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Safer Choices

Overview of the Program
Unique Features of the Program
Theoretical Framework
Program Costs and Training Information
Evaluation Fact Sheet
References

Note: This section on Safer Choices contains HIV prevention messages that may not be appropriate for all audiences.

Overview of the Program

The Safer Choices intervention consists of five primary components:

School Organization, featuring a School Health Promotion Council involving teachers, students, parents, administrators, and community representatives;

Curriculum and Staff Development, which includes a sequential 20-session classroom curriculum as well as staff awareness and training events;

Peer Resources and School Environment, which involves establishing a Safer Choices peer team or club that hosts school-wide activities;

Parent Education, featuring activities for parents such as parent newsletters, student-parent homework activities, and other parent events; and

School/Community Linkages, which involve activities to enhance students' familiarity with and access to support services outside school, such as homework to gather information about local services, resource guides, presentations by HIV positive speakers.

Program Objectives
At the completion of the program, students will:

increase their knowledge about HIV and other STDs.

have more positive attitudes about choosing not to have sex or using condoms if having sex.

have greater confidence in their ability to refuse sexual intercourse or unprotected intercourse, use a condom, and communicate about safer sexual practices.

perceive fewer barriers to condom use.
have more accurate perceptions of their risk for HIV and other STDs.

communicate more with their parents regarding sexual issues.

be able to use refusal and negotiation skills in sexual situations.

reduce sexual risk behaviors (by choosing not to have sexual intercourse or by increasing condom use and use of other methods of protection if having sex).

The Safer Choices curriculum is taught over two consecutive years, 10 lessons in Year One (Level One) and 10 lessons in Year Two (Level Two).

Level One:

Class 1:	Not Everybody's Having Sex
Class 2:	The Safest Choice:Deciding Not to Have Sex
Class 3:	Saying No to Having Sex
Class 4:	Understanding STD and HIV
Class 5:	Examining the Risk of Unsafe Choices
Class 6:	Teens with HIV: A Reality
Class 7:	Practicing the Safest Choice
Class 8:	Safer Choices: Using Protection — Part I
Class 9:	Safer Choices: Using Protection — Part II
Class 10:	Know What You Can Do

Level Two:

Class 1:	Making Safer Choices
Class 2:	The Safest Choice Challenge
Class 3:	Talking with a Person Infected with HIV
Class 4:	Personalizing the Risk for Pregnancy
Class 5:	Avoiding Unsafe Choices
Class 6:	Sticking with Your Decision
Class 7:	Using Condoms Consistently and Correctly
Class 8:	Resources
Class 9:	Media Influences
Class 10:	Making a Commitment

The classes are designed for 45-minute periods, but could be extended by providing additional time for skill practice and discussion. Level Two lessons reinforce and build on those lessons in Level One. Safer Choices is not a comprehensive family life or sexuality education program. It assumes that students have basic instruction on reproductive anatomy and physiology and puberty. The 10 lessons at each level were designed sequentially and are most effective when delivered in the order presented.

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Unique Features of the Program

The uniqueness of Safer Choices' multiple component intervention is its focus on school-wide change and the influence of the total school environment on student behavior. By involving teachers, parents, community members, and especially students, the program is designed to have a positive influence on adolescents' decisions regarding sex and help them feel supported in making the safest choices.

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Theoretical Framework

Safer Choices is based on social cognitive theory, social influences theory, and models of school change, all of which have been demonstrated to be effective in other health areas.

Social cognitive and social influences theories hypothesize that in order to reduce risk-taking behavior, people need to:

learn and personalize relevant information,

recognize social pressures and anticipate risky situations,

establish norms for positive behaviors,

learn and practice skills to act on the information and cope with social pressures.

In order to address each of these critical components of the health behavior theories, Safer Choices provides youth with the following:

Information about teen pregnancy, HIV, abstinence, birth control and the risks and consequences of teen pregnancy and HIV/STD.

Opportunities to personalize information by:

having youth identify their own vulnerability to pregnancy, STD and HIV;

examining the impact of pregnancy, STD and HIV on their own lives; and

identifying their personal values regarding abstaining or using protection.

Opportunities to recognize social pressures and anticipate risky situations by:

having youth examine common lines used to pressure for sex; and

teaching youth how to anticipate and prepare for situations in which unwanted or unprotected sex may occur.

Reinforcement of norms for abstinence or protected sex in each of the classes through the information presented and through the skill instruction and practice.

Opportunities to learn and practice skills, including: refusal and protection skills.

Models of school change are addressed through the use of the school health promotion council and other school-wide strategies (e.g., peer resources and school environment component and staff development component).

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Program Costs and Training Information

Program Costs
The Safer Choices program sells for $179 and includes:

the two 10-lesson curricula, plus two workbooks
the Peer Leader Training Guide, plus two workbooks;
the Implementation Manual; and
a Safer Choices Activity Kit.

To order Safer Choices, contact:

ETR Associates
Phone: 1 800 321-4407
Fax: 1 (800) 435-8433
Web Site: www.etr.org

Training
Training is an important aspect of the following components: School organization Curriculum and Staff Development, and Peer Resources and School Environment. The developers recommend a one-day Program Overview Training for school teams made up of an administrator, school health coordinator, 9^th and 10^th grade teachers.

Two-day basic educator trainings for Safer Choices, Level One and/or Level Two are available on a fee-for-service basis from ETR Associates. Fee-for service trainings are provided by request from a state or local education or health agency for groups of approximately 20-50 people. Costs vary depending on the size of the group trained. Average costs for each level include approximately $5,600 for staff time to prepare for and conduct the training plus travel cost (average $2,500 depending on location) and curriculum and training materials costs at approximately $200 per person. For more information, contact ETR Associates' Training Department at training@etr.org.

In addition, there may be a local trainer in your state who is qualified to provide Safer Choices trainings.

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Evaluation Fact Sheet

Intervention
Safer Choices is a two-year, school-based HIV, other STD and pregnancy prevention program for high school students. The Safer Choices intervention is based on social cognitive theory, social influence theory and models of school change.

The program consists of five primary components: school organization, curriculum and staff development, peer resources and school environment, parent education, and school/community linkages. During the two-year implementation phase of the research study (Fall 1993-Spring 1995), intervention schools implemented activities across all five components. Students received their most intensive exposure to the program from the 20-lesson curriculum and school-wide, peer-sponsored events.

Behavioral Findings
Thirty-one months following the baseline survey, Safer Choices reduced the frequency of intercourse without a condom (during the three months prior to the survey), reduced the number of sexual partners with whom students had intercourse without a condom (during the three months prior to the survey), and increased use of condoms and other protection against pregnancy at last intercourse.

Other Significant Findings
Thirty-one months following the baseline survey, Safer Choices' students, relative to comparison students, scored significantly higher on the HIV and other STD knowledge scales, expressed significantly more positive attitudes about condoms; and reported significantly greater condom use self-efficacy, fewer barriers to condom use, and higher levels of perceived risk for HIV and other STD. Safer Choices' students also reported greater normative beliefs about condom use and communication with parents; these differences neared statistical significance (P=0.06 for each variable).

Research Design
Safer Choices was evaluated using a randomized controlled design involving 20 public schools in urban areas of northern California and southeast Texas. A cohort of 3,869 ninth grade students was tracked for 31 months following a baseline survey (Fall 1993 to Spring 1996); 79% of these students completed the 31-month followup survey.

For More In-Depth Information

Karin Coyle, Ph.D.
Director of Research
ETR Associates
(831) 438-4060, ext. 140

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References

Coyle, K.K., Kirby, D., Parcel, G., Basen-Engquist, K., Banspach, S., Rugg, D., & Weil, M. (1996). Safer Choices: A multi-component school-based HIV/STD and pregnancy prevention program for adolescents. Journal of School Health, 66(3), 89-94.

Basen-Engquist, K., Parcel, B., Harrist, R., Kirby, D., Coyle, K., Banspach, S. and Rugg, D. (1997). Methodological issues in school-based health promotion intervention research: The Safer Choices Project. Journal of School Health, 67(9), 365-371.

Basen-Engquist, K., Masse, L.C., Coyle, K.K., Kirby, D., Banspach, S., Nodora, J., & Parcel, G. (1998). Sexual risk behavior, belief, and self-efficacy scales. In C.M. Davis, W.l. Yarber, R. Bauserman, G. Scheer, & S.L. Davis (Eds.), Handbook of Sexuality-Related Measures. Thousand Oaks: Sage Publications.

Basen-Engquist, K., Masse, L., Coyle, K., Kirby, D., Parcel, G., Banspach, S. & Nodora, J. (1999). Validity of scales measuring the psychosocial determinants of HIV/STD related risk behavior in adolescents. Health Education Research, 14(1), 25-38.

Coyle, K.K., Basen-Engquist, K.M., Kirby, D.B., Parcel, G.S., Banspach, S.W., Harrist, R.B., Baumler, E.R., Weil, M.L. (1999). Short-term impact of a multi-component school-based HIV/STD and pregnancy prevention program. Journal of School Health, 69(5), 181-188.

Wang, L.I., Davis, M., Robin, L., Collins, J., Coyle, K., Baumler, E. (2000). Economic evaluation of safer choices: A school-based human immunodefiency virus, other sexually transmitted diseases, and pregnancy prevention program. Arch Pediatr Adolesc Med, 154, 1017-1024.

Basen-Engquist, K., Coyle, K., Parcel, G., Kirby, D., Banspach, S., Carvajal, S., Baumler, E. (2001). Schoolwide effects of a multicomponent HIV, STD and pregnancy prevention program for high school students. Health Education and Behavior, 28(2), 166-185.

Coyle, K., Basen-Engquist, K., Kirby, D., Parcel, G., Banspach, S., Collins, J., Baumler, E., Carvajal, S., Harrist, R. (In press). Safer Choices: Reducing teen pregnancy, HIV, and STDs. Public Health Reports.

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