The U.S. Surgeon General issued a "call to action" Thursday, releasing a report that included recommendations on child and adult sex education, efforts to encourage long-term relationships and families, and guidelines for avoiding unwanted pregnancies and sexually transmitted diseases (STDs).

Surgeon General David Satcher, a Clinton administration appointee whose tenure has carried over to the Bush administration, stressed that abstinence is the only way to avoid pregnancies or STDs. But he stopped short of taking sides in the debate over whether sex education programs that stress abstinence in schools are more effective than those that emphasize contraceptives.

The report, called "The Surgeon General’s Call to Action to Promote Sexual Health and Responsible Behavior," says that there is no evidence that so-called "abstinence-only" education is more effective than programs that stress contraceptive use and that more evidence is needed to make an informed judgment.

"We try to make very clear what’s needed to improve sexual health and what’s supported by the science," he said.

But his report also encourages abstinence from sex until one is involved in a "committed, enduring and mutually monogamous relationship," while federal abstinence programs call for abstinence until marriage.

Satcher also addressed questions of homosexuality, suggesting that it is society’s "responsibility to be more supportive and proactive than judgmental," and called on Americans to respect "the diversity of sexual values within any community." The report also says that, despite a recent report to the contrary, there is no evidence that a person’s sexual orientation can be changed.

Satcher's remarks were met with mixed reviews by the White House as well as from conservative groups and some health and sex experts.

The White House signaled President Bush's frustration with Satcher. "The president thinks abstinence education is important," Bush spokesman Ari Fleischer said Friday in response to Satcher's report.

One senior official, speaking on condition of anonymity, said Bush strongly objected to portions of Satcher's report and had little confidence in him.

Heather Cirmo, a spokeswoman for the Family Research Center, a conservative group that advocates "abstinence only" sex education programs in the schools, said Thursday she was "encouraged by some elements in the report and discouraged by others." She liked that Satcher "wants our country to emphasize abstinence, that this was the most fool-proof way to stop disease."

However, she said she believes the Surgeon General put too much stock in the ability of condoms to prevent the spread of STDs. And she said he did not emphasize parental involvement enough, though Satcher did encourage the dissemination of education materials to parents, teacher, clergy and other community leaders.

And addressing Satcher's treatment of homosexuality, she said that it is "unfounded" to suggest a national movement to remove any stigma.

Joe McIlheney, president and founder of the Medical Institute, was one of Satcher's consultants for the report. He said he was generally pleased with the recommendations, but, like Cirmo, he doesn’t think the Surgeon General went far enough.

"He doesn’t clearly point out a lot of the problems we’re heading to in this area," he said. "The primary problem is that people will have sex with more than one person. The data clearly shows that the biggest risk for STDs is having multiple partners. The fundamental issues of sexual health are STDs, the scar and damage of STDs and being free of a non-marital pregnancy."

In regards to the homosexual issues addressed in the report, McIlheney said "[gay men and women] do suffer, there is no question about that." He said it does a "disservice," however, to suggest that the number of STD cases among gay men and lesbians community is perpetuated by the public’s non-acceptance of them. The proliferation is due to unprotected sex, he said, as it is for heterosexual partners.

"I believe Dr. Satcher stops short of what should be advocated — even for homosexuals — that responsible sex behavior for their own health is to limit their sexual partners." Ideally, he said, this would be one partner for life.

And for kids, the best course of action is inaction — to avoid out-of-wedlock sex altogether is the best defense against pregnancy and disease risks, McIlheney said.

Other recommendations in the report include providing adequate training and sex education for health care professionals, ensuring that programs that fight sex abuse are available and increasing scientific research on sex health during the entire life span

Satcher's term expires in February, and administration officials expect that Bush will appoint his own surgeon general.

The Associated Press contributed to this report.