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Safer Choices

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

Program Contact Information
Email: sales@etr.org
Phone: (800) 321-4407
Website: http://www.etr.org/ebi/programs/safer-choices/

Training Contact Information
Kelly Gainor, M.Ed.
ebptraining@etr.org
Website: http://www.etr.org/ebi/programs/safer-choices/

Sample of Curriculum Available for Review Prior to Purchase

Yes

Languages Available

English

Monitoring and Evaluation Tools

Monitoring and evaluation tools available

Yes

Monitoring and evaluation tool usage required

Information about available monitoring and evaluation tools (if applicable)

ETR provides a fidelity log and pre- and post-test surveys to examine whether participants have met short-term learning objectives. In addition, the Safer Choices Implementation Manual that comes with the program helps users implement the school-wide components of the intervention.

Program Components and Core Components

Last updated in 2024

The data presented on this page reflect responses from the program’s developer or distributor to a program component checklist that asked them to report on the individual components within their TPP program. The same program component checklist was sent to the developer or distributor of every active TPP program with evidence of effectiveness. The program component table provides information on seven types of program components including content, delivery mechanism, dosage, staffing, format, context, and intended population characteristics; whether the component was present or optional in the program; whether the component is considered to be core to the program; and the lesson number or activity where the component can be found in the program.

In the drop-down menu below, under “Has component,” there are four options that indicate a component as present in the program: (1) “Yes” indicates that the component is present in at least one version of the program (whether that be the program version that was evaluated, the current version, or both versions); (2) “Yes (both versions)” indicates that the component is present in both the evaluated version of the program and the current version of the program; (3) “Yes (current version)” indicates that the component is present in the current, but not the evaluated, version of the program; and (4) “Yes (evaluated version)” indicates that the component is present in the evaluated version of the program, only. Note that for dosage components, the dosage itself is described in the Notes when available.

Category	Component	Core Component	Component present	Notes	Lesson number(s) / activities where present
Content	Contraception - Condoms	Yes	Yes (evaluated version)	Some school-wide peer team activities focused on this type of content in study.	Class 10, manual Level 1, page 197
Content	Anatomy/physiology		Optional	Program assumes this has been taught. School wide peer team component could plan activities related to this content.
Content	Other
Content	Other
Content	Other
Content	Volunteering/civic engagement		No
Content	Spirituality		No
Content	Morals/values
Content	Identity development		No
Content	Social support/capital	Yes	Yes (evaluated version)		School wide peer team component
Content	Social influence/actual vs. perceived social norms	Yes	Yes (evaluated version)		Class 2, manual Level 1, page 53
Content	Social competence	Yes	Yes (evaluated version)		Class 8, manual Level 1, page 163
Content	Parenting skills		No
Content	Normative beliefs	Yes	Yes (evaluated version)		Class 2, manual Level 1, page 53
Content	Leadership	Yes	Yes (evaluated version)		School wide peer team component
Content	Gender roles		Optional
Content	Gender identity		Optional
Content	Cultural values		No
Content	Connections with trusted adults	Yes	Yes (evaluated version)		Class 1, manual Level 1, page 35
Content	Conflict resolution/social problem solving		No
Content	Communication skills	No	Yes (evaluated version)		Class 3, manual Level 1, page 81
Content	Child development		No
Content	Boundary setting/refusal skills	Yes	Yes (evaluated version)		Class 2, manual Level 1, page 53
Content	Substance use cessation		No
Content	Substance use - Other drugs		No
Content	Substance use - Alcohol		Optional	Some peer team school-wide activities focused on this type of content in study.
Content	Substance use - Abstinence		Optional	Some peer team school-wide activities focused on this type of content in study.
Content	Brain development and substance use		No
Content	Vocational/skills training		No
Content	Supplemental academic services		No
Content	School engagement		No
Content	Graduating from high school		No
Content	College preparation		No
Content	Alternative schooling		No
Content	Self-esteem		No
Content	Self-efficacy/empowerment	Yes	Yes (evaluated version)		Class 3, manual page 81
Content	Sexual orientation		Optional
Content	STIs - Vaccination	Yes	Yes (evaluated version)		Class 4, manual Level 1, page 101;
Content	STIs - Treatment	Yes	Yes (evaluated version)		Class 4, manual Level 1, page 101;
Content	STIs - Screening	Yes	Yes (evaluated version)		Class 4, manual Level 1, page 101;
Content	STIs - Prevention	Yes	Yes (evaluated version)		Class 4, manual Level 1, page 101; Class 1, manual Level 2, page 31
Content	STIs - Information	Yes	Yes (evaluated version)		Class 4, manual Level 1, page 101;
Content	Sexual risk reduction	Yes	Yes (evaluated version)		Class 9, manual Level 1, page 183
Content	Sexual risk discontinuation	Yes	Yes (evaluated version)	Choosing not to have sex is presented as the safest choice throughout program.	Class 1, manual Level 2, page 31
Content	Sexual risk avoidance	Yes	Yes (evaluated version)		Class 2, manual Level 1, page 53
Content	Puberty/development		No
Content	Contraception - Long-acting reversible contraceptives	Yes	Yes (both versions)		Class 9, manual Level 1, page 183
Content	Contraception - Other	Yes	Yes (evaluated version)		Class 9, manual Level 1, page 183
Content	Contraception - Pills, patches, rings, and shots	Yes	Yes (evaluated version)		Class 9, manual Level 1, page 183
Content	Maternal health		No

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.

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.

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/.

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.

Adaptation Guidelines or Kit

Yes

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.

KEY

Evidence Indication

Favorable findings

Potentially favorable findings

Indeterminate findings

Conflicting findings

Potentially unfavorable findings

Unfavorable findings

Note: n.a. indicates the study did not examine any outcome measures within that particular outcome domain, or the study examined outcome measures within that domain but the findings did not meet the review evidence standards.

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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Safer Choices

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