Program

Mar 02, 2011

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, students’ self-efficacy to refuse sex and
communicate with a partner, 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 9th and 10th
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

Study1: 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.

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 9th 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 unprotectedsex
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.

Study2:
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 9th 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.
Study 3: Coyle, K., Basen-Engquist, K., Kirby, D., Parcel, G.,
Banspach, S., Collins, J., Baumler, E., Carvajal, S., & Harrist, R. (2001). Safer choices: Reducing teen pregnancy, HIV, and STDs. Public Health
Reports, 116,
82-93.

Evaluated population:
This study is a follow-up to Study 1 and uses the
same participants.

Approach: See
Study1 for randomization procedures. Students completed surveys at baseline, 7
months after baseline, 19 months after baseline, and 31 months after baseline.
The behavioral outcomes that were examined were sexual initiation, frequency of
intercourse without a condoms in the past 3 months, number of sexual partners
without a condom in the past 3 months, use of condoms at first intercourse, use
of condoms at last intercourse, use of protection against pregnancy at last
intercourse, number of times they had sexual intercourse in the past 3 months,
number of sex partners in the past 3 months, use of alcohol and other drugs
before sex in the past 3 months, having been tested for HIV, and having been
test for other STDs. The psychosocial outcomes that were examined were knowledge
of HIV and other STDs, attitudes towards sexual intercourse and condoms,
normative beliefs about sexual intercourse and condoms, self-efficacy regarding
refusing sex, condom use, and communication, perceived barriers to condom use,
risk perceptions regarding HIV and other STDs, and communication with parents.

Results:

Behavioral

At the 7-month follow-up, students in intervention
schools reported less frequent intercourse without a condom and were more likely
to have used a condom and a contraceptive method at last intercourse, compared
with students in schools that did not receive the intervention. They also
reported marginally fewer sexual partners without a condom. There was no impact
on sexual initiation, use of condoms at first intercourse, number of times they
had sexual intercourse, number of sex partners, use of alcohol or drugs before
sex, or having been tested for HIV or other STDs.

At the 19-month follow-up, students in intervention
schools reported fewer sexual partners without a condom. There was no impact on
sexual initiation, frequency of intercourse without a condom, use of condoms at
first intercourse, use of condoms or use of contraceptives at last intercourse,
number of times they had sexual intercourse, number of sex partners, use of
alcohol or drugs before sex, or having been tested for HIV or other STDs.

At the 31-month follow-up, students in intervention
schools reported fewer sexual partners without a condom and were more likely to
have used a condom at last intercourse. They also reported less frequent
intercourse without a condom and were more likely to have used a contraceptive
at last intercourse. There was no impact on sexual initiation, use of condoms at
first intercourse, number of times they had sexual intercourse, number of sex
partners, use of alcohol or drugs before sex, or having been tested for HIV or
other STDs.

Psychosocial

At the 7-month follow-up, students in intervention
schools had more knowledge of HIV and other STDs, reported more positive
attitudes regarding condoms, had greater self-efficacy regarding condom use,
reported lower perceived barriers to condom use, had higher risk perceptions
regarding HIV and other STDs, and reported greater communication with parents.
They also reported greater normative beliefs regarding condoms. There was no
impact on attitudes or normative beliefs regarding sexual intercourse or
self-efficacy to refuse sex or communicate with a partner.

At the 19-month follow-up, students in intervention
schools had more knowledge of HIV and other STDs, reported more positive
attitudes and greater normative beliefs regarding condoms, had greater
self-efficacy regarding condom use, reported lower perceived barriers to condom
use, had higher risk perceptions regarding HIV and other STDs, and reported
greater communication with parents. There was no impact on attitudes or
normative beliefs regarding sexual intercourse or self-efficacy to refuse sex or
communicate with a partner.

At the 31-month follow-up, students in intervention
schools had more knowledge of HIV and other STDs, reported more positive
attitudes regarding condoms, had greater self-efficacy regarding condom use,
reported lower perceived barriers to condom use, and had higher risk perceptions
regarding HIV and other STDs. They also reported marginally greater normative
beliefs regarding condoms and communication with parents.

SOURCES FOR MORE INFORMATION

Curriculum materials available for purchase at:


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

References:

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.

Coyle, K., Basen-Engquist, K., Kirby, D., Parcel, G., Banspach, S., Collins, J.,
Baumler, E., Carvajal, S., & Harrist, R. (2001). Safer choices: Reducing teen
pregnancy, HIV, and STDs. Public Health Reports, 116,82-93.

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.

KEYWORDS: Adolescents (12-17), High School, Males and Females (Co-ed), Urban, White/Caucasian, Black/African American, Hispanic/Latino, Asian, School-based, Manual, Community or Media Campaign, Parent or Family Component, Parent-Child Relationship, Sexual Activity, Condom Use and Contraception.

Program information last updated 3/2/11.