Safer Choices

Safer Choices (SC) is a comprehensive intervention to reduce the number of students engaging in unprotected sexual intercourse by reducing the number of students who initiate or have sex during their high school years, and by increasing the use of latex condoms and other birth control methods among those students who do have sex. Safer Choices promotes the message that unprotected intercourse or intercourse before one is ready is an unsafe choice, using protection against pregnancy and STDs is a safer choice, and choosing not to have intercourse is the safest choice. This program seeks to create schoolwide change, through the institution of multiple program components. The curriculum component of the program consists of 20 class sessions for 9th and 10th grade students. As part of this curriculum, students learn about support services available in their community. The program also includes the creation of a school health promotion council and a Safer Choices peer team. Both of these groups plan schoolwide events designed to alter the normative culture of the school. Additionally, the program includes activities for parents and seeks to get parents involved in talking to their children about the Safer Choices message.

The program incorporates five primary components:
1. School Organization: a broad-based School Health Promotion Council supports and coordinates SC activities.
2. Curriculum and Staff Development: There are ten classroom lessons for ninth and tenth graders (for a total of 20). Sessions are sequential in nature, activities in each class build on those from prior classes. In-class peer leaders receive training to assist with specific activities. Teacher training prepares educators to implement the curriculum completely, and to provide a feedback loop at the end of the school year.
3. Peer Resources and School Environment: A student peer resource team/club conducts activities such as publishing articles in the school newspaper, conducting opinion polls and organizing public speakers throughout the school year.
4. Parent Education: Newsletters are sent to parents three times a year to help increase parent-child communication in the areas of sexuality, HIV and other STDs.
5. School Community Linkages: Homework assignments require students to develop information on and/or visit local health service providers.

The goal of the Safer Choices program is to reduce the number of students engaging in unprotected sexual intercourse.

The program reduced the frequency of intercourse without a condom, reduced the number of sexual partners with whom students had intercourse without a condom, and increased use of condoms and other protection against pregnancy at last intercourse.

Multiple evaluations of Safer Choices have demonstrated a variety of benefits. One study used a randomized controlled trial involving 20 high schools in California and Texas. A cohort of 3869 ninth-grade students was tracked for 31 months from fall semester 1993 (baseline) to spring semester 1996 (31-month follow-up). Safer Choices had its greatest effect on measures involving condom use. The program 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, and increased use of condoms and other protection against pregnancy at last intercourse. Safer Choices also improved 7 of 13 psychosocial variables, many related to condom use, but did not have a significant effect upon rates of sexual initiation.

In another evaluation of the intervention, it was shown that it reduced the frequency of sex without a condom (p = 0.02), reduced the number of sexual partners in the last three months with whom a condom was not used (p = 0.04), increased condom use during last sex among those who had sex in the last three months (p = 0.02), and marginally increased contraceptive use among those who had sex in the last three months (p = 0.07).