Draw the Line/Respect the Line

Developers
University of California, San Francisco Center for AIDS Prevention Studies, and ETR.
Program Summary
Draw the Line/Respect the Line promotes abstinence by providing students in grades 6, 7, and 8 with the knowledge and skills to prevent HIV, other sexually transmitted diseases (STDs) and pregnancy. Using an interactive approach, this program shows students how to set personal limits and meet challenges to those limits. The grade 6 content features limit setting and refusal skills in a nonsexual context. Grade 7 content examines consequences of unplanned sex, information about STDs, and applying refusal skills in a party context. Grade 8 features practice of refusal skills in dating contexts and a condom demonstration.
Intended Population
The program was designed for and tested with youth in grades 6 to 8.
Program Setting

The program was designed for and evaluated in a classroom-based, school setting.

Contact and Availability Information
Nancy Gonzalez-Caro, MPH
Evidence-Based Product Specialist
ETR
100 Enterprise Way, Suite G300
Scotts Valley, CA 95066
Ph: 800-321-4407 x237
Website: http://www.etr.org/ebi/programs/draw-the-line/
Cody Sigel, MPH, CHES
Health Education Training Coordinator
ETR
1333 Broadway, Suite P110
Oakland, CA 94612
Phone: 510-858-0995
Website: http://www.etr.org/ebi/programs/draw-the-line/
Sample of curriculum available for review prior to purchase
Yes
Adaptation guidelines or kit available
Yes
Languages available
English and Spanish
Program Core Components
Category Component Core Component Component present Notes Lesson number(s) / activities where present
Content School engagement No
Content Anatomy/physiology No
Content Other
Content Volunteering/civic engagement No
Content Spirituality No
Content Morals/values No
Content Identity development No
Content Social support/capital No
Content Social influence/actual vs. perceived social norms No
Content Social competence No
Content Parenting skills No
Content Normative beliefs No
Content Leadership No
Content Gender roles No
Content Gender identity No
Content Cultural values No
Content Connections with trusted adults Yes Yes (both versions) Family homework in Grade 6, Lesson 1.6, pages 25-26; Lesson 3.4 pages 62-63. Grade 7, Lesson 3.5, pages 52-53.
Content Conflict resolution/social problem solving No
Content Communication skills No
Content Child development No
Content Boundary setting/refusal skills Yes Yes (both versions) Grade 6, Lesson 1.3, 1.4, 1.5, pages 18-24, Lesson 2, pages 37-46, Lesson 3.3/3.4, pages 59-64, Lesson 4, pages 71-79; Grade 7, Lesson 3.3/3.4, pages 47-51, Lesson 4.3/4.4/4.5, pages 67-74, Lesson 6.4, pages 111-112, Lesson 7.3/7.4, pages 135-137; Grade 8 Lesson 4.3/4.4, pages 89-93, Lesson 7.4, pages 151-152
Content Substance use cessation No
Content Substance use - Other drugs No
Content Substance use - Alcohol No
Content Substance use - Abstinence Yes Yes (both versions) Grade 6, Lesson 4.4/4.5, pages 74-78
Content Brain development and substance use No
Content Vocational/skills training No
Content Supplemental academic services No
Content Graduating from high school No
Content College preparation No
Content Alternative schooling No
Content Self-regulation Yes Yes (both versions) Grade 8, Activity 7.4
Content Self-esteem No
Content Self-efficacy/empowerment Yes Yes (both versions) All skill-focused activities are designed to reinforce self efficacy and are listed here. Grade 6, Lesson 1.3, 1.4, 1.5, pages 18-24, Lesson 2, pages 37-46, Lesson 3.3/3.4, pages 59-64, Lesson 4, pages 71-79; Grade 7, Lesson 3.3/3.4, pages 47-51, Lesson 4.3/4.4/4.5, pages 67-74, Lesson 6.4, pages 111-112, Lesson 7.3/7.4, pages 135-137; Grade 8 Lesson 4.3/4.4, pages 89-93, Lesson 7.4, pages 151-152
Content Resilience No
Content Sexual health No
Content STIs - Treatment No
Content STIs - Screening Yes Yes (both versions) Grade 7, Lesson 5.4, pages 93-94, Lesson 5.6, pages 97-98
Content STIs - Prevention Yes Yes (both versions) Grade 7, Lesson 5, pages 87-99; Grade 8, Lesson 2.3/2.4, pages 37-41; Lesson 5.3, pages 107-108.
Content STIs - Information Yes Yes (both versions) Grade7, Lesson 5; Grade 8, Lesson 2.3, 2.4
Content Sexual risk reduction Yes Yes (both versions) Grade 7, Lesson 5, pages 87-99; Grade 8, Lesson 2.3/2.4, pages 37-41; Lesson 5.3, pages 107-108. All skills-based activities around drawing the line.
Content Sexual risk discontinuation No
Content Sexual risk avoidance No
Content Personal vulnerability No
Content Maternal health No
Content Contraception - Condoms Yes Yes (both versions) Grade 8, Lesson 6.4, pages 120-122
Content Contraception - Long-acting reversible contraceptives Yes Yes (both versions) Grade 8, Lesson 6.3, pages 118-119
Content Contraception - Other Yes Yes (both versions) Grade 8, Lesson 6.3, pages 118-119
Content Contraception - Pills, patches, rings, and shots Yes Yes (both versions) Grade 8, Lesson 6.3, pages 118-119
Content Reproduction No
Program Objectives
The goal of Draw the Line/Respect the Line is to provide students with knowledge and skills critical to prevent HIV infection, other sexually transmitted disease and pregnancy. All three grade levels focus on setting personal limits and using refusal and other intrapersonal skills to draw and maintain those limits. Lessons also include the importance of respecting others’ personal limits.
    Program Content

    Draw the Line/Respect the Line is a three-year curriculum, that focuses on changing functional knowledge, attitudes and beliefs, social norms, skills, and parent-child communication.

    Sixth Grade (5 Lessons):

    • Functional knowledge; attitudes and behaviors; social norms regarding the concept of limits; and how to respect limits.
    • Refusal skills and skills that encourage respecting limits.
    • Parent-child communication, including discussion of cultural and family values and pressure situations for young people.

    Seventh Grade (7 Lessons):

    • Functional knowledge and social norms regarding signs and situations that could lead to sex; emotional and social consequences of having sex versus not having sex; pressure situations teens face around sex; and facts about STD.
    • Attitudes and beliefs that foster positive attitudes toward not having sex and drawing the line.
    • Skills, including refusal skills and inter- as well as intra-personal skills to get out of risky situations that may lead to sex.
    • Parent-child communication, including discussion of intentions to avoid having sex and getting out of risky situations.

    Eighth Grade (7 Lessons):

    • Functional knowledge of facts about HIV and other STDs; proper steps of condom use; situations that could make it difficult to stick with personal limits; and behaviors that increase the risk of HIV.
    • Attitudes and beliefs that foster positive attitudes toward not having sex; important reasons for sticking with personal limits; and overcoming barriers to sticking with limits.
    • Norms regarding choosing not to have sex; using condoms and other protection if having sex; and having and respecting limits.
    • Skills, including refusal skills, condom use skills and intra-personal skills to stick with limits.
    • Parent-child communication, including discussion of HIV and its impact on those who are affected by HIV.

    Draw the Line/Respect the Line is based on several social psychological theories, particularly Social Inoculation Theory and Social Cognitive Theory. The curriculum is based on numerous principles, including:

    • Not having sex is the healthiest sexual limit for students in middle school.
    • Students can set sexual limits.
    • Students can be motivated to maintain their limits.
    • Students will encounter challenges to maintain their limits.
    • Students can overcome challenges to their limits.
    • Students who respect the limits of others will be less coercive.
    • Each student has unique needs; and condom use is essential protection for those who are sexually active

    The program logic model can be found on ETR's website: http://www.etr.org/ebi/programs/draw-the-line/

    Program Methods
    The program is delivered through role play, mini-lectures, brainstorming, games, small group work, an anonymous question box, videos, and guest speakers.
    Program Structure and Timeline

    The program is delivered in nineteen 45-minute sessions, over 3 years. In sixth grade there are 5 lessons, and in seventh and eighth grade there are 7 lessons each. The lessons should be taught in sequence.

    Ideally, classes are taught 2-3 times per week. The ideal group size ranges from 10 to 35 youth.

    Staffing
    The curriculum can be used by either classroom teachers or community-based educators.
    Program Materials and Resources

    Core intervention materials include a teacher guide (English only) for each grade and student workbooks (English and Spanish).

    Additional Needs for Implementation
    None specified
    Fidelity
    ETR provides an adaptation kit, grade-specific fidelity logs, and grade-specific Draw the Line/Respect the Line Student Knowledge Surveys that can be administered as a pre-test/post-test, and survey answer keys. These materials can be found here: http://www.etr.org/ebi/programs/draw-the-line/
    Staff Training

    It is highly recommended that educators who plan to teach Draw the Line/Respect the Line receive professional development to prepare them to effectively implement the curriculum with its intended target group.

    Training on Draw the Line/Respect the Line is available through ETR’s Professional Learning Services. Training options include:

    1. Three-day Training of Educators (TOE)—the learning process includes pre-work, skill-based instruction and post-training follow-up support.
    2. Four-day Training of Trainers (TOT)—available for seasoned trainers who have experience in delivering the intervention. Completion entitles participants to use ETR’s research-based training designs to conduct TOEs for their organization or designated affiliate group. TOT attendees who have completed the four-day TOT are eligible to attend a condensed TOT course on additional EBIs.
    Technical Assistance and Ongoing Support

    ETR provides in-person and web- or phone-based technical assistance before, during and/or after program implementation. TA is tailored to the needs of the site and is designed to support quality assurance, trouble-shoot adaptation issues, and boost implementation.

    ETR also provides evaluation support for EBI implementation. Services address process and outcome evaluation and include assistance with evaluation planning, instrument design and development, implementation fidelity, data management and analysis, performance measurement, continuous quality improvement (CQI) protocols, and effective tools and strategies for reporting results.

    Allowable Adaptations

    In-depth adaptation guidelines and tools are available through ETR at the following link: http://www.etr.org/ebi/programs/draw-the-line/.

    Examples of allowable adaptations include implementing the program in a community setting; tailoring role plays to be more relevant to the population; updating statistics with the most current information; and implementing the program with educators who are not the same race/ethnicity or gender as the learners.

    Reviewed Studies
    Citation High-Quality Randomized Trial Moderate-Quality Randomized Trial Moderate-Quality Quasi-experiment Low Study Rating Did Not Meet Eligibility Criteria

    Coyle et al. 2004

         		✓
    Study Characteristics
    Citation Setting Majority Age Group Majority Racial/Ethnic Group Gender Sample Size

    Coyle et al. 2004

         		In school: Middle school 13 or younger Hispanic or Latinx of any race Youth of any gender 2829
    Study Findings

    Evidence by Outcome Domain and Study

    Citation Sexual Activity Number of Sexual Partners Contraceptive Use STIs or HIV Pregnancy

    Coyle et al. 2004

         		Favorable evidence Potentially favorable evidence n.a. n.a. n.a.
    Detailed Findings
    Citation Details

    Coyle et al. 2004

         		The program was evaluated in a cluster randomized controlled trial involving 19 ethnically diverse schools in northern California. Ten schools were randomly selected to implement the Draw the Line/Respect the Line program and nine were randomly selected for a control group that continued their regular school programming. Surveys were administered before the program started in spring of sixth grade (baseline) and then annually in spring of seventh, eighth, and ninth grades.

    In the second year of the program in the spring of seventh grade, and again at the end of the program in the spring of eighth grade, boys in the schools implementing the intervention were significantly less likely to report ever having had sexual intercourse and having had sexual intercourse during the previous 12 months. In addition, boys in the intervention group also reported a lower frequency of sexual intercourse and having had fewer partners in the previous 12 months. A year after the program ended in the spring of ninth grade, boys participating in the intervention were significantly less likely to report ever having had sexual intercourse and having had sexual intercourse during the previous 12 months. Program impacts on the frequency of sexual intercourse and number of sexual partners were no longer statistically significant for boys one year after the program ended. The study found no statistically significant program impacts for girls on any of these outcomes for any of the follow-up periods.

    The study also examined program impacts on measures of knowledge, attitudes, normative beliefs, self-efficacy, sexual limits, coercive behavior, and unwanted sexual advances. Findings for these outcomes were not considered for the review because they fell outside the scope of the review.

    Notes

    Some study entries may include more than one citation because each citation examines a different follow-up period from the same study sample, or because each citation examines a different set of outcome measures on the same study sample. A blank cell indicates the study did not examine any outcome measures within the particular outcome domain or the findings for the outcome measures within that domain did not meet the review evidence standards.

    Information on evidence of effectiveness is available only for studies that received a high or moderate rating. Read the description of the review process for more information on how these programs are identified.