Safer Choices

Featured Grant OpportunitySchool Emergency Response to Violence (Project SERV) (Funding Opportunity) 

Featured Grant OpportunityShare with Youth: NOAA Student Opportunities Database

Developers

Karin K. Coyle, Ph.D., Joyce V. Fetro, Ph.D., C.H.E.S. and Richard P. Barth, M.S.W., Ph.D.

Program Summary

Safer Choices is a two year multi-component STD, HIV, and teen pregnancy prevention program for high school students. The program aims to reduce the frequency of unprotected sex among high-school-age students by reducing the number of sexually active students and increasing condom use among students who are sexually active. It seeks to motivate behavioral change by increasing students’ knowledge about HIV and STDs as well as promoting more positive norms and attitudes toward abstinence and condom use at the student, school, and community levels.

Intended Population

The program was designed for high school students. It was evaluated with 9th grade students in an urban setting.

Program Setting

The program was designed to be implemented in a classroom-based, school setting, and was also evaluated in this 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/safer-choices/

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/safer-choices/

Sample of curriculum available for review prior to purchase

Yes

Adaptation guidelines or kit available

Yes

Languages available

English

Program Core Components

Program Objectives

Safer Choices aims to reduce the frequency of unprotected sex among high-school-age students by reducing the number of sexually active students and increasing condom use among students who have sex. It will reach these objectives by:

Increasing students' knowledge about HIV and other STDs.
Promoting more positive attitudes and peer norms toward abstinence and condom use.
Increasing students' belief in their ability (self-efficacy) to refuse sex or unprotected sex, use a condom, and communicate about safer sexual practices.
Decreasing perceived barriers to condom use.
Aligning students' perceptions of risk for HIV and other STDs based on their risk behaviors.
Increasing communication with parents.

Program Content

Safer Choices is a comprehensive program focused on reducing the frequency of unprotected sex. It is based on Social Cognitive Theory, Social Influence Theory, and Models of School Change. Safer Choices consists of five main components:

Component 1 - School Organization: The program begins with schools establishing a Health Promotion Council, composed of teachers, students, parents, administrators, and community members. The Council has lead responsibility for organizing and planning the other four components of the program.
Component 2 - Curriculum: The 21-session curriculum is taught over two years. It uses interactive activities to provide information about HIV and STDs; teach effective condom use, refusal skills, and decision-making skills; and promote positive attitudes and norms about refusing sex and using condoms. Peer leaders, selected by their classmates, facilitate several activities.
Component 3 - Peer Resources and School Environment: Each school convenes a student organization to reinforce the curricular messages in the broader school environment through school-wide activities, events, and services. Suggested activities include publishing articles in school media, presenting dramatic skits, or organizing speakers and assemblies.
Component 4 - Parent Education: Schools engage parents in the program’s goals through newsletters, child-parent discussions on sexuality topics, and parent education workshops or speakers.
Component 5 - School-Community Linkages: This component seeks to connect students with community resources such as local information hotlines, clinics, and testing services. Students receive homework assignments that require them to find out more about the services available in the community.

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

Program Methods

The curriculum component of the program is delivered through brainstorms, small group work, worksheets, videos, demonstrations, and homework.

Program Structure and Timeline

The curriculum component of Safer Choices consists of twenty-one 45-minute sessions over two years: 11 lessons in level 1, taught during 9th grade, and 10 lessons in level 2, taught during 10th grade. The program relies on 5 to 8 peer educators from each classroom. The other components of the program are conducted in parallel with the delivery of the curriculum.

Implementation of the complete school-wide program also involves selecting a site coordinator, establishing a school health promotion council, providing staff development, establishing a peer team to conduct school-wide activities, promoting family involvement and parent education, and creating school-community linkages.

Staffing

Teachers selected to implement the program should have knowledge of the content areas covered in the curriculum, be comfortable discussing the material, have experience teaching a skills-based program, and be interested in and committed to the goals of the program.

Program Materials and Resources

Core intervention materials are a teacher's guide for each level, student workbooks for each level, peer leader training guide and workbooks, and an implementation manual.

Additional Needs for Implementation

None specified

Fidelity

ETR provides a fidelity log, adaptation kit, a Safer Choices Student Knowledge Survey, and a survey answer key that can be administered as a pre-test/post-test. These materials can be found here: http://www.etr.org/ebi/programs/safer-choices/.

Staff Training

It is highly recommended that educators providing Safer Choices receive training and follow-up support to prepare them to effectively use the curriculum with its intended target group.

ETR offers training on both the Safer Choices curriculum and overall program implementation through its professional development and technical assistance services:

Three-day Training of Educators (TOE)—the learning process includes pre-work, skill-based instruction and post-training follow-up support.
Four-day Training of Trainers (TOT) — available for seasoned trainers who have experience in delivering the intervention, and includes training on all of the Safer Choices program components. 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 can provide in-person and web- or phone-based technical assistance before, during and after program implementation. TA supports quality assurance and problem-solving of implementation and adaptation issues. ETR also provides evaluation services.

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 Associates at the following link: http://www.etr.org/ebi/programs/safer-choices/.

Examples of allowable adaptations include tailoring role plays to be more relevant to the population, updating statistics with more current information, and allowing students to complete homework activities with another adult if they are unable to talk with a parent or guardian.

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. 1999 Wang et al. 2000 Basen-Engquist et al. 2001 Coyle et al. 2001 Kirby et al. 2004 ?Kirby et al. 2011	✓

Study Characteristics

Citation	Setting	Majority Age Group	Majority Racial/Ethnic Group	Gender	Sample Size
Coyle et al. 1999 Wang et al. 2000 Basen-Engquist et al. 2001 Coyle et al. 2001 Kirby et al. 2004 ?Kirby et al. 2011	In school: High school	14 to 17	White	Youth of any gender	3869

Study Findings

Evidence by Outcome Domain and Study

Citation	Sexual Activity	Number of Sexual Partners	Contraceptive Use	STIs or HIV	Pregnancy
Coyle et al. 1999 Wang et al. 2000 Basen-Engquist et al. 2001 Coyle et al. 2001 Kirby et al. 2004 ?Kirby et al. 2011		n.a.		n.a.	n.a.

Detailed Findings

Citation Details

Citation	Details
Coyle et al. 1999 Wang et al. 2000 Basen-Engquist et al. 2001 Coyle et al. 2001 Kirby et al. 2004 ?Kirby et al. 2011	The program was evaluated in a cluster randomized controlled trial involving 20 high schools in southeastern Texas and northern California. Ten schools were randomly select to implement the Safer Choices program and 10 were randomly selected to implement a five-session knowledge-based curriculum about the consequences of unprotected sex, contraception, STDs, and HIV. Surveys were administered to incoming 9th grade students in fall and spring of their 9th grade year and spring of their 10th and 11th grade years. The study found that when the curriculum ended in spring of 9th and 10th grades, among the subgroup of students who were sexually experienced at baseline, the students in the schools implementing the program were more likely to have used a condom and to have used an effective contraceptive method the last time they had sex. A year after the curriculum ended in the spring of 11th grade, program impacts on condom use and contraceptive use were no longer statistically significant. The study did not find evidence of statistically significant program impacts on rates of sexual initiation. The study also examined program impacts on measures of frequency of sexual activity and number of sexual partners in the last three months. Findings for these outcomes were not considered for the review because they did not meet the review evidence standards. Specifically, findings were reported only for subgroups of youth defined by sexual activity at follow-up.

Coyle et al. 1999

Wang et al. 2000

Basen-Engquist et al. 2001

Coyle et al. 2001

Kirby et al. 2004

?Kirby et al. 2011

The program was evaluated in a cluster randomized controlled trial involving 20 high schools in southeastern Texas and northern California. Ten schools were randomly select to implement the Safer Choices program and 10 were randomly selected to implement a five-session knowledge-based curriculum about the consequences of unprotected sex, contraception, STDs, and HIV. Surveys were administered to incoming 9th grade students in fall and spring of their 9th grade year and spring of their 10th and 11th grade years.

The study found that when the curriculum ended in spring of 9th and 10th grades, among the subgroup of students who were sexually experienced at baseline, the students in the schools implementing the program were more likely to have used a condom and to have used an effective contraceptive method the last time they had sex. A year after the curriculum ended in the spring of 11th grade, program impacts on condom use and contraceptive use were no longer statistically significant. The study did not find evidence of statistically significant program impacts on rates of sexual initiation.

The study also examined program impacts on measures of frequency of sexual activity and number of sexual partners in the last three months. Findings for these outcomes were not considered for the review because they did not meet the review evidence standards. Specifically, findings were reported only for subgroups of youth defined by sexual activity at follow-up.

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