Safer Sex Intervention (SSI)

Developers

Lydia A. Shrier, M.D., M.P.H.

Program Summary
Safer Sex Intervention (SSI) is an individual intervention intended to reduce STIs and improve condom use among female adolescents and young adults at high-risk for contracting an STI. The program is delivered one-on-one through a 30- to 50-minute session with a health educator, with three 10- to 30-minute follow-up sessions over the following six months.
Intended Population
The program was designed for sexually active females ages 12 to 23 who have been diagnosed with an STI. It was evaluated with sexually active African American females who were 14 to 19 years old, and sought treatment for STIs at an adolescent health clinic.
Program Setting

The program is designed for and was tested in health clinics.

Contact and Availability Information

Sociometrics Corporation
1580 W. El Camino Real, Suite 8
Mountain View, CA 94040
Ph: 650-949-3282
Email: socio@socio.com

Dr. Lydia Shrier
Boston Children's Hospital
333 Longwood Avenue, 5th Floor
Boston, Massachusetts 02115
Ph: 617-355-8306
Email: Lydia.shrier@childrens.harvard.edu 

Sample of Curriculum Available for Review Prior to Purchase
No
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)

SSI offers the evaluation instruments used in the original implementation of the program. The Prevention Minimum Evaluation Data Set is a generic questionnaire that can be adapted to suit most prevention programs.

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 Contraception - Condoms Yes Yes (both versions) Facilitator's Manual, pages 10-12, 23-25, 33
Content Anatomy/physiology No Yes (both versions) The health educator is instructed to use a female anatomical model to briefly demonstrate ascension of infection when discussing STIs as a potential consequence of unprotected sex. Facilitator's Manual, pages 6, 19
Content Other
Content Volunteering/civic engagement No
Content Spirituality No
Content Morals/values Yes Yes (both versions) Facilitator's Manual, pages 1-30
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 No
Content Conflict resolution/social problem solving No
Content Communication skills Yes Yes (both versions) Facilitator's Manual, pages 15, 28-30
Content Child development No
Content Boundary setting/refusal skills Yes Yes (both versions) Facilitator's Manual, pages 13-15, 26-30
Content Substance use cessation No
Content Substance use - Other drugs No
Content Substance use - Alcohol No
Content Substance use - Abstinence No
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-regulation No
Content Self-esteem No Yes (both versions) User's Guide, page 2
Content Self-efficacy/empowerment Yes Yes (both versions) The intervention uses motivational interviewing techniques that empower the participant to be in control User's Guide, page 2
Content Resilience No
Content Sexual health Yes Yes (both versions) Facilitator's Manual, pages 5-33
Content STIs - Treatment No
Content STIs - Screening No
Content STIs - Prevention Yes Yes (both versions) Facilitator's Manual, pages 8-14, 21-27
Content STIs - Information Yes Yes (both versions) Facilitator's Manual, pages 5-6, 18-19
Content Sexual risk reduction Yes Yes (both versions) Facilitator's Manual, pages 8-15, 21-30
Content Sexual risk discontinuation Yes Yes (both versions) Facilitator's Manual, pages 13-14, 26-27
Content Sexual risk avoidance Yes Yes (both versions) Facilitator's Manual, pages 8-15,21-30
Content Sexual orientation No
Content Maternal health No
Content Contraception - Long-acting reversible contraceptives Yes Yes (both versions) Facilitator's Manual, pages 8-9, 21-22
Content Contraception - Other Yes Yes (both versions) Facilitator's Manual, pages 8-9, 21-22
Content Contraception - Pills, patches, rings, and shots Yes Yes (both versions) Facilitator's Manual, pages 8-9, 21-22
Content Reproduction No
Program Objectives
The intervention's primary objective is to reduce risky sexual behaviors and reduce HIV and other STI infections by increasing participants' knowledge of condoms, HIV and STIs, pregnancy, and abstinence.  
Program Content

SSI draws upon Social Cognitive Theory, the Transtheoretical Model of Behavior Change, and motivational interviewing models. The sessions are designed to be conducted at the time of an STI diagnosis or treatment, when the participant is most likely to be thinking about her diagnosis relative to sexual risk behaviors.

There are two SSI curricula - Precontemplation Stage and Contemplation Stage. The Precontemplation version focuses on risk perception, motivation, education, and skills building. The Contemplation version focuses on education, skills, self-efficacy, and self-esteem. The participant self-assesses her level of risk using a Wheel of Change assessment, which helps the facilitator determine which curriculum to deliver.

Although the education sessions are tailored based on the participant's feedback and stated priorities, all consist of discussion on the consequences of sexual risk behaviors and methods for preventing pregnancy and STIs such as secondary abstinence and consistent condom use. The sessions teach condom use and negotiation skills.

After the initial session, there are three booster sessions to:

  • Reassess the participant's risk level
  • Discuss sexual history
  • Review the video
  • Review program materials

Participants are given condoms, a condom key chain, a Proud Pete booklet, and written materials.

Program Methods
The program is delivered through individual education sessions that incorporate discussion, role play (in the Contemplation curriculum, optional in the Precontemplation curriculum), condom demonstration, and video.
Program Structure and Timeline
The initial session lasts between 30 and 50 minutes, including viewing a 7-minute video. The initial session is followed by three 10- to 30-minute individual booster sessions at a health clinic. The three booster sessions are held at one, three, and six months after the initial session. Booster sessions typically coincide with the participant's clinical treatment schedule. All sessions are individual.
Staffing

Sessions are conducted by a female health educator who is trained in motivational interviewing techniques.

Staff Training
Training is not required, but is highly recommended. Training lasts two to three days and is provided through consultation with the developer. Providers interested in formalized training should contact Dr. Shrier (Email: Lydia.shrier@childrens.harvard.edu)  .
Program Materials and Resources

The following program materials are available through the distributor:

  • Safer Sex Intervention User's Guide
  • Safer Sex Intervention Curriculum Manual
  • Private Lives, HIV and STI Education DVD
  • Photocopy Masters: Handouts and Booster Session
  • Proud Pete Flipbook
  • Condom Keychains
  • Each of the following six brochures:  STD Facts,
    Birth Control Choices, Condoms: How to Use Them, 101 Ways of Saying No, 101 Ways of Making Love without Doin' It, and Safer Sex: Talking with Your Partner.
  • Fidelity toolkit
  • Set of Original Evaluation Instruments
  • Prevention Minimum Evaluation Data Set (PMEDS)
  • Local Evaluator Consultant Network Directory

While a free sample curriculum is not available, providers may purchase an automatic digital download of the user’s guide to review program components, core competencies for facilitators, and scientific evidence of effectiveness. If providers decide to purchase the program, the price of the download is deducted.

Additional Needs for Implementation

The program requires a video/DVD player, male and female anatomical models, condoms, personal lubricants, and a private space for sessions.

Fidelity

SSI has a fidelity toolkit/checklist, and tools for monitoring program implementation. These may be accessed on the Sociometrics website: https://www.socio.com/products/pasha-safer-sex-intervention

Technical Assistance and Ongoing Support

Sociometrics provides telephone technical support on implementation and evaluation for one year with purchase of the program materials.

Allowable Adaptations
The developer has noted several allowable adaptations:
  1. Updating or customizing statistics and facts about youth sexual behavior, pregnancy risk, STIs, and the effectiveness of condoms and other contraception in order to keep the program up-to-date and accurate.
  2. Using different information in materials or brochures that is more up-to-date or relevant for a particular community's population, as long as the new material covers the same information and delivers the same messages.
  3. Adding or replacing incentives/giveaways, such as pens, condoms, bracelets, or Post-it pads, particularly with the clinic's contact information or with messages such as "use protection" or "it's never too late to abstain."
  4. Providing additional resources, such as referrals to other clinics or educational activities or a list of places to get condoms, as long as they are consistent with the intervention's messages and/or promote other clinic sessions.
Adaptation Guidelines or Kit
Yes
Study Characteristics
Citation Setting Majority Age Group Majority Racial/Ethnic Group Gender Sample Size

Shrier, L. A., Ancheta, R., Goodman, E., Chiou, V. M., Lyden, M. R., Emans, S. J. (2001). Randomized controlled trial of a safer sex intervention for high-risk adolescent girls. Archives of Pediatrics Adolescent Medicine, 155(1), 73-79.

 		Health clinic or medical facility 14 to 17 African American or Black Young women

123

The Policy Research Group (2015b). Evaluation of Safer Sex Intervention in New Orleans, LA: Findings from the Replication of an Evidence-Based Teen Pregnancy Prevention Program. New Orleans, LA: Jenner, E., Walsh, S., Jenner, L. W., Demby, H., Gregory, A.

 		Health clinic or medical facility 14 to 17 African American or Black Young women

319

Abt Associates. Safer Sex Intervention: Interim Impact Report, Teen Pregnancy Prevention Replication Study, Report prepared for the Office of Adolescent Health and the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, September 2015b.

Kelsey, M., Walker, J. T., Layzer, J., Price, C., Juras, R. (2016e). Replicating the safer sex intervention: 9-month impact findings of a randomized controlled trial. American Journal of Public Health, 106, S53-S59. doi:10.2105/AJPH.2016.303372

Kelsey, M., Layzer, J., Price, C., Juras, R., and Walker, J. "Safer Sex Intervention: Short-Term Impact Report." Draft Teen Pregnancy Prevention Replication Study, Abt Associates: Cambridge, MA, November 2016f.

 		Health clinic or medical facility 14 to 17 African American or Black Young women

1809
Study Findings

Evidence by Outcome Domain and Study

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

Shrier, L. A., Ancheta, R., Goodman, E., Chiou, V. M., Lyden, M. R., Emans, S. J. (2001). Randomized controlled trial of a safer sex intervention for high-risk adolescent girls. Archives of Pediatrics Adolescent Medicine, 155(1), 73-79.

 		n.a. Potentially favorable evidence Indeterminate evidence n.a. n.a.

The Policy Research Group (2015b). Evaluation of Safer Sex Intervention in New Orleans, LA: Findings from the Replication of an Evidence-Based Teen Pregnancy Prevention Program. New Orleans, LA: Jenner, E., Walsh, S., Jenner, L. W., Demby, H., Gregory, A.

 		Indeterminate evidence n.a. Indeterminate evidence n.a. n.a.

Abt Associates. Safer Sex Intervention: Interim Impact Report, Teen Pregnancy Prevention Replication Study, Report prepared for the Office of Adolescent Health and the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, September 2015b.

Kelsey, M., Walker, J. T., Layzer, J., Price, C., Juras, R. (2016e). Replicating the safer sex intervention: 9-month impact findings of a randomized controlled trial. American Journal of Public Health, 106, S53-S59. doi:10.2105/AJPH.2016.303372

Kelsey, M., Layzer, J., Price, C., Juras, R., and Walker, J. "Safer Sex Intervention: Short-Term Impact Report." Draft Teen Pregnancy Prevention Replication Study, Abt Associates: Cambridge, MA, November 2016f.

 		Potentially favorable evidence Potentially favorable evidence Potentially favorable evidence Indeterminate evidence Indeterminate evidence
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

Shrier, L. A., Ancheta, R., Goodman, E., Chiou, V. M., Lyden, M. R., Emans, S. J. (2001). Randomized controlled trial of a safer sex intervention for high-risk adolescent girls. Archives of Pediatrics Adolescent Medicine, 155(1), 73-79.

The program's evidence of effectiveness was first established in a randomized controlled trial involving young women recruitment from the adolescent health clinic of an urban children's hospital. The sample was limited to women younger than 24 who were seeking treatment for cervicitis or pelvic inflammatory disease. Study participants were randomly assigned to either a treatment group that received the intervention or a control group that received the usual clinic services. Surveys were administered immediately before the program started (baseline) and again one, three, six, and 12 months after study enrollment.

The study found that six months after the intervention ended, adolescents in the intervention group were significantly less likely to report having had another sexual partner (in addition to their main partner) in the previous six months. The study found no statistically significant program impacts on having another sexual partner or on condom use at their last sexual encounter at the time of the one-month follow-up survey.

Findings from the 3-month and 12-month follow-ups were not considered for the review because they did not meet the review evidence standards. Specifically, both the 3- and 12-month follow-ups had a high rate of sample attrition, and the study did not establish baseline equivalence for the remaining sample members.

The study also examined program impacts on four measures of condom use (frequency and consistency of use with main partner, and frequency and consistency of use with another partner, in the past six 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 defined by sexual activity at follow-up.

The Policy Research Group (2015b). Evaluation of Safer Sex Intervention in New Orleans, LA: Findings from the Replication of an Evidence-Based Teen Pregnancy Prevention Program. New Orleans, LA: Jenner, E., Walsh, S., Jenner, L. W., Demby, H., Gregory, A.

Six months after the program ended, the study found no evidence of statistically significant program impacts on the number of times in the past three months the study participants reported having had sex. The study also found no statistically significant program impacts on the proportion of times in the past three months that the young women in the study's sample had sex without using a condom or without using any type of contraceptives.

Abt Associates. Safer Sex Intervention: Interim Impact Report, Teen Pregnancy Prevention Replication Study, Report prepared for the Office of Adolescent Health and the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, September 2015b.

Kelsey, M., Walker, J. T., Layzer, J., Price, C., Juras, R. (2016e). Replicating the safer sex intervention: 9-month impact findings of a randomized controlled trial. American Journal of Public Health, 106, S53-S59. doi:10.2105/AJPH.2016.303372

Kelsey, M., Layzer, J., Price, C., Juras, R., and Walker, J. "Safer Sex Intervention: Short-Term Impact Report." Draft Teen Pregnancy Prevention Replication Study, Abt Associates: Cambridge, MA, November 2016f.

A subsequent study conducted by a separate group of researchers evaluated the program when implemented on a broader scale and with a more broadly-defined target population. The study used a randomized controlled trial involving young women recruited from 37 clinics across three states (Florida, Minnesota, and Tennessee). The study focused on young women who were sexually active or about to become sexually active. Participants were randomly assigned to either a treatment group that received the intervention or to a control group that received the standard clinic services. Data were collected immediately before random assignment (baseline) and again nine and 18 months after study enrollment.

The study found that nine months after enrolling in the study, adolescents in the treatment group were significantly less likely to report having had sexual intercourse without birth control in the previous 90 days. The study also found that among the subgroup of adolescents who were sexually inexperienced at baseline, those in the treatment group were significantly less likely to report having had sex or having had more than one lifetime sexual partner. These program effects did not persist 18 months after enrollment in the study. In particular, the study found no evidence of statistically significant program impacts, for the full sample and for any of the subgroups of youth defined by sexual experience at baseline, on rates of sexual activity or sexual activity without birth control in the last 90 days, or on having had more than one lifetime sexual partner.

At the 18-month follow-up, the study also found no evidence of statistically significant program impacts on becoming pregnant or being diagnosed with a STI in the last 12 months for either the full sample or the subsample of youth who were sexually inexperienced at baseline. At both the 9- and 18-month follow-ups, the study found no statistically significant program impacts on the percentage of participants who reported having had sex without a condom in the past 90 days.

The study also examined program impacts on measures of knowledge of pregnancy risk and STI risk, attitudes toward protection, attitudes toward risky sexual behavior, motivation to delay childbearing, condom negotiation and refusal skills, and intentions to engage in sexual risky behavior. 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.