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Elders then received a National Institutes of Health career development award, also serving as assistant professor in pediatrics at the University of Arkansas Medical Center from 1967. She was promoted to associate professor in 1971 and professor in 1976. Her research interests focused on endocrinology, and she received certification as a pediatric endocrinologist in 1978. She became an expert on childhood sexual development. In 1987, Elders was appointed Director of the Arkansas Department of Health by then-Governor Bill Clinton. Her accomplishments in this position included a ten-fold increase in the number of early childhood screenings annually and almost a doubling of the immunization rate for two-year-olds in Arkansas. In 1992, she was elected President of the Association of State and Territorial Health Officers. Elders became Surgeon General of the Public Health Service on September 8, 1993, appointed by President Clinton. She was the first African American to serve in the position. As Surgeon General, Elders argued the case for universal health coverage, and was a spokesperson for President Clinton's health care reform effort. She was a strong advocate for comprehensive health education, including sex education, in schools. Her last day in office was December 31, 1994. She returned to the University of Arkansas Medical Center as professor of pediatrics.
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