Impacts of a theoretically-based teacher-delivered sex
education programme (SHARE) on NHS-registered conceptions and terminations up to
5 years post intervention: an RCT in Scotland.
M Henderson1, D Wight1, G Raab2
& G Hart1
1Medical
Research Council Social & Public Health Sciences Unit, Glasgow, Scotland,
2Napier
University, Edinburgh, Scotland
Objectives: Despite widespread support for school sex
education, there are very few large scale, long-term trials of its effects on
behaviour, and hardly any that use service-based, rather than self-reported,
outcomes. This paper presents the final outcomes from a RCT of a
theoretically-based teacher-delivered sex education programme for 13-15 year
olds in Scotland. The SHARE programme (20 session pack and five day teacher
training course) was developed and carefully piloted over two years. Interim
outcomes at 6 mths post intervention, average age 16.1 yrs, showed no impact on
behaviour, but at this age only 1/3 of the sample reported sexual intercourse
and there was 32% attrition. This paper describes the impact of the intervention
on conceptions and terminations up to age 20, 4.5 yrs post intervention, as
recorded by the National Health Service. The outcomes are not subject to
reporting bias or attrition.
Design & Methods: Twenty-five schools in eastern
Scotland were assigned by a balanced randomisation either to deliver SHARE or to
continue with their existing sex education. All third year pupils in two
successive years were invited to participate in the study (N=8,430).
Participants were followed-up at 6 mths (N=5,854) and 2.5 yrs (N=2,864)
post-intervention with self-complete questionnaires. The Information and
Statistics Division of the National Health Service provided data on conception,
miscarriage and termination in aggregated form for all females in the sample
(N=4,196) up to the age of 20.
Results: At baseline predictors of sexual experience (parenting
and socio-economic) were balanced between the arms of the trial. The achieved
sample was representative of all Scottish 14 year olds in terms of social class
and family composition (1991 Census). By age 20, 22% of young women had
conceived, 58% of all their conceptions (1205 conceptions to 922 women)
resulting in a live birth/miscarriage, and 42% a termination. Conceptions rose
from 23:1000 at age 15 to 70:1000 at age 19, while the proportion of all
conceptions terminated fell from 50% at 15 to 39% at 19. This paper will present
analyses of outcomes by arm of the trial and by school, both ‘intention-to-treat’
and ‘on-treatment’ analyses.
Conclusions: These analyses will allow us to report (at
conference) on the effect of the SHARE programme on conceptions and terminations
at 4.5 yrs post-intervention. The findings will be discussed in terms of the
efficacy of the programme, the extent and quality of its delivery, and possible
limitations in evaluation design.