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School-Based program offers safer way to reduce risky sexual behaviors

Teenagers have a safer way to reduce their risk of getting pregnant or contracting HIV and other sexually transmitted diseases, say researchers with the Center for Health Promotion and Prevention Research at The University of Texas School of Public Health at Houston.

Safer Choices, a school-based program funded by the Centers for Disease Control and Prevention, was designed to encourage high school students to adopt behaviors to avoid pregnancy and to protect against HTV and other sexually transmitted diseases (STDs) – life-threatening effects of unprotected sexual intercourse.

Guy Parcel, Ph.D., principal investigator of the study and director of UT-Houston’s Center for Health Promotion and Prevention Research, says the main goals of the program are to reduce the number of students having unprotected sex by 1) reducing the number of students who have sex during their high school years, and 2) increasing condom use among those students having sex.

“Many HIV, STD and pregnancy prevention programs have been implemented in schools across the nation, but only a few have demonstrated a long-term effect on sexual risk behaviors,” Parcel said. “Due to the limited results of past studies, we developed and implemented Safer Choices and demonstrated that we could significantly reduce the risk-taking over a longer time period.”

The five-year study, which started in 1993 at 20 high schools in Houston and San Jose, Calif., involved 3,869 ninth-graders from culturally diverse populations. Half of the schools in each city were randomly selected to join the program, while the other half served as a comparison group. Trained data collectors administered a confidential survey about the students’ demographics, attitudes and beliefs about sex, and risk perceptions about HIV and other STDs. The same students completed follow-up surveys at the end of their ninth, 10th- and 11th- grade years.

Parcel reported that among students who had sex, the Safer Choices students reported a 33 percent reduction in the frequency of having unprotected sexual intercourse, and the number of sexual partners with whom they had sex without a condom was reduced by nearly a fourth.

“We saw risk-taking behavior increase over time among both groups of students and less increase in those who were in the program,” said Parcel, who has been involved in programs dealing with adolescents and sexuality for 30 years. He said the students did not hesitate to participate in the study.

“Safer Choices was well received by the students,” Parcel said. “The students were comfortable about answering the questions since they knew they wouldn’t be identified with the responses.”
Even though Safer Choices does not only address sexual abstinence as a way to reduce risk, Parcel said it does encourage students to choose not to have sex as an option and to use protection for students having sex.

“Some people worry if you teach adolescents about sex they will have sex. Fortunately, this study did not increase sexual behavior,” Parcel said. “The best way teenagers can reduce their risk is by choosing not to have sex. This was the consistent message we sent to the students in this program.”
Parcel said although this study provides evidence that school-based programs that have a clear message and help students to develop skills can reduce sexual risk behaviors among high school students, more work is needed – particularly how to involve parents.

“There is a need to develop programs to help parents be effective in talking to their children about sexual risk-taking behavior,” Parcel said.
“Very few parents have a model to help their child make good choices. We hope to someday provide an extension of Safe Choices that includes a parental component.”

Parcel and his UT-Houston colleagues are currently involved in Safe Choices 2, a follow-up study adapted for alternative schools. The study received $3.3 million in funding in 1998 from the National Institute for Child Health and Human Development (NIGHD) the children’s health research arm of the National Institutes of Health. Results from the study are expected in 2002. Susan Tortolero, Ph.D., assistant professor of epidemiology at UT-Houston School of Public Health, is the principal investigator. Parcel is co-principal investigator.
Other researchers working with Parcel and Tortolero on Safer Choices incude Chris Markham, project director; and co-investigators Karin Basen-Engquist, Ph.D.; Ronald Harrist, Ph.D., Elisabeth Baumler, Ph.D., and Ronald Peters, Dr.P.H. Other collaborators include Karen Coyle, Ph.D. and Douglas Kirby, Ph.D. of ETR Associates in Scotts Valley, Calif., and Scott Carvajal, Ph.D.
The Center for Health Promotion and Prevention Research is a World Health Organization collaborating center dedicated to developing, studying and disseminating cost-effective health promotion strategies through schools, health care facilities, worksites and communities.

Safer Choices is now available for purchase by school districts through ETR Associates, the largest not-for-profit publisher of skills-based health promotion resources in the U.S. Some of the features of the program include: a 20-session classroom curriculum for ninth- and 10th-grade students; parent education, including project newsletters with tips on talking with teenagers about HIV, STDs and pregnancy; and school-community links to support services outside school. School administrators may contact ETR’s customer service department by calling 1-800-321-4407 for more information.