skin.

Trends in risk behaviors for HIV infection among U.S. high school students, 1989-1991.

The objective of this study was to examine trends in rates of self-reported HIV-related instruction and behaviors among high school students in the United States. Self-administered questionnaires were completed by three independent, multistage national probability samples of public and private school students in grades 9 through 12 who were surveyed in the spring of 1989, 1990, and 1991, respectively. Controlling for demographic characteristics, we used logistic regression to test for trends from 1989 to 1991. From 1989 to 1991, the proportion of students who had received HIV instruction in school significantly increased from 53.7% in 1989 to 83.3% in 1991. At the same time, the proportion of students engaging in selected sexual behaviors generally decreased. We found significant declines in the proportion of students who had engaged in sexual intercourse (58.5% in 1989 to 54.1% in 1991), had two or more sex partners during their lifetime (40.1% in 1989 to 35.2% in 1991), and had four or more lifetime sex partners (23.6% in 1989 to 18.7% in 1991). School-based HIV instruction, which is reaching greater numbers of U.S. students, may be contributing to the decline in reported risk behavior. However, because the current level of HIV-related behavior is still too high, risk-reduction efforts for adolescents should be maintained and strengthened.

Age of initiating selected health-risk behaviors among high school students in the United States.

PURPOSE: To estimate and compare the age of initiation of alcohol use, cigarette smoking, sexual intercourse, and marijuana use among female and male students in U.S. high schools. METHODS: Using data from the 1991 and 1993 national school-based Youth Risk Behavior Surveys, life-table analysis was used to create hypothetical cohorts to estimate age of initiation of selected health-risk behaviors. The sample size was 12,272 in 1991 and 16,296 in 1993, with an overall response rate of 68% in 1991 and 70% in 1993. RESULTS: Male students initiate each of these behaviors earlier than female students, but the pace of initiation for females accelerates so that by age 15 years the cumulative proportion of male and female students who have initiated these behaviors is similar. For both female and male students, the youngest cohort appears to initiate use of alcohol and sexual intercourse at earlier ages than older cohorts. Similarly, the younger cohorts of female students appear to initiate smoking cigarettes and using marijuana at earlier ages than older cohorts. CONCLUSIONS: Many high school students are initiating alcohol use, cigarette smoking, sexual intercourse, and marijuana use at early ages. These data suggest a need for intensive intervention programs by middle/junior high school to motivate and prepare students to avoid these behaviors. Clinicians should begin screening and counseling for risk behaviors in early adolescence.

Use of birth control pills, condoms, and withdrawal among U.S. high school students.

PURPOSE: To examine the use of contraception at last sexual intercourse among currently sexually active adolescents. METHODS: We analyzed data from national school-based Youth Risk Behavior Surveys (YRBS) conducted in 1991, 1993, 1995, and 1997. The YRBS is a self-administered, anonymous survey which uses a national probability sample of U.S. students in public and private schools from grades 9 through 12. RESULTS: From 1991 to 1997, condom use significantly increased (from 46% to 57%), birth control pill use decreased (from 21% to 17%), and use of withdrawal significantly decreased (from 18% to 13%). In 1997, although more students were using condoms, 13% reported using withdrawal and 15% reported using no method to prevent pregnancy at last sexual intercourse. In 1997, condom use among females was significantly lower in the 9th grade than in the 12th grade (p <.001), whereas birth control pill use was higher (p <.001) and use of withdrawal remained stable. Among males, condom use and withdrawal use remained stable from 9th to 12th grade, whereas birth control pill use by their partner increased (p <.001). CONCLUSIONS: Inadequate contraceptive use among sexually active adolescents continues to be a major public health problem in the United States. For young people who will not remain sexually abstinent, families, health care providers, schools, and other influential societal institutions should promote the correct and continued use of condoms as essential protection against sexually transmitted diseases and human immunodeficiency virus infection.

Current CDC efforts to prevent and control human immunodeficiency virus infection and AIDS in the United States through information and education.

The human immunodeficiency virus (HIV) is estimated to have infected more than a million people in the United States and millions more in other countries. Even though there is no vaccine or effective treatment, HIV infection can be prevented through behavioral change. As the lead Public Health Service Agency for disease prevention, the Centers for Disease Control (CDC) has designed and implemented information and education activities with the ultimate goal of preventing HIV infection and AIDS in the United States. The target populations include the general public, school- and college-aged populations, persons infected or at increased risk of infection, minorities, and health workers. Because AIDS will be with us for a long time, CDC views educating the public as a long-term undertaking. The agency has initiated an intensive continuing national public information campaign, an informational brochure to be distributed to every U.S. household, a national AIDS information toll-free hotline, and a clearinghouse system that will maintain a comprehensive inventory of AIDS information resources and services. CDC also supports public information and education efforts by State and local health agencies. To reach school- and college-age youth, CDC, in consultation with governmental and national private sector organizations, developed guidelines for effective school health education to assist school health personnel in determining the scope and content of AIDS education. CDC also works with State and local education agencies to help carry out and evaluate educational efforts to prevent the spread of HIV among school- and college-age youth. The populations with the highest priority for AIDS information and education efforts are those who are at increased risk of acquiring or transmitting the AIDS virus because they use illicit intravenous drugs and share needles, engage in anal intercourse, have many sexual partners, practice prostitution, or engage in sex with those who practice these behaviors. Another high-priority population, because they can infect their offspring,is reproductive age women engaging in high-risk behavior and women infected with HIV who become pregnant. CDC programs targeted to these groups include community health education and risk reduction interventions, counseling and testing for HIV infection, AIDS community demonstration projects, perinatal AIDS prevention projects,and programs focused on preventing AIDS in minority populations. CDC is developing a variety of educational approaches for health workers in clinical settings because they are an important channel for providing accurate AIDS information, helping to assess risk, and counseling to actively reduce risk for the patient, sex partners of the patient, friends, and family members of the patient. CDC has conducted research and provided information and training on the use of HIV laboratory tests. CDC has also developed numerous scientific and technical guidelines and recommendations in consultation with practitioners, public health officials, and others and disseminated these through the Morbidity and Mortality Weekly Report. In addition,CDC has provided information about the risk of HIV transmission in the workplace and about methods of prevention. CDC will continue to evaluate these activities and support research in education and related interventions that may be necessary to prevent infection by the HIV virus. By providing educational support for behavior changes that decrease HIV transmission, we can contribute to AIDS prevention in the 1990s.

Progress in efforts to prevent the spread of HIV infection among youth.

The Human Immunodeficiency Virus (HIV) that causes AIDS will continue to threaten public health for years to come. Despite some popular misperceptions, adolescents are at risk of infection. Twenty percent of persons reported with AIDS have been ages 20 through 29. Given the long incubation period between HIV infection and AIDS, some of these young adults probably were infected while they were teenagers. Young people must develop the skills they will need to avoid HIV infection and other related health problems. In 1987, the Centers for Disease Control (CDC) launched a national program to help schools and other agencies that serve youth across the nation provide effective health education to prevent the spread of HIV. CDC supports and works closely with national health and education organizations, State and local education agencies, colleges and universities, and local health departments to establish HIV prevention policies and programs, training and demonstration centers, information development and dissemination activities. The impact of these efforts are assessed through applied surveillance and evaluation research. Through this system, CDC is attempting to institutionalize the means for continuously providing educational programs that will be effective in preventing HIV infection and other important health problems.

School-based programs to reduce sexual risk behaviors: a review of effectiveness.

This review was undertaken in recognition of the mounting public health and social problems associated with adolescent sexual behavior and the importance of basing school-affiliated programs designed to reduce sexual risk-taking behavior on sound research. The authors were commissioned by the Division of Adolescent and School Health within the Centers for Disease Control and Prevention, Public Health Service, to review carefully the research on these programs and to assess their impact on behavior. The authors identified 23 studies of school-based programs that were published in professional journals and measured program impact on behavior. They then summarized the results of those studies, identifying the distinguishing characteristics of effective programs, and citing important research questions to be addressed in the future. Not all sex and AIDS education programs had significant effects on adolescent sexual risk-taking behavior, but specific programs did delay the initiation of intercourse, reduce the frequency of intercourse, reduce the number of sexual partners, or increase the use of condoms or other contraceptives. These effective programs have the potential to reduce exposure to unintended pregnancy and sexually transmitted disease, including HIV infection. These programs should be replicated widely in U.S. schools. Additional research is needed to improve the effectiveness of programs and to clarify the most important characteristics of effective programs.

Results from the 1995 National College Health Risk Behavior Survey.

Results from the 1995 National College Health Risk Behavior Survey, which monitored health risk behaviors among US college and university undergraduates, suggest that many students' behaviors increase their likelihood of adverse health outcomes. During the 30 days preceding the survey, 34% of the participants had consumed five or more alcoholic drinks on at least one occasion, and 27% had drunk alcohol and driven a car. Thirty-one percent had smoked cigarettes regularly during their lifetimes, 49% had ever used marijuana, 30% had used a condom during their last sexual intercourse, 21% were overweight, and 38% had participated in vigorous physical activity on 3 or more of the 7 days preceding the survey. These data were analyzed by gender, age group, race and ethnicity, and institution type. They can be used by those responsible for the health and education of college students to reduce risks associated with the leading causes of mortality and morbidity.

Evolution of the national disease prevention and health promotion strategy: establishing a role for the schools.

The history and evolution, during the past decade, of the national disease prevention and health promotion strategy is recounted, culminating with a description of the national prevention objectives. Objectives that directly could be attained by: (1) school health education; (2) school health services; (3) efforts to ensure healthy school environments; and (4) school physical education programs are delineated, as are objectives that could be influenced in important ways by school health programs. The nation's schools could contribute significantly and measurably toward improving the health of all Americans, if school health professionals, individually as well as within their various organizations, could seize and create opportunities to work with other health and educational professionals, and the public, to impel and enable schools to attain relevant national prevention objectives.

The role of school health education in preventing heart, lung, and blood diseases.

The scope and dynamics of heart, lung, and blood diseases in the United States are reviewed and the need for research about the primary prevention of these conditions among large populations of children and youth is explained. Ways in which school health education could contribute to the primary prevention of these diseases are delineated; risk factors and social issues that might be addressed by the nation's schools are identified. A brief review of educational efforts to discourage adolescent cigarette smoking during the last 30 years illustrates some of the problems and opportunities presented by school health education research.