Program

Nov 04, 2010

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

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.

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.

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

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