The American College of Obstetricians and Gynecologists has a long-standing interest in the development of adequate and comprehensive health services for adolescents, especially in regard to reproductive health services. Since 1964, ACOG has conducted organized activities in the area of adolescent health and produced numerous policy statements, committee opinions and other reports on issues of particular importance to this population.

STATEMENTS
The following statements are currently in use by ACOG:

1.        Statement on Sexuality Education (originally written in 1967, incorporated into Guidelines for Women’s Health Care in 2002, incorporated into Health Care for Adolescents in 2003)

2.        The Executive Board endorsed the recommendation from "Risking the Future," in principle (1987)

3.        Statement on Tobacco Advertising Aimed at Women (1990, reaffirmed 2000, revised and approved July 2004)

4.        Access to Reproductive Health Care for Adolescents (originally written in 2000, incorporated into Guidelines for Women’s Health Care in 2002, incorporated into Health Care for Adolescents in 2003)

5.        Protecting Adolescents: Ensuring Access to Care and Reporting Sexual Activity and Abuse. Position Paper of the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the Society for Adolescent Medicine (2004, published in Journal of Adolescent Health 2004;35:420–423)

OTHER ACOG DOCUMENTS
Additionally, the following documents are available to assist Fellows and other health care practitioners who provide services to adolescents:

1.        Committee Opinion: Adolescents' Right to Refuse Long-Term Contraceptives (originally written in 1994, revised and incorporated into Health Care for Adolescents in 2003)

2.        Technical Bulletin: Pediatric Gynecologic Disorders (originally written in 1995, incorporated into Special Issues in Women’s Health in 2005)

3.        Committee Opinion: Condom Availability for Adolescents (originally written in 1995, revised and incorporated into Health Care for Adolescents in 2003)

4.        Committee Opinion: Hepatitis B Immunization for Adolescents (originally written in 1997, incorporated into Guidelines for Women’s Health Care in 2002)

5.        Committee Opinion: Prevention of Adolescent Suicide (originally written in 1997, revised and incorporated into Health Care for Adolescents in 2003)

6.        Stay Alert! Stay Safe! pocket cards (5/98)

7.        Educational Bulletin: Confidentiality in Adolescent Health Care (originally written in 1998, revised and incorporated into Health Care for Adolescents in 2003)

8.        Adolescent Sexuality: A Presentation Resource Kit, 3rd Edition (#AA106, 9/98) – currently under revision

9.        Educational Bulletin: Adolescent Victims of Sexual Assault (originally written in 1995, incorporated into Special Issues in Women’s Health in 2005)

10.     Sexual Assault rolodex cards include tools for screening teens and information on sexual assault (5/99)

11.     Educational Bulletin: Primary and Preventive Health Care for Female Adolescents (originally written in 1999, incorporated into Health Care for Adolescents in 2003)

12.     Educational Bulletin: Oral Contraceptives for Adolescents: Benefits and Safety (originally written in 1999, incorporated into Health Care for Adolescents in 2003)

13.     Drawing the Line: A Guide to Effective Sexual Assault Prevention Programs for Middle School Students (April 2000)

14.     Strategies for Adolescent Pregnancy Prevention (2002 revision) –currently under revision

15.     Committee Opinion: Nonsurgical Diagnosis and Management of Vaginal Agenesis (July 2002); revised in 2006

16.     Adolescent Pregnancy Facts (2003 revision) –currently under revision

17.     Adolescent Pregnancy Information Packet: References and resources on adolescent pregnancy, childbearing, and prevention (revised periodically)

18.     Tool Kit for Teen Care (2003) – provides tools to help health care providers to implement primary and preventive health care for adolescent patients. A tent card designed to encourage mothers of adolescent girls to bring patients into care, fact sheets on various adolescent issues, and an adolescent visit record are included in this kit and also available separately.

19.     Health Care for Adolescents (2003)- book designed to provide the information necessary for the provision of health services to adolescent patients in a comprehensive fashion. It includes all previously published ACOG documents on adolescent health as well as two new documents on eating disorders and screening for chlamydia and gonorrhea.

20.     Committee Opinion: Cervical Cancer Screening in Adolescents (October 2004)

21.     Committee Opinion: Sexually Transmitted Diseases in Adolescents (October 2004)

22.     Committee Opinion: Guidelines for Adolescent Health Research (October 2004)

23.     Fact Sheet: HPV in Adolescents (October 2004)

24.     Committee Opinion: Endometriosis in Adolescents (April 2005)

25.     Committee Opinion: Meningococcal Vaccination for Adolescents (September 2005)

26.     Committee Opinion: Evaluation and Management of Abnormal Cervical Cytology and Histology in the Adolescent (April 2006)

27.     Committee Opinion: The Initial Reproductive Health Visit (May 2006)

28.     Committee Opinion: Human Papillomavirus Vaccination (September 2006)

29.     Committee Opinion: Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign (November 2006)

30.     Committee Opinion: Breast Concerns in the Adolescent  (November 2006)

31.     Committee Opinion: The Overweight Adolescent: Prevention, Treatment, and Obstetric-Gynecologic Implications (November 2006)

32.     Committee Opinion: Vaginal Agenesis: Diagnosis, Management, and Routine Care  (December 2006)

33.     Weight Management: A Guide to Caring for Adolescent Patients (October 2007)

34.     Committee Opinion: Intrauterine Device and Adolescents (December 2007)

Patient Education Pamphlets designed specifically for or about adolescents
o Growing Up: Especially for Teens (all about puberty, for ages 9-14) (#AP-041) (Spanish version #SP-041)
o You and Your Sexuality: Especially for Teens (#AP-042)
o Menstruation (#AP-049)
o Birth Control: Especially for Teens (#AP-112)
o Having a Baby: Especially for Teens (#AP-103) (Spanish version #SP-103)
o Your First Ob-Gyn Visit: Especially for Teens (#AP-150)

There are other patient education pamphlets that cover areas that might be of interest to adolescents, although they are not prepared specifically for this age group, for example:

Contraception:
o Birth Control (#AP-005) (Spanish Version #SP-005)
o Birth Control Pills (#AP-021)
o Natural Family Planning (#AP-024)
o Emergency Contraception (#AP-114)
o Barrier Methods of Contraception (#AP-022)
o Hormonal Contraception – Injections, Rings and Patches (#AP-159)

o The Intrauterine Devise (#AP-014) 

Special Procedures:
o The Pap Test (#AP-085)
o Induced Abortion (#AP-043)

Physiology and Sexuality:
o Sexuality and Sexual Problems (#AP-072)

Gynecologic Problems:
o Dysmenorrhea (#AP-046)
o How to Prevent Sexually Transmitted Diseases (#AP-009) (Spanish Version #SP-009)
o Genital Herpes (#AP-054)
o Gonorrhea, Chlamydia and Syphilis (#AP-071)
o Human Papillomavirus (HPV) Infection (#AP-073)
o Pelvic Inflammatory Disease (#AP-077)
o Vaginitis: Causes and Treatment (#AP-028)

o Endometriosis (#AP-013)

o Detecting and Treating Breast Problems (#AP-026)

o Fibrocystic Breast Changes (#AP-138)

o Urinary Tract Infections (#AP-050)

o Premenstrual Syndrome (#AP-057)

o Abnormal Uterine Bleeding (#AP-095)

o Abnormal Pap Test Results (#AP-161)

  Pregnancy:
o Nutrition During Pregnancy (#AP-001) (Spanish #SP-001)

Women's Health:
o It's Time to Quit Smoking (#AP-065)
o Immunizations for Women (#AP-117)
o Weight Control: Eating Right and Keeping Fit (#AP-064)

o Exercise and Fitness: A Guide for Women (#AP-045)

o Healthy Eating (#AP-130)
o Staying Healthy at All Ages (#AB-006) (Spanish #SB-006)
o HIV Infection and Women (#AP-082)
o Depression (#AP-106)
o Alcohol and Women (#AP-068)

o Eating Disorders (#AP-144)

o Protecting Yourself Against Hepatitis B (#AP-125)

WHAT CURRENT ACOG POLICY SAYS ABOUT…
* Refers to numbers on list in this document of statements currently in use.
** Refers to numbers on list in this document of other ACOG documents.

Sex and Family Life Education:

"The American College of Obstetricians and Gynecologists supports the inclusion of age-appropriate sexuality education from grades kindergarten through 12th grade as an integral part of comprehensive health education in schools and communities. The American College of Obstetricians and Gynecologists encourages its members to advocate for and participate in such education." (1*)

"All sexuality education programs should provide scientifically accurate information about sexuality, STDs, contraception, and preventive health care." (1*)

ACOG supports “ongoing rigorous evaluation of the effectiveness of a variety of forms of sexuality education in terms of their effect on sexual behavior, as well as unintended pregnancy and abortion rates." (1*)

Contraception or Family Planning for Minors:

"Health professionals have an obligation to provide the best possible care to respond to the needs of their adolescent patients. This care should, at a minimum, include comprehensive reproductive health services, such as sexuality education, counseling… [and] access to contraceptives ..." (4*)

"Legal barriers that restrict the freedom of health care practitioners to provide these services should be removed." (4*)

Reproductive Health Services For Adolescents:

"The potential health risks to adolescents if they are unable to obtain reproductive health services are so compelling that legal barriers and deference to parental involvement should not stand in the way of needed health care for patients who request confidentiality. Therefore, laws and regulations that are unduly restrictive of adolescents' confidential access to reproductive health care should be revised." (4*)

Confidentiality:

" Because the involvement of a concerned adult can contribute to the health and success of an adolescent, policies in health care settings should encourage and facilitate communication between a minor and her parent(s), when appropriate." (4*)

"Most adolescents underuse existing health care services. A major obstacle to the delivery of health care to adolescents is their concern about confidentiality." (7**)

"… physicians should work with the political process to eliminate laws unduly restrictive of confidential health services for adolescents." (7**)

“To overcome barriers to confidentiality imposed by legal and economic constraints, physicians should discuss confidentiality with both the adolescent girl and, where appropriate, her parent(s) or guardian(s). Health care provides should be familiar with current state and local statutes on the rights of minors to consent to healthcare services, as well as those federal and state laws that affect confidentiality. It also is important to involve and inform office staff about those policies and procedures that facilitate and ensure confidentiality." (7**)

School-Based Clinics:

"Comprehensive services may be delivered to adolescents in a variety of sites, including schools, physician offices, and community-based and other health care facilities." (4*)

For additional information, contact Lisa Smith Goldstein, MS, Director, Adolescent Health Care, American College of Obstetricians and Gynecologists, 409 12th Street, SW, PO Box 96920, Washington, DC 20090-6920, (202) 863-2497, (202) 484-3917 FAX, adolhlth@acog.org.

January 2007