Safer Choices

Guide to Effective Programs
for Children and Youth

SAFER CHOICES

OVERVIEW

Safer Choices is a multi-component program aimed at reducing instances of unprotected sexual intercourse among high school students. The program involves classroom curriculum and schoolwide activities. In an experimental evaluation of 20 schools, schools assigned to implement the Safer Choices program were compared with schools assigned to a control group.

The program was not effective at delaying sexual initiation, reducing the frequency of sex, or decreasing students’ number of sexual partners. However, the program was successful in reducing instances of unprotected sex. The program also had a positive impact on parent-child communication, students’ knowledge, and on students’ beliefs, attitudes, and perceptions related to condom use.

DESCRIPTION OF PROGRAM

Target population: High school students

Safer Choices is a two-year, theory-based program designed to reduce the number of students engaging in unprotected sexual intercourse. Safer Choices promotes the message that unprotected intercourse or intercourse before one is ready is an unsafe choice, using protection against pregnancy and STDs is a safer choice, and choosing not to have intercourse is the safest choice.

This program seeks to create schoolwide change, through the institution of multiple program components. The curriculum component of the program consists of 20 class sessions for 9^th and 10^th grade students. As part of this curriculum, students learn about support services available in their community. The program also includes the creation of a school health promotion council and a Safer Choices peer team. Both of these groups plan schoolwide events designed to alter the normative culture of the school. Additionally, the program includes activities for parents and seeks to get parents involved in talking to their children about the Safer Choices message.

EVALUATION(S) OF PROGRAM

Evaluated population: 10 high schools from northern California and 10 high schools from southeast Texas were selected to take part in this study. The 6,488 9^th graders enrolled in these schools during the 1993-94 school year served as the pool of subjects. 3,869 of these students received parental consent to participate and also remained enrolled in school for the entirety of the school year. The sample was 31% white, 27% Hispanic, 18% Asian, 17% African American, and 7% of other ethnicity.

Approach: Using random assignment, five schools from each study site were assigned to the treatment group. These schools received training and support to conduct the Safer Choices intervention during the 1993-94 and 1994-95 school years. The remaining schools received a basic information-based sex education curriculum that included five 50-minute sessions.

All students completed baseline surveys before the intervention began and were re-surveyed seven months later.

Results:

7-month follow-up

Compared with students at control schools, students from schools where the Safer Choices program had been implemented had significantly greater knowledge of HIV and other STDs. Treatment students did not differ significantly from control students on measures of attitudes and beliefs about sex, nor on their perceived self-efficacy in refusing sex. Treatment students did, however, have significantly more favorable attitudes and beliefs about condoms. Treatment students perceived significantly fewer barriers to condom use and had significantly greater perceived self-efficacy in using condoms. Treatment students also reported significantly greater communication with their parents about sex and a greater perception of risk to STDs.

Students from Safer Choices schools were neither more nor less likely than students from control schools to initiate sex during the follow-up period. They did not report fewer sexual partners or have sex any less frequently. Treatment students did have unprotected sex significantly less frequently than control students, however. Treatment students also reported having had unprotected sex with fewer partners than did control students and this difference approached significance (P = .07). Compared with control students, treatment students were significantly more likely to have used condoms and/or another method of birth control when having sex. Treatment students were no more likely than control students to have gotten tested for HIV and/or other STDs during the follow-up period.

Basen-Engquist, K., Coyle, K., Parcel, G., Kirby, D., Banspach, S., Carvajal, S., et al. (2001). Schoolwide Effects of a Multicomponent HIV, STD, and Pregnancy Prevention Program for High School Students. Health Education & Behavior, 28(2), 166-185.

Evaluated population: This study examined the same 20 schools as the above study. Instead of only surveying students who were in 9^th grade when the study began, however, this set of researchers examined cross-sections of students from all grades. Consequently, many students included in this treatment group were exposed to the Safer Choices program on the schoolwide level, but did not receive the Safer Choices classroom curriculum. Thus, this evaluation assessed a population-based approach by looking at change for all students in a school. A sample of 7,614 students completed baseline questionnaires, 8,319 completed follow-ups at 19 months, and 9,489 completed follow-ups at 31 months.

Results:

Psychosocial

At the 19-month follow-up, compared with students from control schools, students from schools where the Safer Choices program had been implemented had significantly greater knowledge of HIV and other STDs. Treatment students were more supportive of STD, HIV, and pregnancy prevention, but did not differ significantly from control students on other measures of attitudes and beliefs about sex. Treatment students did have significantly more favorable beliefs about condoms and marginally more favorable attitudes towards condom use (P = .09). Treatment students reported significantly greater self-efficacy in refusing sex and using condoms and reported communicating with their parents about sex significantly more frequently than control students.

At the 31-month follow-up, the impact on knowledge remained significant. Additionally, treatment students continued to have marginally more favorable attitudes toward condom use. No other psychosocial impacts persisted.

Behavioral

At the 19-month follow-up, students from Safer Choices schools were not any less likely than students from control schools to report having had sex during the past three months, nor did they report having had unprotected sex with any fewer partners. Treatment students did report significantly fewer occasions of sex without a condom over the past three months, however.

At the 31-month follow-up, the impact on frequency of sex without a condom had faded, but an impact on number of unprotected sex partners had emerged. Compared with control students, treatment students had engaged in unprotected intercourse with significantly fewer partners over the past three months.

SOURCES FOR MORE INFORMATION

Curriculum materials available for purchase at:

http://pub.etr.org/ProductDetails.aspx?id=110000&prodid=H556

References:

Coyle, K., Basen-Engquist, K., Kirby, D., Parcel, G., Banspach, S., Harrist, R., et al. (1999). Short-Term Impact of Safer Choices: A Multicomponent, School-Based, HIV, Other STD, and Pregnancy Prevention Program. Journal of School Health 69(5), 181-188.

Program also discussed in the following Child Trends publication(s):

Manlove, J., Terry-Humen, E., Romano Papillo, A., Franzetta, K., Williams, S., & Ryan, S. (2002). Preventing teenage pregnancy, childbearing, and sexually transmitted diseases: What the research shows (Research brief). Washington , DC : Child Trends.

Manlove, J., Terry-Humen, E., Romano Papillo, A., Franzetta, K., Williams, S., & Ryan, S. (2001). Background for community-level work on positive reproductive health in adolescence: Reviewing the literature on contributing factors. Washington, DC: Child Trends.

Program categorized in this guide according to the following:

Evaluated participant ages: High school students / Program age ranges in the Guide: 15-21

Program components: school-based, community or media component, parent or family component

Measured outcomes: reproductive health

Program information last updated 7/24/07