Program Success Center

for Sexual & Reproductive Health

Reducing the Risk

Reducing the Risk (RTR) is a 16-session curriculum designed to help high school students delay the initiation of sex or increase the use of protection against pregnancy and STD/HIV if they choose to have sex. This research-proven approach addresses skills such as risk assessment, communication, decision making, planning, refusal strategies and delay tactics.

Category Program Features

School based
May be adapted for out-of-school or rural settings

Program Length

16 hours/year | 1 year
16 sessions total
Age Group Ages 14–18
Look Inside

Table of Contents
Sample Lesson

Find out what's new in the Revised Fifth Edition >>

See alignment with the Tool to Assess Characteristics >>

National Recognition

Proven effective in 3 studies, RTR has been chosen as an effective evidence-based program by the Centers for Disease Control and Prevention (CDC), the Office of Adolescent Health and other national organizations recognized as authorities on teen pregnancy prevention, including Emerging Answers 2007 and What Works 2010: Curriculum-Based Programs That Help Prevent Teen Pregnancy, The National Campaign to Prevent Teen and Unplanned Pregnancy; Programs That Work, 2010, Promising Practices Network; and Science and Success, Second Edition: Sex Education and Other Programs that Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections, Advocates for Youth.

Overview | Description | Population | Author | Who's Using


Reducing the Risk (RTR) is a 16-session curriculum designed to help high school students delay the initiation of sex or increase the use of protection against pregnancy and STD/HIV if they choose to have sex. The major focus is the development of attitudes and skills that will help teens prevent pregnancy and the transmission of STD, including HIV. This research-proven approach addresses skills such as risk assessment, communication, decision making, planning, refusal strategies and delay tactics.



The greatest emphasis of Reducing the Risk is on teaching students the interpersonal or social skills they can use to abstain or protect themselves. Abstinence is presented as the best, safest and most common choice for high school students, but Reducing the Risk also recognizes that some students are sexually active. For this reason, students are given clear guidelines and rationales for using protection during sex. Young people do not find these messages contradictory, and lessons reviewing protection do not increase the likelihood that students will become sexually active. Students learn they must consult with their parents and think through their own values to decide what to do.

Two key skills are taught:

  • Refusal skills – Responses that clearly say no in a manner that doesn't jeopardize a good relationship, but which leave no ambiguity about the decision not to have sex or to refuse unprotected sex.
  • Delay tactics and alternative actions – Ways students can avoid a situation or delay taking action until they have time to decide what to do or say, or until they are more prepared to make a decision.

Reducing the Risk is delivered through roleplays, skill practice, brainstorming, mini-lecture and worksheet activities. Roleplays are an essential and powerful part of the program. At first, students may be hesitant about their performances, but they soon begin to enjoy these opportunities and use them to great advantage. Teachers help students by encouraging them to practice their interpersonal skills in the roleplays. The more students practice effectively saying no to sex (or to unprotected sex), the more likely they'll be to use these skills in real life.

As a result of participating in RTR, students will be able to:

  • Evaluate the risks and lasting 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 and other STD.
  • Conclude that factual information about conception and protection is essential for avoiding teen pregnancy, HIV and other STD.
  • Demonstrate effective communication skills for remaining abstinent and for avoiding unprotected sexual intercourse.


Population Served & Setting

RTR can be implemented with high school students in both rural and urban areas. It has been used successfully with students from a range of racial/ethnic backgrounds. While designed primarily for ninth grade students, it can be used with students in other appropriate grades (e.g., 8–12) or the appropriate age (e.g., 13–18).


About the Author

Richard P. Barth, MSW, PhD, is Dean, School of Social Work, University of Maryland. His AB, MSW and PhD are from Brown and UC Berkeley, respectively. He has served as a chaired professor at UC Berkeley and the University of North Carolina.

He was the 1986 winner of the Frank Breul Prize for Excellence in Child Welfare Scholarship from the University of Chicago, a Fulbright Scholar in 1990 and 2006, the 1998 recipient of the Presidential Award for Excellence in Research from the National Association of Social Workers, the 2005 winner of the Flynn Prize for Research, and the 2007 winner of the Peter Forsythe Award from the American Public Human Services Association.

He is the author, co-author, or editor of ten books and three curricula, including Reducing the Risk, Safer Choices and Power through Choices, all designed to reduce the likelihood and risks of youth becoming sexually active. He was also the Principal Investigator (PI) of the ENABL evaluation in California, and served as PI of the evaluation of the Hewlett Foundation’s Responsible Fatherhood and Male Involvement Initiative in the San Francisco Bay Area and the Teenage Pregnancy Prevention Initiative (TPPI) in North Carolina. He has published more than 120 articles in a variety of health and social work journals and is on the editorial board or a consulting editor of Social Work, Social Service Review, the Journal of Adolescent Research, Children and Youth Services Review and Adoption Quarterly. He has also served on the boards of numerous child-serving agencies and is now a Commissioner on the Advisory Board of the Baltimore City Social Services Department.

He has led research studies and service evaluations for numerous federal and state agencies and foundations in the area of children’s services. For 8 years he served as Co-PI on the National Survey of Child and Adolescent Well-Being, the first national probability study of child welfare services. He is currently PI of a Maryland DHR funded effort to examine reproductive health services and teenage births in foster care.


Who’s Using?

ETR's effective, award-winning, evidence-based resources are used by schools, departments of education, youth groups, government agencies and clinics nationwide.

Some of the sites that have purchased Reducing the Risk include:

  • Montana Department of Health & Human Services
  • Duval County Public Schools, Florida
  • Maricopa County Department of Public Health, Arizona
  • San Diego Youth Services, California
  • Wyoming Alliance of Boys & Girls Clubs
  • Buffalo Public Schools, New York
  • San Antonio Metropolitan Health District, Texas
  • Belmont County Health Department, Ohio
  • Communities in Schools of the Charleston Area, Inc, North Carolina
  • Planned Parenthood of Greater Ohio
  • Sedgwick County Health Department, Kansas
  • West Virginia Department of Health & Human Resources


Length | Elements | Staffing | Notification

Length of Program

The program consists of 16 classes, conducted 2-3 times per week. The classes must be taught in sequence. The ideal class size is between 10 and 30 youth. The classes are designed for 45-60 minute periods. Most can be expanded to fill more time, or 2 full periods, by increasing time to practice the skills and discuss the activities.


Program Elements

The Reducing the Risk Basic Set includes a teacher's guide, activity kit, and student workbooks, plus STD Facts for Teens, HIV Facts for Teens and Birth Control Facts for Teens pamphlets—everything required for one classroom of 30 students. Student workbooks are available in English and Spanish.

An optional LGBTQ Supplementhelps teachers build a supportive environment for LBGTQ students. It includes a lesson that can be taught before implementing the intervention as well as suggestions for acceptable adaptations to make the RTR program more inclusive of LGBTQ youth.

Student workbooks are required for every student. Additional classroom workbook sets of 5 and 30 are available. Contact ETR regarding custom site license pricing to reprint student workbooks.

Program sets with supplemental materials to enhance student learning, including DVDs, pamphlets and posters, are also available. The enhanced set includes the LGBTQ Supplement.

ETR also provides free downloads of pre- and post-tests and Adaptation Tools.


Staffing Requirements

This curriculum is designed to be taught by classroom teachers or family life educators. Educators interested in implementing this program should be skilled in using interactive teaching methods and guiding group discussions, and should be comfortable with the program content.


Parent/Guardian Notification

It is essential to inform parents and guardians regarding the nature and scheduling of this or any sexual health education program. Prior to implementation of the curriculum, families should receive written notice describing the goals of Reducing the Risk and the nature of the content to be covered. Parents also should be given an opportunity to view the curriculum and related materials if they wish. The vast majority of parents want their children to receive appropriate instruction and be given the information and skills they need to protect their sexual health, but parents/guardians also must be allowed the chance to opt out or exclude their children from participating in the program, if they wish.

Theory | Core Content | Logic Model | Evidence Summary | References


Reducing the Risk is based upon several interrelated theoretical models: Social Learning Theory, Social Inoculation Theory and Cognitive Behavior Theory. As applied to pregnancy prevention, Social Learning Theory suggests that the likelihood of an action such as using birth control is influenced by an understanding of what must be done to avoid pregnancy, a belief that the method will successfully prevent pregnancy and the anticipated benefit of the action. Social Inoculation Theory suggests that people develop resistance to social pressure when they can recognize the forms of pressure, are motivated to resist them, and are capable of doing so. Cognitive Behavior Theory suggests that young people need specific cognitive and behavioral skills to resist pressures and successfully manage interpersonal encounters. The model has 3 components: activities to personalize information about sexuality, reproduction and contraception; training in decision-making and assertive communication skills; and practice in applying these skills in personally difficult situations.

Key content covered by the program consists of:

  • Knowledge of pregnancy risk and prevention.
  • Knowledge about STD and HIV risk, prevention, transmission, treatment and consequences.
  • Perception of individual risk for pregnancy, STD and HIV and their consequences if teenagers engage in unprotected sex.
  • Knowledge of how to be abstinent or use birth control methods effectively and how to access health care information and contraception (including condoms).
  • Effective and ineffective refusal skills.
  • Social and peer norms, as well as personal attitudes about abstinence, sex, unprotected sex, condoms and contraception.
  • Refusal and communication skills in pressure situations in order to avoid pregnancy and STD.
  • Skills to obtain health care information and contraception from a clinic and use it.
  • Skills to communicate with parents or other adults about teen sexual activity and birth control.


Logic Model

The program logic model can be found here:

Logic Model (pdf)


Evidence Summary

Reducing the Risk is one of the first rigorously evaluated sexuality education curricula to have a measurable impact on behavior, and the first curriculum that has been independently implemented and evaluated in three different states and been found to significantly improve one or more sexual behaviors in each.

In a California study:

  • Reducing the Risk delayed the onset of intercourse at 18 months among sexually inexperienced students by as much as 24% and reduced the rate of unprotected intercourse by 40% (Kirby, et al., 1991).
  • The program significantly increased teens' knowledge and communication with parents regarding abstinence and contraception.

In an Arkansas study:

  • Reducing the Risk both delayed the initiation of sex among youth who had not had sex at pretest and increased condom use among those youth who did initiate sex (Hubbard, Giese and Raney, 1998).

In a Kentucky study:

  • Reducing the Risk significantly delayed the initiation of sex (Zimmerman et al., 2008).

In additional studies:

Adaptation Guidelines | Other Tools | Pre/Post Tests | FAQ | Policy

Adaptation Guidelines

ETR is a leader in developing adaptation guidelines to enable professionals to adapt evidence-based intervention programs for implementation in underserved communities, while maintaining fidelity to the intervention's core components. To produce the best adaptation tools, ETR works directly with the developer of each intervention to ensure that these tools are of the highest quality and meet the different needs of the field and end users, e.g., teachers, trainers, program mangers/staff, research teams, and funders.

Click the links below to view Adaptation Guidelines for Reducing the Risk.

Adaptation Green/Yellow/Red Guidelines (pdf)

Core Components (pdf)

For answers to Frequently Asked Questions about program adaptations, please visit our Program Support Help Desk.

Read ETR's Adaptations Policy.


Tools for Online Implementation

ETR has developed the following PowerPoint to facilitate implementation of the curriculum, particularly in virtual settings:

  • Reducing the Risk PowerPoint Slides

Click HERE to request access.


Other Implementation Tools

ETR also produces other tools to facilitate implementation. Click the link to view.

Fidelity Log (pdf)


Pre/Post Tests

Classroom teachers can use pre/post tests to examine whether short-term knowledge learning objectives have been met. A simple pretest-posttest assessment design can be used to measure pre-instruction levels and post-instruction changes in student learning.

Your ability to detect student change using this survey may vary and can be affected by numerous factors (e.g., number and content of lessons students receive, student scores at pretest, student motivation and interest in topic and survey, etc.) Improvement on the Reducing the Risk Student Knowledge Survey between pretest and posttest can be viewed as supportive, but not definitive, evidence of the curriculum's impact on short-term knowledge learning objectives. A well designed evaluation study (e.g., using a strong experimental design with a well matched comparison group and adequate sample size) with more extensive measurement would be needed to provide stronger evidence of curriculum impact.

Survey (English) (pdf)    Survey (Spanish) (pdf)

Survey Answer Key (pdf)

Learn more about how ETR can help with your evaluation needs >>

Training & TA

For over 30 years, ETR has been building the capacity of community-based organizations, schools, school districts, and state, county and local agencies in all 50 states and 7 U.S. territories to implement and replicate evidenced-based programs (EBPs) to prevent teen pregnancy, STD/STI and HIV. Our nationally recognized training and research teams work in partnership with clients to customize training and technical assistance (TA) to address the needs of their agencies and funding requirements.

Training of Educators

Educators interested in implementing RTR should be skilled in using interactive teaching methods and guiding group discussions. It is highly recommended that educators who plan to teach RTR receive research-based professional development to prepare them to effectively implement and replicate the curriculum with fidelity for the intended target group.
Training on RTR is available through ETR's Professional Learning Services. Training options include:

  • Three-day Training of Educators (TOE)—ETR’s TOE is a professional learning process that builds the knowledge and skills required of adult learners to implement RTR with fidelity and, when applicable, germane adaptations. The learning process includes pre-work, skill-based instruction and post-training follow-up support. The TOE is designed intentionally to be outcome based by boosting skills that lead to quality implementation.
  • Four-day Training of Trainers (TOT)—available for qualified, seasoned trainers who have experience in delivering RTR. The TOT prepares select trainer candidates to effectively prepare adult learners to implement the intervention with fidelity. Completion entitles participants to use ETR's research-based training design 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 EBPs.
  • RTRWorks!, a self-paced, highly interactive, evidence-based online training designed to prepare and support educators to effectively lead RTR. The training can be completed in just 2 to 5 hours, at the convenience of the educator.

Technical assistance (TA), coaching and ongoing support

ETR provides in-person and web- and phone-based TA before, during and/or after program implementation. TA is tailored to the needs of the site and is designed to support quality assurance, trouble-shoot adaptation issues, and boost implementation.

Enrichment Training

To support a holistic approach to teen pregnancy and HIV prevention programs, ETR offers a number of additional training and technical assistance opportunities, including content-specific workshops, skill-based trainings, organizational development consultation and much more. To learn more about these opportunities, visit our Training & TA pages >>


Adaptation support materials, training and TA are available to assist educators in meeting the needs of individual communities by implementing EBPs effectively and consistently with core components. All adaptation support is based on ETR's groundbreaking, widely disseminated adaptation guidelines and kits for effective adaptations.


ETR also provides evaluation support for EBP implementation. ETR uses well-established tools for measuring fidelity and outcomes. ETR's evaluation support blends participatory approaches with cutting-edge evaluation science. 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.

Pricing Packages | Product Budget Calculator

RTR Pricing

Basic Set – $249.99 BUY NOW

(contains everything needed to teach with fidelity)

  • Teacher’s Guide
  • Student Workbooks (classroom set of 30)
  • Activity Kit
  • STD Facts for Teens pamphlets (50)
  • HIV Facts for Teens pamphlets (50)
  • Birth Control Facts for Teens pamphlets (50)

Additional Student Workbooks

Additional Pamphlets

Enhanced Set – $349.99

(includes additional materials to enhance learning)

  • All materials in the Basic Set
  • STD Facts laminated poster
  • HIV Facts laminated poster
  • Birth Control Choices laminated poster
  • How to Use a Condom DVD
  • Understanding Self-Identity LGBTQ supplement

RTRWorks! Online Training

Extend the Learning