Science and Success, Second Edition: Sex Education and Other Programs that Work to Prevent Teen Pregnancy, HIV and Sexually Transmitted Infections

Full Study Report [HTML] [PDF]
Executive Summary [HTML] [PDF]

Program Components

• HIV/STI and teen pregnancy prevention curriculum
• Twenty sessions, each lasting one class period, divided evenly over two years
• Experiential activities included to build skills in communication, delaying sex, and among sexually active youth, using condoms
• School health protection council
• Peer team or club to host school-wide activities
• Parenting education
• Links to community services
• HIV-positive speakers (optional)
• Educator training recommended

For Use With

• High school students in ninth and 10th grades
• Sexually inexperienced Hispanic youth
• Urban and suburban youth
• Multiethnic populations – including white, Hispanic, African American, and Asian youth
• Sexually experienced youth

Evaluation Methodology

• Experimental design, including treatment and control conditions, in 20 schools in Texas and California
• Urban and suburban youth (n=3,869 at baseline; n=3,058 at final follow-up)
• Pretest and follow-up surveys at seven months (end of first year of intervention), at 19 months (end of second year of the intervention), at 31 months after baseline, and at 12 months after second year of the intervention

Evaluation Findings

• Delayed initiation of sexual intercourse – among Hispanic youth only
• Increased use of effective contraception
• Increased condom use
• Reduced incidence of unprotected sex and reduced number of sexual partners without the use of condoms
• Increased HIV testing – among students who heard an HIV-positive speaker

Evaluators' comments: First, Safer Choices had positive impacts across a variety of groups, regardless of their gender, ethnicity, or sexual experience before taking Safer Choices… Second, regarding all four outcome measures affected by condom use, Safer Choices appeared to have a greater impact among males than females… Third, Safer Choices appeared to have a greater number of positive behavioral effects on Hispanics… Fourth, Safer Choices appeared to have a greater impact on condom-related measures among higher-risk youth who engaged in unprotected sex before the intervention.
Source: Kirby, Baumler, Coyle et al. 2004

Program Description

Safer Choices is a two-year, school-based, HIV/STI and teen pregnancy prevention program with the primary goal of reducing unprotected sexual intercourse by encouraging abstinence and, among students who report having sex, encouraging condom use. The program seeks to modify:

• HIV/STI knowledge;
• Attitudes and norms about abstinence and condom use as well as barriers to condom use;
• Students' belief in their ability to refuse sex and avoid unprotected sex, use condoms, and communicate with partners about safer sex;
• Perceptions of risk for infection with HIV or other STIs; and
• Communication with parents.[14]

Based on social cognitive theory, social influences theory, and models of social change, Safer Choices is a high school program that includes:

1. A school health protection council;
2. The curriculum;
3. Peer club or team to sponsor school-wide activities;
4. Parenting education; and
5. Links between schools and community-based services.
6. In some schools, programs also incorporate an HIV-positive speaker.[14]

The program is delivered in 20 sequential sessions, divided evenly between ninth and 10th grades. Parents receive a newsletter and participate in some student-parent homework assignments. School-community links center on activities to enhance students' familiarity with and access to support services in the community. Each year of the program, schools implement activities across all five components.[14,15,16]

Evaluation Methodology

Safer Choices was evaluated in 20 high schools in California and Texas. In each state, five high schools were randomly assigned to receive Safer Choices. At the same time, five schools were randomly assigned to receive a standard, knowledge-based, HIV prevention curriculum. A total of 3,869 ninth grade students completed the baseline survey in fall 1993. Twenty-nine percent of participants and control youth were white; 29 percent, Hispanic; 20 percent, African American; and 14 percent, Asian. Participants and control youth were 50 percent male, 50 percent female. The cohort was tracked for 31 months, and follow-up data were collected from 3,058 students, using self-reported surveys administered by trained data collectors.[14,15,16]

Outcomes

• Knowledge—At 31-month follow-up, evaluation found significant improvements in participants' knowledge about HIV and STIs, in comparison to control youth.[14]
• Attitudes and perceptions—At 31-month follow-up, intervention participants expressed significantly more positive attitudes about condoms and reported greater condom use self-efficacy, fewer barriers to condom use, and higher levels of perceived risk for HIV than did control youth.[14]
• Behaviors—
  • Delayed initiation of sexual intercourse—Early analysis of evaluation data found no significant differences between intervention and control youth in the incidence of sexual initiation, either at three-month post-test or at final follow-up.[14,15] Yet, when the evaluators later analyzed the data by race/ethnicity, they found that Safer Choices had a significant impact on delaying the initiation of sexual intercourse among Hispanic students (OR=0.57; P =.02).16 Safer Choices did not significantly delay the onset of sexual intercourse among white, Asian, or black participants, nor did it have a significant effect by gender.[16]
  • Increased use of effective contraception—Sexually experienced students in intervention schools were 1.76 times more likely to use an effective pregnancy prevention method (birth control pills, birth control pills plus condoms, or condoms alone) than were students in comparison schools.[14]
  • Increased condom use—Safer Choices had its greatest effect regarding condom use. Sexually experienced intervention students were less likely to report having sex without a condom in the three months prior to follow-up surveys than were sexually experienced control students. Intervention students who reported having sexual intercourse during the prior three months were 1.68 times more likely to have used condoms than were control students.[15]Safer Choices increased condom use at most recent sex more among Hispanics and whites than among blacks (OR=1.65 and 1.57 versus 1.07, respectively).[16]
  • Reduced incidence of unprotected sexual intercourse—Safer Choices did not have a significant direct effect on incidence of unprotected sex among blacks, Hispanics, or whites. Yet, one or more condom-related measures were significant or close to significance in the desired direction. Among blacks, effects were close to significance for number of partners unprotected (P =.07). Among Hispanics effects were significant or close to significance for number of times of unprotected sex (P =.03), condom use at last sex (P =.04), and use of contraception (P =.06). Among whites effects were significant for number of times of unprotected sex (P =.04) and condom use at last sex (P =.04).[16]
    
    In combination, these results suggest that blacks decreased risk by reducing their number of unprotected partners. Hispanics reduced risk by delaying sex, increasing condom use, and increasing contraceptive use, thereby decreasing frequency of unprotected sex. Whites decreased risk by increasing condom use and thereby decreasing frequency of unprotected sex.[16]
  • Reduced number of partners with whom teens had intercourse without a condom—Intervention students reduced the number of sexual partners with whom they had sexual intercourse without a condom by a ratio of 0.73.[15]
  • Number of sexual partners and use of substances prior to sex unaffected—Evaluation found no significant differences between intervention and control youth on number of sexual partners reported in the last three months, nor on use of alcohol and other drugs before sexual intercourse in the last three months.[14,15]
• Outcomes from integrating HIV-positive speakers into the program
  Separate evaluation found that integrating HIV-positive speakers into the program also produced positive outcomes for inner-city youth. During the two-year intervention in Texas, about 384 high school classrooms (mostly ninth and 10th grade) heard an HIV-positive speaker.[17]
  • Attitudes—Evaluation found that students who heard the speaker’s presentation reported significantly higher perceived risk of HIV infection, compared to control students. Results also suggested that students in the intervention who heard the speaker were more willing to help a person with HIV and were less fearful of hugging an HIV-infected classmate than were those who did not hear the speaker.[17]
  • Behaviors—
    • HIV testing—Students in the intervention condition who heard the HIV-positive speaker were more likely to get tested for HIV, compared to students who did not hear the speaker.[17]

For More Information or to Order, Contact

• Sociometrics, Program Archive on Sexuality, Health & Adolescence: Phone, 1.800.846.3475; Fax, 1.650.949.3299; E-mail, This e-mail address is being protected from spambots. You need JavaScript enabled to view it ; Web, http://www.socio.com
• ETR Associates: Phone, 1.800.321.4407; Fax, 1.800.435.8433; Web, http://www.etr.org/