Date Published: November 25, 2008
Publisher: Public Library of Science
Author(s): David A Ross
Abstract: David Ross discusses a new study of school-based peer-led sex education in London and whether it reduced unintended teenage pregnancy.
Partial Text: Prevention of early, unintended pregnancy, abortions, and sexually transmitted infections among adolescents is a very high priority in the United States and Europe, and the United Kingdom has a target to halve pregnancy rates among under-18-year-olds by 2010 . School-based sexual health education provides an obvious approach, but evaluations of the effectiveness of such interventions, both within high-income [2,3] and low-income  countries have not been very encouraging. In this week’s PLoS Medicine, Judith Stephenson and colleagues report the long-term results of the RIPPLE trial comparing peer-led and teacher-led approaches, which builds on previous studies of school-based sex education.
The long-term evaluation of the effectiveness of peer-led sex education programmes in comparison with standard teacher-led sex education, studied in the RIPPLE trial, is therefore an important addition . Twenty-seven secondary schools in England were randomly allocated to one of two groups: one group had older (16- to 17-year-old) peers lead three one-hour classes on topics such as sexual communication, condom use, contraception, and local sexual health services for 13- to 14-year-olds in their own school. The other group received the same number of sexual education classes but these were, as previously, led by teachers. The study showed that the peer-led programme was more popular with students  and the nature of the interaction in the peer-led sessions was different from the teacher-led sessions.
Despite the rather inconclusive findings, the long-term results of the RIPPLE trial are very important. First, they confirm the importance of including objective, biological outcomes in such trials, rather than only relying on self-reported data even of such salient events as pregnancy or abortion. Second, they give advocates of peer-led over teacher-led sex education reason to pause for thought. The peer-educator approach is far more labour intensive, requiring new cohorts of peer educators to be trained every year or two, and is often seen as more threatening than teacher-led sex education by school authorities. This might partly explain the very low uptake of schools participating in the trial, with less than 10% of eligible schools who were invited willing to participate, though apathy and the additional work related to the evaluation may also have been factors. Although the peer-led programmes were more popular with students, the borderline evidence of greater effectiveness in this trial should make education authorities think twice before replacing teacher-led sex education with peer-led, given the important financial and logistical barriers to large-scale adoption of peer-led sex education in schools.
Despite the inconclusive results of the RIPPLE trial, the scale and importance of immediate, short-term sexual and reproductive health problems among adolescents—and the potential for sex education during adolescence to influence adoption of norms and behaviours that could reap benefits throughout their subsequent adult lives —means that we do not have the luxury of leaving things be. We must continue to develop and rigorously evaluate new approaches to reduce the adoption of sexual risk behaviours by young people. This is vital both in high-income countries such as the UK, and, even more importantly, in low-income countries, especially those with high maternal and infant mortality and incidence of HIV.