Peer-Led Sex Education (RIPPLE study)

Peer-Led Sex Education (RIPPLE study)

OVERVIEW

Peer-led sex education is a school-based intervention in which older high school students lead class sessions on sex education for younger high school students. The program is designed to reduce the prevalence of unprotected sex and unintended pregnancies. The initial evaluation found a marginally positive impact on unintended pregnancies, but no impact on unprotected sex. A long-term follow-up found that girls who received peer-led sex education had marginally fewer live births, but there was no impact on abortions.

DESCRIPTION OF PROGRAM

Target population: Ninth-grade students

Peer-led sex education involves training twelfth-grade students to act as peer educators. The training takes place over two days and provides the peer educators with information about condoms, contraception, STDs, and relationships, and teaches them participatory learning strategies and activities, classroom management, and group facilitation skills. The peer educators lead three class sessions for ninth-grade students. Sessions are approximately one hour in length, use participatory learning methods, and focus on improving students’ sexual communication, condom skills, and knowledge of pregnancy, STDs, contraception, and local services related to sexual health. Topics for the three sessions are relationships, STDs, and condoms and contraception, respectively.

EVALUATION OF PROGRAM

Study 1

Stephenson, J.M., Strange, V., Forrest, S., Oakley, A., Copas, A., Allen, E., Babiker, A., Black, S., Ali, M., Monteiro, H., Johnson, A.M., & the RIPPLE study team. (2004). Pupil-led sex education in England (RIPPLE study): Cluster-randomised intervention trial. Lancet, 364, 338-346.

Evaluated population: 13 to 14 year old students at 29 schools in central and southern England. The sample was 48 percent female and 91 percent white.

Approach: Schools were divided by risk level, which was based on the proportion of students receiving free school meals, ethnicity, educational attainment, the proportion of students who continued after age 16, the quality and quantity of current sex education, availability of health information and links with outside agencies, and the presence of local family planning services. Within each of the three risk levels, schools were randomly assigned to peer-led sex education or to continue with teacher-led sex education (control condition). Data were collected through questionnaires at baseline, 6-month follow-up, and 18-month follow-up. The outcomes assessed were unprotected sex, unintended pregnancies, quality of sexual experiences, quality of relationship with current partner, knowledge, ability to identify local services, confidence (about using condoms, discussing sex and contraception with a partner, and saying no to unwanted sexual activity), and other sexual behaviors.

Results: Outcomes were assessed separately for boys and girls. Girls who received peer-led sex education were less likely to have had sex by age 16 (at the 18-month follow-up), had greater knowledge of STDs at the 6-month follow-up but not at the18-month follow-up, were more confident about using condoms at the18-month follow-up, and had marginally fewer unintended pregnancies than did girls in the control group. However, girls who received peer-led sex education were also less confident about refusing to do something sexual they did not want to do, and there was no impact on the rate of unprotected first-time sex. Boys who received peer-led sex education, compared with their control-group peers, had greater knowledge of STDs at the 18-month follow-up, but not at the 6-month follow-up. There were no treatment impacts for either boys or girls on condom and contraception use, quality of sexual experiences, quality of relationship with current partner, ability to identify local sexual health services, attitudes regarding condom use and sex, confidence in discussing contraception or sex with a partner, or their knowledge of emergency contraception, availability of contraception, and common STDs.

Study 2

Stephenson, J., Strange, V., Allen, E., Copas, A., Johnson, A., Bonell, C., Babiker, A., Oakley, A., & the RIPPLE Study Team. (2008). The long-term effects of a peer-led sex education programme (RIPPLE): A cluster randomised trial in schools in England. PLoS Medicine, 5, 1579-1590.

Evaluated population: 13 to 14 year old students at 27 of the 29 schools from Study 1 (two schools withdrew before implementation).

Approach: See Study 1 for randomization procedure. (This is a follow-up study.) Data were collected from public records of abortions and live births, and from questionnaires given 54 months after baseline, when participants were about 18 years old. The outcomes assessed were abortions, live births, self-reported pregnancy and unintended pregnancy, sexual intercourse and use of contraception, regretted or pressured sex, quality of relationship with current partner, STD diagnosis, knowledge of emergency contraceptive pill, and ability to identify local sexual health services.

Results: Positive impacts were found on the rate of self-reported pregnancy and abortion, and on girls’ use of contraception at last sex. Girls who received peer-led sex education also had marginally fewer live births than did girls in the control group. There was no impact on rates of abortion, sex before age 18, unprotected first sex, regretted or pressured sex, quality of relationship with current partner, STD diagnosis, knowledge of emergency contraception, or ability to identify local sexual health services.

SOURCES FOR MORE INFORMATION

References

Contact Information

Dr. J M Stephenson

Centre for Sexual Health & HIV Research

Mortimer Market Centre, off Capper Street

London WC1E 6AU, UK

jstephen@gum.ucl.ac.uk

KEYWORDS: Adolescents (12-17), High School, Males and Females (Co-ed), School-based, Skills Training, Condom Use and Contraception, Sexual Activity, Teen Pregnancy, STD/HIV/AIDS, Other Relationships, Other Reproductive Health

Program information last updated on 11/4/10

		© Child Trends 2004