Short-term impact of Safer Choices: A multicomponent, school-based HIV, other STD, and pregnancy prevention programs
Original article by: Coyle, K., Basen-Engquist, K., Kirby, D., Parcel, G., Banspach, S., Harrist, R., Baumler, E., & Weil, M.
This study evaluated the effectiveness of the first year of Safer Choices, a two-year, theoretically-based, multicomponent HIV, other STD, and pregnancy prevention program for high school youth. Twenty schools in California and Texas were randomly assigned to receive either the Safer Choices intervention or the comparison program, a knowledge-based HIV prevention curriculum. The Safer Choices program included five program components:
- School organization: a health promotion council to plan and conduct program activities made up of students, teachers, parents, administrators, and community representatives.
- Curriculum and staff development: a sequential, 20-session classroom curriculum for 9th and 10th grade students (10 lessons at each grade level), including peer leaders to facilitate selected activities.
- Peer resources and school environment: a peer team or club at every school to host six types of school wide activities designed to alter the normative culture of the school.
- Parent education: three newsletters sent to parents each year, student homework that includes parents, and involvement in health promotion councils.
- School-community linkages: activities for students to go into the community and identify resources; presentations by HIV+ speakers as part of the curriculum and school environment activities.
To assess program impact, a cohort (group) of ninth grade students was surveyed at baseline and again seven months later. The survey included questions about demographic characteristics, sexuality-related psychosocial factors (e.g., knowledge, attitudes, normative beliefs, self-efficacy), sexual behaviors, and program exposure. A total of 3,677 students (48% male and 52% female) completed both surveys. Students' race/ethnicity varied: 31% White, 27% Hispanic, 18% Asian or Pacific Islander, 17% African American.
The study findings suggest that after seven months, students who received the Safer Choices intervention reported significantly higher levels of HIV and other STD knowledge, more positive attitudes toward condom use, higher self-efficacy for condom use, fewer barriers to condom use, higher levels of perceived risk, and higher levels of communication with parents. The program also reduced sexual risk behaviors among students who reported intercourse.
Specifically, the program decreased the number of times students had unprotected intercourse by approximately one-half. Additionally, sexually active students who received the program were almost two times more likely to use condoms at last intercourse than were sexually active students in the comparison group. The program also significantly increased the use of effective pregnancy prevention methods at last intercourse.
The program did not delay sexual initiation by the first follow-up, but for statistical reasons, it is premature to expect such effects at this time point. The study includes long-term follow-up assessments (19 and 31 months after baseline), which should provide better data on the program's impact on sexual initiation.
In summary, after one year of the intervention, Safer Choices improved psychosocial factors related to sexual risk taking and reduced unprotected sex among ninth grade students from diverse racial and ethnic backgrounds. These results re-affirm the importance of school-based programs to reduce sexual risk taking behaviors. Because these results reflect only one-half of the program, these changes are encouraging.