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Promising Program Seal

Reducing the Risk

Blueprints Program Rating: Promising

A 16-session curriculum to reduce risky sexual behavior by teaching adolescents about reproductive anatomy, risk behaviors and consequences, abstinence, and the use of condoms and birth control to prevent HIV, sexually transmitted infections (STIs), and pregnancy.

Program Outcomes

  • Sexual Risk Behaviors

Program Type

  • Cognitive-Behavioral Training
  • School - Individual Strategies
  • Skills Training

Program Setting

  • Community (e.g., religious, recreation)
  • School

Continuum of Intervention

  • Universal Prevention (Entire Population)
  • Selective Prevention (Elevated Risk)

Age

  • Late Adolescence (15-18) - High School

Gender

  • Male and Female

Race/Ethnicity

  • All Race/Ethnicity

Endorsements

  • Blueprints: Promising

Program Information Contact

ETR Associates
100 Enterprise Way, Suite G300
Scotts Valley, CA 95066-4200
Phone: 1-800-321-4407
Fax: 1-800-435-8433
www.etr.org/ebi/programs/reducing-the-risk/

Program Developer/Owner

  • Richard P. Barth, PhD
  • University of Maryland

Brief Description of the Program

Reducing the Risk is a high school based curriculum designed to reduce sexual risk-taking behavior. The curriculum contains 16 sessions (a total of 13 hours of videos, exercises, and other teaching methods) and is delivered by high school teachers or other community leaders. It focuses on providing students with skills to manage peer pressure, challenging student norms about sexual behavior, increasing students' confidence in obtaining and using contraceptives, and supporting parent-student communication about intercourse, contraceptives and abstinence. It also provides adolescents with more information about reproductive health, options for abstinence, birth control, and condoms, and the potential consequences of risky sexual behaviors. One version (reported in Barbee et al., 2016) is delivered over 2 consecutive Saturdays and targets at high-risk youth and aims to reduce STI rates and teen pregnancies.

See: Full Description

Outcomes

Compared to a traditional sexuality education curriculum, Kirby et al. (1991) found that more students in the Reducing the Risk curriculum:

  • delayed sexual initiation.
  • increased and retained their knowledge about sexual health and contraceptive use (a risk and protective factor).

Hubbard et al. (1998) showed improved risk and protective factors:

  • Students who participated in the curriculum were more likely to have conversations with parents about birth control and prevention of STDs/HIV.

In Zimmerman et al. (2008):

  • The odds of initiating intercourse for students in the comparison group was 2.42 times that of both treatment groups combined.

Barbee et al. (2016) found that, compared to the control group at the 3- and 6-month follow-ups, youth in the intervention group showed significantly:

  • Fewer sexual partners
  • Greater use of birth control

Race/Ethnicity/Gender Details

While the program does not specifically target race and ethnicity differences, the results do show some differential responses to the intervention. In particular, the initial study found that females and Latino youth report the greatest increases in communication with parents, however, all other racial and gender groups also showed results.

Risk and Protective Factors

Protective Factors
  • Individual: Refusal skills

See also: Reducing the Risk Logic Model (PDF)

Training and Technical Assistance

For information about ETR’s distributive learning process please see: http://www.etr.org/ebi/training-ta/professional-learning-services/

Training is three days and the cost per participant is $975. This does not include participant travel or lodging (if they come to a scheduled regional training). If an ETR trainer comes to the site for the training, the agency will need to pay trainer travel and lodging expenses.

ETR trainers use interactive learning activities designed to prepare educators and practitioners for implementing an evidence-based or promising program with fidelity. Each participant will engage in a learning process which includes pre-work, a pre-assessment, an in-person skill-development session with modeling and practice of skills, and follow-up support.

More information can also be found at: http://www.etr.org/solutions/professional-development/

Training Certification Process

ETR offers Training of Trainers sessions for seasoned program facilitators that will qualify them to train other educators in delivery of the program. Regional TOT sessions, in which participants provide their own transportation costs, average $2500 per participant.

Brief Evaluation Methodology

Kirby et al. (1991) evaluated the program using a quasi-experimental design conducted in a total of 46 (23 control; 23 treatment) classrooms across 13 different high schools in 10 school districts in rural and urban California. Survey questionnaires were given to both the treatment and comparison groups before the intervention, immediately after the intervention and then at 6 and 18 months after the intervention. The total number of students in the study started at 1033, however a total of 758 (429 in the treatment group; 329 in the comparison group) completed the final survey at 18-months post-intervention. Hubbard et al. (1998) replicated this study in Alabama, using a quasi-experimental design, matching five comparison school districts to five treatment school districts. The study began with 532 students who completed surveys, 512 of which were usable; however, only a total of 212 completed the final survey at 18 months.

Zimmerman et al. (2008) added a modified version of the curriculum to help adolescents identified as impulsive and high sensation seekers. The original Reducing the Risk curriculum was modified to include peer facilitators, young, HIV-positive speakers, games/prizes, and more input from the students in the creation of role-plays as well as video-taping of the role-plays. Parent communication activities were removed. This three-year longitudinal study was conducted in 10 high school in the Louisville, KY area and seven high schools in the Cleveland, OH area. Using a matched-pairs design, the three curricula (school's standard curricula, Reducing the Risk, modified Reducing the Risk) were randomly assigned to classrooms. Students completed surveys at pretest (2647 students), 6 months and 18 months after the delivery of the curriculum (1424 students).

Barbee et al. (2016) examined 1,448 youths, recruiting those at high risk for adolescent pregnancy to participate in out-of-school activities at 23 different youth-serving organizations in Louisville, Kentucky. The participants were randomly assigned to clusters and the clusters were then randomly assigned to either the intervention or control conditions. Participants were surveyed about four high-risk sexual behavior outcomes at baseline, 3-, and 6-months post-baseline.

References

Kirby, D., Barth, R., Leland, N., & Fetro, J. (1991). Reducing the Risk: Impact of a new curriculum on sexual risk-taking. Family Planning Perspectives, 23(6): 253-263.

Hubbard, B., Giese, M., & Rainey, J. (1998). A replication study of Reducing the Risk, a theory-based sexuality curriculum for adolescents. Journal of School Health, 68(6): 243-247.

Zimmerman, R., Cupp, P., Donohew, L., Sionean, C., Feist-Price, S., & Helme, D. (2008). Effects of a school-based, theory-driven HIV and pregnancy prevention curriculum. Perspectives on Sexual and Reproductive Health, 40(1): 42-51.

Barbee, A. P., Cunningham, M. R., van Zyl, M. A., Antle, B. F., & Langley, C. N. (2016). Impact of two adolescent pregnancy prevention interventions on risky sexual behavior: A three-arm cluster randomized control trial. American Journal of Public Health, 106(S1), S85-S90.