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
No
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 Core Components

Last updated in 2023

The data presented on this page reflects 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 data on seven types of program components including content, delivery mechanism, dosage, staffing, format, environment, 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. For more details, refer to the FAQ.

Category Component Core Component Component present Notes Lesson number(s) / activities where present
Content Boundary setting/refusal skills Yes Yes (evaluated version) Class 2, manual Level 1, page 53
Content Child development No
Content Communication skills No Yes (evaluated version) Class 3, manual Level 1, page 81
Content Conflict resolution/social problem solving No
Content Connections with trusted adults Yes Yes (evaluated version) Class 1, manual Level 1, page 35
Content Cultural values No
Content Gender identity Optional
Content Gender roles Optional
Content Leadership Yes Yes (evaluated version) School wide peer team component
Content Normative beliefs Yes Yes (evaluated version) Class 2, manual Level 1, page 53
Content Parenting skills No
Content Social competence Yes Yes (evaluated version) Class 8, manual Level 1, page 163
Content Social influence/actual vs. perceived social norms Yes Yes (evaluated version) Class 2, manual Level 1, page 53
Content Social support/capital Yes Yes (evaluated version) School wide peer team component
Content Identity development No
Content Morals/values
Content Spirituality No
Content Volunteering/civic engagement No
Content Other
Content Other
Content Other
Delivery mechanism Method: Anonymous question box Yes Yes (evaluated version) Throughout Levels 1 and 2 curricula (introduced in Prior to Class 1 in each manual)
Delivery mechanism Method: Artistic expression Yes Yes (evaluated version) School wide peer team component
Delivery mechanism Method: Assessment/survey Yes Yes (evaluated version) School wide peer team component
Delivery mechanism Method: Booster session Yes Yes (evaluated version) Level 2 can be considered a booster to Level 1. Level 2 curriculum
Delivery mechanism Method: Case management No
Delivery mechanism Method: Cognitive behavioral therapy (CBT) No
Delivery mechanism Method: Demonstration Yes Yes (evaluated version) Class 7, manual Level 2, page 157
Delivery mechanism Method: Discussion/debrief Yes Yes (evaluated version) Class 9, manual Level 2, page 203
Delivery mechanism Method: Family session No
Delivery mechanism Method: Game Yes Yes (evaluated version) Class 2, manual Level 2, page 55
Delivery mechanism Method: Home visiting No
Delivery mechanism Method: Homework assignment Yes Yes (evaluated version) Class 2, manual Level 2, page 55
Delivery mechanism Method: In-session assignment Yes Yes (evaluated version) Class 4, manual Level 2, page 89
Delivery mechanism Method: Introduction Yes Yes (evaluated version) Prior to Class 1, manual Levels 1 and 2
Delivery mechanism Method: Lecture Yes Yes (evaluated version) Class 2, manual Level 1, page 53
Delivery mechanism Method: Motivational interviewing No
Delivery mechanism Method: Music No
Delivery mechanism Method: Parent-focused activity Yes Yes (evaluated version) Parent Education Component
Delivery mechanism Method: Peer-to-peer Yes Yes (evaluated version) Class 7, manual Level 2, page 157
Delivery mechanism Method: Public service announcement Yes Yes (evaluated version) School wide peer team component
Delivery mechanism Method: Reading Yes Yes (evaluated version) Class 5, manual Level 1, page 115
Delivery mechanism Method: Role play/Practice Yes Yes (evaluated version) Class 6, manual Level 2, page 127
Delivery mechanism Method: Self-guided activity Yes Yes (evaluated version) Class 11, manual Level 1, page 215
Delivery mechanism Method: Service learning No
Delivery mechanism Method: Slide show No
Delivery mechanism Method: Social media Optional
Delivery mechanism Method: Spiral learning Yes Yes (evaluated version) Class 8, manual Level 1, page 163
Delivery mechanism Method: Storytelling Yes Yes (evaluated version) School wide peer team component
Delivery mechanism Method: Text message 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:

  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, 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

Indeterminate evidence n.a. Favorable evidence n.a. n.a.
KEY
Evidence Indication
Favorable findings
Two or more favorable impacts and no unfavorable impacts, regardless of null findings
Potentially favorable findings
At least one favorable impact and no unfavorable impacts, regardless of null findings
Indeterminate findings
Uniformly null findings
Conflicting findings
At least one favorable and at least one unfavorable impact, regardless of null findings
Potentially unfavorable findings
At least one unfavorable impact and no favorable impacts, regardless of null findings
Unfavorable findings
Two or more unfavorable impacts and no favorable impacts, regardless of null 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

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.

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.