Safer Choices
The program was designed to be implemented in a classroom-based, school setting, and was also evaluated in this setting.
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/
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.
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.
Some of the components identified are noted as core components of the evidence-based program, but this does not necessarily mean that these components have been rigorously tested and show evidence of effectiveness. Most often developers denoted components as core based on theory or experience in the field. Click here for the list of evidence-based components.
For more details about program components, refer to the FAQ page.
Category | Component | Core Component | Component present | Notes | Lesson number(s) / activities where present |
---|---|---|---|---|---|
Delivery mechanism | Method: Video | Yes | Yes (evaluated version) | Class 7, manual Level 1, page 153 | |
Delivery mechanism | Method: Other | ||||
Delivery mechanism | Method: Other | ||||
Delivery mechanism | Method: Other | ||||
Dosage | Frequency | Yes | Yes (evaluated version) | For the curriculum component, it is ideal to implement the lessons 2-3 times a week to avoid the need for extensive review. Other components have suggested guidelines related to frequency (e.g., frequency of school wide peer team meetings and events). | Curriculum component (all lessons) |
Dosage | Intensity | Yes | Yes (evaluated version) | Curriculum component lessons approximately 45 minutes long. | Curriculum component (all lessons) |
Dosage | Duration | Yes | Yes (evaluated version) | Safer Choices curriculum component consists of 21 sessions taught over 2 years: 11 lessons in Level 1, taught during ninth grade, and 10 lessons in Level 2, taught during tenth grade. Total instructional time across both levels is approximately 16 hours. | Curriculum component (all lessons) |
Dosage | Other | Yes | Yes (evaluated version) | Other time includes meetings (e.g., for school-wide peer team or SHPC) and time for school-wide peer team activities as well as time for any planned parent activities beyond those involving the parent-child homework activities. | School wide peer team component |
Staffing | Deliverer: Community health worker | Optional | A member of School Health Promotion Council | ||
Staffing | Deliverer: Faith-based individual | Optional | A member of School Health Promotion Council | ||
Staffing | Deliverer: Health educator | Optional | |||
Staffing | Deliverer: Mental health provider | Optional | A member of School Health Promotion Council | ||
Staffing | Deliverer: Mentors | No | |||
Staffing | Deliverer: Parents/family | No | |||
Staffing | Deliverer: Peers | Yes | Yes (evaluated version) | Curriculum component; Peer resources and school environment component | |
Staffing | Deliverer: Primary care provider | Optional | A member of School Health Promotion Council | ||
Staffing | Deliverer: Social worker and/or counselor | Optional | A member of School Health Promotion Council | ||
Staffing | Deliverer: Teachers | Yes | Yes (evaluated version) | Curriculum component; Peer resources and school environment component | |
Staffing | Deliverer: Other | ||||
Staffing | Experience: Credentials | Experience teaching sexual health education with young people ideal for curriculum component; rapport; ability to build trust and connect w/young people; respect for young people and their lived experiences required for curriculum component and peer resources and school-environment component. School organization component requires engagement of a school administrator and other school staff. | |||
Staffing | Experience: Education | ||||
Staffing | Experience: Other | ||||
Staffing | Number of staff providing services | 1 - Varies by component. Curriculum component taught by classroom teachers. Peer resources and school environment requires an adult facilitator. School organization component involves multiple school representatives. | |||
Staffing | Training: Additional training required | Optional | |||
Staffing | Training: Developer-led training required | Optional | Encouraged for curriculum component and to support implementation of other components. | ||
Staffing | Training: Other | Implementation TA available upon request. | |||
Staffing | Other | ||||
Staffing | Other | ||||
Staffing | Other | ||||
Format | Group size: Full-group activity | Yes | Yes (evaluated version) | Curriculum component; Peer resources and school environment component | |
Format | Group size: Independent/individual activity | ||||
Format | Group size: Small-group activity | Yes | Yes (evaluated version) | School wide peer team component | |
Format | Group size: Other | ||||
Format | Mode: In-person | Yes | Yes (evaluated version) | All components | |
Format | Mode: Phone (audio) | No | |||
Format | Mode: Phone (text) | Optional | School wide peer teams could design material for delivery via text messages. | ||
Format | Mode: Phone (app) | No | |||
Format | Mode: Online/computer (asynchronous) | Optional | School wide peer teams could design material for delivery online asynchronously. | ||
Format | Mode: Online/computer (synchronous) | No | |||
Format | Mode: Other | ||||
Format | Other | ||||
Format | Other | ||||
Format | Other | ||||
Context | Context: Environmental supports | Yes | Yes (evaluated version) | Implementation of the school-wide components was facilitated by administrator engagement as part of the SHPC. | All components |
Context | Context: Environmental constraints | ||||
Context | Context: Other | ||||
Context | Setting: After school | Optional | School wide peer teams could elect to plan after-school events. The curriculum component was not delivered after school. | ||
Context | Setting: Community based | No | |||
Context | Setting: Correctional facility | No | |||
Context | Setting: Faith based | No |
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- 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.
- 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/.
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.
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.
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.
None specified
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.
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.
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 |
✓ |
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 |
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. |
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. |