{
  "abstract": "Background Relationships and sex education (RSE) impacts some sexual behaviours but could be strengthened by incorporating whole-school approaches (eg, building engagement, providing contraception). These can prevent pregnancies and sexually-transmitted infections but are unevaluated in UK schools.Methods A cluster-randomised trial of ‘Positive Choices’ compared it with usual practice in English secondary schools. Intervention comprised: RSE, school-health-promotion councils involving students, student-needs data to tailor provision; student-led campaigns; review of sexual-health services; and parent information. The primary outcome was prevention of non-competent sexual debut (lacking decision autonomy, judging timing as right, partners’ equal willingness or contraception).Results Of 2845 schools invited, 50 (1.76%) consented, 1 leaving post-allocation. Of 25 control and 24 intervention schools, 4 withdrew pre-endline. 6970 (77.3%) students participated at baseline and 6268 (77.9%) at 33-month endline. Fidelity of whole-school components was suboptimal. No schools achieved ‘good’ fidelity; two achieved ‘adequate’ fidelity across components. 11 achieved ‘adequate fidelity on selected components’ (student-needs report, school-health-promotion council meetings, lessons, parent information). Control schools delivered similar activities to intervention schools. Among 780 (12.44%) students sexually debuting between baseline and endline, non-competent debut was reported by 268 (64.42%) in the control and 240 (65.93%) in the intervention group (risk difference=0.020 (95% CI −0.05 to 0.09)). There were no effects on secondary outcomes. Incremental costs were £1337 per school (£10 per student).Conclusion Positive Choices did not prevent non-competent sexual debut (primary outcome) or impact secondary outcomes compared with usual RSE, possibly explained by weak fidelity of whole-school elements and/or comprehensive RSE in control schools.Trial registration number ISRCTN16723909.",
  "authors": [
    {
      "affiliations": [
        "Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK"
      ],
      "name": "Ruth Ponsford"
    },
    {
      "affiliations": [
        "Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK"
      ],
      "name": "Rebecca Meiksin"
    },
    {
      "affiliations": [
        "Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK"
      ],
      "name": "Joanna Sturgess"
    },
    {
      "affiliations": [
        "Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK"
      ],
      "name": "Veena Muraleetharan"
    },
    {
      "affiliations": [
        "Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK"
      ],
      "name": "Nerissa Tilouche"
    },
    {
      "affiliations": [
        "Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK"
      ],
      "name": "Charles Opondo"
    },
    {
      "affiliations": [
        "Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK"
      ],
      "name": "Steve Morris"
    },
    {
      "affiliations": [
        "University of Exeter, Exeter, Devon, UK"
      ],
      "name": "G J Melendez-Torres"
    },
    {
      "affiliations": [
        "Department of Social and Policy Sciences, University of Bath, Claverton Down, Bath, UK"
      ],
      "name": "Josephine McAllister"
    },
    {
      "affiliations": [
        "Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK"
      ],
      "name": "Neisha Sundaram"
    },
    {
      "affiliations": [
        "University of Bedfordshire, Luton, England, UK"
      ],
      "name": "Alison Hadley"
    },
    {
      "affiliations": [
        "Queen’s University Belfast EPS, Belfast, Northern Ireland, UK"
      ],
      "name": "Maria Lohan"
    },
    {
      "affiliations": [
        "Infection and Population Health, University College London, London, UK"
      ],
      "name": "Catherine Heather Mercer"
    },
    {
      "affiliations": [
        "School of Social Sciences, Cardiff University, cardiff, UK"
      ],
      "name": "Honor Young"
    },
    {
      "affiliations": [
        "University of Bristol, Bristol, England, UK"
      ],
      "name": "Rona Campbell"
    },
    {
      "affiliations": [
        "ETR Associates, Scotts Valley, California, USA"
      ],
      "name": "Karin Coyle"
    },
    {
      "affiliations": [
        "Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK"
      ],
      "name": "Elizabeth Allen"
    },
    {
      "affiliations": [
        "Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK"
      ],
      "name": "Chris Bonell"
    }
  ],
  "title": "Effects of a whole-school relationships and sexual health intervention on non-competent sexual debut: cluster-randomised trial",
  "uid": "f78bfeec-b958-5fe3-ba05-607a52e121f5"
}