A huge number of teens and middle-schoolers still aren’t receiving an adequate sex education, such as how to prevent unwanted pregnancy, HIV, sexually transmitted diseases (STD) and even how to get some condoms. According to a new report released by the U.S. Centers for Disease Control and Prevention, fewer than half of high schools and only a fifth of middle schools teach lessons on all 16 of the nationally recommended topics for sexual health education. Less than 40% of schools nationwide required sex and health education for graduation.

The report’s findings—based on surveys of schools in 48 states, including 19 large urban school districts, and conducted during the 2014 spring semester—also varied widely state by state. Additionally, many schools still don’t provide relevant sexual education to students who identify as lesbian, gay, bisexual or queer, such as materials with inclusive language. Only 24.4% do so—despite the fact that the number of teens who self-identify with that community grows every year.

“Lack of effective sex education can have very real, very serious health consequences,” Dr. Stephanie Zaza, director of the CDC’s division of adolescent and school health, said in a statement. Read more via Newsweek