Safer Choices

Safer Choices is a 2-year, multi-component STD, HIV, and teen pregnancy prevention program for high school students. The program aims to reduce the frequency of unprotected sex by reducing the number of sexually active students and increasing condom use and other methods of pregnancy protection among students who are sexually active. It seeks to motivate behavioral change by addressing factors such as attitudes and beliefs (including self-efficacy), social skills (particularly refusal and negotiation skills), functional knowledge, social and media influences, peer norms and parent/child communication.

Category Program Features
Setting School based

Program Length

8–9 hours/year | 2 years
21 sessions total
Age Group Ages 14–18
Look Inside

Table of Contents (Level 1)
Sample Lesson (Level 1)
Table of Contents (Level 2)
Sample Lesson (Level 2)

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National Recognition

Safer Choices has been chosen as an effective evidence-based program by 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; and Science and Success, Second Edition: Sex Education and Other Programs that Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections, 2008, Advocates for Youth.

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


Safer Choices is a 2-year, multi-component STD, HIV, and teen pregnancy prevention program for high school students. The program aims to reduce the frequency of unprotected sex among high-school-age students by reducing the number of sexually active students and increasing condom use and other methods of pregnancy protection among students who are sexually active. It seeks to motivate behavioral change by addressing factors such as attitudes and beliefs (including self-efficacy), social skills (particularly refusal and negotiation skills), functional knowledge, social and media influences, peer norms and parent/child communication.



The Safer Choices curriculum consists of 2 separate units to be taught over 2 school years. Level 1 provides 11 lessons. Level 2 reinforces and builds on those with an additional 10 lessons. Safer Choices assumes students have had basic instruction on reproductive anatomy and physiology and puberty.

The primary goal of Safer Choices is to prevent HIV, other STD and unintended pregnancy among participating students. The program is designed to reduce the number of high school students engaging in unprotected sexual intercourse in 2 ways:

  1. By reducing the number of students who begin or have sexual intercourse during their high school years.
  2. By increasing the use of latex condoms and other methods of protection among students who do have sex.

Specific objectives include:

  • Increasing knowledge about HIV and other STD.
  • Promoting more positive attitudes about choosing not to have sex and using condoms if having sex.
  • Promoting more positive peer norms regarding not having sex and using condoms if having sex.
  • 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 STD based on their risk behaviors.
  • Increasing communication with parents.

Key features of the program include:

  • Integration of HIV, other STD and pregnancy prevention to identify both shared and specific risk behaviors and teach prevention strategies.
  • Clear and consistent messages, which highlight that it is not healthful to engage in unprotected intercourse.
  • Interactive teaching methods, which include a variety of experiential activities such as roleplays, games, small-group activities demonstrations, and guided discussion.
  • Emphasis on skills training and practice. Student skill practice using the in-class roleplays is an essential part of the curriculum.
  • Use of  peer leaders as facilitators for selected activities. Five to 8 students from each classroom are elected by their classmates to serve as peer leaders.

Implementation of the complete schoolwide program involves selecting a site coordinator, establishing a school health promotion council, implementing both levels of the curriculum, providing staff development, establishing a peer team to conduct schoolwide activities, promoting family involvement and parent education, and creating school-community linkages.


Population Served & Setting

Safer Choices is a school-based program that was evaluated with students in urban and suburban settings. The curriculum was tested with students in Grades 9 and 10.  It is a co-educational program suitable for all racial/ethnic groups. The program is also suitable for all teens regardless of sexual experience.


About the Authors

Joyce V. Fetro, PhD, CHES, was professor and chair of the Department of Health Education and Recreation at Southern Illinois University. In 7 years as supervisor and health education curriculum specialist for the San Francisco Unified School District, she was responsible for planning, implementing and evaluating the district’s coordinated school health program. Her other professional experience includes 13 years as a middle school teacher and 3 years conducting research and evaluation studies about the effectiveness of substance use, STD/HIV infection and pregnancy prevention programs.

She was named American School Health Association’s Outstanding School Health Educator of the Year in 1991; and received the American Association of Health Education’s Health Education Professional of the Year award in 1996, and an Award of Excellence from the Centers for Disease Control and Prevention in 1997 for her innovative and creative efforts toward advancing HIV education and coordinated school health programs.

Richard P. Barth, MSW, 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 eight 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.

Karin K. Coyle, PhD, is Senior Research Scientist at ETR , Scotts Valley, California, where she serves as the lead investigator on a number of research and evaluation projects. She specializes in the development and evaluation of health promotion programs, particularly HIV, other STD and pregnancy prevention programs.

Over the past 15 years she has co-authored four research-based programs (Safer Choices, Draw the Line/Respect the Line, All4You!, and All4You2!), and has served as a principal or co-principal investigator on a number of school-based randomized trials to test the effectiveness of HIV, other STD and pregnancy prevention programs for youth.

Her current work focuses on adolescent relationships and their influence on sexual risk behavior and HIV and STI risk. She is the author of numerous professional articles in the field of health and sexuality education research.


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 Safer Choices include:

  • Planned Parenthood of the Heartland, Iowa
  • Oregon Health Authority Public Health Division
  • El Centro Family Health, New Mexico
  • Hobbs Municipal Schools, New Mexico
  • New Morning Foundation, South Carolina
  • Guam Department of Education
  • Hennepin County Health Department, Minnesota
  • South Carolina Campaign to Prevent Teen Pregnancy
  • Garland County Juvenile Detention Center, Arkansas
  • Leon County School District, Florida

Length | Elements | Staffing | Notification

Length of Program

The curriculum component of Safer Choices 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. Safer Choices classes are designed for 45-minute periods. The lessons are designed sequentially and are most effective when delivered in the order presented. It is best to implement the lessons at least 2-3 times a week to avoid the need for extensive review.

The curriculum relies on 5 to 8 peer educators from each classroom. The other components of the program are planned and conducted throughout the school year. Students receive the most intensive exposure to the program from the curriculum component and the school-wide peer-sponsored events.


Program Elements

The Safer Choices Basic Set include teacher's guides and student workbooks for both Level 1 and Level 2, plus a peer leader training guide, peer leader workbooks for both levels, and an implementation manual. The teacher's guides include blackline masters for transparencies, teacher background pages, and appendixes with additional background information. The Basic Set includes everything required for one classroom of 30 students.

Student workbooks are required for every student. Additional classroom workbook sets of 5 and 30 are available.

An optional LGBTQ Supplement helps 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 program activities more inclusive of LGBTQ youth.

An enhanced set of materials is also available that includes supplemental materials to augment student learning, including DVDs, pamphlets and posters. The enhanced set includes the LGBTQ Supplement.

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


Staffing Requirements

Teachers selected to implement the curriculum should have knowledge of the content areas covered in the curriculum, be comfortable discussing the material, have good rapport with young people, and have experience teaching a skills-based program. Five to 8 students from each classroom are elected by their classmates to serve as peer leaders.


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 Safer Choices 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 | Logic Model | Evidence Summary | References


Safer Choices is based on Social Cognitive Theory, Social Influence Theory, and Models of School Change. The uniqueness of the intervention is its focus on schoolwide change and the influence of the school environment on student behavior. The program includes 5 main components:

  • Component 1—School Organization: The program begins with schools establishing or identifying 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 approaches to provide information about HIV and STDs; teach skills, such as effective condom use and refusal skills; and promote positive attitudes and norms about refusing sex and using condoms and other protection. Peer leaders, selected by their classmates, facilitate several activities.
  • Component 3—Peer Resources and School Environment: Each school establishes a student organization to reinforce the curricular messages in the broader school environment through schoolwide activities, events, and services. Suggested activities include publishing articles in the school newspaper, presenting dramatic skits, or organizing speakers and assemblies.
  • Component 4—Parent Education: Schools engage parents in the program through newsletters, parent-child homework activities in the curriculum, , 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.


Logic Model

The program logic model can be found here:

Logic Model (pdf)


Evidence Summary

Research Design

The evaluation used a randomized trial involving 20 schools—10 schools in southeast Texas and 10 in northern California. The schools ranged in size from 961 to 2,733 students, with an average of 1,767 students. Within each site, half the schools were randomly assigned to receive Safer Choices, while the remaining half were assigned to a comparison group.

Data Gathering

Data were collected from a cohort of 3,869 students over a 3-year period (approximately 7, 19 and 31 months following baseline) to assess the effectiveness of the program.


Results suggest that Safer Choices produced numerous statistically and programmatically significant effects. Over the 3-year study, Safer Choices (Coyle et al., 2001):

  • Reduced the number of acts of intercourse without a condom among sexually experienced students in the cohort at the 7-month and 31-month follow-ups.
  • Reduced the number of partners with whom sexually experienced students had sexual intercourse without a condom at the 31-month follow-up.
  • Increased the use of effective STD and pregnancy prevention methods at last intercourse among sexually experienced students at the 7-month and 31-month follow ups.

In addition:

  • At all 3 follow-ups, the program had a positive impact on the majority of the psychosocial variables related to sexual risk-taking behaviors (e.g., HIV and STD knowledge, self-efficacy to get and use condoms, condom use norms, parent-child communication) (Coyle et al., 2001).
  • Among Hispanic youth, Safer Choices delayed the initiation of sex for 31 months (Kirby et al., 2004).
  • Safer Choices increased condom and contraceptive use among sexually active students at baseline at the 7-month and 19-month follow-ups; these effects were no longer statistically significant at the 31-month follow up (Kirby, Baumler, Coyle, 2011).

The evidence suggests that this theory-driven, school-based multi-component program can play an important role in protecting students from STD, including HIV, as well as unintended pregnancy.



Coyle, K., K. Basen-Engquist, D. Kirby, G., Parcel, S. Banspach, J. Collins, E. Baumler, S. Carvajal, R. Harrist. 2001. Safer Choices—Reducing teen pregnancy, HIV, and STDs. Public Health Reports 116 (Suppl. 1): 82-93.

Kirby, D., E. Baumler, K. Coyle, K. Basen-Engquist, G. Parcel, R. Harrist, S. Banspach. 2004. The “Safer Choices” intervention: Its impact on the sexual behavior of different subgroups of high school students. Journal of Adolescent Health 35 (6): 442-452.

Kirby, D., E. Baumler, K. Coyle. 2011. The impact of “safer choices” on condom and contraceptive use among sexually experienced students at baseline. Unpublished Manuscript Submitted in response to “Call for Studies” due January 7, 2011.

Adaptation Guidelines | Other Tools | Pre/Post Tests | 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.

See ETR’s General Adaptation Guidance

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

Read ETR's Adaptations Policy.


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 All4You! 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.

Level 1 Survey (pdf)

Level 1 Survey Answer Key (pdf)

Level 2 Survey (pdf)

Level 2 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.


Educators interested in implementing Safer Choices should be skilled in using interactive teaching methods and guiding group discussions. It is highly recommended that educators who plan to teach Safer Choices receive research-based professional development to prepare them to effectively implement and replicate the curriculum with fidelity for the intended target group.
Training on Safer Choices 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 Safer Choices 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.

Technical assistance (TA), coaching and ongoing support

ETR provides in-person and web- or phone-based technical assistance 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.