Reducing the Risk (RTR)
Building Skills to Prevent Pregnancy, HIV and STD

• Overview
• Curriculum Objectives and Lessons
• Unique Features of RTR
• Theoretical Foundation of RTR
• Research Results at a Glance

The 4th Edition of Reducing the Risk: Building Skills to Prevent Pregnancy, HIV and STD (RTR) includes 16 well-defined lessons which clearly emphasize teaching refusal statements, delay statements and alternative actions students can use to avoid unprotected sex. Directions for pre-course preparation — obtaining parent permission, establishing ground rules, etc. — are included in the manual. Specific guidelines for class activities, background information for teachers, and complete lecture notes are also included.

top

Youth who participate in RTR will be able to:

• Evaluate the risks and consequences of becoming an adolescent parent or becoming infected with HIV or another STD.
• Recognize that abstaining from sexual activity or using contraception are the only ways to avoid pregnancy, HIV infection and other STD.
• Conclude that factual information about conception and protection is essential for avoiding teenage pregnancy, HIV infection and other STD.
• Demonstrate effective communication skills for remaining abstinent and for avoiding unprotected sexual intercourse.

The lessons are designed for 45-minute periods; however, most can be expanded to fill two periods by increasing practice time and providing more time for discussion RTR’s Lessons are as follow:

Lesson 1: Abstinence, Sex and Protection — Pregnancy Prevention Emphasis (Alternative Lesson 1 has an HIV Prevention Emphasis)
Lesson 2: Abstinence: Not Having Sex
Lessons 3: Refusals
Lesson 4: Using Refusal Skills
Lesson 5: Delaying Tactics
Lesson 6: Avoiding High-Risk Situations
Lesson 7: Getting and Using Protection I
Lesson 8: Getting and Using Protection II
Lessons 9: Knowing and Talking About Protection: Skills Integration – I
Lesson 10: Skills Integration – II
Lesson 11: Skills Integration – III
Lesson 12: Preventing HIV and Other STD
Lesson 13: Risk Behaviors
Lesson 14: Implementing Protection from STD and Pregnancy
Lesson 15: Sticking with Abstinence and Protection
Lesson 16: Skills Integration IV

For greatest impact, students need encouragement to practice their interpersonal skills in role plays. The more students effectively say no to sex or to plan to use protection, the more likely it is that they will act that way outside the classroom.

top

RTR goes beyond the facts about abstinence and protection. It presents a powerful, active approach to prevention of teenage pregnancy and protection against HIV and other STD that motivates students to change their high-risk behaviors. RTR clearly emphasizes teaching refusal skills, delaying tactics and alternative actions students can use to abstain or use protection. Specific guidelines for class activities, background information for teachers, and complete lecture notes are included.

RTR is based on three health behavior theories including Social Learning Theory, Social Influence Theory and Cognitive-Behavioral Theory. These three 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 RTR provides the youth with the following:

• Information about teen pregnancy, 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 and HIV, examining the impact of pregnancy and HIV on their own lives and identifying their personal values regarding abstaining or using birth control.
• 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.
• Norms for abstinence or protected sex are reinforced through the information presented and through all the skill instruction and practice.
• Opportunities to learn and practice skills including refusal skills, delaying skills and protection skills are learned and practiced.

top

Intervention

During the fall semester of 1988 and the spring semester of 1989, 13 high schools in ten California school districts implemented the RTR curriculum during 15 consecutive class periods. Four hundred twenty-nine 9th and 10th grade students received the curriculum; 329 students served as a comparison group and received the standard sexuality education class taught at each school. The curriculum was implemented as part of a more comprehensive, required health education class.

Behavioral Findings

After 18 months, students who had not had sexual intercourse before the intervention reported significantly less initiation of intercourse than students in the comparison group. Those who were sexually active 18 months later reportedly used contraception more often than those in the comparison group. The curriculum increased the proportion of students who reported talking with their parents about abstinence and contraception.

Students in the intervention group had a greater increase in knowledge about the risk of pregnancy and STDs and proper use of condoms and other forms of contraception than did students in the comparison group. The program also significantly affected students' perceptions of the proportion of their peers who had ever had sexual intercourse.

Teachers implementing RTR voluntarily attended a 3-day training session. Observers who assessed implementation found that 95% of teachers using RTR followed the lesson plan, completed the activities, and gave accurate answers to students' questions. More than 85% were comfortable teaching the curriculum and felt adequately prepared.

In the quasi-experimental design, 23 health education classes received the intervention, and another 23 classes received the standard health class in the school. Following implementation, students, teachers, and parents assessed the curriculum. Students were surveyed through confidential questionnaires before the intervention (baseline), immediately after the intervention, six months, and 18 months later. In addition, observers visited participating classes at least once to assess the fidelity of implementation as well as teachers' level of comfort and preparation with teaching the curriculum.

For more in-depth research information:

Kirby D, Barth RP, Leland N, and Fetro JV (1991). Reducing the Risk: Impact of a new curriculum on sexual risk-taking. Family Planning Perspectives 23(6): 253-263.

Barth, R.P., (1986). Social and Cognitive Treatment of Children and Adolescents. San Francisco: Jossey-Bass.

Barth, R.P., Middleton, K. and Wagman, E. (1989). A Social and Cognitive Skill-building Approach to Preventing Teenage Pregnancy, Theory Into Practice 28, (3) 183-189.

Barth, R.P., Schinke, S. & Maxwell, J. (1985). Coping Skills Training for School-age Mothers. Journal of Social Service Research 8, 75-94.

top