VIP – Very Important Persons use contraception! Evaluation of a sexual education intervention among upper secondary school students in Sweden

M. Larsson (1), K. Eurenius (1), R. Westerling (2), T. Tydén (1,2)

Department of Women’s and Children’s Health (1), Department of Public Health and Caring Sciences (2), Uppsala University, Uppsala, Sweden (2)

Introduction: Swedish upper secondary schools offer theoretical programs preparing the students for university studies and vocational programs preparing for various hand-craft professions. Investigations have shown that students on vocational programs have sexual intercourse at earlier ages and are less prone to use contraceptives than students on theoretical programs. Abortion rates and the prevalence of Chlamydia are increasing among Swedish adolescents. The condom is one of the most frequently used contraceptive methods among adolescents in Sweden. In case of condom failure, the emergency contraceptive pill (ECP) can be used as a back-up method. The ECP has been on the Swedish market since 1994 and in April 2001 a levonorgestrel-only preparation became available as an over-the-counter product to a cost of 13 Euros.

Aims and methods: To evaluate an intervention aimed at improving knowledge, attitudes and practices of condoms and emergency contraception (ECP) among a group of students in upper secondary school, we undertook an intervention study with quasi-experimental design. A strategic sample of 25 classes from two vocational high school programs was divided into one intervention group and one comparison group. All students completed questionnaires before and after the intervention which included sexual education lessons, free condoms on request and access to telephone counselling.

Results: Of the 461 eligible students, mean age 17 years, 390 (85%) completed the pre-test and 326 (71%) the post-test. Three out of four (77%) had experienced sexual intercourse. The majority (76%) had used contraception, mostly condoms at first intercourse. The students already had good knowledge about condoms with no change after the intervention, but attitudes improved and condom use increased. Knowledge and attitudes towards ECP improved but the use remained stable (29%). The most important source of information about ECP changed from ‘friends’ to ‘school’ after the intervention. More than one out of four (28%) had opted for free condoms but only 3% had requested telephone counselling.

Conclusions: The sexual education intervention reached one important goal, namely improving knowledge about ECP without increasing ECP use or jeopardizing condom use. Increased availability of condoms and practice of condom skills may be ways of reducing barriers for teenage condom use. Senior students within different health care professions can be a useful resource in school-based sexual health education programs.