BIG DecisionsCurriculum

Document of External Origin
Making Healthy, Informed Choices about Sex
By Janet P. Realini, M.D., M.P.H.

Copyright 2006 - 2009 by Janet P. Realini, M.D., M.P.H.
All rights reserved. Instructors are authorized to reproduce the handouts and other activity resources from the curriculum solely for instructional use. Any more extensive reproduction requires the prior written consent of the author.
Illustrations by Lea Hernandez
TableofContents
IntroductoryMaterials
Sexuality Curriculum Outline (English)........................................... Sexuality Curriculum Outline (Spanish)......................................... KEY MESSAGES Poster (English).................................................... KEY MESSAGES Poster (Spanish)................................................... Acknowledgements................................................................. Introduction.......................................................................... How to Use This Curriculum........................................................ v vi vii viii ix xi xxiii 1 3 15 48 63 101 115 155 167 185 201
SexualityLessons
1 2 3 4 5 6 7 8 9 10
RULES OF THE GAME: A Respectful Group........................................ ANATOMY AND REPRODUCTION: How it Works.................................. RELATIONSHIPS AND ROMANCE: What is Healthy? What is Love? ............ SEXUALLY TRANSMITTED DISEASES (including HIV/AIDS)....................... ABSTINENCE: Why Should I Wait? ................................................. CONTRACEPTION: Pregnancy at the RIGHT Time............................... INFLUENCE: Friends, Culture, the Media, and Sex.............................. GOALS and DREAMS: My Decision.................................................. THE POWER TO SAY NO: Sticking to My Decision............................. WRAP-UP AND EVALUATION: How Did We Do? ..................................
ParentSession
Parent Session......................................................................... Parent Take-Home Handouts (English/Spanish).............................. Parent Session Evaluation Form (English/Spanish).............................. KEY MESSAGES Posters (English/Spanish) ........................................ Sexuality Curriculum Outline (English/Spanish)................................. Sample Parent Letters (English/Spanish)......................................... Sample Consent Forms (English/Spanish)......................................... Resources for Parents................................................................ 213 231 237 239 241 243 245 247
Table of Contents
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TableofContents,continued
Appendices
A1 A2 A3 A4 Logic Models for BIG DECISIONS................................................... Handling Questions.................................................................. TEXAS HEALTH REQUIREMENTS: Coverage of the Texas Essential Knowledge and Skills (TEKS) Education........................................... About the Author.................................................................... 250 253 257 271
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Table of Contents
1. RULES OF THE GAME: Forming a Respectful Group

Fill out the Pre-Participation Questionnaire Receive an overview of the curriculum Identify respect as a key value for the group Develop ground rules for the group
Sexuality Curriculum Outline

7. INFLUENCE: Friends, Culture, the Media, and Sex

Define influence and list things that influence young people about sex Describe some positive influences of your culture Identify examples of influence from the media, & classify them as positive or negative Describe how to resist negative influences about sex
2. ANATOMY AND REPRODUCTION: How it Works

Identify the names and functions of male and female body parts Review how pregnancy happens Evaluate statements about reproduction to determine if they are true or false
3. RELATIONSHIPS AND ROMANCE: What is Healthy? What is Love?

Identify characteristics of healthy and unhealthy relationships Consider how having sex can cause problems in teen relationships Learn how physical attraction (lust) and crushes (infatuation) are different from mature love
8. GOALS AND DREAMS: My Decision

Visualize their goals and dreams for the future Understand how a teen pregnancy or HIV/STD can affect achieving their goals and dreams Personalize the risks of pregnancy and HIV/STD Make a personal decision about how they will avoid pregnancy and STDs
4. SEXUALLY TRANSMITTED DISEASES (including HIV/AIDS)

Increase knowledge of the common STDs, their symptoms, and possible consequences Identify ways to avoid getting and spreading STDs Recognize that abstinence is the most effective way to avoid STDs Learn that teens who have sex must use latex condomscorrectly, every timeto reduce the risk of HIV and other STDs
9. THE POWER TO SAY NO: Sticking to My Decision

Reinforce student decisions of how they will avoid pregnancy and STDs Learn that everyone has the right to say no Consider effective ways to say no when pressured for sex Practice saying no in pressure situations
5. ABSTINENCE: Why Should I Wait?

Define what is meant by abstinence and sex List the advantages of abstinence for teens Learn that teens who choose to wait deserve respect State the most important reason(s) to wait
10. WRAP-UP AND EVALUATION: How Did We Do?

Reinforce KEY MESSAGES and students decisions to avoid pregnancy and HIV/STDs Get more practice in powerful ways to say no Fill out the Post-Participation Questionnaire
6. CONTRACEPTION: Pregnancy at the RIGHT Time

Consider when would be the right time to have a pregnancy Evaluate commonly used contraceptive methods (including abstinence) for effectiveness in preventing pregnancy Recognize that abstinence is the healthiest choice Understand that sexually active people must take action to avoid pregnancy (and STDs)
PARENT SESSION
Describe what parents can do to help their children make healthy decisions about sex Learn 5 steps to use in talking to their children Practice talking with their children about sex If their child(ren) will be participating in BIG DECISIONS: o View the KEY MESSAGES and the Curriculum Outline
Have a chance to ask questions and to view the entire curriculum
Curriculum of Outline Document External Origin
1. REGLAS DEL JUEGO:

Crear un grupo respetuoso
Tomar el cuestionario antes de la participacin Dar una perspectiva general del curso Identificar el respeto como un valor clave para el grupo Establecer reglas bsicas para el grupo
Resumen del Curriculo

7. INFLUENCIAS: los amigos, la cultura,
los medios de comunicacin, y el sexo
Definir el trmino influencia y enumerar las cosas que influyen en los jvenes acerca del sexo Describir algunas influencias positivas de su cultura Identificar ejemplos de influencia de los medios de comunicacin y clasificarlos como positivos o negativos Describir cmo resistir a las influencias negativas acerca del sexo Imaginarse sus deseos para el futuro Entender cmo contraer un ETS o quedar embarazada afecta conseguir sus objectivos Personalizar los riesgos de tener un embarazo o una ETS Tomar su propia decisin personal de prevenir los embarazos y las ETS
2. ANATOMIA Y REPRODUCCIN:
Cmo funciona
Identificar los nombres y las funciones de las partes del cuerpo del hombre y la mujer Repasar cmo ocurre un embarazo Evaluar enunciados acerca de la reproduccin y determinar si son ciertas o falsas
3. LAS RELACIONES Y EL ROMANCE:

Qu es saludable? Qu es amor?
Identificar las caractersticas de las relaciones saludables y no saludables Considerar cmo tener relaciones sexuales puede causar problemas en las relaciones entre adolescentes. Aprender cmo la atraccin fsica (deseo) y el enamoramiento (encaprichamiento) son diferentes del amor maduro
8. DESEOS PARA EL FUTURO: Mi decisin

4. ENFERMEDADES DE TRANSMISIN
SEXUAL (ETS) (incluyendo VIH/SIDA)
Incrementar el conocimiento acerca de las ETS comunes, sus sntomas y posibles consecuencias Identificar maneras de cmo evitar contraer y propagar las ETS Reconocer la abstinencia como el mtodo ms efectivo para evitar las ETS. Conocer que los jovenes que han tenido el sexo requieren un anlisis de deteccin de ETS
9. EL PODER PARA DECIR NO:

Atenerme a mi decisin
Reforzar los estudiantes a las decisiones de cmo van a evitar el embarazo y las ETS Aprender que toda persona tiene el derecho a decir no Considerar formas efectivas para decir no cuando le presionen a tener relaciones sexuales Practicar decir no en situaciones de presin
10. CONCLUSIN Y EVALUACIN:

Cmo lo hicimos?
Enfatizar los mensajes claves y experiencias de las sesiones Obtener ms prctica en decir no Rellenar el Cuestionario Final
5. ABSTINENCIA: Por qu debo esperar?

Definir los trminos abstinencia y sexo Enumerar las ventajas de la abstinencia en los adolescentes Aprender que los adolescentes que escogen esperar merecen respeto Nombrar la razn(es) para esperar
6. ANTICONCEPTIVOS: Embarazo en el
momento adecuado
Considerar cuando es un buen tiempo para tener un embarazo Evaluar los mtodos anticonceptivos comnmente usados (incluyendo la abstinencia) por su efectividad para prevenir un embarazo (y las ETS) Reconocer que la abstinencia es la opcin ms saludable Comprender que las personas sexualmente activas deben tomar medidas para evitar un embarazo (y las ETS)
SESIN PARA PADRES

Describir como ayudar los jovenes que tomen decisiones saludables sobre el sexo Aprender los 5 pasos para hablar con los adolescentes Practicar hablar efectivamente con sus hijos/hijas sobre el sexo Si sus nio(a)s participarn en el programa GRANDES DECISIONES: o Examinar los mensajes claves y el resumen del curriculo o Tener la oportunidad de hacer preguntas sobre el programa
vi Document of External Origin
Curriculum Outline
KEY MESSAGES
Having sex is a BIG DECISION ABSTINENCE is the healthiest choice Teens who have sex must:
use CONDOMS and BIRTH CONTROL Correctly, EVERY time!
KEY MESSAGES Poster
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Copyright 2009 Janet P. Realini, MD, MPH
MENSAJES CLAVES
Tener relaciones sexuales es una DECISIN GRANDE La ABSTINENCIA es la opcin ms saludable Adolescentes que tienen relaciones sexuales deben: usar CONDONES y ANTICONCEPTIVOS juntos Correctamente, CADA VEZ!
MENSAJES CLAVES Poster
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Acknowledgements
I am indebted to so many people for their advice, insights, diligence and patience. Over the years, the staff of Project WORTH at the City of San Antonio has provided helpful feedback and suggestions based on their great connections with young people and their insight into what works on the ground. Coordinator Mario Martinez; Health Program Specialists Vincent Hernandez, Mindy Aguirre-Garcia, Tracie Enriquez, Jose Marchan, Jr., Jennifer Garza, and Janna Campbell; and Caseworker Leticia Segundo have all given thoughtful advice for BIG DECISIONS. Many thanks also to Dr. Shannan McCann, who, from her perspective as an Adolescent Medicine physician and former classroom teacher, made many useful suggestions. I am also indebted to Kate Kauper, a superb teacher and a curriculum expert, for her thoughtful advice. I am indebted to Kathy OBrien for her advice on format and editing. Thanks are also in order for assistance with translation into Spanish. Thanks to Austin/Travis County Health and Human Services Department, especially Maria Gorham, for assisting with translation of several of the lessons. Sandra Hinojosa, Elia Ortiz, and Cresencio Ortiz helped to assure that the Curriculum Outline translation makes sense for parents in San Antonio. This work endeavors to reflect the influence of many great contributors to adolescent sexual health and education. The National Campaign to Prevent Teen and Unplanned Pregnancy has shown the way in many ways. By engaging caring people from the right, the left, and in the middle, the National Campaign has led a national conversation that is constructive and inspiredone that has made a real difference. The National Campaign has also packaged and disseminated the scientific information and research results that we in the local communities have needed. Thanks to Dr. Douglas Kirby for his review of the curriculum and his expert suggestions. Dr. Kirby and his co-workers at ETR have provided tremendous resources for those working in this field, including analysis of what works, catalogues of risk and protective factors, and encouragement to create our own logic models to develop programs that make sense for our communities.
Acknowledgements ix
Marline Pearson, author of Love U2, has been an inspiration, as well. Her energy, knowledge, and love for young people are apparent in her curriculum. Her work is part of why I thought I should put on paper what I have learned. Dr. Antonia Villarruels energy, insights, and work have also been important in influencing the content of the curriculum. The success of Cudate highlighted the need for inclusion of cultural strengths as a component in Lesson 7. I am also grateful for the nurturing and promotion of BIG DECISIONS by the staff of the Center for Health Training in Austin, including Jennifer Curtiss, Stephanie Hebert, Sandy Rice, Monica Leal, and Lizzie Cain Clark, among others. Their expert trainings for teachers, health educators, and others across Texas have made the curriculum accessible to many caring people working with youth. Thanks also to my family for putting up with me through the labor and delivery of writing. I appreciate the energy of teachers, principals, school nurses, parents, and counselors who have shared their viewpoints, opinions, and insights about adolescents and about the curriculum in real life. Thanks especially to the young people who tell me what they think and inspire me every day.
Acknowledgements
Introduction
Overview
The goal of the BIG DECISIONS Curriculum is to help young people make healthy and informed decisions about sex. BIG DECISIONS is designed to vigorouslyand effectivelyencourage young people to postpone sexual involvement, and also to provide the guidance and information young people need to reduce their risks when they do become sexually active. The key messages of BIG DECISIONS for young people are: Having sex is a BIG DECISION
ABSTINENCE is the healthiest choice

Teens who have sex must: o Use CONDOMS and BIRTH CONTROL Correctly, EVERY time!
The BIG DECISIONS Curriculum is recommended for young people in grades 7 through 12 (ages 12 to 18). The Parent Session equips parents with knowledge and skills to help their children make good decisions about sex and also provides background about the curriculum. This curriculum conforms to the Texas Education Code (28.004) requirements for sex education programs in Texas public schools. In addition, BIG DECISIONS incorporates Kirbys 17 characteristics of effective curriculum-based programs. [1] BIG DECISIONS coverage of the Texas Essential Knowledge and Skills (TEKS) for Health Education is detailed in Appendix 3. BIG DECISIONS recommends using the full series of sessions; ensuring consistent group membership; and providing enthusiastic, well-trained facilitators who are comfortable
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discussing sensitive issues with young people. Sex education is likely to be most effective when it is part of an overall youth development strategy. Service-learning is a particularly powerful youth development strategy that has been shown to help young people postpone sexual activity and parenthood.[2] BIG DECISIONS also offers a separate Service-Learning component, which is available for implementation along with this sex education curriculum.
WhyThisCurriculumIsNeeded
When it comes to helping young people make good decisions about sex, we need all the help we can get. Nearly half of U.S. high school students have had (vaginal) sexual intercourse, [3] and over half of teens ages 15 to 19 have had oral sex. [4] Rates of teen childbearing in the U.S. fell from 1991 to 2005, but rose 3% between 2005 and 2007.[5] Moreover, U.S. rates of childbearing among teenagers are far higher than those of other industrialized countries. Sexually transmitted diseases (STDs), especially Chlamydia, genital herpes, and Human Papillomavirus (HPV), are far too common among young people.[6,7] HIV/AIDS, although less common than other STDs, and now treatable, remains a threat.[8] The annual rate of AIDS diagnoses among males age 15-19 years has doubled in the last 10 years. Young people are bombarded with a multitude of sexual images and messages every day from a variety of sources, and these exposures appear to affect their behavior.[9] Parents, even those who try to talk to their children about sex, often find it difficult to do so. In addition, todays young people go through puberty at younger ages than did their ancestors, and society has postponed marriage to later than in previous generations. Consequently, young men and women today must, with adult hormones, navigate safely through an unprecedented number of years before marriage (or other long-term relationships). Our teenagers are confronted with important and difficult decisions about sex. In order to make healthy choices, young people need good information, but information alone is not enough. They also need a constructive framework and guidance for decision-making, a sense of their own value and positive future, and the support of parents and other caring adults. BIG DECISIONS provides a framework in which having sex is seen as a big decisionone that young people need to be ready to handle. In this program, students explore why abstinence is the healthiest choice, and learn that having sex means big responsibility. The BIG DECISIONS curriculum was developed to meet the need for a practical and doable active-learning middle- and high-school program that vigorously promotes abstinence; provides balanced and accurate information about condoms and contraceptives; and meets the requirements of Texas law. In a relatively short series of lessons, and with the simple tools contained in the curriculum, students process basic,
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essential information. The intent of BIG DECISIONS is to be truly Abstinence-Plus: to be successful in helping young people to postpone sexual involvement, while at the same time, giving them the core knowledge that they need to reduce their risks when they do become sexually active.
SearchingfortheRightAbstinencePlusProgram
American parents and teenagers alike favor strong messages from society that young people should wait to have sex at least until they are finished with high school.[10] The majority of teens who have had sex wish that they had waited.[11] Clearly, abstinence is recognized as the best and healthiest choice for teenagers. At the same time, most adults and parents favor providing young people positive information about condoms and contraceptives, in addition to abstinence. [11] Abstinence-Only programs attempt to promote abstinence, and some of them improve student attitudes.[12] However, rigorous studies of this approach so far show no effect of postponing sexual debut.[13,14] Programs disseminated with federal AbstinenceOnly funds must exclude positive information about condoms and contraception.[15] Because many of these programs over-emphasize the limitations of condoms,[16] there is concern that sexually active young people will be discouraged from using condoms. There are more comprehensive, or Abstinence-Plus, programs that are demonstrated to change young peoples behavior, delay sexual debut, and/or reduce teen pregnancy.[2,17] And, importantly, positive information about condoms and contraceptives does not increase adolescent sexual activity.[2] However, evidence-based comprehensive sex education programs have not been widely adopted in many communities, for a number of reasons. In Texas, 94% of school districts offer Abstinence-Only programs.[18] Many barriers exist, including lack of funding; misinformation that sex education increases sexual activity; and a perception that communities are too conservative to tolerate in-school discussion of condoms or contraception. In addition, some evidence-based comprehensive programs have not been ideal for practical use when resources are limited. Some of the most powerful programs, such as the Teen Outreach Program [19] and the Childrens Aid Society/Carrera program [20], are lengthy and require more resources than are available in poor inner-city school districts. Some of the shorter programs that have demonstrated effectiveness in changing behavior have less emphasis on abstinence than is desired by some parents, and many programs do not conform to Texas requirements.[21] Many of the evidencebased programs focus primarily on HIV risk reduction and do not address teen pregnancy
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directly. Other programs have out-of-date or insufficient information about STDs and/or condoms and contraceptives for high school students. Some are perceived as recommending non-coital sexual activities (e.g., outercourse), which has been a feature targeted by critics of comprehensive sex education. [25] Many programs include life-skills lessons that do not focus specifically on decisions about sex. BIG DECISIONS addresses these concerns by providing a framework with both strong encouragement of abstinenceand also balanced and accurate information about condoms and contraceptivesso that the curriculum takes a truly Abstinence-Plus stance. The lessons use active-learning techniques and focus specifically on sexual decision-making. Sex is considered in the context of love and relationships, the strengths of ones culture, and in the context of goals and dreams for the future. Importantly, BIG DECISIONS is careful not to exclude students who may have already had sex, or who may be attracted to members of the same sex. There is meaningful acknowledgement of the sexually saturated environment and various influences. The curriculum highlights strengths, especially cultural strengths, and provides an opportunity to practice refusal skills.
TheRightApproachtoCondomEffectiveness
Recent years have seen great controversy about condoms, and about how to convey information about condom effectiveness to young people. Some Abstinence-Only programs and abstinence advocates overstate the limitations of condoms. [16] Some messages are particularly negative with respect to Human Papillomavirus (HPV) infection, in spite of evidence that condom use reduces the risk of HPV infection, genital warts, and cervical dysplasia and cancer. [23, 24] Young people who believe that condoms do not work are less likely to use them when they become sexually active, increasing their risks for HIV and other STDs. At the same time, it is not appropriate to equate the risks of having sex using condoms with those of abstinence. Nor is it advisable to give the impression that adults endorse young people having sex, if they just use condoms. BIG DECISIONS strives to strike the right note and achieve the right balance: to encourage abstinence and to encourage use of condoms (and contraceptives), for those who have sex. Condom effectiveness is described as goodalthough less than abstinence. Condoms and contraceptives are framed as essential for teens who have sex, and they are represented as far more effective than sex without their use.
SexualityInformationandVisuals
Another reason to develop BIG DECISIONS has been to provide clearer, more concise,
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and more up-to-date information about sex, reproduction, STDs, and contraceptives. The illustrations of anatomy and condom use are reflective of what a physician sees and understands. They are designed to be realistic enough to convey what people really look like, while still providing the psychological distance of drawings rather than photographs. The information on STDs and contraceptives reflect perspectives gleaned from years in primary care and public health, as well as in teaching of health professionals, educators, and young people. For example, the exercises in Lesson 6 clearly demonstrate the likelihood of pregnancy with various contraceptive options. The examples used in the various scenarios for lessons are based on composites of actual teens seen in clinical and educational settings.
MeetingtheRequirementsofTexasLaw
In order to offer a curriculum in Texas public schools, it must meet the requirements of Texas Law [21], including that it:
presentsabstinenceasthepreferredchoiceforunmarriedpersonsofschool age; devotesmoreattentiontoabstinencethantoanyotherbehavior; emphasizesthatabstinenceistheonlymethodthatis100%effectivein preventingpregnancy,STDsandHIV/AIDS,andtheemotionaltrauma associatedwithadolescentsexualactivity; directsadolescentstoastandardofbehaviorinwhichabstinenceisthemost effectivewaytopreventpregnancy,STDsandHIV/AIDS;and teachescontraceptionandcondomuseintermsofhumanuserealityrates ratherthantheoreticaleffectivenessrates.
It should be noted that Texas law permits discussion of condoms and contraceptives in public schools, but does not permit distribution of condoms in conjunction with classroom instruction. BIG DECISIONS is consistent with each of these requirements:
The lessons emphasize abstinence as the healthiest choice, and the most effective way to prevent pregnancy and STDs. Facilitators are encouraged to express their support for abstinence.
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BIG DECISIONS devotes more attention to abstinence than to any other behavior: an entire lesson explores what abstinence is and why it is such a healthy choice. Abstinence is one of the contraceptive methods discussed in Lesson 6, as well. In addition, abstinence is emphasized as the healthiest choice in several other lessons that do not deal with condoms or contraceptives, as well as in the ones that do. The curriculum cites abstinence (used consistently and correctly) as the only method that is 100% effective in preventing pregnancy and STDs. The emotional consequences of having sex are explored in Lesson 3 (RELATIONSHIPS AND ROMANCE: What is Healthy? What is Love?) and in Lesson 8 (GOALS AND DREAMS: My Decision). BIG DECISIONS uses the latest available use-effectiveness failure rates for contraceptives, rather than theoretical-effectiveness failure rates.[25]
DesignandLogicModel
BIG DECISIONS was developed using BDI Logic Models, a process which helps to assure the sound design of programs to address community health problems. [26] The Logic Models incorporate the known risk factors and protective factors for adolescent sexual activity, teen pregnancy, and STDs and the interventions known to affect them. [27] Logic Models for both Student and Parent Components of the program are displayed in Appendix 1. BIG DECISIONS logic model incorporates constructs of Social Cognitive Theory [28] and the Theories of Reasoned Action and Planned Behavior, [29] as well as elements of the Health Belief Model. The BDI Logic Model was used to compile the Pre-Participation and Post-Participation Questionnaires for use in program evaluation. When appropriate to the Logic Model, items validated in previous studies were included. [27]
RealWorldIssues
In addition to guidance from research, BIG DECISIONS incorporates lessons learned from years of working with young people in clinical, educational, and community settings. Young people need honest, basic information that recognizes their realities and meets them where they are. They are hungry for straightforward information about sex, abstinence, relationships, condoms, and birth control. Some young people are already sexually active, even in middle school, [30] and many of these have experienced coercion or abuse. Too many teenagers are in unhealthyeven violentromantic relationships. Many young people live in difficult or unstable home
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situations. Some cannot read well and too many do not expect to finish high school. Some young people are attracted to members of the same sex and do not expect ever to marry. In the U.S., the majority of young people have had sex by the time they graduate from high school, [3] and many are already parents. BIG DECISIONS strives to be nonjudgmental and to avoid excluding any young people, while at the same time encouraging abstinence first. BIG DECISIONS is partly a response to logistical issues that can affect delivery of curricula in inner-city middle- and high schools. In Texas, sex education is not mandated, and many poor school districts have no resources available to implement optional programs. In addition, many schools experience pressure to use more class time to prepare students for standardized testing. It is often difficult to find time in student schedules to offer optional programs, such as sex education. Thus, a series of about 10 sessions is often the maximum time available with students. BIG DECISIONS uses a minimum number of sessions to deliver the essential activities and information, while at the same time offering enough time and material to have a real impact. Because resources are so often limited, BIG DECISIONS is designed to be inexpensive to implement. The materials needed for the lessons are easy to obtain and use: chalkboard or newsprint, index cards, and copies of the handouts and of the signs provided. For some lessons, it is advisable to make transparent copies and use an overhead projector, or, if possible, to print enlarged copies to make posters. A PowerPoint setup can also be used for several of the lessons. The reality that many facilitators encounter working in disadvantaged communities is that some students, even in high school, may not be able to read well. In addition, some students have difficulty completing homework and family activity assignments. In order to deal effectively with these situations, BIG DECISIONS uses simple language, minimal reading and writing tasks, and is structured to accomplish all the sexuality lessons during classroom time.
ActiveLearning
To engage young people, the BIG DECISIONS lessons are interactive. Students actively contribute important ideas and information, work in small groups, participate in active exercises, and consider authentic and credible examples.
TheImportanceofConnections
The effect of any message about health or behavior depends not only on its content, but also on the strength of the connection that the young person feels to the person giving
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the message. [31] For this reason, the facilitators and their ability to connect with young people are key elements of any sex education program. Facilitators should enjoy working with teenagers and should be comfortable with the subject matter. With the first lesson, BIG DECISIONS facilitators should establish an atmosphere of respect and acceptance, and facilitators should encourage participation by all students.
Evaluation
BIG DECISIONS has been evaluated during implementations in San Antonio, Texas. In the Fall of 2006, the curriculum was piloted at a charter school. From Spring 2007 to Fall 2009, the sexuality curriculum has been implemented in 4 high schools of an inner-city San Antonio school district, with positive results. Overall, the curriculum and its lessons were well-received by both the students and facilitators. Pre-Participation and Post-Participation Questionnaires results have found improvement in attitudes and intentions regarding abstinence, and also improvement in understanding of condoms and contraception. For every question that was duplicated in both the Pre-Participation and Post-Participation Questionnaires, students demonstrated improvement (movement in the desired direction) in their average responses. The largest improvement was the change in agreement with: Teens would be better off if they said no to sex.
Facilitators:HealthEducatorsandTeachers
BIG DECISIONS has been successfully implemented by health educators in public schools, private schools, and community agencies. Around the state of Texas, more and more agencies and school districts are using the curriculum, with positive impressions. However, the costs of providing the curriculum in schools using outside personnel can be difficult to fund in todays environment. Because of current workforce and financial limitations, access to the curriculum for all or most students in a district may be hard to achieve using health educators as the model of implementation. Implementation has also been accomplished using classroom teachers in some schools. Health and Physical Education teachers, as well as teachers of other subjects, can implement the program well with trainingespecially if they are interested and comfortable with the topic. School nurses have also implemented the curriculum in schools. Because of the sensitive nature of the subject matterand to encourage students to be able to ask questions freelyteachers may decide to switch classes with another teacher, perhaps from another school, to provide BIG DECISIONS. By teaching each
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others classes, teachers can provide the curriculum to students that do not have them for regular classes. This may afford students (and teachers) an added degree of comfort in dealing with sensitive material. Training in implementing BIG DECISIONS is discussed in the next section, HOW TO USE THIS CURRICULUM.
ServiceLearningComponent
Unless students have service-learning experiences through other programs in their school, it is recommended to include the service-learning component, available separately, from BIG DECISIONS. Service-learning is a powerful youth development strategy, and programs that use it have reduced teen pregnancy and school failure. [32] Service-learning is much more than just doing community service: it involves classroom preparation for the service, reflecting on the service experience, and celebrating accomplishments, as well. The service-learning component of BIG DECISIONS is designed to offer sessions with basic exercises that can be used to help students develop a joint service project. Often in real life, resources and time with students are limited. Providing a servicelearning experience requires taking care of administrative, liability, and transportation issues. Ideally, service-learning means coordinating with school administration, students other teachers, and with community agencies to help the students design and carry out a realisticand neededservice project. Including the service-learning component requires a minimum of 6 to 10 additional class sessions, in addition to the sexuality lessons. The service-learning experience builds students self-efficacy and civic responsibility, and can build a feeling of connection to the school, and to the facilitator. Servicelearning experiences will increase the likelihood that students will want to use the information they learn in BIG DECISIONS to make the best possible decisions for themselves about sex, as well as about other issues.
SupplementalLesson
A Supplemental Lesson (BEING PREPARED: Safer Sex, or No Sex) contains essential information for young people about correct condom use. Because condoms can be controversial, school districts may elect to offer this lesson only to older students, to teen parents, or to groups of students who are likely to be sexually active. Facilitators, parents, community leaders, teachers, and school administrators can be reassured that information about condoms and contraception is shown not to encourage sexual activity.[40] Information about correct condom use is also essential
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for young people to navigate safely through adolescence and young adulthood in todays world.
References
1. Kirby D, Rolleri LA, Wilson MM. Tool to Assess the Characteristics of Effective Sex and STD/HIV Education Programs. Washington, DC, Healthy Teen Network, 2007. 2. Kirby D. Emerging Answers 2007: Research Findings on Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases. Washington, D.C.: National Campaign to Prevent Teen and Unplanned Pregnancy, 2007. 3. Eaton DK, et al. Youth Risk Behavior SurveillanceUnited States, 2007. In Surveillance Summaries. MMWR 2008; 57 (No. SS04). 4. Data from the 2002 National Survey of Family Growth. Science Says: Teens and Oral Sex. National Campaign to Prevent Teen Pregnancy, 2005. 5. Hamilton BE, et al. Births: Preliminary Data for 2007. National Vital Statistics Reports, Vol. 57, No. 12, March 18, 2009. 6. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2007. Atlanta, GA: U.S. Department of Health and Human Services; December 2008. 7. Gavin L, et al. Sexual and Reproductive Health of Persons Aged 10-24 YearsUnited States, 2002-2007. MMWR Surveillance Summaries 2009; 58 (SS06); 1-58. 8. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2007. Vol 19: Atlanta, GA. U.S. Department of Health and Human Services, 2009. 9. Chandra A, Martino SC, Collins RL, Elliott MN, Berry SH, Kanouse DE, Miu A. Does Watching Sex on Television Predict Teen Pregnancy? Findings From a National Longitudinal Survey of Youth. Pediatrics 2008; 122: 1047-1054. 10. National Public Radio/Kaiser Family Foundation/Kennedy School of Government. Sex Education in America: General Public/Parents Survey. January 29, 2004. 11. Albert B. With One Voice 2007: Americas Adults and Teens Sound off about Teen Pregnancy. Washington, DC: National Campaign to Prevent Teen Pregnancy, 2007. 12. Devaney B, Johnson A, Maynard R, Trenholm C. The evaluation of abstinence education programs funded under Title V Section 510: Interim report, 2002.
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Introduction
13. Trenholm C, et al. Impacts of Four Title V, Section 510 Abstinence Education Programs, Final Report. Princeton, NJ: Mathematica Policy Research Inc. April, 2007. 14. Underhill K, Operario D, Montgomery P. Abstinence-only programs for HIV infection prevention in high-income countries (Review). Cochrane Database of Systematic Reviews. (4):CD005421, 2007. 15. For the Record. Administration tightens rules for Abstinence Education Grants. The Guttmacher Report on Public Policy, November 2005, p. 13. 16. United States House of Representatives Committee on Government ReformMinority Staff. The Content of Federally Funded Abstinence-Only Education Programs, December 2004. 17. Kohler PK, et al. Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy. J Adol Health 2008; 42:344-351. 18. Wiley D, Wilson K. Just Say Dont Know. Sexuality Education in Texas Public Schools. Austin, Texas: Texas Freedom Network, 2009. 19. Allen JP, et al. Child Development 1997; 64:729-742. 20. Philliber S, et al. Preventing Teen Pregnancy: An Evaluation of the Childrens Aid Society Carrera Program. Accord, NY: Philliber Research Associates, 2000. 21. Texas Education Code 28.004. 22. Video at www.parentsfortruth.org, accessed August 1, 2009. 23. Centers for Disease Control and Prevention. CDC Fact Sheet. Genital HPV. Updated December 2007. 24. Winer RL, et al. New Engl J Med 2006; 354:2645-54. 25. Trussell J. Contraceptive Efficacy. In, Hatcher RA, et al. Contraceptive Technology, 19th Revised Edition. New York: Ardent Media, Inc. 2007, pp.759-760. 26. Kirby D. BDI Logic Models: A Useful Tool for Designing, Strengthening and Evaluating Programs to Reduce Adolescent Sexual Risk-Taking, Pregnancy, HIV and Other STDs. 2004. 27. Kirby D, Lepore G, Ryan J. Sexual Risk and Protective Factors. Factors affecting Teen Sexual Behavior, Pregnancy, and Childbearing, and Sexually Transmitted Disease: Which Are Important? Which Can You Change?, August, 2005. 28. Bandura, A. (1989). Human Agency in Social Cognitive Theory. American Psychologist, 44, 1175-1184.
Introduction xxi
29. Montao DE, Kasprzyk D, Taplin, S. The Theory of Reasoned Action and the Theory of Planned Behavior. In: Glanz K, Lewis FM, Rimer BK (Eds). Health Behavior and Health Education (Second Edition). San Francisco, CA: Jossey-Bass Publishers, 2002. 30. Albert B, et al. 14 and Younger: The Sexual Behavior of Young Adolescents. National Campaign to Prevent Teen Pregnancy, 2003. 31. Kirby D. Understanding what works and what doesnt in reducing adolescent sexual risk-taking. Family Planning Perspectives 2001; 33:276-280. 32. Billig, Shelley. The Effects of Service Learning. School Administrator , 57 no. 7(1418):2000.
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Introduction
HowtoUsethisCurriculum
ScheduleofLessons
The BIG DECISIONS curriculum can be offered on a variety of schedules. Once- or twice-per-week lessons are the usual method, but the lessons can be offered consecutively on 2 full days (e.g., on 2 Saturdays). The exact schedule is less important than assuring group cohesion, recall of previous information, and momentum. Sessions should occur often enough so that students are able to remember previous sessions, and the group can build on their experiences together. The schedule should also foster consistent attendance. If the Service-Learning component is included, Sexuality Lessons and Service-Learning Lessons can be alternated to enhance group cohesion and empowerment while learning about sexuality issues. Alternatively, the Service-Learning component can be offered before or after the Sexuality Lessons series.
LessonStructureandMaterials
Each lesson contains several activities, with approximate time frames indicated for completing them. At the beginning of each lesson is presented an outline of the lesson, including Objectives, Materials Needed, Activities, and Materials & Resources Included. Lessons are designed to include a series of brief and varied interactive activities. Student handouts, facilitator resources, Signs, cards, diagrams, and other materials are provided at the end of each lesson. Materials are designed to be inexpensive to use and reproduce. Most lessons require a chalkboard or whiteboard, (or newsprint tablet, markers, and easel). In addition, Powerpoint presentations to make some of the materials available visually are available at www.BIGDECISIONS.org.
How to Use This Curriculum
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Facilitators
Facilitators should be enthusiastic about the messages of the curriculum and familiar with the subject areas covered. Facilitators should enjoy working with young people and be comfortable discussing sensitive issues with them. Effective facilitation of BIG DECISIONS requires comfort and skill with interactive classroom activities. It is recommended that 2 facilitators work together to present the sessions. This allows for continuity in the case of illness or other unexpected absence, and also allows teamwork to deal with latecomers needing to take the Pre-Participation Questionnaire, or other special needs. It is also desirable to have both a female facilitator and a male facilitator working together. This provides role models for both male and female students, and may increase the comfort level in dealing with sensitive issues. This curriculum can be taught by community-based health educators or by classroom teachers. BIG DECISIONS has been successfully implemented by health educators in public schools, private schools, and community agencies. If funding for outside facilitators is limited, schools and other agencies can use teachers, school nurses, counselors, or other personnel to facilitate the curriculum. Health and Physical Education teachers, as well as teachers of other subjects, can implement the program well with trainingespecially if they are interested and comfortable with the topic. Students may find it easier to ask questions and speak openly with a facilitator who is not their teacher. For this reason, some schools have devised a plan for teachers to switch classes and facilitate BIG DECISIONS with each others students. This is a low-cost method of implementation that provides students and teachers a degree of added comfort with sensitive topics.
StudentQuestions
Facilitators should encourage spontaneous questions throughout the curriculum and answer them as accurately as possible. When students feel comfortable enough to ask questions, they are likely to have a positive experience and feel connected to the facilitator and to the group. This connectedness in the learning environment makes the lessons more effective. At the same time, facilitators need to balance spontaneity with progress in the lesson, so that the material can be covered adequately. In addition to handling questions during the lessons, facilitators may want to provide additional ways for students to ask questions in a confidential manner. One method to accomplish this is to use index cards. Each student is given a card, and each student is asked to write something, even if they dont have a question, and submit a card into the envelope or box. This allows questions to be submitted in a truly confidential fashion, so that students cannot tell which of their peers are asking questions
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Alternatively, facilitators may want to have a Question Box placed in the back of the classroom. Students can submit questions at other times besides during the lessons. Facilitators may also want to offer office hours when they are available for questions after class, or at other specified times. It is important to try to cover all the questions submitted at some point and in some fashion. Facilitators may want to spend additional time at the beginning or end of other sessions to answer questions students have submitted on cards. Questions should be respected by the class, and not ridiculed. Facilitators should not answer questions about their personal life. Additional information on handling student questions is included in Appendix 2.
ParentSession
It is recommended that a parent session be offered prior to beginning implementation of the curriculum, and a Parent Session is included in the curriculum. Sample parent letters and consent forms are included. Parental consent must be obtained according to school district (or host agency) policy. Texas law concerning public schools does not require active parental consent; passive opt out consent is consistent with Texas law. However, parents must be notified of the basic content of sexuality instruction, and of their right to remove their child from sexuality instruction. BIG DECISIONS includes material to offer a parent workshop, in addition to the orientation session. The Parent Session contains exercises for parents to develop skills and overcome resistance to talking to their children about sex. The Parent Session offers an opportunity to role-play with other parents talking to teens in specific scenarios and situations.
GettingApproval
Before implementing BIG DECISIONS, or any sex education program, in schools, school district administrative processes must be followed and support for the program developed. In Texas, sexuality instruction in public schools must be approved by the districts school board. Each districts School Health Advisory Council, which includes parents, considers sexuality curricula and instruction and makes recommendations to the Board. Educational materials must be available for the public to examine. It is essential to work with agency or school personnel to follow policies and procedures in order to maximize the effectiveness of the program. Implementing the
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Service-Learning lessons requires additional coordination to arrange for projects, community collaboration, and transportation.
TrainingintheCurriculum
Health educators, and others who have previously provided sexuality education, may need little formal training in order to implement BIG DECISIONS. A day-long training is recommended, even for experienced health educators, in order to become familiar with the lessons and activities of the curriculum. For teachers, school nurses, and others without sexuality education experience, a two-day training is recommended. Training in the implementation of BIG DECISIONS is available from the Center for Health Training in Austin, Texas.
FeedbackabouttheCurriculum
Agencies, schools, health educators and teachers are encouraged to offer feedback to the author about any aspect of BIG DECISIONS through the website, www.BIGDECISIONS.org. It is hoped that this curriculum will a tool to help as many young people as possible in Texas, and anywhere. With the experience and insights of those working with young people in the field, BIG DECISIONS can be modified and improved over time. As new knowledge becomes available, and as the legal and social environment changes, BIG DECISIONS will strive to stay up to date and to meet the needs of young people for good information that helps them make healthy decisions about sex
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SEXUALITYLESSONS
LESSON1
RULESOFTHEGAME: FormingaRespectfulGroup
Lesson 1
LESSON 1 Outline
RULESOFTHEGAME: FormingaRespectfulGroup
Objectives
Fill out Pre-Participation Questionnaire Give an overview of the curriculum Identify respect as a key value for the group Develop ground rules for the group
MaterialsNeeded
Pre-Participation Questionnaires, pencils Cut-out Code Cards, one for each student 2 Large envelopes, for completed Pre-Participation Questionnaires and Code Cards Curriculum Outline Handouts Chalkboard, or Newsprint tablet, Markers, and Easel KEY MESSAGES Poster (or PowerPoint slide/setup, or Transparency and Overhead Projector)
Activities
1.1 -- Introduction and Pre-Participation Questionnaire 15 minutes 1.2 -- Curriculum Review 5 minutes 1.3 -- Ice-Breaker: Differences and Respect 10 minutes 1.4 -- Setting Ground Rules 10 to 15 minutes 1.5 -- Wrap-Up 5 minutes
MaterialsandResourcesIncluded
Student Pre-Participation Questionnaire (for Activity 1.1) Facilitators Resource (for Activity 1.1): Code Cards BIG DECISIONS Curriculum Outline (for Activity 1.2) KEY MESSAGES Poster, PowerPoint slide, or Transparency (for Activity 1.2)
Lesson 1
LESSON1 RULESOFTHEGAME: FormingaRespectfulGroup

Objectives
Fill out Pre-Participation Questionnaire Give an overview of the curriculum Identify respect as a key value for the group Develop ground rules for the group
MaterialsNeeded
Pre-Participation Questionnaires, pencils Cut-out Code Cards, one for each student 2 Large envelopes, for completed Pre-Participation Questionnaires and Code Cards Curriculum Outline Handouts Chalkboard, or Newsprint tablet, Markers, and Easel KEY MESSAGES Poster (or PowerPoint slide/setup, or Transparency and Overhead Projector)
Notes for Facilitators

The Pre-Participation Questionnaire BIG DECISIONS includes Pre- and Post-Participation Questionnaires to encourage evaluation of the program at each implementation. Lesson 1 begins with the Pre-Participation Questionnaire, which should be
Lesson 1
administered to every student who participates in the sessions. In order to allow for matching of Pre- and Post-Questionnaire scores, each student is given a code number, which will be used for both the Pre- and the PostQuestionnaire.
Before the lesson, the facilitator gives each of the Pre-Questionnaire forms a code number, and places the corresponding code number on a Code Card. Each PreQuestionnaire is passed out with an accompanying corresponding Code Card. The students are asked to write their name and date of birth on their Code Card. Then, before the students complete the Pre-Questionnaire, the facilitator collects the Code Cards in a separate envelope. The facilitator then has a master list of code numbers, which is kept separate from the actual completed Pre-Questionnaires, to preserve confidentiality. When the Post-Questionnaires are prepared for the students to take in Lesson 10, each Post-Questionnaire is assigned a code number, and the facilitator uses the Code Cards from Lesson 1, so that the Post-Questionnaire with the correct code number is given to the correct student.
Both Pre- and Post-Questionnaires should be scored without referring to the identifying information, preferably by someone who does not know the students in question. If there are latecomers to the group, these students should be asked to fill out a Code Card and Pre-Questionnaire before they participate in the class. As they do, their Code Card is added to the master list. The KEY MESSAGES Poster After the Pre-Questionnaires have been completed and collected, the KEY MESSAGES Poster should be displayed. Displaying the KEY MESSAGES during each of the 10 lessons is an important part of assuring the effectiveness of the program. There are several ways to accomplish displaying the KEY MESSAGES: Project the KEY MESSAGES Poster PowerPoint slide, which is available at www.BIGDECISIONS.org. Make a 24 by 36 enlargement of the KEY MESSAGES poster included at the end of this lesson, and have it laminated and placed on foam board. Print the KEY MESSAGES poster onto transparency film, or photocopy it from a hard copy onto a transparency film. Then use an overhead projector to project the transparency. Make several 8 by 11 inch copies of the poster, and post them so that students can refer to them during the class.
Lesson 1
Curriculum Handouts For programs with many classes to serve, the Curriculum Handouts can be collected and re-used for other classes. Facilitators may want to laminate the curriculum outline handouts for re-use. Ice-Breaker (Activity 1.3) Alternatives If the classroom situation does not allow for a musical chairs activity, this activity can be done with a bean-bag or other tossable toy. When the first student says what they like, students stand or raise their hand to indicate they agree with the statement. The first student then tosses the bean-bag to one of the standing students. If there are disabled students in the class, modifications should be made to assure that all students can participate. For example, if a student is not able to stand up, the facilitator should arrange for the action to signal agreement with the statement to be something that the disabled student(s) can do, e.g., raise their hand. In order to involve all students, the facilitator can change the rules, so that the beanbag is tossed to someone who does NOT agree with the statement.
Activity1.1 Introduction&PreParticipationQuestionnaire15minutes
At the beginning of the session, introduce yourself and welcome the students. Take attendance and collect parent consent forms, as needed. Pass out the Pre-Participation Questionnaires, with the corresponding the Code Cards. Explain to the students that the Pre-Participation Questionnaires and Post-Questionnaires are important because they help the BIG DECISIONS program know how it is doing in helping young people. Honest answers on the Questionnaires help the program to improve and be more effective. Let the students know that the code numbers are needed to match their PreQuestionnaires with their Post-Questionnaires. The Code Cards will be kept separate from their completed tests, and will be used only to match the Pre-Participation Questionnaires with the Post-Questionnaires. Assure the students that their responses are confidential: their individual answers to the questions will not be shared with anyone. Ask the students to fill out the Code Cards with their name and date of birth. Then ask the students to fill out the top of the Pre-Participation Questionnaires with the name of their school, the class period, and the date. Instruct them to circle the word male or female to indicate their gender, their age in years, and the grade level that they are in.
Lesson 1
Also, ask them to circle one of the four racial/ethnic categories, to indicate which one best describes them. Ask them to answer each of the questions honestly as best they can by circling the answer that best reflects their opinion. Ask them to also fill out the write-in question at the end of the page. Point out that they are not to put their names on the paper, and that their answers are confidential. When the students have completed the Pre-Participation Questionnaires, have them put them into a large envelope as you walk through the class.
Activity1.2 CurriculumReview5minutes
Pass out the Curriculum Outline Handouts so each student has one. Let the class know that this group is a special class, BIG DECISIONS, that is designed to help them make healthy and informed decisions about sexan important topic for young people. Show the class the KEY MESSAGES poster (or project the PowerPoint slide or transparency), and post it prominently in the classroom. Let the class know that the KEY MESSAGES of the BIG DECISIONS program are: Having sex is a BIG DECISION

Point out that the Curriculum Outline shows the topics that will be covered during the sessions. This curriculum requires their participation and leadership to learn about sex, relationships, risks and decision-making. Point out that each lesson is important and each student is an important part of the groupso it is important that students attend every session. Answer any questions the students may have about the Curriculum Outline.
Activity1.3 IceBreaker:DifferencesandRespect10minutes
If possible, have the students arrange their desks or chairs in a circle. Explain that this activity is to help the class get to know each other as individuals, and learn what they might have in common with other studentsand what differences there might be.
Lesson 1
Explain that this activity is a game, like Musical Chairs. One person stands in the middle of the circle, and makes a statement about themselves, for example, what they like. Each student who agrees with the statement must stand up, and find another chair to sit in that is empty because a student is standing. Each student who stands up moves to another empty chairbut not to a chair that is right next to the one they were sitting in. The person in the middle also sits in a chair, so that one person is left standing, without a chair to sit in. That person then goes to the middle and makes the statement for the next round of the game. The facilitator begins the game by being in the middle, and says something like: I like everyone here, and I especially like....basketball. If necessary, explain that all the students who like basketball must stand up and find another chair. The facilitator can challenge the students to think of something that every student will stand up for, and something that very few will stand up for. Examples that the facilitator might suggest include: I like Hip-Hop I have a best friend I have traveled to another state My favorite color is purple I already know what I want to do when I finish high school
Encourage the group to let everyone have a chance in the middle, and to avoid getting too rough in this activity. Summarize what this activity shows, that there are similarities and differences among the students in the class. Let them know that the things we have in common can help us understand each otherbut our differences are also important. Each person has their unique set of things they are, and that they like. Let the class know that, in this class, it is important to show respect for each otherand that includes respecting differences as well as similarities. Because we will be covering sensitive and potentially embarrassing topics, it is especially important that each student is shown respect by other students. Write the word Respect on the chalkboard or newsprint.
Activity1.4 SettingGroundRules10to15minutes
Tell the class that, since sex and related topics are sensitive and sometimes emotional, it is important for the class to develop some ground rules for behavior. These rules are to ensure that every person is treated with respect. Each person should feel safe enough to
Lesson 1
share their ideas with the group. This means the class must have an atmosphere that is safe from teasing, making fun of others, and disrespect. Have students call out rules they want for the group. On the board or newsprint, write the rules that students suggest. Get feedback from the group, as needed, to assess acceptability of each rule, and any concerns about them. Help the group evaluate each suggestion for its relevance to respect. The facilitator should model respect for ideas, even when a suggested rule is not popular. Rules should include: The group will not tolerate making fun of anyone or ridiculing them. It is OK to disagree, but it is not OK to humiliate or criticize a person, or indicate that the person is not OK. Everyone has a chance to speak and contribute. The ideas and leadership of every student are importantincluding quiet students. Everyone has the option NOT to speak. Even though everyone must pay attention (and not disrupt the class), no one is forced to say something in front of others if they dont want to. Anyone can pass. What happens in the group stays in the group. There should be no telling others outside the class what a particular student says, unless that student gives their permission to share it. Respect differencesand dont assume that others are in the same situation as you. For example, some students may not have parents that they live with. Some students do not feel attracted to the opposite sex. Students may have different religious backgrounds. Respect other peoples privacy. In this class, no one should share information about someone else without their permission. If you talk about someone else without their permission, be careful not to identify them. There is no such thing as a dumb question in this class. Students must feel confident that they can ask a question without being made fun of.
Activity1.5 WrapUp5minutes
Ask the group to endorse the final rules list. Tell them you will bring the rules sheet and post it at each session. Reinforce how important it is that students come to every one of the classes. Because the group is a special onewhere participation and respect are keyeach students participation is important. Let them know that you are looking forward to working with them.
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Lesson 1
Pre-Participation Questionnaire
YOUR CODE NUMBER: _________ SCHOOL: _______________________________________ Class Period: ______________ Date: ______________
I am (circle one): I am (circle one):
Male
Female
Age: _______ Years Hispanic
Grade: _________ Other
White, not Hispanic
Black (African-American)
Strongly Disagree
Disagree
Please answer honestly. Your answers are CONFIDENTIAL. 1. Teens would be better off if they said no to sex. 2. Getting a sexually transmitted disease (STD) is not a big deal. 3. Right now, I really dont want to get pregnant (or get someone pregnant). 4. I would not have sex now because I do not want any chance of HIV or other STDs. 5. I would not have sex now because I do not want any chance of getting pregnant (or getting someone pregnant). 6. If used correctly every time, condoms can prevent HIV and other STDs. 7. Using contraceptives (birth control) correctly can lower the chance of pregnancy. 8. It is OK to pressure another person into having sex. 9. I plan to abstain from sex until I am older. 10. If someone pressured me to have sex, I am sure I could say no. 11. If I decide to have sex, I am sure I will use a condom every time. 12. If I decide to have sex, I am sure I will use a method of birth control every time.
1 1 1 1 1 1 1 1 1 1 1 1
2 2 2 2 2 2 2 2 2 2 2 2
3 3 3 3 3 3 3 3 3 3 3 3
13. What would you like to learn about? ______________________________________________ ___________________________________________________________________________ THANK YOU for Your Answers!
Student Pre-Participation Questionnaire for Activity 1.1

Lesson 1 11
Strongly Agree
Agree
Please CIRCLE the answer that best matches how much you AGREE or DISAGREE.
4 4 4 4 4 4 4 4 4 4 4 4
FacilitatorResourceforActivity1.1:CodeCards
Note: Make copies of this page, and cut out one card for each student to fill out prior to taking the Pre-Participation Questionnaire Code Number: ________________ Name: ______________________ ---------Date of Birth: ____ / ____ / ____ (Month) (Day) (Year) Code Number: ________________ Name: ______________________ ---------Date of Birth: ____ / ____ / ____ (Month) (Day) (Year)
Code Number: ________________ Name: ______________________ ---------Date of Birth: ____ / ____ / ____ (Month) (Day) (Year)
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Code Cards for ACTIVITY 1.1
Lesson 1











PARENT SESSION
Lesson 1 of External Origin Document
13
KEY MESSAGES
KEY MESSAGES Poster
14
Lesson 1
LESSON2
ANATOMYANDREPRODUCTION: HowitWorks
Lesson 2
15
LESSON 2 Outline
ANATOMYANDREPRODUCTION: HowitWorks
Objectives
MaterialsNeeded
Chalkboard, or Newsprint tablet, Markers, and Easel Set of 4 Anatomy Diagrams: Male Outside, Male Inside, Female Outside, and Female Inside using one of the following methods: o Projection of the PowerPoint slides (available www.BIGDECISIONS.org) o Transparent copies of the diagrams and overhead projector setup, or o Posters (enlarged copies) of the diagrams, with Velcro 1 set of Male (Outside and Inside) and Female (Outside and Inside) Anatomy labels, cut out, with Velcro, masking tape, or transparent tape 2 sets each of printed signs for the Sperms and the Eggs journeys through the body Questions cut out from Facilitator Resource: Reproduction: True or False? Ground Rules Newsprint Sheet from Lesson 1 Chalkboard, or Newsprint tablet, Markers, and Easel KEY MESSAGES Poster (or PowerPoint slide/setup, or Transparency and Overhead Projector)
Activities
2.1 -- Ice-Breaker: What Do They Call It? 5 minutes 2.2 -- Reproductive Anatomy: The Body Parts 15 to 20 minutes 2.3 -- The Journeys of the Sperm and the Egg 10 minutes 2.4 -- Reproduction: True or False?10 minutes 2.5 -- Wrap-Up 5 to 10 minutes
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Lesson 2
LESSON 2 Outline, continued

Anatomy Diagrams (4) for Transparencies, PowerPoint projection, or Posters, for Activity 2.2 Male and Female Anatomy Labels for Activity 2.2 Signs for Journey of the Sperm Game (6), for Activity 2.3 Signs for Journey of the Egg Game (6), for Activity 2.3 Facilitator Resource: True or False? questions for Activity 2.4
Lesson 2
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LESSON2 ANATOMYANDREPRODUCTION: HowitWorks

Objectives
MaterialsNeeded:
Chalkboard, or Newsprint tablet, Markers, and Easel Set of 4 Anatomy Diagrams: Male Outside, Male Inside, Female Outside, and Female Inside using one of the following methods: o Projection of the PowerPoint slides (available www.BIGDECISIONS.org) o Transparent copies of the diagrams and overhead projector setup, or o Posters (enlarged copies) of the diagrams, with Velcro 1 set of Male (Outside and Inside) and Female (Outside and Inside) Anatomy labels, cut out, with Velcro, masking tape, or transparent tape 2 sets each of printed signs for the Sperms and the Eggs journeys through the body Questions cut out from Facilitator Resource: Reproduction: True or False? Ground Rules Newsprint Sheet from Lesson 1 Chalkboard, or Newsprint tablet, Markers, and Easel KEY MESSAGES Poster (or PowerPoint slide/setup, or Transparency and Overhead Projector)
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Lesson 2

Anatomy Diagrams Facilitators will need to choose one of the following methods to enlarge or project the 4 Anatomy Diagrams used in Activity 2.2 in this lesson.
1. PowerPoint Method: This method uses the PowerPoint presentation of the 4 Anatomy Diagrams (available for download at www.BIGDECISIONS.org), projected using a computer and LCD projector onto a whiteboard, wall, or screen. Each diagram appears first without any body-part labels. Each subsequent slide adds the name of a body part, and the facilitator can review the name and its function by going through the slides. To perform the game in Activity 2.2, project the diagram slide with no labels, and have the students on the team match the labels to the correct body part. Then repeat the process for the other 3 Anatomy Diagrams. Depending on the surface that the diagrams are projected on, students can use the cut-out Anatomy Labels, with folded masking tape or transparent tape on the back, to stick the Label to the appropriate blank box. 2. Transparency Method: This method of enlarging the Anatomy Diagrams uses transparencies and an overhead projector. Each of the 4 Anatomy Diagrams can be printed (from the corresponding page of this lessons pdf file) onto transparency film, or photocopied (in black and white from a hard copy) onto a transparency film. The transparencies are then shown to the class using an overhead projector. The diagrams can be projected onto a whiteboard, wall, or screen. The students can then use the cut-out Anatomy Labels, with folded masking tape or transparent tape on the back, to stick the Label to the appropriate blank box. 3. Poster Method: This method uses 4 physical posters printed from the Anatomy Diagrams S. Each diagram can be printed from the pdf file of this lesson as a 24" X 36" poster by a commercial copy center. Each poster can then be laminated and affixed to foam board, if desired. The blank boxes of the posters can then be fitted with small pieces of Velcro, which are glued to the blank box. The opposite sides of the Velcro are then glued to the back side of each of the cut-out Anatomy Labels provided in this lesson. The Lables can be made sturdier by printing them onto heavy paper or cardstock from the pdf file of the lesson, or by photocopying them onto heavy paper. Alternatively, the facilitator may elect to hand-write the Labels onto self-stick notes.
Potential Name Confusion The Facilitator should be aware that hymen may be misheard as Jaime, and that could embarrass a student named Jaime. It may be helpful to spell out hymen to clarify.
Lesson 2
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Time Management for Lesson 2 Students often have many questions about anatomy and reproduction. Facilitators are encouraged to answer as many questions as possible, as they come up during the lesson. However, in order to lay the groundwork for future lessons, it is important to be able to finish Activity 2.3. For some classes, there may not be enough time to complete the last Activity (2.4), Reproduction: True or False? The facilitator may wish to cut up the Facilitator Resource for Activity 2.4, and have students draw questions from a box or envelope. Alternatively, to save time, the facilitator can simply read the questions from the Resource.
Activity2.1 IceBreaker:WhatDoTheyCallIt?5minutes
Let the class know that this session will be about human reproduction, including male and female anatomy and function. This is basic information that is important to being able to make healthy decisions about sex. Refer to the posted (or projected) KEY MESSAGES poster. Post and review the ground rules developed at the last session. Point out that following the ground rules is especially important when discussing sensitive issues like the ones in this lesson. Acknowledge that, even though everybody has genitals, people often feel embarrassed or giggly talking about them. As an ice-breaker, ask the class to mention some commonly used (street or slang) names they may have heard for genital structures, including the penis, vagina, breasts, and testicles. If the students are reluctant to say commonly used names out loud, the facilitator may need to start the list him- or herself. As the students offer a commonly used name, the facilitator should repeat the commonly used name to acknowledge its existence. After the class has had a chance to offer lots of commonly used names, ask them to mention commonly used names for other body parts, like the elbow, foot, or ear. Ask the class why they think there are so many commonly used names for body parts related to sex, but none for nonsexual body parts. Point out that sex and reproduction are emotionally charged and often held secret in our society, and these are some reasons for why there are so many commonly used, or slang, names. Let the class know that it is important to know the proper names for body parts, and to be able to use the proper names.
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Lesson 2
Activity2.2 ReproductiveAnatomy:TheBodyParts15to20minutes
Display or project the 4 Anatomy Diagrams (Male Outside, Male Inside, Female Outside, and Female Inside) so that the class can see them, using one of the three methods described in the Note to Facilitators at the beginning of this lesson. Go over each of the Diagrams, saying the name of each body part and explaining its function. If using the PowerPoint presentation, the first slide of each Diagram has no body-part name labels. Each subsequent slide provides one new body-part namein a more-orless logical sequence. If using an overhead projector or printed enlargements of the Diagrams, the facilitator places each cut-out Anatomy Label, with the name of the body part described, on the Diagram (or projection) in the appropriate location. Note that the labels for the Male Anatomy Diagrams are shaded gray, while those for the Female Anatomy Diagrams are white. The answers to which label goes in each box are listed in the Facilitator Resource, Anatomy Answers. Important additional points to make as you describe the anatomy and function of each body part include: On the Male Outside Diagram: point out that some males are circumcised and some are uncircumcised. Circumcision is removal of the foreskin, and it is usually performed shortly after birth. Let the students know that males can be healthy and normal, whether or not they are circumcised. Mention also that most males have one testicle that hangs lower than the other. On the Male Inside Diagram: trace the path that sperm take from the testis, through the epididymis and vas deferens, into the abdomen at the groin, over and behind the bladder, through the prostate gland, into the urethra, through the penis and out the tip of the penis with ejaculation. On the Female Outside Diagram: point out the opening of the vagina, and let the class know that some females have a hymen, i.e., special tissue around the vaginal opening that makes the opening small. This is the tissue that is sometimes called a cherry. For many females, this tissue is stretched or broken when they first have vaginal sex, and they may have some bleeding or pain. Some females have very little hymeneal tissue, and have no bleeding or pain when they first have vaginal sex. Also, let the class know that a females external genitals are also called the vulva, and these structures include the labia majora, labia minora, clitoris, and entrance to the vagina. (Vulva is not a name in labeling game in this Activity, but it is important to know what it means.)
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On the Female Inside Diagram: trace the path that the egg takes from the ovary, through the Fallopian tube, into the uterus. Then, if it has not been fertilized (in the tube), the egg goes with the menstrual blood flow through the cervix, and through the vagina to the outside of the body. If the egg is fertilized, this happens shortly after ovulation (when the egg is released from the ovary). Fertilization of the egg by the sperm occurs in the Fallopian tube. The fertilized egg takes about a week to travel to the uterus, and then it implants in the uterine lining to begin a pregnancy. If fertilization and implantation are successful, the female will usually not have menstrual bleeding. This missed or late menstrual period is one of the symptoms of early pregnancy. Using the Female Inside Diagram, point out key elements of how pregnancy happens: When a male ejaculates semen (comes), the fluid contains millions of sperm If sperm are placed in the vagina, they can swim up through the cervix, through the uterus, and into the Fallopian tube Sperm can live up to about 5 days inside the female body If the female has recently ovulated (i.e., the ovary has released an egg), one sperm can fertilize (enter) the egg A fertilized egg can develop into an embryo It travels through the Fallopian tube into the uterus The embryo can attach to (or implant in) the lining of the uterus The implanted embryo can grow and develop into a fetus and later be born
Point out that if the egg is not fertilized, it passes through the uterus, and is expelled with menstrual flow (blood) through the cervix, through the vagina, and out of the body. Divide the class into 2 teams, with one team working on labeling the male body parts, and one working on the female body parts. Pass out the Anatomy Labels to the teams. The facilitator may want to distribute the labels so that each label (and finding where it goes on the Anatomy Diagrams) is the responsibility of one or two students. Beginning with the Female Anatomy Diagrams (first the Outside, and then the Inside Diagram), ask the students to take turns bringing their label to the front of the class and finding the correct location for their label on the projection (or poster). Team members can help their teammates with advice. As each body part is labeled, review its function with the class. Give the Female team a score, with 1 point for each label properly placed (out of a maximum of 11). Repeat the process for the Male Anatomy Diagrams, starting with the Male Outside and then the Male Inside Diagrams, and award points for each correct placement. (In order to equalize the number of labels that each team must place, the facilitator can place the Bladder label on the Male Inside projected transparency or poster. This will allow a maximum number of points of 11 for the Male team.)
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Congratulate both teams for their accomplishments, and collect the labels. Reinforce that knowing the names and functions of male and female body parts is an important part of learning about health and sexuality.
Activity2.3 TheJourneysoftheSpermandtheEgg10minutes
Leave the Male Inside diagram projection or poster showing for the Journey of the Sperm game. Ask for student volunteers to form 2 teams of 6 students each to come to the front of the class, with one team in a line on the right side of the class, and one team in a line on the left. Give one student on each team the Sperm sign; they will be the team leaders. Give the other 5 members of each team one of the following signs (in random order): Testicle Epididymis Vas Deferens Urethra Penis
Tell each Sperm to put his or her team in order of how the sperm travels through its journey. The other team members holding up their signs cannot talk, but the rest of the class who are not on a team can assist the 2 Sperms verbally to order their team members. The first team to get into the correct order wins! When the game is over, refer back to the Male Inside Diagram and reinforce the correct order of the signs. Have the Sperm teams sit down, and collect the Journey of the Sperm game signs. Then repeat the game for the Journey of the Egg. Post or project the Female Inside Diagram. Ask for student volunteers (new ones, if possible) to form 2 more teams of 6 students each to come to the front of the class. Give one student on each team the Egg sign; they will be the team leaders. Give the other 5 members of each team one of the following 5 signs (in random order): Ovary Fallopian Tube Uterus Cervix Vagina
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Tell each Egg to put his or her team in order of how the egg travels through its journey. Again, the other team members holding up their signs cannot talk, but the rest of the class who are not on a team can assist the 2 Eggs to order their team members. The first team to get into the correct order wins! Again, when the game is over, refer back to the Female Inside Diagram to reinforce the correct order of the signs. Thank the contestants and collect the Journey of the Egg signs.
Activity2.4 Reproduction:TrueorFalse?10minutes
This activity can be done by cutting out the 10 questions in the Facilitator Resource: Reproduction: True or False? and then placing the strips of paper with the questions into an envelope or box for students to draw. (Alternatively, to save time, the facilitator can simply read the questions.) Ask for volunteers to draw a Reproduction question to answer. Applaud correct answers, and ask other students to help answer questions, when needed. Answer questions as they arise, and help the class to understand why the item is true or false. Cover as many items as time allows. Some points to make during the discussion include:
1.Afemalecangetpregnanttheveryfirsttimeshehassex.
True: Females are not protected from pregnancy by inexperience. If the conditions to allow fertilization and beginning of pregnancy are met, a female can certainly get pregnant the first time she has sex.
2.Spermcanliveonly24hoursinsideafemalesbody.
False: Sperm can live for up to 5 or 6 days inside the females body. This is why, when she ovulates, a fertilization or conception can occur if the female has had sex in the last 5 days or so.
3.Afemalecanonlygetpregnantifshehassexonthe14thdayofher cycle.
False: A female has approximately 6 days each cycle when she can get pregnant if she has sex. However, it is difficult to accurately predict which 6 days these will be.
4.Amalewhogetsanerectionhastoejaculateorhewillhavedamage.
False: This is the myth of blue balls. A male who is turned on and sexually stimulated will not have any damage if he does not ejaculate.
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5.Itisnormalforfemalestohaveasmallamountofdischargefromthe vagina.
True: Healthy females often have a small amount of clear or white liquid that comes out of the vagina. This discharge is part of the bodys natural way to cleanse the vagina. Heavy or discolored discharge, itching, or unusual odors are usually not normal, and these should prompt a female to seek health care.
6.Wetdreamsarenormalformalesduringpuberty.
True: Most males experience nocturnal emissions (wet dreams) during or after puberty. Males may be embarrassed when they wake up with semen on their sheets or pajamas, and often they do not remember a sexual dream. This is perfectly normal.
7.Afemalecannotgetpregnantifshehassexwhilesheisonherperiod.
False: When a female has vaginal bleeding, it may not be her regular menstrual period. Therefore, bleeding is not a guarantee that a female cannot get pregnant. (If she indeed is having her regular menstrual period, then it is unlikelybut not impossiblethat she would get pregnant.)
8.Amalecanhaveagoodsexlifewhetherheiscircumcisedornot.
True: There are many males who are circumcised and many who are not, and all can have fulfilling and healthy sex lives. Circumcision may have the advantages of making it simpler to keep the penis clean with washing; a smaller chance of urine infection for male babies. Circumcised males probably have a lower chance of some sexually transmitted infections, including HIV. (Of course circumcision is not as complete protection as abstinence, and not as effective protection as condoms.) Some people think that a mans experience during sex is more intense without circumcisionbut others disagree.
9.Itisimpossibleforafemaletogetpregnantifthemalepullsoutand ejaculates(comes)outsideofthevagina.
False: Although using withdrawal reduces the risk of pregnancy, a female can get pregnant even if the male pulls out. There is a little fluid that comes out of the tip of the penis before ejaculation (pre-come), and there can be some sperm in this fluid. Also, sometimes, a male might forget to pull out in time, even when he meant to.
10.Ifitoccurs,fertilizationoftheeggbyaspermhappensintheuterus.
False: Fertilization usually happens in the Fallopian tube. By the time the egg reaches the uterus, far too much time has passed (5 to 7 days) for the egg to be able to be fertilized.
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Activity2.5 WrapUp5minutes
Answer as many questions as time permits. Commend the class on following the ground rules and dealing with potentially embarrassing topics so well.
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Anatomy Diagram for Poster or Transparency, for Activity 2.2
Male Outside
Allows for Sexual Stimulation & Intercourse
Head of the Penis, Sensitive Covers the Glans of the Penis; Pulls Back
Contains Testicles, Spermatic Cords, Vessels
Urine and Semen Leave the Body
Uncircumcised
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Circumcised
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Male Inside
Make Fluid for Semen
Holds Urine
Urine & Semen Leave Body Pathway for Sperm
Sperm Mature & Travel Through Produce Sperm & Male Hormones
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Female Outside (Vulva)

Sensitive Bump Allows for Sexual Stimulation Large Lips, Protect Vaginal Area
Small Lips, Protect Vaginal Area
Urine Leaves Body
Allows for Birth, Menstrual Flow, & Sexual Intercourse
Feces Leave Body
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Female Inside
Produce Eggs & Female Hormones
Pathway for Egg; Fertilization Occurs Here
Fetus Grows Inside
Dilates in Labor; Where Pap Smear is Done Allows for Birth, Menstrual Flow & Sexual Intercourse
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Male Outside Labels Foreskin Glans of Penis Scrotum Shaft of Penis
Opening of Urethra Male Inside Labels Urethra Testicle Seminal Vesicles Bladder Epididymis Prostate Gland
Vas Deferens
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Female Outside Labels Anus Labia Minora Clitoris Labia Majora
Opening of Urethra Opening of Vagina

Female Inside Labels Cervix

Uterus
Ovary Vagina Fallopian Tube
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Facilitator Resource for Activity 2.2
Anatomy Answers
Male Outside Foreskin: Covers the Glans of the Penis; Pulls Back Shaft of Penis: Allows for Sexual Stimulation and Intercourse Scrotum: Contains Testicles, Spermatic Cords, Vessels Glans of Penis: Head of the Penis, Sensitive Opening of Urethra: Urine and Semen Leave the Body Male Inside Testicle: Produce Sperm & Male Hormones Epididymis: Sperm Mature & Travel Through Vas Deferens: Pathway for Sperm Bladder: Holds Urine Seminal Vesicles: Make Fluid for Semen (behind Bladder) Prostate Gland: Make Fluid for Semen (under Bladder) Urethra: (Line points to Penile Urethra) Urine & Semen Leave Body
Female Outside (Vulva) Clitoris: Sensitive Bump Allows for Sexual Stimulation Labia Minora: Small Lips, Protect Vaginal Area Labia Majora: Large Lips, Protect Vaginal Area Opening of Urethra: Urine Leaves Body Opening of Vagina: Allows for Birth, Menstrual Flow, & Sexual Intercourse Anus: Feces Leave Body Hormones
Female Inside Ovary: Produce Eggs & Female
Fallopian Tube: Pathway for Egg; Fertilization Occurs Uterus: Fetus Grows Inside Cervix: Dilates in Labor; Where Pap Smear is Done Vagina: Allows for Birth, Menstrual Flow, & Sexual Intercourse
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Signs for Journey of the Sperm Game, for Activity 2.3 Make 2 Copies

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Testicle

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Epididymis

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Vas Deferens
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Urethra

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Penis
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Signs for Journey of the Egg Game, for Activity 2.3 Make 2 Copies

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Ovary
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Fallopian Tube
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Uterus

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Cervix


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Vagina

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Facilitator Resource: Reproduction: True or False? Questions for Activity 2.4
A female can get pregnant the very first time she has sex.
Sperm can live only 24 hours inside a females body.
A female can only get pregnant if she has sex on the 14th day of her cycle.
A male who gets an erection has to ejaculate or he will have damage.
It is normal for females to have a small amount of discharge from the vagina.
Wet dreams are normal for males during puberty.
A female cannot get pregnant if she has sex while she is on her period.
A male can have a good sex life whether he is circumcised or not.
It is impossible for a female to get pregnant if the male pulls out and ejaculates (comes) outside of the vagina.
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If it occurs, fertilization of the egg by a sperm happens in the uterus.
Lesson 2
LESSON3
RELATIONSHIPSANDROMANCE: WhatisHealthy?WhatisLove?
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LESSON 3 Outline
RELATIONSHIPSANDROMANCE: WhatisHealthy?WhatisLove?
Objectives
MaterialsNeeded
Chalkboard, or Newsprint tablet, Markers, and Easel One set of cut-out Love, Crush, or Lust? Cards Ground Rules Newsprint Sheet from Lesson 1 KEY MESSAGES Poster from Lesson 1
Activities
3.1 Healthy and Unhealthy: Relationships and Sex 10 to 15 minutes 3.2 Healthy or Unhealthy? 15 minutes 3.3 Love, Lust, or Crush? 10 to 15 minutes 3.4 Wrap-Up 5 minutes
Facilitator Resource for Activity 3.1: Relationships and Romance: What is Healthy? Facilitator Resource for Activity 3.3: Relationships and Romance: Is It Love? Cards for Activity 3.3: Love, Lust, or Crush?
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LESSON3 RELATIONSHIPSANDROMANCE: WhatisHealthy?WhatisLove?

Objectives
MaterialsNeeded
Chalkboard, or Newsprint tablet, Markers, and Easel One set of cut-out Love, Crush, or Lust? Cards Ground Rules Newsprint Sheet from Lesson 1 KEY MESSAGES Poster from Lesson 1

Anticipating Student Concerns This lesson may bring up difficult issues for young people as they consider their own personal relationships. Students may recognize unhealthy aspects of their romantic relationships, friendships, and family relationships. Be prepared to field questions that students may bring to you after class, and be aware of school and community resources for students who need help in dealing with unhealthy relationships. Also, any child abuse you become aware of must be
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reported according to state law. The Relationship Scenarios Facilitators should point out that the scenarios used in Activity 3.2 are not about actual students. Even if there is a student with the same name as a scenario character, the story is not about them. Facilitators may want to change the name(s) of the characters in the story. Preparing Card Sets Activity 3.3 calls for a cut-up set of Love, Lust, or Crush? cards for each small group in the class. Facilitators may want to print the page of cards on a different color paper for each small group. The cards are then cut out, and they can be easily kept in sets (by the color of the paper) for reuse.
Activity3.1 HealthyandUnhealthy:RelationshipsandSex10to15minutes
Write the word Relationships on the board, and ask the class to say what it means. Key elements include how people treat each other, interact with each other, or relate to each other. Draw two circles on the board and then a (horizontal) line connecting them. Each circle represents a person, and the line represents the relationship between the two people. Under the word Relationships, write on the board Healthy and Unhealthy, and underline each. Ask the class to offer characteristics of healthy relationships and characteristics of unhealthy relationships, and list each in columns underneath each word (see Facilitator Resource: Relationships and Romance: What is Healthy? for Activity 3.1). Under Healthy, concepts to include are: respect (each for the other), trust, honesty, caring, supporting each other, fairness/equality, and good communication. Unhealthy items to include are: disrespect, jealousy, betrayal, lies/dishonesty, taking advantage, making fun of, abuse, irresponsibility, selfishness, and poor communication. Now ask the class to say what items they would add or subtract from each column to describe romantic relationships, (where one or both people feel romantically attracted to the other person). The key point here is that the same characteristics are healthy and unhealthy in romantic relationships, as in friendships.
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Point out to the class that, with romantic relationships, the emotional stakes are often higher. In romantic relationships, there is physical attraction to the other person, and the degree of physical intimacy becomes a big issue. When it comes to physical contact, how far to go is a BIG DECISION. Leave the Healthy and Unhealthy items on the board or newsprint for the students to refer to during the remainder of the class.
Next, write Having Sex? on the board or newsprint, and underline it. Ask the class to think about how having sex might affect a teen relationship. As the students offer ideas, write on the board or newsprint key words to reflect key ideas about the effects having sex might have. Key ideas to highlight include: Having sex can make relationships more difficult and complicated, especially for teens. o Having sex brings in the chance of an STD, which is often emotionally upsetting for both partners, and can threaten the trust in the relationship. If there is a pregnancy, that can be hard on the relationship. Point out that many teen relationships break up with the stress of pregnancy and parenting. Few teen moms (only about 1 in 5) marry the father of their baby.
Having sex does NOT improve an unhealthy relationship. o In unhealthy relationships, having sex may even lead to worsening of abuse [1].
Many teens who have had sex express regret. o The majority (60%) wish they had waited [2].
Most teen relationships break up, and breaking up can be even harder emotionally if the partners have had sex. For many young people, there are emotional consequences to having sex. o For girls especially, having sex can increase the chance of depression [3].
For some people, having sex lets them feel closer to each other
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o However, for teens in middle- and high school, relationships are generally healthier without sex.
Summarize by pointing out that abstinence (not having sex) is the healthiest choice for young peopleboth for individual health and for the health of the relationship. There are lots of other ways to show someone you care besides having sex.
Activity3.2 HealthyorUnhealthy?15minutes
In this activity, the facilitator reads a brief Relationship Scenario, and asks the students to consider how healthy the relationship is, how having sex (or experiencing a consequence of having sex) might affect the relationship. The facilitator manages the discussion and helps the class to recognize key points of what is healthy and unhealthy in each scenario. During the discussion, students may recognize positive consequences of having sex (or experiencing a pregnancy). The facilitator should acknowledge these, but emphasize the risks and difficulties, and the fact that most teens who have had sex say they wish they had waited longer.
RelationshipsScenariosforActivity3.2:HealthyorUnhealthy? Relationship3.2.AStephanieandJay
Stephanie and Jay have gone out together twice. They both feel attracted to each other and each thinks they may be in love with the other. The first time they went out, Stephanie kissed Jay, and Jay told her he did not want to go any farther. He said he did not want to disappoint his parents, and he did not feel ready for a sexual relationship. Stephanie told him she understood, and she wanted to wait, too. Questions: Do you think this relationship is healthy or unhealthy? Why?
If Stephanie pressured Jay to have sex, what effect do you think it would have on their relationship?
Facilitator points to make include: It is healthy that Jay is able to talk to Stephanie about how he feels. He is able to be honest, communicate well, and set limits. Stephanie respects those limits.
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If Stephanie pressured Jay to have sex, it would not be healthy for the relationship. She would be acting selfishly and she would not be respecting his feelings. With pressure, Jay may not feel he could trust Stephanie, and that would not be healthy for the relationship.
Relationship3.2.BCarrieandChris
Carrie has a boyfriend, Chris, who is 3 years older than she is. She feels proud to have the attention from a guy like Chris, because he has a car and a job and seems very mature compared to guys her age. On the other hand, Carrie finds herself going farther than she intended to go sexually. She and Chris have sex pretty much every time they are together, and he does not like to use condoms. Although they have not talked about having children, Carrie thinks it will make them closer if she gets pregnant. Questions: Do you think this relationship is healthy or unhealthy? Why? How do you think a pregnancy might affect their relationship?
Facilitator points to make include: It is not healthy that this relationship is so unequal, with Chris having so much power and Carrie having so little. It is not healthy that he pressures her into having sex, and sex without a condom. An age difference like this often means an unhealthy relationship one that is risky for the younger partner. An unplanned pregnancy does not usually help a romantic relationship. In fact, only one in five teen moms marry the father of their baby [4]. Many times, young men are not involved with their children.
Relationship3.2.CJohnandAlex
John and Alex have gone out a few times. They enjoy being with each other because they can talk about almost anything. Johns friends tease him because Alex is overweight and gets good grades in school. They tell John that he is too cool to be hanging around with such a person. They have even said some mean
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things to Alex in school. John was nervous about standing up to his friends, but he finally told them to quit teasing and disrespecting Alex. Questions: Do you think this relationship is healthy or unhealthy? Why? If John and Alex had a sexual relationship and one of them found out they had a sexually transmitted disease (STD), what effect do you think it would have on their relationship?
Facilitator points to make include: This relationship is healthy in that they feel comfortable with each other and can talk about anything. The fact that John stood up for Alex with his friends indicates strong support of Alex by Johna healthy sign. Getting an STD can happen in a sexual relationship, and an STD can complicate even a relatively healthy relationship. Having an STD would test this couples trust and communication.
Relationship3.2.DJamesandBrandi
James and Brandi have been a couple for a month, and Brandi is getting more and more uneasy. James is jealous of anybody Brandi talks to, including Brandis friends. James wants to know where Brandi is every minute, and now James tells Brandi exactly what to wear and who she can talk to. Brandi thinks that things will get better if she and James have sex. Questions: Do you think this relationship is healthy or unhealthy? Why? Do you think having sex will improve this relationship?
Facilitator points to make include: This relationship is clearly not healthy. Jealousy and trying to control someone are true danger signs. Trust and equality are not in this relationship.
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Having sex does not generally improve unhealthy relationships like this, and things may even get worse. People who are as controlling and jealous as James are not likely to be reassured by their partner having sex with them. Brandi may need to get help to deal with this situation, possibly from a parent or other trusted adult. Most communities also have a battered womens shelter, as well.
In summarizing these examples, the facilitator should reinforce that: Having sexand the consequences of sexare not likely to improve a relationship. For young people, not having sex (abstinence) is the healthiest choice. Even in healthy relationships, sex can complicate things, especially if either or both of the partners is too young. Having sex is healthiest when it is part of a healthy long-term, committed, adult relationship.
Activity3.3 Love,Lust,orCrush?15minutes
Let the class know that romantic relationships and love are important to everyone, but it is important to understand how relationships develop over time and how to recognize mature (true) love. This is especially important when you are an adolescent and new to the world of romance. Write the word Love on the left side of the board or newsprint, and tell the students that there are lots of different kinds of love. There is love that you have for a family member or a best friend, and the love you have for chocolate or for basketball. There is also love for all humankind, and religious love. Tell the students that there is a kind of love that is mature and lasting and healthy, where two people can have a loving and long-term committed relationship. This is what happens in healthy marriages, and could be thought of as true love. Indicate that the word Love on the board or newsprint is meant to describe this mature and true love. Write Lust on the right side of the board or newsprint. Let the students know that there is also a kind of love that is all about physical attraction. This kind of love is sometimes called lust, passion, or physical desire, and is often what helps to begin couple relationships. Physical attraction is also an important part of a mature or true lovebut it is usually not enough by itself to sustain a relationship over a long time.
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Write or Crush next to Lust on the board or newsprint. Let the students know that, early on in a relationship, when there is a physical attraction, a person may experience falling in love, a crush, or infatuation. In this situation, a person feels swept away, excited, or like they are on an emotional roller-coaster. A crush can be very intense and wonderful, but it usually lasts only for a short while. When a couple gets to know each other better, these feelings decrease; that is when the other components of love can develop. For most people most of the time, the crush fades and the intense passion goes away. Most relationships do not develop into mature love. Most of the time, the relationship ends and the partners break up. Most people fall in love several times before they find a person they want to spend their life with. Pass out the cut-out Love, Crush, or Lust? cards so that each card goes to one student, or to a pair of students sitting next to each other who can work together. Ask the students in turn to read their cards. For each card, ask the class to decide which column (Love or Lust or Crush) that word best describes. Help the class arrive at the following suggested categorization:
Love Steady Honest Slow Trust Comfortable Deep Giving Long-Lasting
Lust or Crush Roller Coaster Pretending Fast Doubt Uncomfortable On the Surface Selfish Just for Now
As the students consider each card, clarify the word and its meaning, and why they apply to the column they fit into. (Use the Facilitator Resource: Relationships and Romance: Is It Love? for suggestions on synonyms and clarifications.) Reinforce that mature love is something that lasts. Most people fall in love more than a few times before they find a person with whom they have true love, with its steadiness, unselfishness, honesty, and commitment. Crushes can be wonderful, and we should enjoy them, but they usually do not last.
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Now ask the class what they think about a couple in each of these types of relationshipsshould they have sex? Between the 2 columns on the board or newsprint, write Sex? Are there any disadvantages to having sex in each of these situations? Point out that sex is often an important and wonderful part of a mature, long-term committed relationship. Put Maybe under the Love column, noting that the risks of having sex are less with a long-term (i.e., years) commitment. And many people feel that young people should wait, at least until they are adults and finished with high school, before having sex. Next, the class considers the Lust or Crush column. In real life, most of these relationships dont last, and the couple breaks up. If people have sex at the lust or crush stage, they will have sex with more partners in their lifetime. As we will learn in the next lesson, more partners means higher chances for sexually transmitted diseases (STDs). Also, if there is a pregnancy, the parents may not be able to stay together to raise the child. Write Risky under the Lust or Crush column. Let the class know that it is healthiest to wait to have sex until a person is an adult, and is in a long-term, committed, and healthy relationship. Let them know that there are lots of other ways besides having sex to show your affection for someone.
ACTIVITY3.4 WrapUp5minutes
Let the students know that most relationships are not perfect. A person in a relationship that is a little bit unhealthy may need to talk with the other person to try to make the relationship healthier. Some relationships are so unhealthy, that it may be better to end them. And some relationships can be dangerous, so that a person may need to get help. If there is time, consider with the students examples of relationships that everyone knows about, such as those of celebrities. Help them recognize healthy and unhealthy characteristics. Other points to make in the wrap-up are: Relationships are important to everyone, and healthy relationships are better than unhealthy ones, especially when it comes to romantic relationships. It is important for young people to know that having sex will not make an unhealthy relationship healthy. When sexual activity enters a relationship, things are likely to get more complicated, especially if there is a pregnancy or a STD.
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Having a crush on, or physical attraction to, someone is not the same as mature or true love. Crush or lust relationships can be wonderful, but they do not usually last. Having a relationship with someone a lot older than you can be unhealthy. In adolescence, more than a year or two of age difference can mean a big power differenceand that can be risky for the younger partner. BIG DECISIONS recommends not having sex until you are an adult and are in a long-term, committed love relationship.
Commend the class on following the ground rules and dealing with potentially embarrassing topics so well.
References
1. Kaestle CE, Halpern CT. Journal of Adolescent Health 2005; 36; 401-9. 2. Albert B. With One Voice 2007: Americas Adults and Teens Sound Off About Teen Pregnancy. Washington, DC: National Campaign to Prevent Teen Pregnancy, 2007.
3. Hallfors DD, et al. Am J Prev Med 2005; 29(3):163-170. 4. Brien, MJ, Willis RJ (1997). Costs and Consequences for the Fathers. In
Maynard RA (ed.), Kids Having Kids: Economic Costs and Social Consequences of Teen Pregnancy (pp. 95143), Washington, DC: The Urban Institute Press.
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Facilitator Resource for Activity 3.1: Relationships and Romance: What is Healthy?
Healthy

Unhealthy

Respect Trust Honesty Caring Supporting each other Fairness Equality Good communication
Disrespect Jealousy Betrayal Lies/dishonesty Taking advantage Making fun of the other Abuse (physical, verbal, sexual) Irresponsibility Selfishness Poor communication
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Love, Crush, or Lust? Cards for Activity 3.3 Cut Out each Card: One Set for Each Small Group
Steady
Selfish
Fast
LongLasting Doubt Roller Coaster Just for Now
Honest
Trust
Pretending
Slow
Comfortable
Giving On the Surface
Uncomfortable
Deep
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Facilitator Resource for Activity 3.3: Relationships and Romance: Is It Love?
Love
Steady: stable, even, calm, reliable. Mature love does not come and go from one day to the next. Honest: sincere, open, frank, genuine, the real you. Mature love means you can be yourself because the other person knows you well and loves who you really are. Slow: unhurried, leisurely, patient, calm. Mature love is not a frenzy; it can be slow because it will be there tomorrow and the next day ant the next day. Trust: knowing that the other person will be there for you and will be on your side in life. Mature love means you can depend on the other person being there for you. Comfortable: relaxed, easy, calm, content. Mature love feels comfortable because it is solid and strong and not threatened from day to day. Deep: solid, not just on the surface. Mature love means you really know each other, and there is love on many levels. Giving: generous, unselfish, kind. Mature love is not about me, but rather about wanting the best, and doing the best, for the other person. Long-lasting: enduring, continuing, stable. Mature love lasts, and involves a commitment (or promise) to be there for each other over a long time.
LustorCrush
Roller Coaster: unstable, changing all the time, wild, unpredictable. A lust or crush relationship can be exciting, but it changes from day to day, and you dont know what to expect. Pretending: putting on a front, not showing the real you. In a crush or lust relationship, you dont know if the other person will like the real you, so you hide parts of yourself. Fast: feelings happen fast, things change suddenly. In a crush or lust relationship, a person often feels like they are speeding or moving very fast. Doubt: questioning, uncertain, not sure what to believe. In a crush or lust relationship, you are not sure what is going on with the other person and how they feel about you. Uncomfortable: uneasy, difficult, and sometimes painful. In a crush or lust relationship, your feelings are changing fast, and you dont know what to expect, so you may feel uncomfortable. On the Surface: superficial, shallow, or even phony. In a crush or lust relationship, the partners dont know each other very well yet, so they only know what is on the surface of the other person. Selfish: self-centered, self-absorbed, not generous. Lust and crushes are usually all about me and getting what the person wants, not about pleasing the other person. Just for Now: temporary, immediate, not long-term. Lust and crushes, with their intense feelings, are about the right now rather than about over the long-term
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LESSON4
SEXUALLYTRANSMITTEDDISEASES, IncludingHIV/AIDS
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LESSON 4 Outline
SEXUALLYTRANSMITTEDDISEASES, IncludingHIV/AIDS
Objectives
MaterialsNeeded
Chalkboard, or Newsprint tablet, Markers, and Easel White and colored index cards: with enough cards of a particular color for 25% of the students (one-fourth) STD Student Handouts, one for each group, each printed on a different color paper, and laminated, if desired. Projection setup, for either: o Lesson 4 PowerPoint slides (available www.BIGDECISIONS.org) o Overhead projection of STD Student Handouts Transparencies Cut-out Which STD Am I? statements, with 1 statement per slip of paper A box or envelope to hold the slips of paper, for students to draw from Ground Rules Newsprint Sheet from Lesson 1 KEY MESSAGES Poster from Lesson 1
Activities
4.1 -- Index Cards 5 minutes 4.2 - Common Sexually Transmitted Diseases 20 minutes 4.3 -- Which STD Am I? Game10 minutes 4.4 - Avoiding STDs: Wrap-Up and Questions/Answers 10 minutes
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LESSON 4 Outline, continued

STD Student Handouts for Activities 4.2 and 4.3 Which STD Am I? Statements for Activity 4.3 Facilitator Resources for Activities 4.2 and 4.3: Background Information about STDs Facilitator Resources for Activity 4.4: Sample Questions and Answers about STDs Facilitator Resource: STD Prevention
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LESSON4 SEXUALLYTRANSMITTEDDISEASES, IncludingHIV/AIDS

Objectives
MaterialsNeeded
Chalkboard, or Newsprint tablet, Markers, and Easel White and colored index cards: with enough cards of a particular color for 25% of the students (one-fourth) STD Student Handouts, one for each group, each printed on a different color paper, and laminated, if desired. Projection setup, for either: o Lesson 4 PowerPoint slides (available www.BIGDECISIONS.org) o Overhead projection of STD Student Handouts Transparencies Cut-out Which STD Am I? statements, with 1 statement per slip of paper A box or envelope to hold the slips of paper, for students to draw from Ground Rules Newsprint Sheet from Lesson 1 KEY MESSAGES Poster from Lesson 1
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Preparing for the Lesson Facilitator preparation for this lesson includes reviewing the Facilitator Resources and researching basic information on local resources for STD and HIV testing and treatment. Most cities have a local health department, as well as other agencies and health providers who test and treat for STDs, including HIV/AIDS. Prior to the class, the facilitator should identify agencies and bring key telephone numbers to the session. All 50 states have laws that allow minors to consent to diagnosis and treatment of STDs, so young people can expect these services to be confidential. Projection of the STD Slides The facilitator should project basic information about each of the 6 STDs in this lesson in one of 2 ways. Use of the PowerPoint presentation, available at www.BIGDECISIONS.org, or included on a disc with purchased curricula, allows projection of each STD sign and basic information, so that the entire class can see the basic points. Alternatively, the 6 STD Handouts can be printed or copied onto transparencies, and projected using an overhead projector. Time Management Most sessions on STDs generate lots of questions from students, and sometimes it is difficult to both cover all the material and answer all the questions. The facilitator may need to limit the number of questions that he or she answers during this session. It is important to save 10 minutes for Activity 4.4, which emphasizes the methods to reduce the risk of HIV and other STDs. Answering Questions It is preferable to answer questions as they arise, if possible. Facilitators may also want to give each student a blank index card and ask the students to write a question, or write down that they do not have a question (but not to write their name on the card). The cards are then collected into a large envelope, preserving confidentiality. Questions are read and answered in front of the class. Some common questions are provided in the Facilitator Resource for Activity 4.4: Sample Questions and Answers about STDs. Facilitators may also want to invite a school nurse or health clinic educator to help with presenting the information about STDsor to be available to help answer questions.
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Activity4.1 IndexCards5minutes
When students arrive to class, give each of them an index card. The cards can be any color, but about one in 4 of the cards should be a particular color. For example, if there are 30 students in the class, 7 or 8 of the students could be given pink cards, and the rest should each receive a card of a different color. Ask the students to shake hands with two other students in the class, shaking hands with at least one student who is not sitting immediately next to them. After they have finished shaking hands, ask the students to sit down again. Ask them to remember who they shook hands with. Let the students know that the index cards are a game, with the pink (or other specified color) cards representing having a Sexually Transmitted Disease (an STD). The other-color cards represent NOT having an STD. Now ask the students who were given a pink card to stand up and stay standing. Tell the class that, for the purposes of this activity, we are pretending that these students who are standing are infected with an STD. Let the class know that, among sexually active teens, roughly one in 4 are likely to be infected with an STD. Of course, most teens with STDs have no symptoms, so they are not aware that they are infected, and no one else can tell that they are infected, unless they get tested. Now ask the students who shook hands with the standing students to stand up, too. Tell the class that we are pretending that shaking hands represents having sex with someone. So anyone who shook hands with the first group of students may well be infected, too. Now ask the students who shook hands with the second group of students to stand up, too, because they may also have been infected. Point out that it is easy for young people who have sex to get an STDeven if they have had only one or two partners. As you collect the index cards, let the class know that STDs are common, and it is important for young people to know what they are, how to prevent them, and who should get tested. Refer to the KEY MESSAGES Poster, and point out that Abstinence is the only 100% effective way to avoid STDs (and unplanned pregnancy). This would have been the equivalent of not shaking hands with anyone in the ACTIVITY. Point out that teens who have sex must use condoms correctly, every time, in order to reduce the risk of HIV and other STDs. Sexually active teens should also use a hormonal form of birth control, in order to effectively avoid pregnancy.
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Activity4.2 CommonSexuallyTransmittedDiseases20minutes
Divide the class into 6 small groups, or teams. Each team will be assigned one of the following STDs: Chlamydia and Gonorrhea (these infections are similar in symptoms and complications, and will be considered together) Trichomonas Syphilis HIV Infection Herpes Human Papillomavirus (HPV)
Tell the class that, as you pass out the STD assignments to each of the teams, you will go over some basic information about each infection. The information about each infection will be on the STD Handouts that you will give to each team. Each team will then have the information on their STD to refer to later, when the class plays the Which STD Am I? game. During the game, each team will make sure that the answers to each question are correct, when it comes to their infection. As you review each of the STDs, give each team the STD Handout corresponding to their infection and project the PowerPoint slide or transparency for that Handout. Encourage questions as you proceed. Use the Facilitator Resource and References to learn and review each STD, so you can give a brief summary of the information in each of the boxes on the Handouts. Answer questions as much as possible as they arise, but be sure to leave time for Activity 4.4 to focus on ways to avoid STDs.
Activity4.3 WhichSTDAmI?Game10minutes
Let the class know that they are now going to play the Which STD Am I? Game. Each team will get a point for each one of the 10 Game statements if they answer correctly whether their infection is described by the statement. Tell the class that each slip of paper in this game has a statement that describes one, some, or none of the 6 groups STDs. Show them the slips of paper with the Which STD Am I?
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statements in the box, and mix them up. For each turn, ask a different student to reach in, draw a slip of paper out of the box, and read it to the class. In responding to each statement, each team decides if their infection is a correct answer. If their infection is a correct answer, the team has one of its members stand, holding up its STD Handout. Statements include: Both males and females can have me and not know it, because often they have NO SYMPTOMS Answer: All the infections are correct: Chlamydia, Gonorrhea, Trichomonas, Syphilis, HIV, Herpes, and HPV. I can be cured with antibiotics Answer: This is true for bacterial infections (Chlamydia and Gonorrhea, Syphilis) and for the parasitic infection Trichomonas. Of course, even after they are cured, a person can get them again. Viral infections such as HIV, Herpes, and HPV are NOT curable, although they are treatable. I cause a discharge from a males penis or from a females vagina Answer: Chlamydia and Gonorrhea typically cause a discharge from the penis, and can cause a vaginal discharge. Trichomonas usually causes no symptoms in the male, but causes vaginal discharge in the female. Some types of me cause warts, and some types can lead to cancer Answer: Human Papillomavirus (HPV). Some types of HPV cause genital warts. The high-risk types of HPV can cause dysplasia and cancer of the cervix. These viruses can also lead to dysplasia and cancer of the vagina, vulva, penis, anus, and even the throat. I cause blisters or sores in the genital area Answer: Herpes infection causes painful blisters that can come back from time to time. Syphilis typically causes a painless sore that gets better, even without treatment.
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I can affect a baby, if it is born to a mother that has me Answer: All the infections can affect babies. Chlamydia and Gonorrhea can infect the babys eyes, and Chlamydia can also cause pneumonia. Trichomonas infection of the mother is associated with premature birth. Syphilis can cause many problems for a baby, both before and after birth. Babies can get HIV from their mothers during birth, or from breastfeeding. Babies can get Herpes infection from their mother during birth, and this infection is serious and often fatal. Also, rarely, babies can get HPV in the throat if they are born to a mother who has genital warts.
I am very common among young people who have had sex Answer: Common infections include Chlamydia and Gonorrhea, Trichomonas, Herpes, and HPV. HIV and Syphilis are less commonbut still very important infections among young people.
I kill the cells that protect the body from infection Answer: HIV infection kills immune system cells. Eventually, if not controlled by medication, HIV infection makes the body unable to fight infection, and the person develops AIDS.
I can infect people through oral or anal sex Answer: Chlamydia and Gonorrhea, Syphilis, HIV, Herpes, and HPV infection can all be transmitted through oral-genital contact (i.e., mouth on a males genitals or a females genitals) or through anal sex (i.e., penis in anus). (Note: When considering HIV infection, anal sex without a condom is especially risky. Oral sex is less risky than vaginal or anal sex, but it is possible to contract HIV through oral sex.)
If I am not treated, I might make it hard to get pregnant (or get someone pregnant) later on Answer: Untreated Chlamydia and Gonorrhea infections can travel through a females uterus and tubes (or through a males tubes) and cause infertility (difficulty getting pregnant or causing a pregnancy). This can happen even if a person does not have symptoms of infection. These complications do not happen to everyone, so having one of these infections is NOT a birth control method. But if it happens, it can be emotionally upsetting, and cost lots of money to try to achieve a pregnancy with medical help.
As each statement is read and answered, keep track of each teams points. Clarify answers with the class, and reinforce important points. Congratulate the winning team(s), and praise the efforts of all the teams.
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Activity4.4 AvoidingSTDs:WrapUpandQuestions/Answers10minutes
Summarize by referring to the KEY MESSAGES Poster. Point out that two key ways to avoid STDs are included in it: Abstinence is the most effective way to avoid STDs. For those who have sex, using a latex condomcorrectly, every time reduces the chance for getting STDs.
In addition, review with the students the other important ways to avoid STDs. (This can be done by asking them to list other ways, and writing these on the board or newsprint when they are mentioned.) Have few sexual partners in your lifetime. (The more sexual partners you have, the higher the chance of getting STDs.) Avoid high-risk partners, such as people who have had lots of partners, or who have injected drugs Being in a lifelong faithful relationship (like marriage) with one uninfected person Get tested regularly for STDs Females can get vaccinated to prevent genital HPV infection
Provide the class with information on how and where people can get tested for STDs, including HIV, in your community. Medical organizations recommend that all females who have had sex should be tested for STDs. Males who have had sex may also be tested. Both males and females should have regular checkups during their adolescent years. As time allows, address the questions that the students ask or submit on index cards. If needed, sample questions from the Facilitator Resource: Questions and Answers about STDs can be used to get the Question-and-Answer discussions going.
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STUDENT HANDOUT for ACTIVITIES 4.2 and 4.3: CHLAMYDIA and GONORRHEA
What Kind of Bug? Bacteria How Common? VERY Common, especially Chlamydia
Curable? Yes Effects on Baby? Eye Infection Pneumonia
Symptoms in Males?
Chlamydia & Gonorrhea

What Can it Lead To? Painful Infection Hard to get pregnant
Symptoms in Females?
Drip (discharge) from penis Hurts to pee Many have NO SYMPTOMS
Drip (discharge) from vagina Pain in lower abdomen Many have NO SYMPTOMS
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STUDENT HANDOUT for ACTIVITIES 4.2 and 4.3: TRICHOMONAS
What Kind of Bug? Parasite How Common? VERY Common
Curable? Yes Effects on Baby?
Trichomonas
Born too soon (premature)
Symptoms in Males? Usually NO SYMPTOMS What Can it Lead To?
Drip (discharge) from vagina Itching, Odor May have NO SYMPTOMS
Irritation makes it EASIER to get HIV, if exposed
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STUDENT HANDOUT for ACTIVITIES 4.2 and 4.3: SYPHILIS
What Kind of Bug? Bacteria How Common? Less Common (but still important) Symptoms in Males?
Sores Rash May have NO SYMPTOMS
Curable? Yes Effects on Baby? Birth Defects; Death
Syphilis
Sores Rash May have NO SYMPTOMS
What Can it Lead To? Brain, Heart Disease Death Easier to get HIV, if exposed
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STUDENT HANDOUT for ACTIVITIES 4.2 and 4.3: HIV Infection and AIDS
What Kind of Bug? Virus How Common? Less Common (but very important)
Curable? No (but Treatable)
(Human Immunodeficiency Virus)
HIV
Effects on Baby? Baby can be infected
Symptoms in Males?
Most have NO SYMPTOMS
Most have NO SYMPTOMS
What Can it Lead To? AIDS: Body cant fight infection Death
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STUDENT HANDOUT for ACTIVITIES 4.2 and 4.3: Genital Herpes
What Kind of Bug? Virus How Common? VERY Common
Curable? No (but Treatable) Effects on Baby?
Herpes
What Can it Lead To? Pain and blisters can come back in outbreaks
Birth Defects; Death
Symptoms in Males?
Blisters, raw areas Many have NO SYMPTOMS
Blisters, raw areas Many have NO SYMPTOMS
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STUDENT HANDOUT for ACTIVITIES 4.2 and 4.3: HPV (Human Papillomavirus)
What Kind of Bug? Virus How Common? VERY Common
Curable? No (but Treatable) Effects on Baby? Rarely, baby can get throat warts
(Human Papillomavirus)
Symptoms in Males?
Warts, bumps Many have NO SYMPTOMS
HPV
Warts, bumps Many have NO SYMPTOMS
What Can it Lead To? Some kinds of HPV can lead to cancer (of the cervix)
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Which STD Am I? Statements for Activity 4.3

Each statement describes one, some, or none of the Sexually Transmitted Diseases in this Lesson
Both males and females can have me and not know it, because often they have NO SYMPTOMS
I can be cured with antibiotics
I cause a discharge from a males penis or from a females vagina
Some types of me cause warts, and some types can lead to cancer
I cause blisters or sores in the genital area I can affect a baby, if it is born to a mother that has me I am very common among young people who have had sex I kill the cells that protect the body from infection I can infect people through oral or anal sex If I am not treated, I might make it hard to get pregnant (or get someone pregnant) later on
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FacilitatorResourceforActivities4.2and4.3: BackgroundInformationaboutSexuallyTransmittedDiseases (STDs)

I.ChlamydiaandGonorrhea
What are they?
Chlamydia and Gonorrhea are bacterial infections with very similar symptoms and signs. Chlamydia is caused by Chlamydia trachomatis, and Gonorrhea is caused by Neisseria gonorrheae. Chlamydia is more common than gonorrhea, and its symptoms and signs tend to be less severe than gonorrhea. However, both can cause a spectrum of effects, from no symptoms to severe complications.
How do you get it?

Both Chlamydia and gonorrhea are acquired through person-to-person sexual contact, including vaginal sex, oral sex, or anal sex. These infections are not acquired through toilet seats or casual (non-sexual) contact. A baby can get these infections at the time of birth, if the mother is infected.
What do they do to a person?

Chlamydia and gonorrhea generally infect a male or females urethra (the tube through which urine leaves the body), and also a females cervix. The bacteria can live there for weeks (or longer). The infection may or may not cause symptoms. If symptoms occur, they typically include a discharge or drip from the penis or the vagina, and/or a burning sensation when passing urine. In the female, both Chlamydia and gonorrhea, if untreated, can cause serious complications if the infection goes up into the tubes and ovaries. This can cause pain and inflammation (pelvic inflammatory disease or PID). PID can be mild to severe, and can cause scarring of the Fallopian tubes. Even mild or silent PID can cause scarring of the tubes. If scarring happens, this can increase the risk of infertility (not being able to get pregnant) or of ectopic pregnancy, where a pregnancy implants outside of the uterus, generally in the tube. (However, having a Chlamydial or gonorrheal infection is NOT a good method of birth control! Most females who have had these infections are not sterile.) In the male, both Chlamydia and gonorrhea, if untreated, can cause serious complications if the infection goes up into the vas deferens, epididymis, and testicles. This can cause pain, swelling, and inflammation: epididymitis
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and/or orchitis (inflammation of the testicle). Men who have had this kind of infection have a risk of scarring, which, rarely, can lead to infertility, or difficulty getting a woman pregnant. (However, having a Chlamydial or gonorrheal infection is NOT a good method of birth control! Most males who have had these infections are not sterile.) Chlamydia and gonorrhea can infect the rectum if a person has had anal sex. This can cause pain, discharge, or bleeding from the rectum. Chlamydia and gonorrhea can infect the throat if a person has had oral sex. Sometimes throat infection causes no symptoms, but a person may have a sore throat. A newborn baby who is born to an infected mother can have problems. Babies exposed this way to Chlamydia or gonorrhea can have eye infections, and gonorrhea can even cause blindness. Chlamydia can also cause pneumonia in a newborn baby.
How would a person know that they have it?

The only way a person can know for sure that he or she is infected with Chlamydia or gonorrhea is to get tested. For males and females, this can usually be done with a test on the urine. Some kinds of tests use samples from the females cervix or the males urethral opening of the penis. Many people (females and males) with Chlamydia or gonorrhea have no symptoms at all, so waiting for symptoms to develop is not a good way to tell if a person is infected. Symptoms that might suggest Chlamydia or gonorrhea include: a discharge from the penis or vagina; a burning feeling when urinating; pain or swelling of the testicles (males); or pain in the lower abdomen (females). However, even with symptoms, the only way to know for sure if you are infected is to get tested. Testing for Chlamydia and gonorrhea can be done at a doctors office, health department clinic, or many family planning clinics.
How common are they?

These infections are very common among sexually active young people especially Chlamydia. In 2006 in the U.S., there were over 743,000 cases of Chlamydia reported among youth age 10-24, in addition to those cases that probably occurred and were unreported. In 2006, there were over 211,000 reported cases of gonorrhea among 10-24 year olds.
Are they curable?

Both Chlamydia and gonorrhea are curable with antibiotic medications. However, there is no lasting immunity from having had an infection. A person can get reinfected if they are exposed to Chlamydia or gonorrhea again.
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How are they treated?

Chlamydia is usually treated with single oral dose of pills or a powder mixed in water, or with pills or capsules for a week. Gonorrhea is usually treated with an injection, or with pills. Sexual partners must also be treated, so that the person does not get reinfected, and so that the partner cannot transmit the infection to anyone else.
II.TRICHOMONAS
What is it?
Trichomonas vaginalis is a one-cell parasite that can infect the vagina of females and the urethra of males and females.
How do you get it?

Trichomonas is transmitted through vaginal sex.
What does it do to a person?

Many females and almost all males with Trichomonas have no symptoms. Females may have a vaginal discharge, irritation, itching, or odor. Infection in females usually causes irritation, which can make it easier for a woman to get HIV, if she is exposed to it. Infection can also cause a pregnant woman to have her baby early (prematurely).

The only way to know for sure that a person has Trichomonas is to get tested. A health provider does a pelvic examination on a woman and obtains a sample of vaginal fluid for a laboratory test. The health provider may see vaginal irritation or discharge during an exam.
How common is it?

Trichomonas is very common. In the U.S. each year, there are estimated to be over 7 million cases.
Is it curable?
Yes, Trichomonas is curable with antibiotics. However, a woman can get reinfected with Trichomonas if she is exposed.
How is it treated?
Trichomonas is usually treated with oral antibiotic pills. A womans sexual partners must also be treated to prevent her getting re-infected.
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III.Syphilis
What is it?
Syphilis is a disease caused by a bacterium: Treponema pallidum. Syphilis can cause many different symptoms and problems, if it is not treated.
How do you get it?

Syphilis is generally transmitted by vaginal, oral, or anal sex with an infected person. It is transmitted through direct contact with an open sore, or chancre, on another person. Chancres are usually on or around the genitals, but they can occur on or in the mouth. In addition, a fetus or newborn baby can get it from its mother who is infected while she is pregnant.

Syphilis has several stages of disease. Stage 1 usually involves a painless sore (chancre) on the body part that was exposed. If the sore is internal, the person may not notice it. These sores heal, butunless the infection is treatedthe infection continues. Syphilis sores make it easier to contract HIV, the virus that causes AIDS, if a person is exposed. In Stage 2, a person may have a body rash, sores, fever, or aches. Some infected people have no symptoms of Stage 2. Again, these symptoms get better, but (without treatment) the syphilis infection continues. Stage 3 occurs after years of infection and can cause great damage to the brain, spinal cord, heart, arteries, or other parts of the body. Stage 3 syphilis may cause death. Syphilis infection in a pregnant mother can cause birth defects in the baby and even death (miscarriage) of the fetus. Babies born to infected mothers can also have illnesses and mental retardation.

Many people with syphilis do not know they are infected. The only way to know for sure if you have it is to get tested. A blood test is done to test for syphilis.
How common is it?

Syphilis is less common than some of the other STDs, but still very important. Each year in the U.S., there are an estimated 32,000 cases of syphilis. In 2006, there were 1960 reported cases among youth age 10-24.
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Is it curable?
Yes, syphilis is curable with antibiotics. However, if the treatment is delayed, damage to internal organs will not be prevented. This is why it is so important to detect and treat syphilis when it is in an early stage.
How is it treated?
Syphilis is treated with antibiotic medications, usually penicillin injections. It is essential that sexual partners be evaluated and treated, too.
IV.HIVInfectionandAIDS
What is it?
The Human Immunodeficiency Virus (HIV) is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). AIDS was first noticed in the early 1980s and has grown to be a world-wide epidemic.
How do you get it?

HIV is contracted from having vaginal, oral, or anal sex with an infected person. A person can also get HIV by sharing needles or syringes with an infected person. Babies can get HIV from their mothers during birth or from breastfeeding. HIV is not transmitted by hugging, shaking hands, kissing, swimming pools, mosquitoes, toilet seats, or by sharing towels or silverware.

Most people with HIV have no symptoms for years. Within the first month or two of getting infected with HIV, some people get a flu-like illness, including fever, fatigue, headache, and swollen lymph glands. These symptoms get better even without treatment. Even though the infected person has no symptoms, the HIV virus infects and kills cells of the immune system. Although there are usually no symptoms in this phase, the HIV virus is very active infecting cells, making many copies of itself, and causing destruction of many immune cells (CD4 positive T-cells). For some time, the body keeps up with this rapid destruction of CD4+ cells, but the ability of the body to keep up gets less over time. With time, the immune system gets weaker and is less able to fight infection. Symptoms may not appear for 10 years or more, but most people with HIV infection have progression to deficiency of the immune system, unless their HIV is treated with anti-retroviral medications.
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With progression of the HIV infection, a person may have weight loss, fevers and sweats, fatigue, rashes, and memory problems. When the CD4+ count falls to 200 per cubic milliliter of blood, or when the immune system is so weak that the person cannot fight infection, certain opportunistic types of infection occur, and the person is considered to have the Acquired Immune Deficiency Syndrome, or AIDS. AIDS is the most advanced stage of HIV infection. Without treatment, AIDS causes death. AIDS can also cause death, even with treatment.

The only way to know for sure if you have HIV is to get tested. The test is usually done on blood, but some tests can be done on saliva.
How common is it?

HIV infection is less common than some other STDs, but it is still extremely important because it is so deadly. Nearly a million people in the U.S. are estimated to be infected with HIV. In 2006, there were 2194 new diagnoses of HIV or AIDS among youth age 10-24. The HIV epidemic is spreading most rapidly among minority populations.
Is it curable?
There is no cure for HIV infection or AIDS. Once a person is infected with HIV, the virus remains in the body permanently. However, there is effective treatment, which, for many infected people, can help them feel healthy and live a long time.
How is it treated?
HIV infection can usually be controlled with treatment, highly active antiretroviral therapy, or HAART. Aggressive treatment lowers the level of virus in the blood, and immune cell damage is slowed. Once the illness AIDS develops, however, immune cells cannot be restored. This is why it is so important for people to find out early that they are infected and to take medication to prevent progression to AIDS. Treatment of AIDS must fight many infections while it also tries to control the HIV infection.
V.Herpes
What is it?
Genital herpes is an STD caused by the Herpes Simplex Virus (HSV) infecting areas around the genitals or rectum. Genital herpes is usually caused by Type
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2 HSV, but can also be caused by Type 1 HSV. Type 1 HSV usually causes cold sores and fever blisters around the mouth.
How do you get it?

People get genital herpes by having sexual contact with an infected person (through vaginal, oral, or anal sex). The herpes virus can be transmitted skin to skin even without penetration. The herpes virus enters through skin or mucous membrane (internal surface) of the person. A person can be contagious with herpes infection even when they have no symptoms and no blisters or ulcers.

Many people with genital herpes have no symptoms and do not know that they are infected. Genital herpes sometimes causes painful blisters, which break to form ulcers (raw areas). Blisters and ulcers heal over days or a few weeks. However, even after healing, the virus stays in the nerve cells and can be reactivated to cause outbreaks of blisters and ulcers from time to time. Over time, the outbreaks become less frequent, but the virus infection stays in the body permanently. Genital herpes can be uncomfortable, but it is not generally dangerous for healthy people. A mother with a genital herpes outbreak can pass the virus to her baby during birth. Herpes simplex infection in newborn babies is very serious and can cause death.

The only way to know for sure if you have genital herpes is to get tested. Many people with genital herpes are not aware that they have the infection; that is, they have no symptoms or mild symptoms. Symptoms of genital herpes may include burning, pain, and sores. These symptoms can be confused with other infections and conditions. People with symptoms should see a health provider to find out if they have genital herpes.
How common is it?

Genital herpes infection is VERY common. About 1 in 5 adults (45 million people) in the U.S. have had genital herpes infection, although many do not know it.
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Is it curable?
Genital herpes is not curable. Once a person is infected, they have the virus in their body permanently. However, genital herpes infection is treatable. Medications can control outbreaks and reduce the chance the person will give the infection to a partner. Genital herpes symptoms, even without treatment, usually bother people less with passage of time.
How is it treated?
Prescription antiviral medications can speed healing of an outbreak and help to prevent outbreaks. Medications can keep the infection under control, but they do not cure it.
VI.HumanPapillomavirus(HPV)
What is it?
This infectionreally a group of viral infectionsis caused by one of about 30 types of Human Papillomavirus (HPV). Some types of HPV can cause genital warts, which can occur around the genitals and anus. Other types of HPV can cause cells to become abnormal (dysplasia), and these cells may even develop into cancer. Dysplasia and cancer can occur on the females cervix (mouth of the womb), and also on the vulva, vagina, anus, penis, or throat.
How do you get it?

A person gets genital HPV infection from sexual contact with an infected person through vaginal, oral, or anal sex. HPV can be transmitted skin to skin even without penetration. The HPV virus enters through skin or mucous membrane (internal surface) of the person. Rarely, a baby can get HPV infection in its throat during birth from a mother with genital warts.

The HPV virus lives in the skin or internal lining of the genitals or anus. Most people who have had sex have had HPV, and most have no symptoms; HPV infection most commonly goes away without treatment. That is, most peoplebut not allare able to clear HPV infection through their immune system even though they receive no medical treatment. If the person is infected with one of the types of HPV that causes genital warts, the person may develop warts. Symptoms of warts include
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noticing soft bumps around the genitals or the anus. Warts may sometimes cause itching or irritation. Warts may stay the same, get worse, or get better, even without treatment. Warts are not dangerous, but they are contagious. Warts can be uncomfortable or embarrassing. If the person is infected with a high-risk type of HPV, and the infection persists, abnormal cells may develop on the cervix (dysplasia). Dysplasia can progress to cancer of the cervix if not detected and treated. Dysplasia and early cancer generally have no symptoms. This is why Pap smears of a females cervix are so important, to detect these abnormal cells and treat them before they become cancer. Pap smears can also find cancer early enough, when it can be treated and cured. Similar dysplasia can also occur on the vulva, vagina, anus, penis, or throat.

The only way to know for sure if you have HPV infection, genital warts, dysplasia or cervical cancer is to get examined and tested. Most people with genital HPV infection have no symptoms and do not know they are infected. Genital warts are diagnosed by a health provider looking at the genital and anal areas. Dysplasia is detected by Pap smears. Women should have Pap smears beginning by 3 years after their first sex (or by age 21, whichever comes first). There are also some other laboratory tests to test for HPV.
How common is it?

Genital HPV infection is extremely common! Each year in the U.S., there are an estimated 6.2 million new infections. Over half of those who have had sex have had genital HPV, even if they did not know it. Again, most genital HPV infections go away on their own, even without treatment. However, some infections cause warts, and others cause dysplasia and possibly cancer.
Is it curable?
Most genital HPV infections are cleared by the bodys natural defenses. However, if the body does not clear the HPV infection naturally, genital HPV infection cannot be cured by medication or surgery. However, HPV infections can be treated.
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A new HPV vaccine (Gardasil) prevents most cases of cervical cancer and many cases of genital warts. The 3-dose vaccine is recommended for females aged 9 to 26.
How is it treated?
Genital warts can be treated with a variety of medications, with freezing, or with surgery. Abnormal Pap smears must be investigated and followed to diagnose important dysplasia or cancer. Severe or persistent abnormalities on a Pap smear are generally investigated by doing colposcopy. This is a special office procedure examining the cervix, often with biopsies (taking samples of cervical tissue to send to the laboratory for diagnosis). If dysplasia or early cancer is confirmed by these tests, treatment may require surgery or freezing treatments to eliminate the problem.
VII.OtherSTDS Hepatitis
Hepatitis means inflammation of the liver, and there are several viruses that can cause this. Some of these viruses can be sexually transmitted. Hepatitis A is generally less severe than Hepatitis B or C, and less likely to lead to long-term liver disease. Hepatitis A is usually transmitted nonsexually (by the fecal-oral route, through contaminated hands, food or utensils). Hepatitis A can be transmitted to sexual partners and household contacts. Recently, vaccination has reduced the incidence of Hepatitis A. Hepatitis B is one of the most serious forms of viral hepatitis, and it is transmitted sexually (vaginal, anal, or oral sex). Hepatitis B can also be acquired by exposure to the blood or body fluids of an infected person, e.g., sharing needles or works. Hepatitis B can cause chronic illness, cirrhosis of the liver, liver cancer, and death. There is no cure, but some treatments can be effective. In the United States since 1991, children are routinely vaccinated against Hepatitis B, so infection among young Americans is becoming more unusual. Hepatitis C is a serious infection that is most commonly transmitted through injecting drugs with contaminated needles. It may be also possible to transmit Hepatitis C through sexual contact, although this is debated. Hepatitis C can cause chronic illness, cirrhosis of the liver, liver cancer, and death. There is no vaccine, but there is treatment for Hepatitis C infection.
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Pubic Lice (Crabs) Pubic lice are parasitic insects that are found on the genital areas. They are transmitted sexually, but can occasionally be transmitted by sharing a bed, towels, or clothes. Pubic lice cause itching, and are diagnosed by finding the lice in the genital area, or their eggs (nits) attached to pubic hairs. Treatment consists of topical medications (used externally on the skin and pubic hair) that kill the lice and nits. Sexual partners must be treated, and the clothes, towels, and bed linens must be washed also. Bacterial Vaginosis (BV) Bacterial vaginosis is a very common condition in which a womans normal vaginal bacteria are replaced by an overgrowth of certain bacteria. Women with BV may have a vaginal discharge, odor, or irritation. The cause of BV is not known, and it is not clear that it is acquired sexually. However, it is rare in women who have never had sex, and it is more common in women with a new partner or with multiple partners. Douching (washing the vagina with fluids) increases the risk of BV. BV can increase the risk of pelvic inflammatory disease (PID) occurring after gynecologic surgery. It can also increase the risk of premature labor in pregnant women. In addition, BV may cause irritation that makes it easier to transmit or become infected with HIV, if exposed. BV is treated with antibiotics (vaginally or orally), but it often comes back. Sexual partners are not usually treated. Molluscum Contagiosum Molluscum contagiosum is a skin disease caused by a virus. It is transmitted skin-to-skin, most often during sexual activity. However, it can be transmitted by touch, clothes, towels, or swimming pools. Children can get Molluscum without sexual contact, usually on the face, trunk, arms, or legs. Molluscum causes small smooth round bumps with a small dent in the center, on or near the genitals. Sometimes the bumps can itch. Treatment with topical chemicals or freezing is available from a health care provider. Chancroid Chancroid is a less common bacterial infection of the genital area, with painful ulcers or sores, and swollen lymph glands. It is spread by skin-to-skin sexual contact, and can be cured with antibiotics.
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References: 1. CDC. Sexual and Reproductive Health of Persons Aged 10-24 Years United States, 2002-2007. Surveillance Summaries, July 17, 2009, MMWR 2009; 58(No. SS-6). CDC Fact Sheet on Chlamydia. Available at www.cdc.gov/std/Chlamydia/Chlamydia-Fact-Sheet.pdf, Accessed 8/15/09. CDC Fact Sheet on Gonorrhea. Available at www.cdc.gov/std/Gonorrhea/gonorrhea-fact-sheet.pdf, Accessed 8/15/09. CDC Fact Sheet on Trichomoniasis. Available at www.cdc.gov/std/trichomonas/Trichomoniasis-Fact-Sheet.pdf, Accessed 8/15/09. CDC Fact Sheet on Syphilis. Available at http://www.cdc.gov/std/syphilis/syphilis-fact-sheet.pdf, Accessed 8/15/09. CDC. Condoms and STDs: Fact Sheet for Public Health Personnel. Available at www.cdc.gov/condomeffectiveness/latex.htm, Accessed 8/15/09. CDC HIV/AIDS Fact Sheet. HIV/AIDS in the United States, August 2008. Available at www.cdc.gov/hiv/resources/factsheets/PDF/us.pdf, Accessed 8/15/09. CDC HIV/AIDS Fact Sheet. HIV/AIDS among Youth, August 2008. Available at www.cdc.gov/hiv/resources/factsheets/PDF/youth.pdf, Accessed 8/15/09. CDC HIV/AIDS Fact Sheet: Oral Sex and HIV Risk. Available at www.cdc.gov/hiv/resources/factsheets/PDF/oralsex.pdf, Accessed 8/15/09. CDC Fact Sheet on Genital Herpes. Available at www.cdc.gov/std/Herpes/Herpes-Fact-Sheet.pdf, Accessed 8/15/09. CDC Fact Sheet on Genital HPV Infection. Available at www.cdc.gov/std/HPV/hpv-fact-sheet.pdf, Accessed 8/15/09. National Institute of Allergy and Infectious Diseases. Human Papillomavirus (HPV) and Genital Warts. Available at www3.niaid.nih.gov/topics/genitalWarts, Accessed 8/19/09. CDC. Updated hepatitis A postexposure prophylaxis and traveler vaccination recommendations. MMWR 2007; 56(41). CDC. Prevention of Hepatitis A Through Active or Passive Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR 2006;55(RR07). CDC. The ABCs of Hepatitis, Available at www.cdc.gov/hepatitis/Resources/Professionals/PDFs/ABCTable.pdf, Accessed 8/15/09.
2. 3. 4.
5. 6. 7. 8. 9. 10. 11. 12.
13. 14.
15.
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16.
CDC. Quadrivalent Human Papillomavirus Vaccine. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recommendations and Reports 2007; 56: RR-2, March 23, 2007. CDC. Fact Sheet: Pubic Lice Infestation. Available at www.cdc.gov/lice/pubic/factsheet.html, Accessed 8/15/09. CDC. Fact Sheet: Bacterial Vaginosis. Available at www.cdc.gov/STD/BV/BVFact-Sheet.pdf, Accessed 8/15/09. American Social Health Association. Molluscum contagiosum: Questions and Answers. Available at www.ashastd.org/learn/learn_mc.cfm, Accessed 8/15/09. American Social Health Association. Chancroid: Questions and Answers. Available at www.ashastd.org/learn/learn_chancroid.cfm, Accessed 8/15/0.
17. 18. 19. 20.
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Facilitator Resource Sample Questions and Answers about STDs For Activity 4.4
1. Is a vaginal yeast infection a sexually transmitted disease (STD)? No, yeast infections are not STDs. They occur in females who have never had sex, as well as in those who have had sex. The cause is an overgrowth, or imbalance, of yeast organisms that outnumber the normal bacteria. Usually a yeast infection causes a female to have a thick white vaginal discharge and itching.
2. If it hurts when I pee, does that mean I have an STD? Maybe. Burning or discomfort with urination can be a symptom of Chlamydia, gonorrhea, genital herpes, or trichomonas. However, there are other things besides STDs that can cause a feeling of burning when someone pees. Urine infections are common among females, and less common among young men. Urine infections are not STDs. Vaginal yeast infections can cause this symptom, too.
3. Is it possible to get an STD if both partners are virgins? If neither partner has ever had sexual contact, then it is very unlikely they will have an STD or give one to their partner. However, many people do not tell the whole truth about their past. And many people do not talk to their partner about theiror their partnerspast. Also, a person can get HIV without ever having sex, if they shared needles.
4. Can you get HIV or other STDs from kissing? There is no evidence that kissing mouth-to-mouth transmits HIV through saliva. However, if semen, blood, or vaginal fluid from an HIV-infected person contacts the mouth, HIV infection can occur. Oral sex (mouth-to-penis or mouth-to-vagina) can transmit gonorrhea, Chlamydia, and HPV, but kissing mouth-to-mouth does not. Oral sex (mouth-to-penis or mouth-to-vagina) can transmit Syphilis and Herpes. Kissing mouth-to-mouth can also transmit syphilis or herpes if there are sores in the mouth. (Of course, herpes in the mouth is fever blisters or cold soresnot genital herpes).
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5. Can you get an STD from toilet seats or hot tubs? No, HIV and other STDs are not transmitted by toilet seats or hot tubs.
6. Can STDs come back after treatment? Some STDs can be cured (gonorrhea, Chlamydia, trichomonas, and syphilis), but after the cure, a person can be re-infected if they are re-exposed to these infections. For HIV, herpes, and HPV, these infections are not cured when they are treated. The symptoms may improve with treatment, but the infection remains and can cause problems again after the treatment is stopped. Also, there are many types of HPV; even if a person has had one type of HPV, they can get other types.
7. Can a female who has had an STD get pregnant? Yes, a female can get pregnant after having an STD. Complications of gonorrhea or Chlamydia can cause problems getting pregnant, but most women who have these STDs do not have any difficulty getting pregnant. Complications of gonorrhea and Chlamydia can cause a male to be unable to cause a pregnancy, but this is rare. Most males who have these STDs have no difficulty causing a pregnancy.
8. Does a person need to get tested if they know everyone their boyfriend or girlfriend has been with, and they are clean? Yes. Knowing a person does not tell you if they are infected or not. The only way to know for sure is to get tested. It is important to remember that, the more sexual partners a person has in their lifetime, the more likely it is that they will get an STD (or more than one STD!)
9. Does a person who has always used a condom need to get tested? Yes. Although latex condoms are effective at preventing STDs, but they are not perfect. Even people who use condoms should get tested for STDs.
10. If a persons test was positive for STDs, the clinic would have called them, right?
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Maybe not. Some clinics call, and some dont. Even the clinics that call may have lost your phone number, or written it down wrong. Call the clinic back and ask for your results.
11. How much does it cost to get tested? Most cities have a local health department, as well as other agencies and health providers who test and treat for STDs, including HIV. Many of these provide free or discounted services to teens. The facilitator may want to call selected agencies to ask what teenagers would be charged for STD testing.
12. Do I have to have my parents permission to get tested? All 50 states have laws that allow minors to get testing and treatment for STDs without their parents knowledge or consent. Prior to the class, the facilitator should identify agencies and bring key telephone numbers to the session.
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FacilitatorResource:STDPrevention
Because STDs are so common among young people who are sexually active, it is important that young people understand how to avoid becoming infected. There are 7 important ways that people can reduce their risks of getting STDs: 1. Abstinence 2. Using latex condoms correctly, EVERY time they have sex 3. Having few sexual partners in their lifetime 4. Avoiding high-risk sexual partners (those who have had lots of partners, used injection drugs, or been in jail; men who have had sex with men) 5. Being in a lifelong faithful relationship with one uninfected person 6. Getting tested regularly for STDs 7. Females can get vaccinated to prevent HPV infection The most effective way to avoid all the STDs in this lesson is to avoid having sexual contact. Abstinence (defined as not having vaginal, oral, or anal sex), if used consistently and correctly, is essentially 100% effective in preventing the transmission of Chlamydia, gonorrhea, trichomonas, and the sexual transmission of HIV. Of course, HIV can be transmitted by sharing needles with an infected person, even without sexual activity. To be completely effective in preventing genital herpes and genital HPV infection, abstinence probably needs to include abstaining from genital touching, as well. There is evidence that HPV may be found on fingers, and herpes infection can occur on fingers that touch infected areas (a herpetic Whitlow). To be effective, abstinence must be used consistently and correctly. Young people who plan to abstain, but do not abstain, are at risk for STDs and unwanted pregnancy. In BIG DECISIONS, facilitators should emphasize that abstinence is the healthiest choice, and the one that is recommended for young people in middle and high school.
1.Abstinence:
2.Condoms:
Sexually active people can reduce their risk of HIV and other STDs by using latex condoms correctly and consistently. While condom use does not eliminate the risk of STDs (or pregnancy), it does reduce the risks remarkably. HIV: The evidence for condom effectiveness is strongest for HIV infection. Because HIV is so lethal, this makes condom use an important part of programs to prevent HIV and AIDS. Latex condoms are highly effective in preventing the sexual transmission of HIV, the virus that causes AIDS[1]. The best estimate of the effectiveness of correct and consistent condom use is 80% [2].
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Chlamydia and Gonorrhea: Strong evidence shows that condom use prevents gonorrhea in men [3]. In addition, although the studies have methodologic limitations, the stronger studies find statistically significant protective effects of consistent condom use in reducing the risk of gonorrhea and Chlamydia [4]. Trichomonas: There is little evidence about condom effectiveness for Trichomonas. One study suggested a reduced risk [5]. Syphilis: There are methodologic limitations in the studies of syphilis and condom use, but several studies suggest protection [6]. Genital Herpes: Condom use reduces the risk of genital herpes infection for both women and men [7,8]. HPV: Condoms have been shown to reduce the risk of acquiring HPV infection [9]. In addition, condoms have been shown to reduce the risk of genital warts and cervical cancer [10]. Some STDs are transmitted by exposure to body fluids (HIV, Chlamydia, gonorrhea, trichomonas). For these infections, condom use theoretically can provide very high levels of protection. Other infections can be spread skin to skin, as well as through contact of mucous membranes (urethra, vagina, mouth, anus). These include genital herpes, HPV, and syphilis. Condoms have been shown to reduce the risk for acquiring these infections. However, if lesions (ulcers or sores) are present on areas outside those covered by a condom, then using a condom would be expected to provide less protection for these infections. Condom failure is most often due to not using one. Slippage and breakage occur much less frequently (about 1% to 3% of condoms). Holes in the condom material are not considered a cause of condom failure [1]. It is important to be accurate in describing condom effectiveness. Condoms are not completely protective, but they DO reduce risks substantially, if used consistently and correctly. In the BIG DECISIONS program, condom effectiveness should not be exaggerated, but neither should the limitations of condoms be overemphasized. The message should be clear that abstinence is the healthiest option, and sexually active young people should use latex condomscorrectly, EVERY time they have sex.
3.FewSexualPartners: The risk of acquiring an STD is directly related to the number of sexual partners a person has in their lifetime. The more partners a person has, the more likely they are to get an STD. Thus, a key strategy to minimize the risk of getting an STD is to minimize the number of partners a person has.
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A person can be at high risk of contracting an STD even if they have only one partner (or few partners), if that partner is likely to have an STD. High-risk sexual partners include those who: have had lots of partners have used injection drugs have been incarcerated are men who have had sex with men
4.AvoidingHighRiskPartners:
In order to avoid high-risk partners, it is essential to know someone well enough to be able to find out if they are high-risk. Young people should know that it is safer to avoid sexual relationships with people in high-risk categories.
5.MutualMonogamy: The risk of contracting an STD can also be reduced by

being in a long-term mutually monogamous relationship (like marriage) with someone who is uninfected. In order for this to be effective, both partners must be uninfected, and they must stay faithful to one another. If either partner has had previous partners, he or she should be tested to be sure there is no infection. Serial monogamy, where a person has a series of faithful relationships, one after the other, has risks of getting an STD, depending on the number of relationships, and the risk level of the partners.
6.GettingTested: People at risk for STDs can reduce their risk of complications
and of transmitting the infection by getting tested regularly. Chlamydia, gonorrhea, syphilis, and trichomonas can be treated and cured. HIV, if detected early, can be treated and progression of the disease delayed. HPV-related abnormalities can be detected early by Pap smears. While routine screening for genital herpes and HPV infection is not recommended, anyone with symptoms should be examined by a health provider. In 2006, the U.S. Food and Drug Administration approved a HPV vaccine developed to prevent cervical cancer and dysplasia, and genital warts. This vaccine (Gardasil) is highly effective in preventing infection with 2 of the most common high-risk types of HPV (16 and 18), which are thought to be responsible for 70 percent of cases of cervical cancer. This vaccine is also effective in preventing HPV Types 6 and 11, the virus types associated with 90 percent of genital warts. The series of 3 doses of the vaccine is recommended for all adolescent females at ages 11 to 12. The series can be started as early as age 9, and catch-up vaccination is recommended up to age 26. Ideally, the vaccine should be given before the girl becomes sexually active; the vaccines effectiveness depends on it being received before the female is exposed to HPV.
7.Vaccination:
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Because the vaccine does not include all high-risk HPV types, and because it may not be 100% effective in all cases, females who receive the vaccine series should still have regular Pap smear screenings for cervical dysplasia and cancer.
References:
1. 2. 3. CDC. Fact Sheet for Public Health Personnel: Male Latex Condoms and Sexually Transmitted Diseases. Weller S, Davis K. Cochrane Database Syst Rev 2001; 3:CD00325. NIAID, NIH, DHHS. Workshop summary: scientific evidence on condom effectiveness for sexually transmitted diseases (STD) prevention. Herndon, VA: 2001. Warner L, et al. Sex Transm Dis 2006;33:36-51. Rosenberg MJ, et al. Am J Public Health 1992;82(5):669-74.3.
Koss CA, et al. Sex Transm Dis 2009;36:401-5. Wald A, Langengerg A, Link K et al. JAMA 2001; 285:3100-6.
4. 5.
6. 7. 8. 9.
Wald A, et al. Ann Intern Med 2005;143:707-713. Winer RL, et al. New Engl J Med 2006;354:2645-54. Papillomavirus infection. CDC, 2004.
10. Gerberding JL. Report to Congress: Prevention of genital Human
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LESSON5
ABSTINENCE: WhyShouldIWait?
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LESSON 5 Outline
ABSTINENCE: WhyShouldIWait?
Objectives
MaterialsNeeded
Chalkboard, or Newsprint tablet, Markers, and Easel Sets of 20 Is THIS Abstinence? cards, cut out from Facilitator Resource, 1 set for each small group A piece of paper and a pencil or pen for each student Ground Rules Newsprint Sheet from Lesson 1 KEY MESSAGES Poster from Lesson 1
Activities
5.1 -- What is Abstinence, anyway? 5 to 10 minutes 5.2 -- Is THIS Abstinence? 5 to 10 minutes 5.3-- So Why Should I Wait? 10 minutes 5.4-- Respecting the Choice to Wait 5 to 10 minutes 5.5-- Wrap-Up: Giving My Best Advice 5 to 10 minutes
Activity 5.2: Cards for Small Groups Facilitator Resource for Activity 5.2 Is THIS Abstinence? Suggested Categorization Facilitator Resource for Activity 5.3: So Why Should I Wait? Pros and Cons of Abstinence vs. Having Sex Facilitator Resource for Activity 5.4: Respecting the Choice to Wait
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LESSON5 ABSTINENCE: WhyShouldIWait?

Objectives
MaterialsNeeded
Chalkboard, or Newsprint tablet, Markers, and Easel Sets of 20 Is THIS Abstinence? cards, cut out from Facilitator Resource, 1 set for each small group A piece of paper and a pencil or pen for each student Ground Rules Newsprint Sheet from Lesson 1 KEY MESSAGES Poster from Lesson 1
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Reaching all Students As you prepare for this lesson on abstinence, consider the students that you are working with. Some students may be sexually experienced and others not. It is not necessary (or appropriate) to identify which students in the class are experienced and which are not. However, it is important to choose words carefully, and not to assume that students have had sex, or that they have not had sex. This lesson should be comfortable for both groups of studentsand it should encourage abstinence among both groups, as well. Preparing the Card Sets To prepare materials for Activity 5.2, make enough copies of the Is THIS Abstinence? page of cards so that each small group of 3 or 4 students will have a set of cards to work with. Cut out the 20 cards for each group, and either clip the cards for each group together, or put them in a small locking plastic bag. It is helpful to print each page (set) of cards on a different color of paper: After the sets of cards are used, they can be easily collected and used again for future classes. In Activity 5.2, it is important to set the correct criteria for the groups to sort the cards into OK and NOT OK categories. Facilitators should be careful to frame the card sorting as applying to the situation in which a person has chosen abstinenceand decided not to have sex. Classifying Activities In Activity 5.2, students may ask about various sexual activities that are not included in the card sets. Do your best to consider the activity calmly and non-judgmentallyand without embarrassing the student asking the question. It is important to repeat the question and acknowledge that some people do the activity. (It is not recommended to write the activity or question on the board.) It may also be helpful to repeat that it is good to think about what you will and wont do ahead of time. Consider with the class help whether the activity would be OK to do for a person who wants to remain abstinent. It may be helpful to use the category of May be Abstinence, but may still want to Avoid, which is created at the end of Activity 5.2. If someone asks about masturbation, give a brief definition (touching
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oneself for pleasure) and acknowledge that this is a controversial topic. Let the class know that masturbation is something that many people do both males and females. It does not have risks of pregnancy or of STDs, and it does not cause health problems. However, some families, and some religions, do not approve of masturbation. Time Management It is important to manage the time so that the class can complete Activity 5.5, Giving My Best Advice. This allows students to individually process the positive information about abstinence as a message of advice for someone they care about. The written examples of advice are collected (if the student is willing) at the end of the Activity. Facilitators may use these examples of advice as a form of feedback about the session, and how effective it is in encouraging positive attitudes toward abstinence. Names in the Scenario In Activity 5.4, facilitators should point out that the scenario is not about actual students. Even if there is a student with the same name as a scenario character, the story is not about them. Facilitators may want to change the name(s) used in the scenario.
Activity5.1 WhatisAbstinence,anyway?5to10minutes
Divide the class into small groups of 3 to 4 students. Let the class know that this session will be about Abstinence. Tell the class that sometimes it seems like most teens are having sex, but the truth is that: Fewer than half of U.S. high school students have ever had sex, and even fewer report that they have had sex in the last 3 months [1] Six in 10 teens who have had sex say they wish they had waited longer [2] Most teens and most adults think teens should be given a strong message that they should not have sex until they are at least out of high school [2]
Write Abstinence on the board, and ask the class to define it. Key points to make during the discussion include: Abstaining is not doing something; e.g., not having sex.
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Abstinence means waitingbut until when? Many people feel that young people should wait to have sex until they are adults and in a committed, faithful, and life-long relationship (like marriage). Abstinence is MORE than just accidentally not having sex (or not having sex because you didnt have the opportunity). It is a decision and a plan. It is thinking ahead, making a decision.
Most classes will at some point define abstinence as not having sexand that leads to the next issue: What is sex? Write Sex on the board, and ask the class to define it. Key points to make during the discussion include: Sex includes vaginal, oral, or anal sex (i.e., penis-to-vagina, penis-to-anus, mouth-to-genitals) Even though you cant get pregnant from oral or anal sex, you can get STDs. Genital touching without penetration may not technically be sex by some definitions, but it can lead to some STDs (e.g., herpes or HPV)
Activity5.2 IsTHISAbstinence?5to10minutes
Ask the students to think about the following situation: Imagine that you have thought carefully about relationships and sex, and you have decided that abstinence is the right choice for you at this time in your life. Whether you have had sex before or not, you can choose to be abstinent. You know that abstinence is not just what might happen by accidentit is a decision and a plan. You want to be ready to make good decisions about what you might doand what you wont do. That is, you want to think ahead about which activities are OK for you to do, and which are not OK to do. Thats what this exercise is about: which activities are OK to do for someone who wants to be abstinent, and not have sex? And which activities are NOT OK for someone who wants to be abstinent? At this point, pass out the sets of 20 cut-out Is THIS Abstinence? Cards, one set for each small group. Let the students know that some of these cards describe activities that are pretty personaland many people may feel embarrassed talking about some of these things. Still, it is important to know about these activities because some people, including some teenagers, engage in these activities. And it is important for
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young people to know about sexual activities, so they will be ready to make good decisions about what they will doand what they will not do. It is essential to think ahead and plan ahead. Tell the class that you want each group to sort the cards into 2 groups: those activities that are OK to do if a person wants to choose abstinence those activities that are NOT OK to do if a person wants to choose abstinence
Give the groups a few minutes to discuss and sort the activity cards. Circulate through the classroom to assure that groups are on task, and monitor their progress. Most groups will quickly categorize some of the cards, and discuss several of the gray area cards. Give the groups a deadline of 1 more minute to finish their categorizations, and then proceed with the whole-class discussion. On the board or newsprint, start 2 columns labeled Abstinence and Not Abstinence. Leave room in the middle of these 2 columns for a third columnbut do not yet write ina May be Abstinence, but May Still Want to Avoid column. With the help of the students, go through each of the activities listed on the cards, getting feedback from the groups about into which column they would place each activity. When there is controversy about an activity, ask the students for their reasoning about the activity. During the discussion, create the new middle column, May be Abstinence, but May Still Want to Avoid. (The suggested categorization of items is listed in the Facilitator Resource for Activity 5.2.) Once all 20 items are categorized, reinforce that having oral, anal, or vaginal sex is not abstinence. Acknowledge that there are some activities that all seem to agree they are OK to do if you want to choose abstinence. However, there are some that may technically be abstinence, but that a person may want to avoid anyway. That is why, for people who want to choose abstinence, there are lots of other activities (besides oral, anal, or vaginal sex) that people might want to abstain from. They may want to avoid situations that they think might lead to sexual intercourse. Or they may simply want to avoid activities that are too personal or intimate. Every person should set their own boundariesthat is, set the line between what they will do and what they wont do. Examples of activities that people may want to avoid include: Physical intimacy that may be too intimate, or that may make it difficult to resist going farther and having sex, for example: o o Touching breasts Touching below the waist
Other activities that put them in a vulnerable or risky situation, such as: o Being alone with a boyfriend/girlfriend
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o o
Using drugs or alcohol with a boyfriend/girlfriend Having an older boyfriend/girlfriend
Have the class suggest other activities that they might want to avoid if they chose abstinence.
Summarize that abstinence means not having sex, but it also means a decision and a planand the plan might mean not doing other things, even if they are not technically sex. For the rest of this session, leave the definitions on the board: Abstinence = not having sex Sex = vaginal, oral, or anal sex
Activity5.3 SoWhyShouldIWait?10minutes
Write on the board or newsprint 2 categories: Reasons to Have Sex and Reasons to Wait. As the students offer reasons in either category, you will write them in a list under the appropriate category. Explain that people, including some teenagers, decide to have sex at various times in their lives for many different reasons. There are also many reasons that people choose abstinenceto wait and not have sex. Let the class know that deciding whether to have sex is a big decisionone that should be made carefully, and for the right reasons. Remind them that people who have sex have a big responsibility: they must take action to reduce their risk of STDs and unplanned pregnancy. Tell the class that you want them to weigh the pros and cons of students having sex while they are in their middle or high-school years vs. abstinence (waiting). They should think, not just about themselves, but of other students, too. For example, how would they weigh sex vs. waiting for their best friend, or for a younger sister or brother? Ask the students to call out reasons for having sex. Write the reasons on the board or newsprint in the Reasons to Have Sex column. Now ask the students to call out reasons to wait and not have sex, and write these in the Reasons to Wait column. Help the class come up with all the reasons for waiting that are in the Facilitator Resource. Now, for each reason in the two columns, ask the students to rate how healthy and how strong each reason is. Go through each reason on both lists, asking the class to raise their hands if they thought the reason was a good onethat is it was a healthy and strong reason.
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When the class demonstrates a clear consensus, place a star in front of the reason they consider to be healthy and strong. Place a zero in front of the reason they consider NOT to be healthy and strong. For those where there is a difference of opinion, or where a consensus is not clear, place a question mark in front of that reason. The students ratings reflect their perceptions and their reality, and they should be respected. However, if the facilitator disagrees with the classs assessment of how healthy a reason is, he or she should let the class know why they disagree. Help the students add up the healthy and strong reasons to assess the overall pros and cons of having sex as a teenager. This exercise should demonstrate why students should consider abstinence to be such a healthy and good choice. Leave the lists of reasons on the board or newsprint for the following class activities.
Activity5.4 RespectingtheChoicetoWait5to10minutes
Ask the class to work as a whole for the next activity. Read out loud the story, Respecting the Choice to Wait, about Jennifer and her first day in her new school. Then read each of the 3 questions, leading a brief class discussion on each question. In the discussion, reinforce that Jennifer was not treated with respect. Help the students verbalize that standing up for what you think is right should be respected, even if it is different than other peoples ideas. Students who choose abstinence should be respected, especially when it might not be the most popular choice. In the discussion about Questions 2 and 3, point out how it is important to do what is right for yourself, even if it does not seem popular. Point out that sometimes it takes real courage to do what you think is right.
Activity5.5 WrapUp:GivingMyBestAdvice5to10minutes
Remind the class that deciding whether to have sex is a big decisionone that should be made carefully, and for the right reasons. Let the class know, that, as someone who cares about them, you encourage them to decide to wait and not have sexthat is, to choose abstinence. And for any student who does have sex, you want them to take action to protect themselves both from too-early pregnancy and from STDs. Ask the class to do a short exercise. Give each student a piece of paper or an index card, and make sure that each has a pencil or pen to write with.
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Let the students know that what they write will be confidential, and they should not put their name on the paper or card. After they are done, they can choose to keep the paper or card for themselves, or give it to the facilitator. The facilitator will not know who wrote what, but will be interested to see what students think is important. Ask the students to imagine that they have a little brother or sister who is just beginning middle school and who really looks up to them. Tell them they (the older brother or sister) feel kind of protective of their little brother or sister. Ask them to imagine that their little brother or sister has just asked them what they really think about abstinence. Ask the students to write down on their paper or card what they would tell their little brother or sister. What would be their best advice, from the heart? Would they tell them to wait to have sex, and what reason (or reasons) for waiting would be the most important one(s)? After the students have written their reasons, ask them to fold their piece of paper or card in half. Collect the papers or cards (in a box or envelope, to maintain confidentiality) from students who want to turn them in.
References:
1. Eaton DK, et al. Youth Risk Behavior SurveillanceUnited States, 2005. In Surveillance Summaries, June 9, 2006. MMWR 2006; 55 (No. SS-5). 2. Albert B. With One Voice 2007: Americas Adults and Teens Sound off about Teen Pregnancy. Washington, DC: National Campaign to Prevent Teen Pregnancy, 2007.
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Is THIS Abstinence?
Touching Touching Buttocks Holding Hands Breasts (Outside Clothes) Talking about Sex Vaginal Sex (Penis to Vagina) Touching Being Alone Together Breasts (Inside Clothes) Taking Drugs when Together Arm around Waist Kissing (Mouth Closed) Kissing (Mouth Open) Touching Genitals (Outside Clothes) Arm around Shoulder
Touching Genitals (Inside Clothes) Touching above Waist (not Breasts)
Drinking Alcohol when Together Oral Sex (Mouth on Genitals)
Take Clothes Off
Hugging
Anal Sex (Penis to Anus)
Directions: Cut into 20 cards for groups to sort. Make one set for each small group. Activity 5.2: Cards for Small Groups
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FacilitatorResourceforActivity5.2 IsTHISAbstinence? SuggestedCategorization

Abstinence Holding Hands Hugging Arm around Shoulder Arm around Waist Kissing (Mouth Closed) Kissing (Mouth Open) Touching Above Waist Breasts) Talking about Sex May be Abstinence, but may Still Want to Avoid Touching Buttocks Touching Breasts (Outside Clothes) Touching Breasts (Inside Clothes) Touching Genitals (Outside Clothes) Touching Genitals (Inside Clothes) Take Clothes Off Drinking Alcohol When Together Taking Drugs While Together Being Alone Together Not Abstinence Vaginal Sex (Penis to Vagina) Oral Sex (Mouth on Genitals) Anal Sex (Penis to Anus)
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FacilitatorResourceforActivity5.3:SoWhyShouldIWait? ProsandConsofAbstinencevs.HavingSex
Reasons to Wait Feel like it is the right thing to do It is healthier Not so many risks Because of my values Religious beliefs Dont want to get pregnant* Dont want to get an STD* Dont want to get HIV/AIDS* Want to show I am strong Want to protect my family and future children Dont feel ready Feel embarrassed Want to focus on school Want to achieve other goals Not interested Want to focus on sports Dont want to disappoint parents Want to live up to high expectations Dont want to hurt their reputation Afraid it will hurt Want to wait for their life-long partner Want to wait until they are an adult Want to wait until they are married Reasons to Have Sex Pressure from partner Pressure from peers Embarrassed to be a virgin Want to be popular To show love and affection To feel loved To keep from feeling lonely For fun or pleasure Out of curiosity To show they are grown up To have a baby To feel cool
*The facilitator should point out that abstinence, if used consistently and correctly, is 100% effective in preventing pregnancy, STDs, and sexual transmission of HIV/AIDS
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FacilitatorResourceforActivity5.4: RespectingtheChoicetoWait
Jennifer was nervous about her first day at her new school, especially since she didnt know anybody in this town yet. In the cafeteria, she could see that each group of girls had its own table, and she worried that she would never be accepted by any of them. For one thing, they all seemed so cool and grown-up. That afternoon in sex education class, the discussion was about abstinence. Jennifer decided to be brave and spoke up in class. She gave a couple of strong reasons she thought young people should wait to have sex. As they were leaving the class, in the hallway, two girls laughed at her and called her a prude and SO old-fashioned.
Question 1. What do you think of how the girls treated Jennifer? Did they treat her with respect?
Question 2. Is it hard for young people to choose abstinence? Why or why not?
Question 3. Suppose this story was about a guy rather than a girl. Do you think it is harder or easier for a guy to choose abstinence?
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LESSON6
CONTRACEPTION: PregnancyattheRIGHTTime
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LESSON 6 Outline
CONTRACEPTION: PregnancyattheRIGHTTime
Objectives
Consider when would be the RIGHT time to have a pregnancy Evaluate commonly used contraceptive methods (including abstinence) for effectiveness in preventing pregnancy Recognize that abstinence is the healthiest choice Understand that sexually active people must take action to avoid pregnancy (and STDs)
MaterialsNeeded
Chalkboard, or Newsprint tablet, Markers, and Easel Printed Method Signs representing each of 9 methods Printed Contraceptive Effectiveness Charts for each of 9 Methods Lesson 6 PowerPoint Presentation (if desired) Ground Rules Newsprint Sheet from Lesson 1 KEY MESSAGES Poster from Lesson 1
Activities
6.1 When is the RIGHT time to have a Pregnancy? 5 minutes 6.2 How do People get Pregnant? 5 minutes 6.3 Birth Control (Contraceptive) Methods 20 minutes 6.4 How Effective is it in Preventing Pregnancy? 10 minutes 6.5 Wrap-up 5 minutes
Materials&ResourcesIncluded
PowerPoint presentation of the various Contraceptive Methods (see disk, or website to download) Method Signs for each of 9 methods for Activities 6.3 and 6.4 Contraceptive Effectiveness Charts for Activities 6.3 and 6.4 Facilitator Resources for each of 9 methods (Activities 6.3, 6.4) Facilitator Resource for Activity 6.4: Protection from Pregnancy
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LESSON6 CONTRACEPTION: PregnancyattheRIGHTTime

Objectives
Consider when would be the RIGHT time to have a pregnancy Evaluate commonly used contraceptive methods (including abstinence) for effectiveness in preventing pregnancy Recognize that abstinence is the healthiest choice Understand that sexually active people must take action to avoid pregnancy (and STDs)
MaterialsNeeded
Chalkboard, or Newsprint tablet, Markers, and Easel Printed Method Signs representing each of 9 methods Printed Contraceptive Effectiveness Charts for each of 9 Methods Lesson 6 PowerPoint Presentation (if desired) Ground Rules Newsprint Sheet from Lesson 1 KEY MESSAGES Poster from Lesson 1

Preparing for this Lesson To prepare for this lesson, read over the Facilitator Resources, in addition to reading over the lesson itself. Be prepared to answer basic questions about the
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various contraceptive methods. Visuals for the Lesson Facilitators have the option of using the Lesson 6 PowerPoint presentation, if desired. It contains basic information about the 9 methods covered in this lesson, and is provided on the accompanying disk with purchased curricula. The PowerPoint may also be downloaded at www.BIGDECISIONS.org. Using the PowerPoint presentation allows projection of the material visually, but it is difficult to change the order of the methods presented to accommodate the order in which students bring up the methods. Methods can also be reviewed verbally, without the use of the PowerPoint presentation, in the order that each method is mentioned by a student. Facilitators should hold up the Method Sign as each method is discussed. For each method, review with the class the basic information included in the Facilitator Resource sheets for each method. Method Signs Make 1 copy each of the Method Signs and Contraceptive Effectiveness Charts for the 9 contraceptive methods. The Sign allows the methods name and picture to appear large enough for the class to see from the front of the room, and the Effectiveness Chart provides a visual representation of method effectiveness during Activity 6.4. It is recommended that these materials, once printed, be laminated to allow for repeated use. For best results, laminate each methods Sign and Effectiveness Chart together, so that one is on the back side of the other. Facilitators may want to use colored paper, with each contraceptive method having its own color. For example, the Sign and Effectiveness Chart for the shot could both be on light blue paper, and those for condoms could be on yellow paper. This will assist the Facilitator and the students to recognize more easily the materials for each method.
Time Management For optimal effect of this Lesson, it is important to complete Activity 6.4, including review of the Major Points demonstrated by this activity. This emphasizes the KEY MESSAGE that sexually active teens must protect themselves from both pregnancy and STDs.
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Facilitators are encouraged to limit the contraceptive information to basics, in order to be able to complete the Lesson in one class period. If more than 45 or 50 minutes are available for the Lesson, this allows for more extensive discussionand for more questions and answers. Answering Questions Facilitators may want to invite a school nurse or health clinic educator to help with presenting the information about contraceptive methodsor to be available to help answer questions. Such classroom guests should be cleared, as appropriate, per school or agency policy. In addition, with limited time, it is important that the guest be familiar with the lesson and be able to support accomplishing the activities in the time allotted.
Activity6.1 WhenistheRIGHTtimetohaveaPregnancy?5minutes
Write Pregnancy on the board or newsprint, and let the class know that, in this lesson, they will be learning about birth control methods to prevent or postpone pregnancy. Ask the class when they think is the right time to get pregnant (or get someone pregnant) and have a child. Encourage responses from multiple students, and reinforce points such as: When you are an adult When you are mature enough to handle the responsibility When you have your education When you are in a committed and healthy relationship When you are married When you are financially ready (e.g., have a job, a house, a car)
Summarize by saying that having children is a BIG DECISION. It is important to be ready to be a parent, so that children can be born and raised in families prepared to give them all that they need and deserve.
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Activity6.2 HowdoPeoplegetPregnant?5minutes
Next ask the class to remember what they learned in Lesson 2 about how people get pregnanthow does a pregnancy happen? Encourage several students to say what happens when a pregnancy begins. Reinforce key elements students offer, and remind the group about some key facts: If a male and female have (vaginal) sex, the sperm from the male can enter the vagina If sperm get into the vagina, they can swim through the uterus and into the fallopian tube If the females ovary has recently released an egg (ovulation), the sperm can fertilize that egg A fertilized egg travels through the fallopian tube into the females uterus If the embryo implants in the uterus, it can grow and develop
Activity6.3 BirthControl(Contraceptive)Methods20minutes
Now ask the class what people can do so as NOT to get pregnantthat is, until it is the RIGHT time for them. What are possible methods of birth control, or contraception? Reinforce the importance of having information about the various methods, so that young people will be able to make informed decisions about timing a pregnancy.
ContraceptiveMETHODScoveredinthisLESSONinclude:
Abstinence This method should be highlighted throughout as the healthiest choice for teens. Sex using No Method (Wishing and Hoping) This is not actually a contraceptive method, but some young people use it, and it is important to compare the effectiveness of the various methods to it. Withdrawal While not generally recommended for adolescents, pulling out is included in the Lesson because many young people use itand students should compare it to other methods. Sponge The Today contraceptive sponge is included because it is again available, and it has been popular among teens in the past.
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Condoms Generally, condoms should be referred to in the Lesson as Latex Condoms. Brief information on lambskin, polyurethane, and female condoms is included, but the focus should be primarily on male latex condoms, since these have the highest effectiveness for both pregnancy- and STD-prevention. Pill, Patch, or Ring For the purposes of this Lesson, these 3 methods are grouped together. They all contain two hormones (estrogen and progestin) and are taken in a cyclic fashion. The skin patch and the vaginal ring are essentially the same medication as the pillbut it enters the body by different routes. Shot The Depo-Provera injection is used by many adolescents and is included in the Lesson. Implant The Implanon single-rod implant is available, and is a long-acting reversible method that can be used by sexually active adolescent females. Intrauterine Device (IUD) This method is included because IUDs are increasingly being considered for adolescents. IUDs are important long-acting reversible options for young adults who are at low risk of STDs.
Other methods, if mentioned by students, can be noted. However, since these are not usually considered as choices for teenagers (and there is not enough time to explain them fully in a class period), they will not be included in this Activity: Sterilization (a female getting her tubes tied, or a male getting a vasectomy) these are permanent methods of birth control, and they are generally not appropriate for teens. These should not be chosen unless someone is sure they do not want to have any more children ever. Female Condomthese can be mentioned as an alternative to male condoms. They are made of polyurethane rather than latex, and they are not quite as effective as male latex condoms. Spermicides other than the sponge (foams, film, gels, suppositories)these are not as effective as condoms, and they may cause microscopic vaginal irritation, which may make HIV transmission more likely, if exposed. Natural Family Planning (periodic abstinence, sometimes called rhythm methods)these methods are not often recommended for teens. Couples who use these methods need special education and excellent cooperation.
As each method is mentioned, hold up that methods Sign (or project the PowerPoint slide) and briefly review the information about each method in the Facilitator Resource. Ask the class the questions in the Facilitator Resources, and help them answer the basics: 1. What is it? 2. How does it work to prevent pregnancy?
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3. How effective is it? 4. What other things are there to know about this method? Because most classes have limited time available, spend only 1 or 2 minutes on each method, touching only on the basics. Condoms and Pill/Patch/Ring should receive the most attention, since these are the methods most commonly recommended for sexually active adolescents. Condoms and hormonal contraceptives are often recommended to be used together as dual protection. Dual protection provides better prevention of pregnancy than either method used alone. Using condoms along with hormonal contraceptives also reduces the risk of STDs and HIV transmission. As students bring up each contraceptive method, review the basic information about that method, using the Facilitator Resource sheets as a guide. As each of the 9 Methods is reviewed, hold up the Method Sign for the class to see the name and picture of the method, or project the PowerPoint slide for that method. When explaining its effectiveness, hold up or project the Effectiveness Chart. Give both the Method Sign and the Effectiveness Chart to a student, who will represent that method in Activity 6.4.
Activity6.4 Howeffectiveisitinpreventingpregnancy?10minutes
Write out this question on the board or newsprint, and ask the students who are representing each method bring their Signs and Contraceptive Effectiveness Chart to the front of the classroom. Point out that (with the exception of the Abstinence chart) the Effectiveness Charts are based on what typical couples experience in real life. This means that some couples might not use the method perfectly, but they are still counted in measuring the effectiveness of the method. Show on one of the Effectiveness Charts (or on a PowerPoint slide) how to read it and understand the chart: Each method has a level of effectiveness in preventing pregnancy that is measured by counting the percentage of couples who would get pregnant in the first year of using the method. This means that, if you could observe 100 couples using this method for a whole year, by the end of that year, you would likely see a certain number of pregnancies. (In the case of the Pill, Patch, or Ring, that number would be 8). Show the class that each of the Effectiveness Charts has 100 little pictures of a female. The lighter ones represent NOT becoming pregnant while using the
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method, and the darker ones represent becoming pregnant using the method. Point out that, the more dark (pregnant) pictures on the Chart, the higher the pregnancy rate (or failure rate) with that method. Also point out that the Sponge has two different failure rates. The pregnancy rate is much higher for women who have already had a baby (32 per 100) than for women who have not had a baby (16 per 100). It is not certain why this is true, but it may be because the sponge can cover the cervix better if the woman has not yet delivered a child. Ask the representatives to hold their Contraceptive Effectiveness Charts in front of them, so the whole class can see it. Then ask them to arrange themselves along a line according to the effectiveness of their teams method for preventing pregnancy. The most effective method should be at one end of the room, and the least effective method should be at the other end. Now ask the rest of the class to help adjust the position of the line-up to better reflect exact effectiveness of each method. Refer to the Facilitator Resource: Protection from Pregnancy for accurate spacing of the different methods. Abstinence should be at one end of the line, and No Method should be at the other end. Help assure that the representatives space themselves according to the contraceptive effectiveness of their method, with mathematically linear spacing. Sex with No Method should be far separated from all the others. To assure accurate spacing of the methods, it may be helpful to help the students see the half-way points (with a marker or sign) and then arrange themselves appropriately:
Show them where 50 pregnancies per 100 couples would be, halfway across the room. Check that No Method (85 pregnancies per 100 couples) is closer to 100 than to 50. Next show the students where 25 pregnancies per 100 couples (half of 50) would be. Withdrawal and the Sponge (for women with children) are a little higher than this. Next, show them where 13 pregnancies per 100 couples (half of 25) would be. Condoms (and the Sponge in females without children) would be a little higher than this. Next, show them where 6 pregnancies per 100 couples (half of 13) would be. The Pill, Patch, or Ring would be a little higher than this. Next, show them where 3 pregnancies per 100 couples (half of 6) would be. This is where the Shot would be.
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Finally, show them where 1 pregnancy per 100 couples (one-third of 3) would be. This is where the Implant and the IUDs would be. This is very close to 0 pregnancies, which is where Abstinence is.
Clearly, things get crowded at the lower failure rates. Do your best to help the students line up as mathematically correctly as possible. Once the students, with their Contraceptive Effectiveness Charts are lined up accurately, point out to the students several Major Points: Abstinence is the only method that, when used consistently and correctly, is 100% effective, with no pregnancies per 100 couples. If couples have sex and use No Method, chances are very high that they will experience a pregnancy, with 85 (or more) of 100 couples pregnant in the first year. There is a BIG difference between using a method and not using a method. The most effective contraceptive methods are the long-acting ones (Implant, IUD), followed by the hormonal ones (Shot; Pill, Patch, or Ring). Condoms have a much lower pregnancy rate than having sex using No Method. Condoms also have about half the pregnancy rate of Withdrawal.
Now ask the class to say which of the contraceptive methods reduce the risk of STDs. Point out that only Abstinence and Condoms reduce STD risk, in addition to reducing the risk of pregnancy. Abstinence (used consistently and correctly) presumably has zero risk of STDs Latex condoms (used consistently and correctly) substantially reduce STD risk. o When it comes to HIV, the most deadly STD, Condoms are highly effective in reducing the risk. o Condoms also reduce the risk of other STDs, including HPV. o While they are not perfect, condoms are effective and should be used every time a teen has sex
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Point out to the students these additional Major Points: If teens are not abstinent, they need to use condomscorrectly, every time to reduce STD risk. Sexually active people can reduce their risk of both pregnancy and STDs by using both condoms and a very effective form of birth control (such as the PILL). These 2 methods can back each other up to reduce the chance of pregnancy. (Using 2 contraceptive methods together will lower the risk of pregnancy more that using just one.)
Activity6.5 Wrapup5to10minutes
Thank the representatives for their cooperation, and commend the students for following the ground rules, especially considering how sensitive information about contraceptives can be. Remind the class how important it is to get pregnant at the RIGHT timewhen they are prepared and looking forward to being a parent. Refer to the KEY MESSAGES of the BIG DECISIONS program, and reinforce each point. Review the fact that, in order to reduce their risks of both pregnancy and STDs, sexually active teens must use both condoms and birth control, correctly, every time they have sex:
Having sex is a BIG DECISION

Thank the class for their participation, and collect all the Method Signs and Contraceptive Effectiveness Charts. As time permits, answer as many questions as possible.
ReferenceforContraceptiveEffectiveness
Trussell J. Contraceptive Efficacy. In, Hatcher RA, et al. Contraceptive Technology, 19th Revised Edition. New York: Ardent Media, Inc. 2007, pp.759-760.
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ABSTINENCE
METHOD SIGN for ACTIVITIES 6.3, 6.4
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NO METHOD
(Wishing & Hoping)
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Sex using
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WITHDRAWAL (Pulling Out)

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SPONGE
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CONDOMS
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PILL, PATCH, RING

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SHOT
132
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IMPLANT
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INTRAUTERINE DEVICE (IUD)

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ABSTINENCE
IF used CONSISTENTLY & CORRECTLY
0 of 100 Couples PREGNANT in the First Year

CONTRACEPTIVE EFFECTIVENESS CHART For ACTIVITY 6.4
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SEX using NO METHOD

Wishing & Hoping

Document of External Origin 136
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SPONGE
16 to 32 of 100 Couples PREGNANT in the First Year

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CONDOM

PILL, PATCH, or RING

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SHOT

IMPLANT
0 or 1 of 100 Couples PREGNANT in the First Year

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0 or 1 of 100 Couples PREGNANT in the First Year

Facilitator Resource for Activities 6.3, 6.4:
ABSTINENCE
1. What is it and how does it work to prevent pregnancy?

Abstinence means not having sex (i.e., not having vaginal, oral, or anal sex) Abstinence involves a decision and a plan, and it works only if used consistently and correctly The penis does not touch the vaginal area, so sperm cannot enter the vagina to fertilize an egg1
2. How effective is it in preventing pregnancy?

If used consistently and correctly, abstinence is 100% effective in preventing pregnancy. Young people who plan to abstain, but then have sex without using another method, are at high risk of pregnancy (and STDs)
3. How effective is it in preventing Sexually Transmitted Diseases (STDs)?
If used consistently and correctly, abstinence is 100% effective in preventing STDs2
4. Other Things to Know about ABSTINENCE:

It is the only method that protects completely from pregnancy and STDs It is free, and no prescription required It is more than just accidentally not having sex. It involves a decision, and a plan. Advantages include: o o o No worry about pregnancy, birth control, or diseases You can get to know each other without a sexual relationship Following your values (and your parents values) Feeling impatient or curious
Disadvantages might include: o
However, if a male ejaculates close to the vaginal opening, there is a possibility that semen could enter the vagina, and a pregnancy could occur. However, some activities consistent with abstinence, such as genital touching, could theoretically transmit some STDs, such as HPV or Genital Herpes.
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SEX using NO METHOD (Wishing and Hoping)

This is not really a method It doesnt work!

NOT effective at all! 85 of 100 couples would be pregnant by the end of a year This is the same pregnancy rate as those who are trying to get pregnant

NOT effective at all! There is zero protection from STDs or HIV
4. Other Things to Know about NO METHOD:

Advantages: some people may want to get pregnant, or cause a pregnancy Disadvantages include: o o o o o Not being in control Pregnancy as a teen makes it harder for both mothers and fathers to reach their goals Babies born to teens are at higher health risks Pregnancy often stresses a relationship STDs can make you (or your baby) sickSTDs can even kill
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The male pulls his penis out of the vagina before he ejaculates (i.e., before he comes) Semen does not go into the vagina, so sperm cannot get to the egg

27 out of 100 couples typically experiencing a pregnancy in the first year Sometimes there are sperm in the pre-come, the fluid that comes out of the penis before ejaculation. This means a pregnancy could theoretically happen, even if the male pulls out in time. Sometimes the male does not pull out in time, even though he meant to

NOT effective at all! There is nothing in this method that reduces the risk of any of the STDs, or HIV
4. Other Things to Know about WITHDRAWAL:

People have used withdrawal for centuries Advantages: o It is free, and it does not require a prescription
Disadvantages o o o It takes lots of self-control on the part of the male It means doing something during sex, which can be a hassle. The male, not the female, is in control. (This could be seen as a disadvantage for the female.)
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SPONGE

It is a soft plastic (polyurethane) sponge that is worn in the vagina during sex The female moistens the sponge with water, and inserts it into the vagina before having sex Spermicide (sperm-killing medicine) in the sponge kills the sperm, and the egg is not fertilized. The sponge also absorbs semen and sperm, and physically blocks the cervix. To be effective, it must be left in the vagina for at least 6 hours after intercourse

16 to 32 out of 100 couples will have a pregnancy in the first year. Females who already have had a baby have a higher chance of pregnancy with the sponge It may be that the sponge can cover the cervix better if the woman has not yet delivered a child

NOT effective at all! The sponge may irritate the vagina and actually make it a little easier to get HIV, if a female is exposed.
4. Other Things to Know about the SPONGE: Advantages: o o o o No prescription is needed The female can use it without a partners cooperation It is effective for 24 hours It can be kept in and used for repeated acts of intercourse It must be left in the vagina 6 hours after having sex It should not be left in the vagina for more than 30 hours Rare side effects (Toxic Shock Syndrome)
Disadvantages o o o
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CONDOMS

Thin sheaths made out of latex (rubber) Condoms are worn on the penis while it is inside the partner Condoms are a barrier that blocks sperm from going into the vagina There are also plastic (polyurethane) condoms for males (and for females); these are useful if there is an allergy to latex. These work well, but are slightly less effective than latex condoms Skin condoms, made from lamb intestine, prevent pregnancy but not STDs. (These are not recommended.)

Typically, only 15 of 100 couples will have a pregnancy in the first year Polyurethane condoms have a somewhat higher failure rate The most common reason condoms fail is that people dont use them with every act of sex

Condoms are highly effective in preventing HIV, the virus that causes AIDS Condoms reduce the risk of many other STDs Condoms must be used correctly every time a person has sex to be effective in preventing STDs and HIV
4.
Other Things to Know about CONDOMS: Advantages: o o o o No prescription is required There is no age limit to purchasing condoms Condoms can be bought at grocery stores and drug stores Free condoms are available at Health Department clinics
Disadvantages: o o A few people are allergic to latex, and they should use polyurethane (plastic) condoms Condoms can slip off or break, especially if someone does not use them correctly. Slippage and breakage happen with about 1-3% of condoms.
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PILL, PATCH or RING

Hormones (estrogen and progestin) stop the ovary from releasing an egg, so there is no egg for the sperm to fertilize. This is the main way these methods work. The hormones also cause thickening of the mucus in the cervix, making it hard for sperm to get through. With the PILL, the hormones are swallowed every day With the PATCH, the hormones enter the body through the skin. Each patch is worn for 7 days, and then replaced with a new patch (at a different site). After 3 patches (3 weeks), there is a week with no patch, when the female usually has some bleeding, like a period. With the Vaginal RING, the hormones come in through the vagina. Each ring is worn in the vagina for 3 weeks, and then removed. After a week, a new ring is inserted into the vagina. The female usually has some bleeding, like a period, while the ring is out.

These methods are very effective Only 8 of 100 couples typically become pregnant in the first year

These methods are NOT AT ALL effective in preventing STDs or HIV If a person has sex, condoms must ALSO be used to reduce the risk of STDs and HIV
4. Other Things to Know about the PILL, PATCH, and RING: Advantages:
o o o Using the PILL, PATCH, or RING does not cause cancer or weight gain In fact, these methods protect from two kinds of cancer: cancer of the ovary, and cancer of the endometrium, or lining of the uterus The female is in control
Disadvantages:
o o o A prescription is needed from a doctor or clinic There is a slight risk of rare, but serious, cardiovascular events: blood clots (venous thromboembolism), strokes, or heart attacks Spotting between periods, breast soreness, and nausea may happen. These minor side effects generally improve with continuation of these methods.
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SHOT
The shot, or injection (Depo-Provera), contains a large dose of a progestin hormone that stays in the body for 3 months This hormone stops the ovary from releasing an egg, so there is no egg for the sperm to fertilize. This is the main way the shot works. The shot also causes thickening of the mucus of the cervix, and thinning of the lining of the uterus that can help prevent pregnancy

The shot is highly effective Typically, only 3 of 100 couples become pregnant in the first year

The shot is not at all effective in preventing STDs or HIV If a person has sex, condoms must ALSO be used to reduce the risk of STDs and HIV
4. Other Things to Know about the SHOT:

Advantages: o o The female is in control A couple does not have to remember to do something during sex to prevent pregnancy
Disadvantages: o o o o Females on the shot do not have regular monthly periods Some females have irregular bleeding, and some have no bleeding at all. This is normal with the shot The shot can cause weight gain and feeling tired A female must go to a doctor or clinic to receive the shot
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Facilitator Resour rce for Activ vities 6.3, 6.4: 6
IM MPLANT
1. What W is it and how do oes it work to prevent pregnanc cy?
The im mplant is a flexible f plas stic rod abou ut the size of o a matchst tick, which has a progestin ho ormone It is placed under r the skin of the arm, an nd the horm mone is slowl ly released e body over 3 years to the The hormone stop ps the ovary y from releas sing an egg, so there is no egg for perm to fert tilize. This is i the main way w the imp plant works. the sp The im mplant also causes thick kened mucus in the cerv vix and chan nges of the lining of the uteru us
2. How H effecti ive is it in preventing g pregnanc cy?

The im mplant is ex xtremely effe ective Typica ally, none or 1 of 100 co ouples will become b preg gnant in the e first year
3. How H effecti ive is it in preventing g Sexually Transmitte ed Diseases (STDs)?

This method m is no ot at all effe ective in pre eventing STD Ds or HIV If a pe erson has se ex, condoms must also be b used to re educe the risk of STDs and HIV H
4. Other O Thin ngs to Know w about the e IMPLANT T:

Advan ntages: o o The couple e does not have h to reme ember to do o something to prevent pregnancy y It lasts for r 3 years, un nless it is rem moved soone er
vantages: Disadv o o o o A female must m go to a doctor or clinic c to rece eive the imp plant The implant must be inserted (an nd removed) ) by a health h provider Many fema ales do not have regular monthly pe eriods Some have e headaches s, emotional l symptoms, or weight gain g
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A plastic T shaped device (about an inch and a half tall) that is placed inside the uterus of a female There are 2 types availableone with copper metal and one with progestin hormone It is inserted during an office visit by a medical provider The copper IUD lasts up to 10 years, and the hormone IUD lasts up to 5 years The devices affect sperm so that the egg is not fertilized The hormone IUD usually changes a females periods, with less bleeding over time IUDs are recommended only for females in a long-term relationship with one partner who has no other partners

Intrauterine devices (IUDs) are extremely effective Typically, none or 1 of 100 couples will become pregnant in the first year

This method is not at all effective in preventing STDs or HIV If a person has sex, condoms must also be used to reduce the risk of STDs and HIV Someone who is at high risk for STDs (for example, someone who has more than one partner) should not use this method
4. Other Things to Know about IUDs: Advantages: o The couple does not have to remember to do something to prevent pregnancy o The copper IUD lasts 10 years, and the hormone IUD lasts 5 years, unless they are removed sooner Disadvantages: o A female must go to a doctor or clinic to receive an IUD o The IUD must be inserted (and removed) by a health provider o With the copper IUD, periods may be heavier or have more cramps o With the hormone IUD, most females do not have regular monthly periods, but there is usually less bleeding
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Facilitator Resource for Activities 6.4 Protection from Pregnancy Of 100 couples using this Method, how many will be PREGNANT by the end of the first year?
0 Pregnancies 6 13 25 50 75
100 Pregnancies
CONDOMS: 15 Pregnancies PILL/PATCH/RING: 8 Pregnancies SHOT: 3 Pregnancies IUD or IMPLANT: 0 or 1 Pregnancy ABSTINENCE (Consistently & Correctly): 0 Pregnancies
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SPONGE: (16 to) 32 Pregnancies WITHDRAWAL: 27 Pregnancies NO METHOD: 85 Pregnancies
LESSON7
INFLUENCE: Friends,Culture,theMedia,andSex
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LESSON 7 Outline
INFLUENCE: Friends,Culture,theMedia,andSex
Objectives
Define influence and list things that influence young people about sex Describe some positive influences of your culture Identify examples of influence from the media, and classify them as positive or negative Describe how to resist negative influences about sex
MaterialsNeeded
Chalkboard, or Newsprint tablet, Markers, and Easel One or both of the following: Ads from magazines that appeal to teens A CD of a popular song (and a CD player or boom box) Ground Rules Newsprint Sheet from Lesson 1 KEY MESSAGES Poster from Lesson 1
Activities
7.1 -- What Influences Young People about Sex? 10 minutes 7.2 -- The Influence of Culture 10 minutes 7.3 -- Magazine Ads and/or a Song/CD 10 to 15 minutes 7.4 -- Friends: Adriana and the Party 10 minutes 7.5 -- Wrap-up - 5 minutes
Facilitator Resource for Activity 7.2: The Influence of Culture Facilitator Resource for Activity 7.4: Friends: Adriana and the Party
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LESSON7 INFLUENCE: Friends,Culture,theMedia,andSex

Objectives
Define influence and list things that influence young people about sex Describe some positive influences of your culture Identify examples of influence from the media, and classify them as positive or negative Describe how to resist negative influences about sex
MaterialsNeeded
Chalkboard, or Newsprint tablet, Markers, and Easel One or both of the following: Ads from magazines that appeal to teens A CD of a popular song (and a CD player or boom box) Ground Rules Newsprint Sheet from Lesson 1 KEY MESSAGES Poster from Lesson 1
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Preparing for the Lesson This lesson requires preparing ahead of time to bring current and relevant materials for Activity 7.3. Depending on the amount of participation and discussion generated by the exercises, there is often time to consider only either the magazine ads or the song/CD. If there is time, both ads and songs can be used. Magazine ads from publications that appeal to young people can be cut out and glued or stapled to construction paper, so that they can be passed around the class or held up in the front of the class. A CD of a popular song and a way to play it for the class are also important to bring. You may want to discuss with students ahead of time which magazines and songs they like, and which they want to discuss, and which include messages about sex. Addressing Cultural Influences Activity 7.2 is designed to focus the discussion on cultural influences that may be important in the students decisions about sex. While it is difficult to generalize about any racial, ethnic, or geographic group, the intent is to help the students focus on the strengths and positive influences that their culture may provide. Classes may have students from several different cultures or racial/ethnic groups, and some students may come from multiple cultures. The facilitator should strive to identify as many positives from the cultures represented in the class, with the help and feedback from the students themselves. Students may bring up some negative cultural influences, as well. It is valuable to acknowledge these, and guide the focus to the more positive aspects of cultural influence. Some possible cultural influences and strengths, and how they might affect sexual decisions, are listed in the Facilitator Resource for Activity7.2: The Influence of Culture. Names in the Scenario In Activity 5.4, facilitators should point out that the scenario is not about actual students. Even if there is a student with the same name as a scenario character, the story is not about them. Facilitators may want to change the name(s) used in the scenario.
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Activity7.1 WhatInfluencesYoungPeopleaboutSex?10minutes
Let the class know that, in this session, they will consider what influences young people as they make their BIG DECISIONS about sex. Remind them that the messages about sex that this curriculum is trying to get across are:

Write on the board the word Influence and ask the students to say what it means. Help the class to come up with several synonyms (e.g., affects you, makes you think or do something, pressures you, sways you, manipulates you). Ask the students what they think influences young people in their community in how they think about sexespecially when it comes to what is normal and what is cool. To answer this, they might think about how young people learn about sex, hear about sex, or see people in sexually-related situations. Write their suggestions on the board or newsprint, and help them to come up with the following categories, among others: Parents and family Friends or peers Movies and television Video games and the internet Commercials and advertising Songs on the radio Partners (someone a person is dating) Religious organizations and beliefs Culture (e.g., being part of an ethnic, racial, or other group)
Explain that all these people and things can influence young people in how they think about sex and how they make decisions about sex. These influences can affect how young people understand what is right, what is normal, what is cool, and what they should do.
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Ask the students to give specific examples of how each of these people or things might influence young people in their decisions about sex. For each category, try to elicit at least one idea for a positive influence, as well as an example of a negative influence. Use the students examples as much as possible. If you need to suggest examples, they might include: Parents and family o o Parents may talk to their children about abstinence, and about being responsible when they become sexually active. (Positive) A cousin might be sexually active without protection and accidentally get his girlfriend pregnant. (Negative) A friend might encourage you to stand up for yourself and say no to a partner who is pressuring you for sex. (Positive) Friends may tease someone for being a virgin. (Negative) Video games can foster a sense of power and accomplishment. (Positive) Pornography on the internet can show sex as using other people, without considering their feelings. (Negative) A movie can show a couple who spend time and have fun together, respecting each other. (Positive) A TV show can show people having sex on the spur of the moment, and not using condoms or birth control. (Negative) A song can talk about why it is important to protect yourself. (Positive) A song can describe having sex (but not caring about the partner). (Negative) A commercial can promote parents talking to their kids. (Positive) A commercial can make it seem that everybody is having sex and no one is using condoms or birth control. (Negative) A partner may support your decision to choose abstinence. (Positive) A partner may pressure a person to have sex, or pressure them to have sex without condoms or contraception. (Negative)
Friends or peers o o
Video games and the internet o o
Movies and television o o
Songs on the radio o o
Commercials and advertisements o o
Partners (someone a person is going out with) o o
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Religious organizations and beliefs o o A religion may teach that sex should happen only when people are adults in a committed relationship. (Positive) A religion might make it difficult to be ready to prevent STDs and pregnancy when a person does become sexually active. (Negative) A culture (e.g., some Latino or Hispanic cultures) might teach that men should protect their families, and women should take care of their families. (Positive) Another culture might make it too uncomfortable for parents to talk to their children about sex at all. (Negative)
Culture (shared values of a racial, ethnic, or other group) o
Activity7.2 TheInfluenceofCulture10minutes
First, write Culture on the board or newsprint, and ask what the word means. Help the class to come up with the definition: shared values of a racial, ethnic, or other group. This means that there are some things, or ideas, that the group believes to be important. Ask the students to identify which cultures are important in their lives. Examples might include Hispanic, Latino, or Mexican-American culture; urban, inner-city, or AfricanAmerican culture; middle-class American culture; youth culture; Texas culture; and others. Acknowledge that most people have more than one cultural influence. Ask the students to think about what messages their culture gives them. On the board or newsprint, construct a list of positive influences from the cultures represented in the classroom. Next, referring to the list of positive influences, relate them to decisions about sex. For example, the importance of family and protecting ones family would mean that a person should avoid getting STDs or HIV; they would not put their partner (or their future children) at risk of these infections. Protecting ones family might also mean not getting pregnant (or not getting someone pregnant), until it is the RIGHT time to have a child. Being prepared and ready to be a parent would be part of protecting ones child and family. Thus protecting ones family might mean choosing abstinence, or using condoms and birth controlcorrectly, every time.
The Facilitator Resource for Activity 7.2 lists possible messages about sex that students may get from their culture.
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Summarize by pointing out how students have lots of positive influence from their culture(s)and lots of healthy messages to listen to about sex.
Activity7.3 MagazineAdsand/oraSong/CD10to15minutes
Depending on the amount of participation and discussion generated by the exercises, there is often time to consider only either the magazine ads or the song/CD. If there is time, both ads and songs can be used. Before the Lesson, the Facilitator will have chosen to use either the Magazine Ads or a Song/CD (or both) for this Activity, and selected examples with overt or covert messages about sex. For Magazine Ads: Show the collection of magazine ads to the class and ask them: How might these ads influence how a person thinks about sex or abstinence? Do you think this influence is positive, or negative? Why do you think these ads are giving out this message? Do you think young people should accept this influence, or resist it? If a person wanted to resist this influence, what suggestions would you give them?
In the discussion, help the class to focus on the underlying messages the ads give about sex, about what is normal and what is desirable. Encourage them to identify these messages as positive or negative ones. Help them brainstorm ways to resist negative messages and influences, while accepting positive influences and messages. For example, an ad for clothes might show a female wearing very little, or in a pose with a male that suggests they are having sex. This could influence young people to think that all young people are having sex (theyre not), and that females have to show their bodies to be attractive. These could be seen as negative messages in that they might encourage young people to have sex when it may not be a healthy choice for them. For a Song or CD: Play the CD, and ask the students to call out or write down the words that they hear. Pause the song, if necessary, to clarify for the class what words are in the song. When the song is finished ask the class: What is the message this song gives about sex? How might this message influence young people? Why do you think this song is giving out this message? Do you think this influence is positive, or negative? Do you think young people should accept this influence, or resist it?
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If a person wanted to resist this influence, what suggestions would you give them?
In the discussion, help the class to focus on the underlying messages the songs give about sex, about what is normal and what is desirable. Encourage them to identify these messages as positive or negative ones. Help the class brainstorm ways to resist negative messages and influences, while accepting positive influences and messages. For example, a song might have a male talking about how he had sex with a female. This might make it seem that having sex makes him important, and a man. It could be that songs with sex might sell more, and make more money for the artist and the label. The message could be seen as negative by making it seem like everybody is doing it, or that people should have sex so they can brag about it.
Activity7.4 Friends:AdrianaandtheParty10minutes
Read the story in the Facilitator Resource for Friends: Adriana and the Party. Ask the students to help answer the questions, and lead a discussion that includes the following points: Who might influence Adriana, and how? Influences include: o o o o o her friend Carlos (its his party) her friends (who she thinks would call her a coward) her grandmother, who she does not want to disappoint her culture, which values family Other influences could be movies, television, songs, and ads that make it seem important to go to parties and do risky things
Do you think this influence is positive, or negative? o Carlos influence is probably negative, since he could be seen as pressuring her to have sex when she wants to stay abstinent. Also, Carlos is having this party when his parents are away, and he will probably have alcohol there. Her friends influence could be seen as negative because they would be encouraging her to do something she really doesnt think is right, and would be making fun of her if she didnt.
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Her grandmothers (and her cultures) influence could be seen as positive, because Adriana feels close to her and does not want to disappoint her. It sounds like her grandmother wants the best for her.
Which influence should Adriana accept, and which should she resist? The Facilitator should support accepting positive influences and resisting negative ones. Ask the students to say how they decide which influences to resist. Tell them to imagine that Adriana is their little sister, who they want to protect and take care of. What advice they would give her about which influences to accept and resist?
If she decides not to go to the party, how could Adriana deal with Carlos and with her friends? Help the students brainstorm how Adriana could cope with pressure from Carlos and with the teasing or disapproval of her friends. Encourage them to consider that Adriana could feel good about her independence, and be able to stand up for herself. She can tell Carlos that she likes him, but she wants to do what she thinks is right for her. She can let her friends know that she needs their support, not their criticism.
Activity7.5 Wrapup:5minutes
If there is time, the class can consider a television show or movie that they like, and consider how it might influence them about sex. Congratulate the class for their work on the Influence examples. Summarize the lesson by indicating that there are lots of pressures and influences on young people, especially when it comes to sex. It is important that the students be able to recognize both positive and negative influences. Recognizing influence is the first step in being able to take charge of the decision of whether to accept or resist an influence. And when it comes to sex, these are BIG DECISIONS.
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Facilitator Resource for Activity 7.2: The Influence of Culture

While it is not possible to generalize about anyones cultural background or their racial/ethnic groups influences, these suggestions may help the Facilitator to highlight and reinforce cultural influences that can positively affect students decisions.
Latinos/Hispanics2 Possible Cultural Values The importance of family Males should be strong and protect their family Females should care for and protect their family The value/importance of virginity Possible Cultural Values Pride, self-respect Strong sense of community Importance of family Possible Messages about Sex Your decisions about sex are for your familynot just for you Avoid bringing an STD or HIV into the family Avoid pregnancy as a teen, when risks to the baby are high Abstinence is the best choice for teens Possible Messages about Sex Your decisions show how you respect yourself Dont spread STDs or HIV in your community Your decisions about sex are for your familynot just for you Possible Messages about Sex Make responsible decisions about sex It is important not to get HIV or other STDs Dont get pregnant (or get someone pregnant) until you are ready to properly provide for a child Getting a good education before becoming a parent is important for your future Texas Culture Possible Cultural Values Independence (thinking for yourself) Doing the right thing, even if it is not easy Strength
2
Urban/Inner-city/ African-Americans3:
Middle Class/Non-Hispanic Whites Possible Cultural Values Responsibility Health Caring for Children Education
Possible Messages about Sex You can resist negative influences about sex Stick with your decision, even when under pressure Make strong and smart decisions about sex
These items are derived from cultural strengths highlighted in publications about the Cudate! curriculum (Villarruel AM, et al. Arch Pediatr Adolesc Med 2006;160:772-777. Villarruel AM, et al. J Assoc Nurses in AIDS Care 2005;16:23-31.)
These items are derived from cultural strengths highlighted in the descriptions of the Be Proud! Be Responsible! and Making a Difference curricula.
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Facilitator Resource for Activity 7.4

FRIENDS: Adriana and the Party Adriana is invited to a party this weekend at her friend Carlos house. His parents have to be out of town, and there will definitely be lots of people there, not to mention alcohol and who knows what else. Adriana is kind of scared to go because she does not want to get in trouble or disappoint her grandmother. Carlos has let her know that he would like to have sex with her, and he hinted that the party might be the right time. Adriana really wants to stay abstinent, but she is curious and feels like her friends will call her a coward if she doesnt go. Who might influence Adriana, and how? Do you think these influences are positive, or negative?
What might be the influence of Adrianas culture? Is this influence positive, or negative?
Which influence(s) should Adriana accept, and which should she resist?
If she decides not to go to the party, how could Adriana deal with Carlos and with her friends?
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LESSON8
GOALSANDDREAMS: MyDecision
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LESSON 8 Outline
GOALSANDDREAMS: MyDecision
Objectives
Visualize their goals and dreams for the future Understand how a teen pregnancy or HIV/STD can affect achieving their goals and dreams Personalize the risks of pregnancy and STDs Make a personal decision about how they will avoid too-early pregnancy and STDs
MaterialsNeeded
Chalkboard, or Newsprint tablet, Markers, and Easel Index cards, one for each student Large envelope to collect filled-out index cards Student Worksheets (Story 1 and Story 2) for Activity 8.3 one for each small group of 3 or 4 Paper and pencils for small groups to write down ideas Small prizes for winning groups Ground Rules Newsprint Sheet from Lesson 1 KEY MESSAGES Poster from Lesson 1
Activities
8.1 - My Goals and Dreams 5 to 10 minutes 8.2 - How Might a Pregnancy or an STD affect your Goals and Dreams? 10 minutes 8.3 -- Personalizing the Risks: How Would It Feel in Real Life? 15 to 20 minutes 8.4 -- Wrap-Up: My Decision, My Limits 5 to 10 minutes
Facilitator Resource for Activity 8.2 How Might a Pregnancy or an STD Affect your Goals and Dreams? Student Worksheets (Story 1 and Story 2) for Activity 8.3
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LESSON8 GOALSANDDREAMS: MyDecision

Objectives:
Visualize their goals and dreams for the future Understand how a teen pregnancy or HIV/STD can affect achieving their goals and dreams Personalize the risks of pregnancy and STDs Make a personal decision about how they will avoid too-early pregnancy and STDs
MaterialsNeeded:
Chalkboard, or Newsprint tablet, Markers, and Easel Index cards, one for each student Large envelope to collect filled-out index cards Student Worksheets (Story 1 and Story 2) for Activity 8.3 one for each small group of 3 or 4 Paper and pencils for small groups to write down ideas Small prizes for winning groups Ground Rules Newsprint Sheet from Lesson 1 KEY MESSAGES Poster from Lesson 1
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Helping Students Personalize the Risks This lesson helps students personalize the risks by examining the impact of having a pregnancy or HIV/STD or having as a teen, including how being a teen parent might interfere with achieving goals and dreams. It is important for facilitators to demonstrate a caring and nonjudgmental attitude toward the students throughout the programand this is especially vital in this Lesson as students think about their goals and dreams. It is important to be sensitive to the fact that some students in the class may already be pregnant or parenting. Others may have friends or family who are pregnant or parenting as teens. It is not appropriate to imply that teen parenthood is shameful, or that it means that achieving goals and dreams is impossible. Rather, parenthood should be framed as making goals and dreams more difficult to achieve, and it may take longer to achieve them. Note that Activity 8.3 calls for gender-specific groups to answer from a male and a female point of view. The impact of this activity depends on the students imagining how the young people in the stories feel about what is happening to them. It is important to cultivate the students exploring how the youth in the story might feel, and to talk about their ideas. Names in the Scenarios Facilitators should point out that the stories in Activity 8.3 are not about actual students. Even if there is a student with the same name as a story character, the story is not about them. Facilitators may want to change the name(s) of the story characters.
Activity8.1 MyGoalsandDreams5to10minutes
Let the class know that, in this session, they will be considering their own personal decisions about sex, and the limits of what they will and wont do. This session will help them think about their goals and dreams for the future and how their future might be affected by a pregnancy or an STD. Then they will consider some stories about young people who experience some surprises after having sex. At the end of the lesson, they will consider what they can do to keep pregnancy and STDs from interfering with their goals and dreamsi.e., what decisions they can make. Then, in the next lesson, they will have a chance to practice putting their decision into action and sticking to their limits.
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Pass out the index cards so that each student has one, and make sure that each student has something to write with. Tell the students not to write their name on the card; what they write will be confidential. When they are done with the lesson, they can choose to keep the index card for themselves, or give it to the facilitator, who will walk around the classroom at the end of the lesson with an envelope for them to drop their card into. The facilitator will not know who wrote what, but he or she will be interested to see what students write down. Write Goals and Dreams on the board or newsprint. Let the students know that goals and dreams are important to many young people. Goals and dreams give people hope for the future, and having goals and dreams is the first step to getting what they want. Ask the students to think about a goal or dream that they have for their future, something that is important to them. Ask them to imagine what it would be like to achieve their goal or dream, to visualize (see in their minds eye) what it would be like to reach their goal. What will they be doing? Where will they be? Who will be there with them? Ask the students to call out what they think people their age might have as goals and dreams. If they want to share their own goals and dreams, that is fine too. Write their suggestions on the board or newsprint. If necessary, prompt them with some goals and dreams that other young people have told you about, for example:

A great job, like a doctor or a businessperson To be a soldier Having lots of money To have fun Someone to love thema healthy and close relationship To get married (or have a lasting relationship) A nice house A nice car To make a difference in their community To travel Adventure A healthy baby/children A happy family To be famous To make their parents proud
As the goals and dreams are listed, ask a few of the students to say what would be the best thing about achieving that goal or dream. Encourage them to be specific about the reasons
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they think young people might have for wanting something, and what they would like most about achieving it. Strive to have each student contribute at least one goal or dream for the list. If there are duplicates, the facilitator can make marks to indicate that an item was listed by more than one person. After the groups list is made, ask the students to write down on their index card at least one goal or dream that they have for their own future. Remind the students not to write their name on the cardjust a goal or dream (or more than one). Give them a minute or two to complete the task. When they are finished, tell the students to keep their index cards until the end of the lesson. They may want to fold the index card in half to cover what they wrote.
Activity8.2 HowMightaPregnancyoranSTDaffectyourGoalsandDreams? 10minutes

Let the students know that the whole point of the BIG DECISIONS program is to help them achieve their goals and dreams. Getting pregnant and having a baby as a teen can make it much harder to achieve their goals. If they are already a parent, having another child too soon can mean even bigger obstacles. And having HIV or another STD can affect them in lots of ways, and get in the way of their goals, too. These are some of the reasons why having sex is such a big decision. Write Pregnancy on the board or newsprint on one side of the list of Goals and Dreams. Ask the class to consider what effect they think a pregnancy as a teenager (either getting pregnant or getting someone pregnant) might have on achieving these goals and dreams. Give them an example, e.g., being pregnant or being a teen parent could interfere with being able to go to the prom, because the family cant afford all the bills, or because there is no one else available to baby-sit. As suggestions are made, write on the board or newsprint key words in the Pregnancy column next to the appropriate goal affected. Help the class to see how each goal might be harder to achieve, less likely to be achieved, or delayed by a teen pregnancy. Refer to the Facilitator Resource for Activity 8.2 for ideas about how a teen pregnancy can interfere with goals and dreams. During the discussion, it is important to acknowledge that teen parents can indeed achieve their goals, and many do. But the odds are tougher for teen parents. Achieving their goals is harder, and it takes more time.
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Be sure to include in the discussion the effects on the baby of being born to teen parents, rather than older parents. Children of school-age parents are more likely to be born premature, to die before their first birthday, to live in poverty, to have trouble in school, and many other challenges (see the Facilitator Resource for Activity 8.2). Now, on the other side of the list of Goals and Dreams, write HIV/STD. Ask the students to share their ideas about how having HIV or another STD might affect achieving one or more of these goals. Write key words for their points under HIV/STD on the board or newsprint. Help the class include the ideas listed in the Facilitator Resource for Activity 8.2. During the discussion, it is important to acknowledge that people with HIV and other STDs can get treatment and live productive and happy lives. However, HIV infection, and to a lesser extent other infections, can still make it harder to achieve some goals. Thank the students for their insight and ideas. Point out that the BIG DECISIONS program wants them all to achieve their goals and dreams, and avoiding teen pregnancy and HIV/STDs can help. Review the KEY MESSAGES in this context: Having sex is a BIG DECISION

If possible, keep the list of Goals and Dreams on the board or newsprint, so it will be visible later in the lesson. If there is not much room, the lists of ideas under Pregnancy and HIV/STD can be erased.
Activity8.3 PersonalizingtheRisksHowWouldItFeelinRealLife? 15to20minutes

Divide the class into gender-specific groups of 3 or 4, with males and females in different groups. Pass out the Student Worksheets, so that each small group has one set of the 2 stories. Read Story 1 (Joe and Crystal) out loud, and ask the groups to work together to answer the first 2 questions in the Worksheet, with the male groups answering Question A and the female groups answering Question B. Ask the groups to come up with as many answers as they can, and to be able to explain why they think Joe and Crystal would feel that way. Both males and females should answer Question C. Read the questions out loud for the students.
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Give the groups a few minutes to discuss and answer the questions, and ask each group of males to volunteer their answers to Question A. Write Joe on the board or newsprint, and, as ideas are voiced, write the ideas under his name to keep a list. Help get the ideas started, if necessary. Male responses might include:

Being scared or embarrassed Worried about HIV and AIDS Worried about damage from the infection Worried about being contagious Worried his parents might find out Wondering who he got it from (more than one partner?) Thinking that Crystal (or another partner) was cheating on him Worried that other people might think he is dirty Feeling like this is not really happening (denial) Feeling angry with Crystal (or another partner) Feeling angry with himself for getting this infection Dreading talking to Crystal, and avoiding talking to her He might feel depressed
Summarize by noting how uncomfortable and difficult this situation would be for most guys. Now ask each group of females to volunteer their answers to Question B. Write Crystal on the board or newsprint, and write the ideas under her name as they are suggested. Female responses might include:

Being scared or embarrassed Worried about HIV and AIDS Worried about damage to her tubes and ovaries from the infection Wondering where he got it from, especially if he is her first/only partner Wondering whether she gave it to him Thinking that Joe is cheating on her Worried other people might think she is dirty Feeling like this is not really happening (denial) Feeling angry with Joe (or another partner) Feeling angry with herself for getting into this situation She might yell at Joe, or break up with him She might feel depressed
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Reinforce how stressful and difficult this situation might be. Let the students know that having an STD can threaten a relationship. Many people find that their trust in their partner is shaken by an STD. Some couples break up after they are diagnosed. Remind the students that Chlamydia is very common among sexually active young people, especially if they dont use condoms correctly, every time they have sex. Point out that Chlamydia is easily curable, but it still can be upsetting to get it. Let the students know that getting an STD that is not curable (genital herpes, HPV, or HIV) would likely be even more stressful. Next, ask all the students to help answer Question C: What Joe and Crystal could have done to prevent getting an STD like Chlamydia. Write Prevent STDs and HIV on the board or newsprint, and list key words from the students suggestions. Responses should include:

Abstinence, noting that this is the healthiest choice Using a condom, pointing out the importance of using one correctly, every time Getting tested, which means a person can get treated even if they have no symptoms, and before he or she infects another person
Then ask the students the second part of Question C. Acknowledge that abstinence is the most effective prevention for STDs. Let the students know that many young people think that STDs, HIV, and pregnancy will not happen to them, but STDs, HIV, and pregnancy do happen. Tell the students that each of them should decide what they will do to avoid getting STDs. Recommend abstinence as the healthiest and most effective way to avoid STDs and pregnancy. If they choose to have sex, though, they must take action to avoid STDs and pregnancy. In the case of STDs, the actions to take include using latex condoms, correctly, every time a person has sex. Point out that having sex as a teen means lots of responsibility. Read Story 2 (Angela and Terrence) out loud, and ask the groups to work together to answer the first 2 sets of questions in the Worksheet. The groups of females should discuss and answer Question A, and the groups of males should discuss and answer Question B. Ask the groups to come up with as many answers as they can. Both males and females should answer Question C. Read the questions out loud for the students. Give the groups a few minutes to discuss and answer the questions, and ask for each group of females to volunteer their answers to the Question A. Write Angela on the board or newsprint, and list the ideas under her name. Female responses might include:

Being shocked and surprised Not really believing it (denial) Feeling embarrassed Worried that her parents will be angry or disappointed
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Feeling desperate Feeling confused Feeling happy to be pregnant Wondering whether to carry the pregnancy, whether to place the baby for adoption, or whether to have an abortion Feeling overwhelmed at the idea of talking with Terrence Feeling depressed Worried that Terrence will be angry, or will not want the child Worried that Terrence will abandon her
Summarize by noting how stressful and difficult this situation would be for most females. If positive feelings about being pregnant are expressed, the facilitator can help to frame the issue as being about timing. It would be better/healthier to be pregnant when both partners have finished school and they are planning a pregnancy together. Now ask the males in the class to help answer Question B. Write Terrence on the board or newsprint, and list ideas under his name. Male responses might include:

Being shocked and surprised Feeling trapped Being angry with Angela Feeling angry with himself Wondering if he is really the father Not really believing it (denial) Feeling embarrassed Worried that his parents will be angry or disappointed Feeling desperate Feeling confused Being happy or proud about the pregnancy Feeling depressed
Reinforce how stressful and difficult this situation might be. Let the students know that pregnancy is very common among sexually active young people, especially if they dont use effective contraception every time they have sex. Now ask all the students to help answer Question C: What Angela and Terrence could have done to prevent pregnancy. Write Prevent Pregnancy on the board or newsprint and underneath it, list as the students offer them the key things Angela and Terrence could have done. Responses should include:
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Abstinence noting that this (used consistently and correctly) is the most effective way to prevent pregnancy; Using a condom pointing out the importance of using condoms correctly, every time; Using another method of contraception, such as hormonal methods like the pill, the patch, the ring, or the shot; To use dual protection both condoms and birth control:
o
Using an effective method of birth control (in addition to using condoms correctly, every time) provides dual protection against both HIV/STDs and pregnancy Using both condoms and birth control correctly makes the chance of pregnancy very small
Let the students know that many young people think that a pregnancy will not happen to them, but pregnancies do happen. Chances of pregnancy are very high if couples do not use an effective method of contraception. Commend the students on their ideas and their willingness to share them. Leave the lists under Prevent STDs and HIV and Prevent Pregnancy on the board or newsprint for the class to refer to in the next activity.
Activity8.4 WrapUp:MyDecision,MyLimits5to10minutes
To summarize, point out that, if students want to have the best chance of achieving their goals and dreams, they need to avoid teen pregnancy and avoid getting HIV and other STDs. They have some important decisionssome big decisionsto make about how they as individuals will avoid pregnancy and STDs. Refer to the KEY MESSAGES Poster to emphasize that their choices include:

Abstinence the healthiest choice Teens who have sex must use condoms and birth control, correctly, every time
Ask the students to consider individually which of these 2 ways they will use to help them achieve their goals and dreams. This is their own personal decision for this time in their lives, and it is a big decision, which should be made carefully. Ask the students, if they feel comfortable, to write down on their index card (which was used in Activity 8.1 to write their goals and dreams) their decision of which of the 2 ways they will avoid STDs and pregnancy (i.e., using abstinence; or using condoms and birth control). Remind them not to put their names on the index cards, so that what they write will be confidential. Students should not look at what others are writing, so that it can stay private.
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After writing down their decision, students can fold their index card over so that what they wrote is covered. The students can choose to keep the card, if they like, or to put it in the envelope as the facilitator walks through the classroom. Let the students know that after they make their decision, it is important to put their decision into actionto stick to their decision. This means they will need to set limits, or boundaries, for what they will and will not do. They will need to be effective in saying no to things they decided they would not do. Let the students know that in the next lesson, they will get an opportunity to make their limits clear, and to practice saying no effectively. This will put their decision into action. If there is time, the facilitator may want to answer questions or review important points from previous lessons. This is a good time to be sure that all students have their questions answered about:
What abstinence means: It is a decision and a plan to not have vaginal, oral, or anal sex HIV and other STDs Condoms and other contraceptive methods
Collect the index cards in an envelope, and thank the students for their participation.
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Facilitator Resource for Activity 8.2: How Might a Pregnancy or an STD affect your Goals and Dreams?
GOAL Education Graduate high school

PREGNANCY
STD or HIV
Harder to finish high school. Less than half of mothers under age 18 will graduate high school [1] Teen dads complete less school than older fathers [2]
Chronic illness (e.g., from HIV) could make it harder to study and graduate
Go to college/higher education Employment A good job/career
Less than 2% of mothers under 18 will graduate college (compared to 9% of moms at age 20-21) [2]
Chronic illness (e.g., from HIV) could make it harder to study and graduate
Harder to get a good job with less education. The dad could be in trouble if he doesnt pay child support Jobs are more likely to be fun and interesting if you have more education, and thus more jobs to choose from
Chronic illness (e.g., from HIV) could make it harder to work hard at a job Having HIV could keep you out of the military. Chronic illness (e.g., from HIV) could make it harder to work hard and get the job you really want
Soldier/military career Fun and interesting job
Prosperity Make lots of money Both the teen mom and the dad are likely to make less money and to be poor Less likely to have enough money to have a house of your own Lower income means it will be harder to get the car of your dreams Chronic illness (e.g., from HIV) may make it harder to work hard and have a high-paying job Chronic illness (e.g., from HIV) may make it harder to work hard and have a high-paying job Chronic illness (e.g., from HIV) may make it harder to work hard and have a high-paying job
Nice house
Nice car
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Facilitator Resource for Activity 8.2, Continued

GOAL Take care of myself and my family PREGNANCY Teen dads often are frustrated that they cant provide what their babies need
STD or HIV Chronic illness (e.g., from HIV) may make it harder to work hard & have a good job If you die from HIV (or syphilis), you wont be there to take care of your family
Help my community
It is harder to help your community when you are poor, or are struggling to make ends meet
With chronic illness (e.g., from HIV), a person may not have enough energy or money to help their community
Love and Family A great relationship Pregnancy and parenthood are often stressful for relationships.
An STD can make it so people dont trust each other Having an STD can interfere with dating and getting to know someone An STD can threaten a relationship and cause a breakup Having an STD can interfere with dating and finding your true love
A lasting love relationship
80% of the fathers dont marry the mother of a teen birth [3] Less than 8% marry the father within a year of the birth [4] Teen marriages are twice as likely to fail as marriages of those over 25 [5] Teen moms are less likely to be married at age 35 [6]
Someone I can trust/be honest with
An STD can make it so partners dont trust each other An STD can make it harder to be honest (about the STD)
To be respected
An STD can hurt a persons selfrespect, and the respect of their partner
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GOAL To have a healthy baby (or babies). PREGNANCY Children of teen parents more likely to: [2]

STD or HIV STDs can hurt the baby Some STDs can cause Pelvic Inflammatory Disease (PID) and make it hard to get pregnant later on Cancer of the cervix (caused by HPV) may require surgery to remove the uterus Dysplasia of the cervix may require treatment that can make it harder to carry a pregnancy Males with HIV can infect their partner trying to cause a pregnancy HIV can be stressful on families STDs can cause stress and conflict between partners STDs can cause couples to break up
be born prematurely die before age 1 have health problems be abused or neglected live in poverty do poorly in school be teen parents be incarcerated

To have a happy family
If a pregnancy is not wanted, it can be stressful Teen parents are more likely to divorce It may be hard to find a life partner who will accept your pregnancy or child with a previous partner Parents may be disappointed if they got pregnant/got someone pregnant Parents may be disappointed if they did not graduate high school or go to college
To make my parents proud
Parents would be disappointed if they got an STD Parents would be afraid that their child would be sick or die
Fun and Adventure To have fun With the responsibility of having children, teens often have to miss fun with their friends, parties, prom, etc. STDs may cause symptoms that interfere with having funat least temporarily Chronic illness or medication side effects (e.g., with HIV and treatment) can make you feel sick and not want to go out and have fun.
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GOAL To be free PREGNANCY With the responsibility of having children, there is less freedom STD or HIV Having HIV would require taking medicines for the rest of a persons life, and there would be worries about the cost, and health insurance Some countries wont let in people with HIV An STD (like genital herpes sores or warts) can interfere with sex and be contagious. Having HIV may mean having to use condoms or abstain your whole life, even if you find your true love
To travel To have great sex
Travel is more difficult and expensive with children Teen parenthood often means less likely to get married Married people report higher satisfaction with their sex lives, and have sex more often, than unmarried people
References:
1. Hoffman SD. By the Numbers: The Public Costs of Adolescent Childbearing. Washington, DC: National Campaign to Prevent Teen Pregnancy, 2006. 2. National Campaign to Prevent Teen Pregnancy. Teen Pregnancy: Not Just Another Single Issue. Washington, DC: November, 2002. 3. National Campaign to Prevent Teen Pregnancy. Teen Pregnancy, Poverty, and Income Disparity. 4. Child Trends, Facts at a Glance, 2005. Child Trends: Washington, DC. 5. Lichter D. Marriage as public policy. Progressive Policy Institute. Washington, DC, 2001. 6. Lichter D, Graefe DR. Finding a Mate? The Marital and Cohabitation Histories of Unwed Mothers, In: W LL, Wolfe B, Eds. Out of Wedlock: Causes and Consequences of Nonmarital Fertility. New York: Russell Sage Foundation, 2001
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Student Worksheet for Activity 8.3 Story 1: Joe and Crystal

Joe and Crystal have been going out for two months, and they first started having sex about 2 weeks ago. Joe used a condom at first, but later he would just pull out. Joe and Crystal dont really talk to each other about sex or protection. Joe just wants to have fun, but lately Crystal seems like she wants to change their relationship. She is always wanting to talk. Yesterday, Joe noticed that, when he peed, he felt a kind of burning in the tip of his penis. A small amount of cloudy liquid drips out of his urethra, and there is a yellowish stain on the front his underwear. He has never had anything like this before. Joe went to the Health Department clinic, where they did a test, and gave him a shot and some medicine by mouth. When he called the clinic for the results of the tests, the nurse told him that the test showed he had Chlamydia. She reminded him that he must talk with all his recent partners because they need to be tested and treated, too. Also, he must not have sex for at least 7 days, and not until all his partners are treated. A. Questions for male students: How do you think Joe might feel about having this infection? How would he feel about having to talk to Crystal about it?
B. Questions for female students: When Crystal learns about Joes infection, how do you think she will feel? What do you think she would say and do?
C. Questions for all students: What could Joe and Crystal have done to prevent this situation? What is the most effective way to avoid STDs?
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Student Worksheet for Activity 8.3 Story 2: Angela and Terrence

Angela had admired Terrence for a long time, and she felt so wonderful when he finally asked her out. Angela feels really lucky to have such a popular boyfriend. Terrence is not sure how he feels about Angela, though. There is another girl who he likes a lot, too. Angela and Terrance have had sex a few timesbut only once or twice without a condom. Last week, Angela got up her courage and made an appointment at the Health Department clinic to get on the pill or the shot. At her appointment today, everyone at the clinic was nice and helpful. In the examination room, the nurse tells Angela that her pregnancy test was positivethat she is pregnant. The nurse asks Angela how she is feeling, and asks about her thoughts and plans. A. Question for female students: How do you think Angela might feel about this news? How would she feel about talking to Terrence about it?
B. Question for male students: When Terrence learns about Angelas pregnancy, how do you think he will feel? What do you think he would say and do?
C. Question for all students: What could Angela and Terrence have done to prevent this situation? What is the most effective way to prevent pregnancy?
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LESSON9
THEPOWERTOSAYNO: StickingtoMyDecision
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LESSON 9 Outline
THEPOWERTOSAYNO: StickingtoMyDecision
Objectives
MaterialsNeeded
Newsprint tablet, Markers, and Easel Facilitator Resource for Activity 9.2: Pressure Situation: Jasmine and Michael Facilitator Resource for Lessons 9 and 10: The Power to Say No: Tools and Tips Facilitator Resource for Activity 9.3: Pressure Situation Scripts Student Worksheet for Activity 9.4: Role-Play #1 (The Party) Ground Rules Newsprint Sheet from Lesson 1 KEY MESSAGES Poster from Lesson 1
Activities
9.1 -- Sticking to Your Decision: Setting Limits 5 to 10 minutes 9.2 - Pressure Situation 5 to 10 minutes 9.3 - Role-Play Demonstration 5 to 10 minutes 9.4 - Role-Play #1 (The Party) 15 to 20 minutes 9.5 - Wrap-up 5 minutes
Facilitator Resource for Activity 9.2: Pressure Situation: Jasmine and Michael Facilitator Resource for Lessons 9 and 10: The Power to Say No: Tools and Tips Facilitator Resource for Activity 9.3: Pressure Situation Scripts Student Worksheet for Activity 9.4: Role-Play #1 (The Party)
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LESSON9 THEPOWERTOSAYNO: StickingtoMyDecision

Objectives
MaterialsNeeded
Newsprint tablet, Markers, and Easel Facilitator Resource for Activity 9.2: Pressure Situation: Jasmine and Michael Facilitator Resource for Lessons 9 and 10: The Power to Say No: Tools and Tips Facilitator Resource for Activity 9.3: Pressure Situation Scripts Student Worksheet for Activity 9.4: Role-Play #1 (The Party) Ground Rules Newsprint Sheet from Lesson 1 KEY MESSAGES Poster from Lesson 1

The Importance of Role-Play Practice Activity 9.4 (the role-play) is the most essential exercise in this lesson. Facilitators should strive to ensure that each student actively practices saying
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no effectively during this activity. There is a second role-play practice in Lesson 10, and students should participate in both role-play scenarios. Care must be taken in the role-play activities to indicate that role-play means playing a part, like in a movie or play. Facilitators should be clear that demonstrations and role-plays are not about real or actual relationships between the participants. Assistance with the Role-Play Demonstration Facilitators should seek another adult to play Michael to their Jasmine in Activity 9.3, the Role-Play Demonstration. It is preferable to avoid having students act out pressure situations with adult facilitators, if at all possible. As with role-play practice by students, facilitators should clarify that they and their assistant are playing a part, and pretending; the role-play is not about any real or actual relationship that they have. The List of Tools and Tips The list of Tools and Tips is an important visual guide for students as they practice saying no and sticking to their limits in the role-play exercises of both this lesson and Lesson 10. Facilitators should use newsprint and markers, if at all possible, to develop the list of Tools and Tips with the class. Then the newsprint list can be displayed during Lesson 10, as well. Possible Student Concerns about Unequal or Unhealthy Relationships This session may bring up difficult and upsetting feelings among young people who have experienced sexual abuse or coercion. It is important to acknowledge the phenomenon of abuse early in the session. The facilitator should make it clear that abused people are not at fault for what happened to them, and that there is help for young people who have been abused. Be prepared to refer young people to appropriate services. It is also essential to report sexual abuse in accordance with the law [1]. During Activity 9.2, when discussing Question #2, it is important for facilitators to emphasize that a relationship with someone who is more than a year or two older is risky because there is often a big difference in power, with the older person having more power than the younger person. This can be unhealthy and can make pressure situations more likely. Names in the Scenarios As in other lessons, facilitators should point out that the scenarios in this
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lessons activities are not about actual students. Even if there is a student with the same name as a scenario character, the story is not about them. Facilitators may wish to change the names of the characters in the scenarios and role-plays.
Activity9.1 StickingtoYourDecision:SettingLimits5to10minutes
Review with the class what happened in Lesson 8: students thought about how a pregnancy as a teen, or getting an STD or HIV, might make it harder to reach their goals and dreams. At the end of Lesson 8, students made a decision of how they as individuals will avoid getting HIV or another STD, and how they will not get pregnant (or cause a pregnancy) until it is the RIGHT time for their family. Review the KEY MESSAGES poster to highlight the 2 choices that students have:

Let the students know that, once each of them makes their decision about which of these 2 ways they will use, the next step is to put that decision into action. In this lesson, they will learn how to take action to stick to their decision: how to say no to things that they decided not to do. In real life, many young people are not able to say no when they want to. Most teens who have had sex (60%) say they wish they had waited longer [2]. Many (especially girls) report that they didnt really plan to have sex. Some young people are actually forced to have sex against their will. Let the students know that there are several important rules when it comes to sexual pressure, setting limits, and a persons ability to say no. The first rule is that everyone has the right to say no. This means that everyone has the right to say no to sex. Everyone has the right to say no to sex, even if: You have said yes before
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You have had sex before You have been making out (kissing and touching) You love the other person The other person has spent money on you
This rule also means that people who have sex have the right to say no to sex without a condom. And they have the right to say no to sex without birth control, too. Setting limits and sticking to your limits is important for people who have sex, too. The second rule is that it is never OK to pressure someone for sex. It is OK to ask for something you want, but it is never OK to insist, or to threaten someone. Pressuring someone for sex (or for sex without a condom or birth control) is not in keeping with this rule. Tell the class that when someone is pressured to have sex, that is coercion. When someone is forced to do something sexual, that is sexual abuse, which is a crime. (If a person is forced to have sex, that is sexual assault.) Let the class know that there is help for young people who have been abused. Abused people are not at fault for what happened to themthe fault is with the abuser. Still, it is good to know as much as possible to be able to avoid sexual pressure, coercion, and even abuse. Tell class that, in this lesson, they will consider situations where they might be pressured about sex. This lesson will help them: Discover the power they have to say no to things that are not in keeping with their decision about how they will avoid HIV/STDs and pregnancy; and Avoid getting into pressure situations in the first place.
This lesson will give them some tools for saying no effectively, and a chance to practice saying no in a role-play (pretend) situation.
Activity9.2 PressureSituation5to10minutes
Let the class know that they will now consider an imaginary pressure situation. The situation you are going to read has a male (Michael) pressuring a female (Jasmine), but sometimes females pressure males, too. In fact, in any relationship, one person might try to pressure the other. From the Facilitator Resource, read Pressure Situation: Jasmine and Michael out loud to the class (see Facilitator Resource). After the situation is read, point out that, in the story, Michael seems to be pressuring Jasmine for sex.
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Ask the class to help answer some questions as you read them out loud. Read Question #1, and write Why is it hard to say no? on the board or newsprint. Help the class to come up with several appropriate answers, including perhaps: o o o o o o It would not seem cool to say no She does not want to disappoint him She may feel turned on or sexually aroused She doesnt know what to say or do She may feel helpless, like there is nothing she could do She likes the attention and closeness
Ask the class whether they think it would be easier or harder to say no if it were a girl pressuring a guy. (Guys might feel particular pressure to prove themselves, for example.) Summarize by noting that there are lots of reasons that it might be hard for a person to say no when pressured. Now ask the class to tell you what it would take for Jasmine to resist the pressure Michael is putting on her. Help the class come up with important elements, including perhaps: o o o o o o Knowing ahead of time where her limits are (i.e., making her decision) A commitment to not getting pregnant until it is the right time for her and her family A commitment to protecting herself (and her family) from HIV and other STDs Courage and determination Having some tools she can use to resist pressure Knowing what to say and how to say it
Summarize by noting that it takes a decision about what your limits are. And it takes standing up for yourself to stick to your decision and to your limits. Now read Question #2 and ask the class how they would answer. Write How to Avoid Pressure Situations on the board or newsprint. Help the class to come up with several appropriate answers, including: o o o o o Avoid being alone with Michael Ask about the situation before she agrees to go Avoid alcohol and drugs, since they reduce resistance to pressure Tell him about her limits ahead of time She should not date someone who is a lot older
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Read Question #3, and write The Power to Say No on the board or newsprint. Help the class to come up with the Tools and Tips in the Facilitator Resource for Lessons 9 and 10 (The Power to Say No: Tools and Tips). Write the list of Tools and Tips on newsprint, so that the students can refer to them for the rest of the lesson. Writing the Tools and Tips on newsprint allows the list to be brought to Lesson 10, as well. Help the class to include the following Tools and Tips:

Say the Word: use the word no Use your Voice: say it strong and be clear that you mean it Use Body Language: stand up, move away, lean back, move his or her hand Repeat It: say no again Say, I Dont: This lets the person know it is your decision not to do something Suggest an Alternative: lets do something else instead Preserve the Relationship: with I like you, but I am not going against what I think is right Turn the Tables: ask why the other person is pressuring you Leave the Area, if necessary
Point out that the class can use this list of Tools and Tips to evaluate how well they and other students are able to say no in a practice. Leave the The Power to Say No Tools and Tips list on the board during the role-play activity.
Activity9.3 RolePlayDemonstration5to10minutes
In this activity, the facilitator demonstrates both weak and powerful ways to say noto resist sexual pressure. Ask a co-facilitator, a teacher, an aide, or another adult volunteer to play the part of Michael, by reading his pressure lines. Let the class know that you and Michael will go through the situation twice. The first time, you will use only weak techniques and ways of saying no. The second time, you will use the Tools and Tips that the class developed to say no in a powerful waya way that will be effective. Ask the students to watch carefully to see which of the Tools and Tips for a powerful no that you use. Using the Facilitator Resource, read through the first attempt to say no. Use timid and unsure body language, and dont look Michael in the eye. Ask the students for feedback about how well you did. Help the class to see that:
Jasmine did not use the key Tools or Tips.

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Jasmine seemed unsure, and Michael kept trying. Jasmine did not say the word no. She did not use strong body language. She did not use a strong voice. She did not say I dont or let Michael know what her decision was. She did not suggest another thing to do.
Now, using the Facilitator Resource, with your assistant playing Michael, read through the second, more powerful way of saying no. When you are finished, ask the students for feedback about how powerful your no was this time. Help the class to see the Tools and Tips that were used:

Jasmine seemed sure of herself, even when Michael kept trying. Jasmine said the word no. She used strong body language. She used a strong voice. She said I dont want to, and this let Michael know what her decision was. She suggested another thing to do. This was powerful and effectiveMichael stopped pressuring her.
Ask the class what Jasmine could have done if none of the things she tried had worked. Help the class remember that she could have turned the tables and asked what was wrong with him (Michael) that he was pressuring her like this. Or, she could have left the area and walked away. Thank Michael for his great performance, and the students for all their observations.
Activity9.4 RolePlay#1(TheParty)15to20minutes
Pass out the Student Worksheets for the Role-Play #1 (The Party). Let the class know that filling in this worksheet will help them be ready to play the role of someone who has the power to say no. In this activity, they will write the lines to say no in this situation. Then, in pairs, they will practice saying no. Read aloud the first situation in the Student Worksheets, with the students reading the situation for Role-Play #1 (The Party) along silently. Then read Your Dates lines out loud, as well. Tell the students that their job is to write lines for themselves in the blankslines that will help them say no in a powerful way. Remind them to use the Tools and Tips displayed on the newsprint to say no in a powerful and effective way.
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Once all the students have written their lines, ask them to work in pairs, with a student sitting near them. Have the students take turns playing out the scene, with one student playing Your Date, and the student who wrote the lines playing You. You should use all the Tools and Tips as effectively as possible. In addition to reading his or her lines, Your Date keeps track of which Tools and Tips You uses. When the students have finished the first role-play, have the student playing Your Date give You feedback about how effective You was in saying no. Which Tools and Tips did You use? Which did You use powerfully? Walk around the class to assure that the student pairs are on task, and offer praise and suggestions on their ways of saying no. Then, ask the students to switch roles and repeat the exercise, this time the other student plays You and uses the lines that he or she wrote. When the role-play is finished, the student playing Your Date gives feedback about how effective You was in saying no. When each student has had a chance to role-play his or her ways of saying no, and each pair has given each other feedback, ask for 1 or 2 volunteers to act out their lines for the rest of the class. If students are reluctant to volunteer, ask their partners (who role-played Your Date) to point out who they thought was very powerful and used the Tools and Tips well. Encourage them to explain what lines or techniques were particularly powerful.
Activity9.5 Wrapup5minutes
Ask the class as a whole for feedback about their experience with the role-play. Questions that may be helpful for discussion include: What do they think was the most effective Tool or Tip to use to say an effective and powerful no? What things did not work as well as they thought? What other Tips and Tools did they discover? What do they think was the most effective line that they heard? What made it so effective?
Congratulate the students on their acting ability, and thank them for their feedback. Let them know that in the next lesson, they will be able to practice sticking to their decision (and their limits) in a different role-play situation.
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ReferencesandEndnotes
1. In Texas, the Texas Family Code, Chapter 261 requires that suspected child abuse, including sexual abuse, be reported immediately. This can be done by calling the Texas Department of Family and Protective Services Child Abuse Hotline: 1-800252-5400, or by contacting local law enforcement. 2. Albert B. With One Voice 2007: Americas Adults and Teens Sound Off About Teen Pregnancy. Washington, DC: National Campaign to Prevent Teen Pregnancy, 2007.
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Facilitator Resource for Activity 9.2 Pressure Situation: Jasmine and Michael
Jasmine has had a crush on Michael for a long time, and she was really happy that he asked her out. This is their first time out together, and they have fun. Michael is smart and funny, and Jasmine really likes him. After they saw a movie, Michael brought her to his mothers house. When they got there, it was clear that nobody was home, and Jasmine and Michael were alone. They sit on the couch and kiss, and then Michael starts to undo Jasmines jeans. Jasmine is feeling very uncomfortable and confused. She likes Michael, and she likes feeling close to him, but she does not want to have sex. She starts to pull away, and Michael says, Whats the matter? Dont you love me? QUESTIONS: 1. Why do you think it might be hard for Jasmine to tell Michael she does not want to have sex?
2. How could Jasmine have avoided this pressure situation?
3. How would you advise Jasmine to say no to Michael?
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Facilitator Resource for Lessons 9 and 10 The Power to Say No: Tools and Tips
Say the Word: use the word no Use your Voice: say it strong and be clear that you mean it Use Body Language: stand up, move away, lean back, move his or her hand
Repeat It: say no again Say, I Dont: This lets the person know it is your decision not to do something
Suggest an Alternative: lets do something else instead Preserve the Relationship: with I like you, but I am not going against what I think is right
Turn the Tables: ask why the other person is pressuring you Leave the Area, if necessary
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Facilitator Resource for Activities 9.3 Pressure Situation Demonstration Role-Play Scripts
I. WEAK (Ineffective) Attempts to Say No
Michael (Assistant): Jasmine (Facilitator): Michael (Assistant): Jasmine (Facilitator): Michael (Assistant): Jasmine (Facilitator): Michael (Assistant): Jasmine (Facilitator): Whats the matter? Dont you love me? (shyly, looking down) Well, yeah. But I dont know about this I just want to be close to you. I want to be close to you too. But I am not sure. Come on. Everybody does it. Yeah, but I dont want to get in trouble. Is there something wrong with you? Im nervous. I am scared I would get pregnant.
II. POWERFUL Ways to Say No

Michael (Assistant): Jasmine (Facilitator): Michael (Assistant): Jasmine (Facilitator): Michael (Assistant): Jasmine (Facilitator): Michael (Assistant): Jasmine (Facilitator): Michael (Assistant): Whats the matter? Dont you love me? (standing with hands on hips, and firm voice) I like you, but I dont want to go any farther. I just want to be close to you. NO. I dont want to have sex. Come on. Everybody does it. NO, not me. I dont want to. Is there something wrong with you? I am fine. Lets go over to my house instead. We could play video games with my brother. OK. That would be OK, I guess.
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Student Worksheet for Activity 9.4 Role-Play #1 (The Party)
SITUATION: On Saturday night, you go to a party with someone that you really like.
There are no adults at the party, and everyone is drinking. You and your date dance and have a beer. Your date leads you into a bedroom, locks the door, and kisses you. Your date starts to lie down on the bed. You feel a little dizzy from the beer, and you are uncomfortable with the situation. You do not want to have sex. DIRECTIONS: Fill in the blanks with what you would say or do to say no: Your Date: Whats the matter? Come lie down. You: _____________________________________________________________________ Your Date: Come on, it will feel good. You: ____________________________________________________________________ Your Date: Dont you love me? You: ____________________________________________________________________ Your Date: I just want to get closer. Whats wrong with you? You: ____________________________________________________________________ Your Date: OK, OK, sorry. I didnt mean to pressure you like that.
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LESSON10
WRAPUPANDEVALUATION: HowDidWeDo?
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LESSON 10 Outline
WRAPUPANDEVALUATION: HowDidWeDo?
Objectives
MaterialsNeeded
Tools and Tips Newsprint Sheet from Lesson 9 Facilitator Resource for Lessons 9 and 10: The Power to Say No: Tools and Tips Student Worksheet for Activity 10.2: Role-Play #2 (After School) Student Worksheet for Alternate Activity 10.2: Role-Play #3 (In the Future) Post-Participation Questionnaires, pencils Master List of code numbers from the Pre-Participation Questionnaires Large envelope for completed Post-Participation Questionnaires Chalkboard, or Newsprint tablet, Markers, and Easel Ground Rules Newsprint Sheet from Lesson 1 KEY MESSAGES Poster from Lesson 1
Activities
10.1 -- Reinforcing Your Decision 5 to 10 minutes 10.2 -- Role-Play #2 (After School) or Role-Play #3 (In the Future) 15 minutes 10.3 -- Post-Participation Questionnaires 20 minutes
Facilitator Resource for Lessons 9 and 10: The Power to Say No: Tools and Tips Student Worksheet for Activity 10.2: Role-Play #2 (After School) Student Worksheet for Alternate Activity 10.2: Role-Play #3 (In the Future) Post-Participation Questionnaires for Activity 10.3
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LESSON10 WRAPUPANDEVALUATION: HowDidWeDo?

Objectives
MaterialsNeeded
Tools and Tips Newsprint Sheet from Lesson 9 Facilitator Resource for Lessons 9 and 10: The Power to Say No: Tools and Tips Student Worksheet for Activity 10.2: Role-Play #2 (After School) Student Worksheet for Alternate Activity 10.2: Role-Play #3 (In the Future) Post-Participation Questionnaires, pencils Master List of code numbers from the Pre-Participation Questionnaires Large envelope for completed Post-Participation Questionnaires Chalkboard, or Newsprint tablet, Markers, and Easel Ground Rules Newsprint Sheet from Lesson 1 KEY MESSAGES Poster from Lesson 1
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Overview of the Lesson This lesson begins with a summary and recap of the BIG DECISIONS program. It is not necessary or advisable to go into great detail about earlier lessons, however. The main task is to remind the students that: they have learned a lot; and they put it all together by making their (big) decision about how they will avoid pregnancy (until it is the right time for them) and how they will avoid HIV and other STDs.
The recap serves to re-set the stage for additional role-play practice in saying no. It is important that students have the opportunity for more practice in saying no effectively. Role-Play Scenarios Facilitators have two possible role-play scenarios from which to choose for Lesson 10. Role-play #2 (After School) presents a situation in which the student has decided to remain abstinent. Role-Play #3 (In the Future) focuses on saying no to sex without condoms and contraceptives. For this reason, Role-Play #3 may be preferred for use with groups of students who are likely to already be sexually active.
Role-Play #3 is constructed to avoid normalizing being sexual active during middle or high school years. This scenario does not assume that students are, have been, or will be sexually active. Moreover, it is set in the futureafter completing high school. In order to save enough time to complete the Post-Participation Questionnaires, it is recommended that only one Situation Role-Play (#2 or #3) be completed in this lesson. Post-Participation Questionnaires For evaluation purposes, it is important that all students have time to complete the Post-Participation Questionnaire.
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When preparing the Post-Participation Questionnaires for this lesson, each PostParticipation Questionnaire is assigned a code number. The facilitator should use the Master List, i.e., the Code Cards from Lesson 1, so that the PostParticipation Questionnaire with the correct code number is given to the correct student. If there is extra time during this lesson, it can be used to answer questions from earlier lessons, or to solicit feedback from the students.
Activity10.1 ReinforcingYourDecision5to10minutes
Ask the students to help you summarize the most important messages of the BIG DECISIONS lessons. If necessary, help the students come up with the main points of BIG DECISIONS:

Review with the students how in the BIG DECISIONS program they learned about: Body parts (Lesson 2) Relationships (Lesson 3) HIV and other STDs (Lesson 4) Abstinence (Lesson 5) Birth control methods to time pregnancy at the RIGHT time (Lesson 6) Influence (positive and negative) (Lesson 7) How pregnancy and disease might affect their Goals and Dreams (Lesson 8)
Remind them how, in Lesson 8, they made a decision of how they will avoid STDs, HIV, and pregnancy, so that they will have the best chance of reaching their goals and dreams. Then, in Lesson 9, they learned how to stick to their decision by setting limits. In that lesson, they learned how to say no in powerful and effective ways. They had a
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chance to practice saying no and sticking to their decision and their limits. And they also had a chance to get feedback about how powerful a no they gave, and how they used the Tools and Tips for a powerful no. Display the newsprint sheet of The Power to Say No: Tools and Tips developed in Lesson 9.
ACTIVITY10.2 RolePlay#2(AfterSchool)15minutes
Pass out the Student Handouts for the Role-Play #2 (After School). Let the class know that filling in this worksheet will help them be even more effective in saying no to something that would not be sticking to their decision. In this activity, they will write the lines to say no in this situation. Then, in pairs, they will practice saying no. Read aloud the situation in the Student Handout, with the students reading the situation for Role-Play #2 along silently. Then read Your Friends lines out loud, as well. Explain to the students that their job is to write lines for themselves (You) in the blankslines that will help them say no in a powerful way. Remind them to use the Tools and Tips displayed on the newsprint. Once all the students have written their lines, ask them to work in pairs, with a student sitting near them. Have the students take turns playing out the scene, with one student playing Your Friend, and the student who wrote the lines playing You. Again, in addition to reading his or her lines, Your Friend keeps track of which Tools and Tips You uses. When the students have finished the first role-play, have the student playing Your Friend give You feedback about how effective You was in saying no. Then, ask the students to switch roles and repeat the exercise, this time the other student plays You and uses the lines that he or she wrote. When the role-play is finished, the student playing Your Friend gives feedback about how effective You was in saying no. Congratulate the students on their acting ability, and their feedback to each other.
AlternateACTIVITY10.2 RolePlay#3(IntheFuture)15minutes
Pass out the Student Handouts for the Role-Play #3 (In the Future). Let the class know that filling in this worksheet will help them be even more effective in saying no to something that would mean not sticking to their decision. In this activity,
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they will write the lines to say no in this situation. Then, in pairs, they will practice saying no. Read aloud the situation in the Student Handout, with the students reading the situation for Role-Play #3 along silently. Then read Your Girlfriend/Boyfriends lines out loud, as well. Explain to the students that their job is to write lines for themselves (You) in the blankslines that will help them say no in a powerful way. Remind them to use the Tools and Tips displayed on the newsprint. Once all the students have written their lines, ask them to work in pairs, with a student sitting near them. Have the students take turns playing out the scene, with one student playing Your Girlfriend/Boyfriend, and the student who wrote the lines playing You. Again, in addition to reading his or her lines, Your Girlfriend/Boyfriend keeps track of which Tools and Tips You uses. When the students have finished the first role-play, have the student playing Your Girlfriend/Boyfriend give You feedback about how effective You was in saying no. Then, ask the students to switch roles and repeat the exercise. This time the other student plays You and uses the lines that he or she wrote. When the role-play is finished, the student playing Your Girlfriend/Boyfriend gives feedback about how effective You was in saying no. Congratulate the students on their acting ability, and their feedback to each other.
ACTIVITY10.3 PostParticipationQuestionnaire20minutes
Pass out the Post-Participation Questionnaires to each student, assuring that each student gets the Post-Participation Questionnaire with his or her correct Code Number, based on the Pre-Participation Questionnaire Code Numbers. Ask the students not to write their names on the Questionnaires, so that their answers can be confidential. Instruct the students on how to complete the Post-Participation Questionnaire. Let the students know that their thoughtful completion of the tests and questions will help give the facilitators important feedback about how they did, and about the lessons. When all the students have completed their Post-Participation Questionnaires, collect the papers, and thank the students for their participation and their feedback. If there is time, answer some questions, or invite students to discuss the PostParticipation Questionnaires or the lessons.
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Facilitator Resource for Lessons 9 and 10 The Power to Say No: Tools and Tips
Say the Word: use the word no Use your Voice: say it strong and be clear that you mean it Use Body Language: stand up, move away, lean back, move his or her hand
Repeat It: say no again Say, I Dont: This lets the person know it is your decision not to do something
Suggest an Alternative: lets do something else instead Preserve the Relationship: with I like you, but I am not going against what I think is right
Turn the Tables: ask why the other person is pressuring you Leave the Area, if necessary
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Student Worksheet for Activity 10.2 Role-Play #2 (After School)

SITUATION: You have talked and flirted with someone in your school who you really
like. You think this person (your friend) likes you, too, but you are not sure. You have decided that, in order to avoid pregnancy and HIV or other STDs, you are not going to have sex until at least after high school. After school, you go over to your friends house to work on a school project, and you two are alone. At first you think you should leave, but you dont want to look like a coward. You and your friend start kissing and hugging. You are excited and nervous, but you feel things are going too far and too fast.
DIRECTIONS: Fill in the blanks with what you would say or do to say no: Your Friend: This feels so good. Lets go to my bedroom. You: _____________________________________________________________________ Your Friend: Dont worry. Nothing bad will happen. You: _____________________________________________________________________ Your Friend: Everybody does it. Dont be weird. You: _____________________________________________________________________ Your Friend: Dont you care about me? You: _____________________________________________________________________ Your Friend: OK, I guess we have to stick to your decision.
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Student Worksheet for Activity10.2 Role-Play #3 (In the Future)

SITUATION: It is several years in the future, and you have graduated from high
school. You have gone out several times with someone, and you are starting to think of this person as your girlfriend/boyfriend. You are together at a party, dancing and having fun. Some couples have left the partyyou think these couples may have left the party to have sex. You have decided that, in order to avoid pregnancy and HIV or other STDs, you will not have sex without using both condoms and birth control. You do not have condoms, and you and your girlfriend/boyfriend have not talked about sex or birth control. You do not want to have sex without using both condoms and birth control.
DIRECTIONS: Fill in the blanks with what you would say or do to say no: Your Girlfriend/Boyfriend: Lets go find a place to be alone. You: _______________________________________________________________ Your Girlfriend/Boyfriend: Come on. Tonights the night! You: _______________________________________________________________ Your Girlfriend/Boyfriend: We dont need condoms or birth control. You: _______________________________________________________________ Your Girlfriend/Boyfriend: Just this once. Nothing bad will happen. You: _______________________________________________________________ Your Girlfriend/Boyfriend: All right. You really want to stick to your decision!
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Post-Participation Questionnaire
YOUR CODE NUMBER: _________ SCHOOL: _______________________________________ Class Period: ______________ Date: ______________
I am (circle one): I am (circle one):
Male
Female
Age: _______ Years Hispanic
Grade: _________ Other
White, not Hispanic
Strongly Disagree
Disagree
Please answer honestly. Your answers are CONFIDENTIAL.
1. Teens would be better off if they said no to sex. 2. Getting a sexually transmitted disease (STD) is not a big deal. 3. Right now, I really dont want to get pregnant (or get someone pregnant). 4. I would not have sex now because I do not want any chance of HIV or other STDs. 5. I would not have sex now because I do not want any chance of getting pregnant (or getting someone pregnant). 6. If used correctly every time, condoms can prevent HIV and other STDs. 7. Using contraceptives (birth control) correctly can lower the chance of pregnancy. 8. It is OK to pressure another person into having sex. 9. I plan to abstain from sex until I am older. 10. If someone pressured me to have sex, I am sure I could say no. 11. If I decide to have sex, I am sure I will use a condom every time. 12. If I decide to have sex, I am sure I will use a method of birth control every time. 13. The educators in the BIG DECISIONS classes had a positive impact on me.
14. Overall, the group sessions were (Circle One):
Horrible Bad OK Good
1 1 1 1 1 1 1 1 1 1 1 1 1
2 2 2 2 2 2 2 2 2 2 2 2 2
3 3 3 3 3 3 3 3 3 3 3 3 3
Great
15.
What did you LIKE about the program? _______________________________________________
____________________________________________________________________________________ 16. What did you DISLIKE about the program? _____________________________________________
____________________________________________________________________________________
THANK YOU for Your Answers!
Student Post-Participation Questionnaire for Activity 10.3

Lesson 10
Strongly Agree 4 4 4 4 4 4 4 4 4 4 4 4 4
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Agree
Please CIRCLE the answer that best matches how much you AGREE or DISAGREE.
PARENTSESSION
Parent Session
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Outline
PARENTSESSION:
Objectives
Describe what parents can do to help their children make healthy decisions about sex Learn 5 steps to use in talking to their children Practice talking with their children about sex If their child(ren) will be participating in BIG DECISIONS: o View the KEY MESSAGES and the Curriculum Outline o Have a chance to ask questions and to view the entire curriculum Ice-Breaker Quiz Handouts and Answer Sheets (English and Spanish) o or Parent Session PowerPoint presentation, with projection setup Parent Take-Home Handout (English and Spanish) Facilitator Resource for Activity P.5: Talking with Your Kids Demonstration RolePlay Facilitator Resource/Parent Handout for Activity P.5: Talking with Your Kids Role-Play (English and Spanish) Parent Session Evaluation Forms (English and Spanish) BIG DECISIONS materials for parents of participating students: O KEY MESSAGES Poster (English and Spanish) O Curriculum Outline (English and Spanish) O Sample Parent Letters (English and Spanish) O Sample Parent Consent Forms (English and Spanish) O One or two copies of the entire BIG DECISIONS Sexuality Curriculum Additional materials for parents, as available (see List of Resources for Parents)
MaterialsNeeded

Activities
P.1 -- Introduction and Ice-Breaker 10 to 15 minutes P.2 -- What Helps Young People Make Good Decisions about Sex? 5-10 minutes P.3 -- What Can Parents Do? 10 minutes P.4 -- The Messages in BIG DECISIONS 10 minutes P.5 - Practice Talking to Your Kids 20 to 30 minutes P.6 -- Wrap-Up and Evaluation 5 minutes
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Outline, Continued
PARENTSESSION:
Ice-Breaker Quiz Handouts and Answer Sheets (English and Spanish) Parent Take-Home Handout (English and Spanish) Facilitator Resource for Activity P.5: Talking with Your Kids Demonstration RolePlay Facilitator Resource/Parent Handout for Activity P.5: Talking with Your Kids Role-Play (English and Spanish) Parent Session Evaluation Forms (English and Spanish) BIG DECISIONS materials for parents of participating students: O KEY MESSAGES Poster (English and Spanish) O Curriculum Outline (English and Spanish) O Sample Parent Letters (English and Spanish) O Sample Parent Consent Forms (English and Spanish) List of Resources for Parents
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PARENTSESSION:
Objectives
Describe what parents can do to help their children make healthy decisions about sex Learn 5 steps to use in talking to their children Practice talking with their children about sex If their child(ren) will be participating in BIG DECISIONS: o View the KEY MESSAGES and the Curriculum Outline o Have a chance to ask questions and to view the entire curriculum Ice-Breaker Quiz Handouts and Answer Sheets (English and Spanish) o or Parent Session PowerPoint presentation, with projection setup Parent Take-Home Handout (English and Spanish) Facilitator Resource for Activity P.5: Talking with Your Kids Demonstration RolePlay Facilitator Resource/Parent Handout for Activity P.5: Talking with Your Kids Role-Play (English and Spanish) Parent Session Evaluation Forms (English and Spanish) BIG DECISIONS materials for parents of participating students: O KEY MESSAGES Posters (English and Spanish) O Curriculum Outline (English and Spanish) O Sample Parent Letters (English and Spanish) O Sample Parent Consent Forms (English and Spanish) O One or two copies of the entire BIG DECISIONS Sexuality Curriculum Additional materials for parents, as available (see List of Resources for Parents) List of Resources for Parents
MaterialsNeeded

AlsoIncluded:
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About the Parent Session This session contains both a Parent Orientation to the BIG DECISIONS curriculum, and also activities to assist and empower parents whose children are not participating in any program. This session can be used for either or both purposes, depending on which Activities are included. Facilitators are encouraged to use the Activities that are appropriate for their situation. Completing the activities other than Activity P.4 serves as a brief workshop for parents to learn effective strategies to talk to their children about sex. The entire set of Activities can be used together to supply both an orientation and a workshop. It is recommended that Parent Sessions be scheduled for a block of 2 hours, if possible. This allows parents to participate more fully in both the Introduction, and in the Role-Play activities. A minimum of 1 hours should be scheduled to complete the workshop. Please note that this session is not intended to be exclusively for parents. Some students may have grandparents or other relatives who fill in for their parents; others have foster parents or other adults in their lives. In this context, parents refers to all the caring adults that may attend such a session. Note also that parents of younger children can participate in these sessions, if desired. While the role-play exercises are designed for parents with young adolescents, parents also need to develop skills to talk to their elementary schoolage children. (Also, parents of teens may also have younger children.) The same principles (steps) can be applied to conversations with younger children, and guidelines for topics by age can be found in the Project WORTH parent guides, referenced in the Facilitators Resource. PowerPoint Presentation BIG DECISIONS offers a PowerPoint presentation for use with Parent Sessions, and the file can be downloaded at www.BIGDECISIONS.org. This presentation includes the basics of the Session in both English and Spanish, including: the Icebreaker Quiz; the 5 Steps for Talking; the two Situations for the role-play Activity; and the KEY MESSAGES posters.
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Ice-Breaker Quiz This lesson contains 4 Questions and Answers about teen sex and pregnancy that can be used as an Ice-Breaker, if desired. The Quiz is available as a Parent Handout for Activity P.1, with separate Quiz and Answer Sheet. The Quiz is also included in Spanish. The Ice-Breaker Quiz can also be projected using the PowerPoint presentation available at www.BIGDECISIONS.org. Facilitators may want to provide small prizes for correct answers. Parent Orientation Activity P.4 provides a brief orientation to the BIG DECISIONS curriculum. Included also are KEY MESSAGES posters in English and Spanish, as well as Curriculum Outlines in English and Spanish. Facilitators are encouraged to use other activities to allow participatory, active learning when possible. Parent engagement with their adolescent children is likely to increase the effectiveness of this curriculum, and the other Activities of the Parent Session can help parents feel empowered to communicate effectively with their teens.
ActivityP.1 IntroductionandIceBreaker10to15minutes
Introduce yourself and thank the parents for coming to the session. Let the parents know that the purpose of this session is to help them talk more effectively with their middle school and high school aged children about sex. The session will cover what parents can do to help their teenage children make healthy decisions about sex; and they will have an opportunity to practice, through role-playing, talking to their children about sex. Encourage the participants to ask questions and make comments as you go along in the session. If the session is also to provide an orientation for parents of participants in the BIG DECISIONS program, let the parents know that the session will also give them an overview of the BIG DECISIONS curriculum. Ice-Breaker Quiz: Using either the Parent Handouts (Quiz and later Answer Sheet), or the PowerPoint presentation, ask the parents to identify the correct answer for each of the Quiz questions. For each question, ask the group which they think is the answer, and allow a bit of discussion before citing the correct answer. If desired, provide small prizes for the first correct answer. Answer Sheets can be handed out, or provided as you pass out the Parent Handouts for the Session as a whole.
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How Did You Learn? Ask the participants to think about how they learned about sex, and what their parents or guardians told them. Ask if anyone wants to share their story with the group, and encourage several to speak. Telling and listening to one or two stories can help the group loosen up and feel more comfortable with the topic. Let the group know that many parents feel that they did not get enough information, especially from their own parents. A Difficult Topic: Acknowledge to the group that sex is a difficult topic for many parents and children. Many parents feel embarrassed to talk to their children about sex. And many teens feel embarrassed to talk to their parents about it, too. Sex is Everywhere: In todays media environment, sex is everywhereon TV, in movies, in video games, on the radio, and in ads. Our children are exposed to messages about sex constantly. Many teens today will learn about sex from the mediaand the messages are usually not very healthy. Silence is Too Risky: If we want our children to get healthy messages about sex, it is essential for parents to send those messages. That is why we have programs for parents (and sex education programs for teens)to give our children a healthy way to understand this important part of life. Start Early: It is important that young people learn about sexand how to make healthy decisionsBEFORE they are in a situation where they need the information. They need to be prepared for the decisions they will face. For this reason, parents should not wait until they know their children are having sex; they should start talking to their children before then.
ActivityP.2 WhatHelpsYoungPeopleMakeGoodDecisionsaboutSex?5to 10minutes

Let the group know that there has been lots of research and study to learn what works in helping young people make healthy decisions about sex. Go over with the group some of the things that help young people, including:
A close relationship with parents and family. This is one of the things that protect young people the most. Feeling connected to their school. A sense of belonging is very important for young people to want to make good decisions. A commitment to learning is a strong factor that helps young people avoid risky behavior. Parents are clear that they do not want their teenage children to have sex. Parents attitudes have a big effect on young people. Surveys of teenagers show
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that they list their parents more often than any other source as most influencing their decisions [1].
Feeling that they have a positive future and lots to offer their community. This gives young people reasons to make healthy decisions for themselves. Learning about condoms and contraception can help teens to delay sex. This information does not encourage them to have sex. This is important to understand because some people worry that information about contraceptives will give the message that it is OK to have sex. Many, many studies show that this does not happen [2, 4, 5]. In fact, programs that teach about both abstinence and contraceptives (Abstinence-Plus programs) that have been found effective in helping teens to delay sex and to use condoms, if they have sex.
ActivityP.3 WhatCanParentsDo?10minutes
Pass out the Parent Take Home Handouts in English and/or Spanish, as appropriate. Go over with the group some important things we know about what parents can do to help their children make healthy decisions about sex [3]. The following points are listed in the Parent Handouts, and are expanded on here so facilitators can explain and discuss each point: Show them you care Close relationships with parents protect teens. This means expressing your love for them, listening to them, supporting them, spending time with them, respecting them, and setting limits for them. It means talking with them about lots of thingsnot just sex.
Talk to your kids about sex (Participants will have a chance to practice this in Activity P.5) Talking is important for both boys and girls. Girls are the ones that can get pregnant, but boys are important in pregnancy too. Both girls and boys need to know why they should wait to become parents. And both boys and girls can get STDs. Boys and girls both need to know what their parents think about abstinence, sex, responsibility, and relationships. Be clear that you do not want them to have sexand tell them why you feel this way. It is good to give your opinion about what you think is right, as well as what is safe. Parents can say, I think, or in our family, we believe Let them know condoms and contraceptives are important for teens who do have sex. Half of high school-age students are sexually experienced, and they
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need to know how to reduce their risk of pregnancy and disease if they have sex. Parents can be reassured that information about contraceptives does not increase the chance that teens will have sex. The research is consistent and reassuring about this issue [2, 4, 5]. In fact, teens are often less likely to have sex if they receive information about contraceptives, as well as about abstinence. Supervise and monitor your teenage children Know where they are going and what they are doing. It is important to have rules and to let your children know what you expect of them. Parents should make sure their children are safe and that they have useful activities to do. Find out what they are watching and reading, and talk with them about it. Get to know their friends and their school. Friends have a big influence, and knowing their parents can help both families monitor their teens. Being involved in your childrens school gives them a message that education is important. Protect your children from sexual pressure and abuse. Some teens are forced or coerced into sex, and parents must be alert for clues to problems. Teach your teen to beware of date rape, to say no strongly, and to seek help in uncomfortable situations. Of course, too much supervision can backfire. Adolescents can rebel, especially if parents are too strict and authoritarian. Teenagers are learning to be more independent, and they need caring and reasonable rules and more responsibility as they grow.
Help them choose activities that will protect them Discourage dating older partners. Going out with someone 2 or more years older increases the risk that teens will have sex, get pregnant, or get a sexually transmitted disease (STD). Discourage working more than 20 hours/week. Teens who work more than 20 hours per week are at higher risk of having sex and becoming a parent. Encourage your daughter(s) to participate in sports. For females, especially, participating in sports can help them avoid risky behaviors.
Let the group know that there are many other factors that affect teens and their decisions about sex, but few factors are as powerful as parents.
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ActivityP.4 TheMessagesinBIGDECISIONS10minutes
Some parent sessions will be intended to give parents background about the BIG DECISIONS curriculum, especially for parents considering whether their children should participate in the program. Pass out the BIG DECISIONS materials for these parents: O O O O KEY MESSAGES Posters (English and Spanish) Curriculum Outline (English and Spanish) Parent Letters (English and Spanish) Parent Consent Forms (English and Spanish)
It is also useful to project the KEY MESSAGES Posters in English and/or Spanish. These are available as a PowerPoint slides at www.BIGDECISIONS.org. There should also be available one or two copies of the entire BIG DECISIONS Sexuality Curriculum for parents to view. The BIG DECISIONS program provides strong encouragement for young people to wait and not have sex, i.e., to choose abstinence. The program also gives young people basic contraceptive information that they need if they do become sexually active. The key messages of the BIG DECISIONS program for young people are:

Briefly go over the Curriculum Outline Handouts with the group. Point out that, in addition to abstinence and contraception, BIG DECISIONS helps teens learn about: Healthy Relationships Anatomy and Reproduction Sexually Transmitted Diseases (including HIV/AIDS) How to Recognize and Resist Influence How their Decisions might affect their Goals and Dreams How to Say No Effectively
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Review the Parent Letter and the Parent/Guardian Consent Form (samples of which are provided). Facilitators may want to ask parents to complete and turn in the Consent Form during the session.
ActivityP.5 PracticeTalkingtoYourKids20to30minutes
Let the participants know that many parents and guardians find it difficult to talk to their children about sex. Some of the reasons they give include:
Their parents didnt talk to them very much They dont know what to say They are afraid they wont know the answers to their childs questions They are embarrassed
Tell the participants that they will now have a chance to role-play, or practice, talking to their kids about sex. To help prepare for this exercise, go over the Steps for Talking in the Parent Handout: 1. Bring up the subject. This means starting the conversation, and letting your child know you want to talk about sex or a related subject. Many times it is easiest to use teachable moments: those times when the subject of sex comes up on television, in the news, or when a friend or family member has a pregnancy, for example. 2. Find out what your child thinks. It is important early in the conversation to ask your child questions and to listen to their point of view. Show respect for their feelings, even though you may tell them you disagree. 3. Give clear messages. This is a key part of the conversation. Give a clear and direct message, e.g.: I think you are too young right now to have sex. I want you to wait. If you do have sex, I want you to use condoms and birth control every time. Encourage parents to giving both messages (about waiting and about using condoms and birth control), and reassure them that these messages are compatible, and not conflicting [2, 4, 5]. Talking about birth control or condoms does not encourage young people to have sex. Project the BIG DECISIONS KEY MESSAGES Poster, which can be used as a model for parent messages. 4. Let your child know WHY you care. Explaining your concern about consequences is important. And parents messages are more powerful when children understand that parents love them and want the best for them.
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5. Keep the door open for more talking. Let your child know that you want to talk more in the future. And teens need to know that you will be there for them, no matter what. Some additional tips and guidelines for talking to their kids may be helpful. Write the key words on the board or newsprint as you review them, and encourage questions and discussion about each point: The Talk is not just one talk. It is a continuing conversation over many years. Parents should start early, and keep talking. Dont just talk. Listen. It is important to understand what your child is asking before you answer. Why is your child asking this questionwhat is he/she concerned about? Talk about your values. Its not just about the parts of the body and how they work. Children want to know what their parents think about sex, and why. Its OK to say I dont know. If you dont know the answer to a question, tell your child that you dont know, and offer to find out. Or look up the answer with your child. Tell your child what you DO know, and why you think it is important. You dont have to confess everything. If your child asks about what you did when you were their age, you dont have to answer in detail if you are not comfortable. You may want to let your child know that there are some decisions that you could have been better prepared for, and that you hope they are able to make healthy decisions.
Next, demonstrate the role-play activity. Pass out the Talking with Your Kids RolePlay Handouts. Have either a parent volunteer or a co-facilitator play the child, as the Facilitator plays the parent. Read Situation 1, and let the participants know that you will follow the 5 steps in the Directions in the Parent Handout. Do your best to have a conversation with your son or daughter. Use the Facilitator Resource, with its suggested lines for both the Parent and Child. After the demonstration role-play, lead a brief discussion about some of the tough issues facing this parent, including: Ask the parents about whether they think you should let your son or daughter go to the party. [There is no right answer, but setting appropriate limits should be reinforced by the Facilitator.] What things can you, as the parent, do to lower the chance your son or daughter will have sex at the party? [Answers might include talking to the
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parents of the party-giver; giving your child a curfew; driving/taking your son or daughter to the party yourself; inviting the friend over so you can get to know him or her; not letting your son or daughter go to the party at all. Other possibilities include making sure your son or daughter has good sex education; and rehearsing with him or her how to say no to advances, and to alcohol and drugs.] Now ask the parents to pair up so that each of them can practice role-playing a similar conversation. Ask them to refer to the Talking with Your Kids Role-Play Handouts, and to spend a few minutes trying to cover each of the 5 steps. Ask them to take turns playing the parent and the child. First, one of the pair plays the parent, and the other plays the child. Once they have completed the task, the child then gives the parent some feedback about how they thought the parent did. Give the pairs a few minutes to complete the task, and circulate through the room to offer suggestions and to assess progress. Remind the children to give the parents some feedback about how they did: How well did they cover each of the 5 steps? What did they do best? What do they need to work on?
When the pairs have completed this task, ask for feedback about how the exercise went. Were they able to cover the 5 steps? What was the most difficult thing to do? Do they feel that they were able to get their message across? Next, the players switch places, so that the person role-playing the child now roleplays the parent, and vice-versa. Once again, give the participants a few minutes to do the role-play and cover the 5 steps. Then remind the child to give the parent feedback. When the role-playing is complete, ask the group for additional feedback about how it went: What was the step that was the most difficult? What was easier than you thought? Did anything surprise you? What else do you need to do to prepare to have a similar conversation with your child?
If there is time, repeat the process for Situation 2. Based on how well the participants did with Situation 1, the Facilitator may decide to demonstrate the parent role in Situation 2, also.
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After the role-playing is complete, solicit additional feedback about how the participants thought they did, and whether they felt the activity was helpful to them.
ActivityP.6 WrapUpandEvaluation5minutes
Thank the parents for their participation, and answer any questions they might have. Distribute the Parent Evaluation Form, and ask each parent to fill it out and return it to the facilitator. At this time, the facilitator may also wish to collect the BIG DECISIONS Parent Consent Forms.
References
1. Albert B. With One Voice (lite). A 2009 Survey of Adults and Teens on Parental Influence, Abstinence, Contraception, and the Increase in the Teen Birth Rate. Washington, DC: National Campaign to Prevent Teen and Unplanned Pregnancy, 2009. 2. Kirby D. Emerging Answers 2007: Research Findings on Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases. Washington, D.C.: National Campaign to Prevent Teen Pregnancy, 2007. 3. Kirby D, Lepore G. Sexual Risk and Protective Factors. Factors affecting Teen Sexual Behavior, Pregnancy, Childbearing, and Sexually Transmitted Disease: Which Are Important? Which Can You Change? Washington, DC: National Campaign to Prevent Teen and Unplanned Pregnancy, November, 2007. 4. Kohler PK, Manhart LE, Lafferty WE. Abstinence-Only and Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy. Journal of Adolescent Health 2008; 42: 344-351. 5. Underhill K, Montgomery P, Operario D. Abstinence-Plus Programs for HIV infections prevention in high-income countries. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD007006.
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Parent Handout for Activity P.1 Ice-Breaker Quiz

Which is the correct answer? -------------------------------------------Q1. Teens say their decisions about sex are MOST influenced by: A. their friends B. television C. their parents D. their teachers -------------------------------------------Q3. Among teens who have had sex, how many say they wish they had waited longer before losing their virginity? A. B. C. D. about 1 in about 1 in about 1 in about 2 in 10 5 3 3
---------------------------------------------Q2. How many U.S. teen girls will have at least one pregnancy? A. 1 in 10 B. 1 in 5 C. 1 in 3 D. All of them
---------------------------------------------Q4. How many U.S. teen girls (14-19) have a sexually transmitted infection? A. 1 in 100 B. 1 in 10 C. 1 in 4 D. 1 in 2
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Parent Handout for Activity P.1 Ice-Breaker Quiz Answer Sheet

-------------------------------------------Q1. Teens say their decisions about sex are MOST influenced by: A. their friends B. television C. their parents D. their teachers Answer: C, their parents. 31% of teens surveyed said their parents most influenced them. Only 18% said friends; 7% said media; and 3% said teachers Source: National Campaign to Prevent Teen and Unplanned Pregnancy, With One Voice (lite) 2009. ---------------------------------------------Q2. How many U.S. teen girls will have at least one pregnancy? A. 1 in 10 B. 1 in 5 C. 1 in 3 D. All of them Answer: C: It is 31% (about 1 in 3). For Latinas, it is 53% (1 in 2) Sources: National Campaign to Prevent Teen and Unplanned Pregnancy. Fact Sheet: How is the 3 in 10 Statistic Calculated?, April 2008. National Campaign to Prevent Teen and Unplanned Pregnancy. A Look at Latinos. May 2008 ----------------------------------------------------------------------------------------Q3. Among teens who have had sex, how many say they wish they had waited longer before losing their virginity? A. B. C. D. about 1 in about 1 in about 1 in about 2 in 10 5 3 3
Answer: D. 60% say they wish they had waited Source: National Campaign to Prevent Teen and Unplanned Pregnancy, With One Voice 2007 ---------------------------------------------Q4. How many U.S. teen girls (14-19) have a sexually transmitted infection? A. 1 in 100 B. 1 in 10 C. 1 in 4 D. 1 in 2
Answer: C. 26% have at least one Sexually Transmitted Infection (STI) Source: CDC Press Release, 3/11/08
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Folleto para los Padres para la Actividad P.1 Quiz/Juego
Cual es las respuesta correcta? -------------------------------------------Q1. Los adolescentes dicen que sus decisiones sobre el sexo son MS influencidas por: A. sus amigos B. la televisin C. sus padres D. sus maestros -------------------------------------------Q3. Entre los adolescentes que han tenido relaciones sexuales, cuantos dicen que desean que haban esperados? A. ms o menos 1 en 10 B. ms o menos 1 en 5 C. ms o menos 1 en 3 D. ms o menos 2 en 3
---------------------------------------------Q2. Cuantas adolescentes en los E.E.U.U. tienen, por lo menos, un embarazo? A. 1 en 10 B. 1 en 5 C. 1 en 3 D. Todas
---------------------------------------------Q4. En los E.E.U.U., cuantas chicas de edad 14 a 19 tienen una infeccin de transmisin sexual? A. 1 en 100 B. 1 en 10 C. 1 en 4 D. 1 en 2
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Folleto para los Padres para la Actividad P.1 Quiz/Juego Hoja de Respuestas
-------------------------------------------Q1. Los adolescentes dicen que sus decisiones sobre el sexo son MS influencidas por: A. sus amigos B. la televisin C. sus padres D. sus maestros Respuesta correcta: C, sus padres. 31% dicen que los padres son lo mas importante; 18% dicen amigos; 7% dicen la media; 3% dicen los maestros Fuente: National Campaign to Prevent Teen and Unplanned Pregnancy, With One Voice (lite) 2009. ---------------------------------------------Q2. Cuantas adolescentes en los E.E.U.U. tienen, por lo menos, un embarazo? A. 1 en 10 B. 1 en 5 C. 1 en 3 D. Todas Respuesta correcta: C: Es 31% (ms o menos 1 en 3); para Latinas, es 53%, (1 en 2) Fuentes: National Campaign to Prevent Teen and Unplanned Pregnancy. Fact Sheet: How is the 3 in 10 Statistic Calculated?, April 2008. National Campaign to Prevent Teen and Unplanned Pregnancy. A Look at Latinos. May 2008 ----------------------------------------------------------------------------------------Q3. Entre los adolescentes que han tenido relaciones sexuales, cuantos dicen que desean que haban esperados? A. ms o menos 1 en 10 B. ms o menos 1 en 5 C. ms o menos 1 en 3 D. ms o menos 2 en 3 Respuesta correcta: D. 60% desean que haban esperados Fuente: National Campaign to Prevent Teen and Unplanned Pregnancy, With One Voice 2007 ---------------------------------------------Q4. En los E.E.U.U., cuantas chicas de edad 14 a 19 tienen una infeccin de transmisin sexual? A. 1 en 100 B. 1 en 10 C. 1 en 4 D. 1 en 2
Respuesta correcta: C: 26% tienen (por lo menos) una infeccin de transmision sexual Fuente: CDC Press Release, 3/11/08
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Parent HANDOUT (English)

WHAT CAN PARENTS DO? Show them you care Close relationships with parents protect teens Talk to your kids about sex Talking is important for boys as well as girls Be clear that you do not want them to have sexand why Tell them teens who have sex must use condoms and birth control Supervise your teenage children Know where they are going and what they are doing Get to know their friends and their school Protect your children from sexual pressure and abuse Too much supervision can backfire Help them choose activities that will protect them Discourage dating older partners Discourage working more than 20 hours/week Encourage your daughter(s) to participate in sports
STEPS for TALKING 1. 2. 3. 4. 5. Bring up the subject Find out what your child thinks Give clear messages Let your child know WHY you care Keep the door open for more talking
REMEMBER: Its not just one Talk Dont just talk. LISTEN to your child, too Talk about your VALUES Its OK to say I dont know
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FOLLETO Para Los Padres (Espaol)

QU PUEDEN HACER LOS PADRES? Hable con sus Hijos sobre el sexo Es importante hablar con los hijos, no solo con las hijas Sea claro de que n quiere que tengan sexo todavia y porqu Djeles saber que los condones y contraceptivos son importantes para los adolescentes que tienen sexo Supervise a su adolescente Sepa en dnde est y que est haciendo Conozca a sus amigos y a su escuela Proteja a sus nios de presin sexual y abuso Mucha supervisin puede fallar Aydeles a escoger actividades que los protejan Desanmelos de salir con personas mayores Desanmelos de trabajar mas de 20 horas por semana Anme a su(s) hija(s) de participar en deportes PASOS para HABLAR:
1. Saque el tema de las relaciones sexuales 2. Averigue qu piensa su hijo/a 3. Dle mensajes claros 4. Hgale saber a su hijo/a POR QU usted se preocupa 5. Deje la puerta abierta" para otras conversaciones
RECUERDE: No es solo una Charla Tambin es importante escuchar a su hijo/hija Hable sobre valores tambin Est bin no saber todo
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Facilitator Resource for Activity P.5 Talking with Your Kids Demonstration Role-Play Suggested lines for Situation 1 Step
1. Bring up the subject 2. Find out what your child thinks
Examples of Parent Lines

You know, I am thinking about that party you want to go to. I am worried. I dont know this friend of yours, and risky things can happen at parties. How are you feeling about it? Will his/her parents be there? What about alcohol? How will you protect yourself if someone pressures you about sex? What do you think about girls/boys your age having sex? Maybe those arent the right friends for you then. I just want you to know how I feel. I think you are too young to be having sex. I want you to waitat least until you are an adult. Of course, any teen who has sex must use protectionbut waiting is the best thing. I dont want you to get into a situation that could be dangerous. Having sex is a big decision, and its too important to let just happen. Your education is too important to be slowed down by a pregnancy. And I dont want you to get HIV or any other disease, either. I love you too much to see you get hurt. You know, you can ask me ANYTHING. I may not know the answer, but I will find it out. And I want you to understand that you can tell me anything, too. No matter what, you are my son/daughter, and I love you. If there are problems, we can work on them together.
Suggested Child Lines

You worry too much, Mom/Dad. It will be OK.
I dont know. I am a little nervous, but it will be OK. I dont really plan to have sex right now, but I dont know. You know, they make fun of virgins. Yeah, waiting is good. But I know these girls/guys who say its OK if you love somebody.
3. Give clear messages: Waiting is best Teens who have sex must use protection
4. Let your child know WHY you care
Ill be careful.
5. Keep the door open for more talking
Thanks, Mom/Dad. Good night.
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Facilitator Resource for Activity P.5 Talking with Your Kids Demonstration Role-Play Suggested lines for Situation 2 Step
1. Bring up the subject 2. Find out what your child thinks 3. Give clear messages: Waiting is best Teens who have sex must use protection 4. Let your child know WHY you care 5. Keep the door open for more talking
Examples of Parent Lines

You know, this show really upsets me. I dont like that these people hardly know each other, and they are already having sex. And there is no mention of birth control, or condoms! Do you think thats OK in real life? How does sex on TV affect young people, do you think? What do you think your friends think about this? Well, I dont want you to be jumping into bed with just anyone. Sex should be something shared between two people who are committed to each other. The best thing is to wait and not have sexat least until youre an adult. But if you do have sex, you should use protection, every single time. I dont want you to get a disease, or be a teen parent. I hope you have a more meaningful relationship than those characters on TV. You have more important things to do right nowlike school and sports. I remember having lots of questions about sex when I was your age. I hope I can give you better answers than my parents gave me. I want you to feel like you can talk to me about ANYTHING.
Suggested Child Lines

I guess they were just swept away.
I dont know. A lot of kids I know are already having sex. They say its no big deal. It seems like everybody expects us to have sex. Most people just want to have fun. I want to wait, but there is lots of pressure.
Dont worry. I wont get any disease. I wont get pregnant (or get anyone pregnant).
Um, thanks, Mom/Dad. I do have some questions. Can a person get pregnant their first time?
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Facilitator Resource/Parent Handout for Activity P.5 Talking with Your Kids Role-Play
Situation 1
Situation 1: Your 13-year old son or daughter wants to go to a party at a friends
house. You dont know this friend very well. You are worried because you think some of your childs friends may be having sex. One girl in your childs class is pregnant. Practice with another parent who pretends to be your child. As you talk with your child, try to cover the 5 Steps.
Situation 2
Situation 2: Your 14-year old son or daughter is watching a soap opera on TV. On
the show, there is a couple in bed with no clothes on. You decide this would be a good time to talk to your son or daughter about sex. Practice with another parent who pretends to be your child. As you talk with your child, try to cover the 5 Steps.
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Recurso para Facilitadores/Folleto para Padres para la Actividad P.5 Juego de Roles Hable con sus Hijos
Situacin 1
Situacin 1: Su hijo/a de 13 aos quiere ir a una fiesta en la casa de un amigo/a.
Usted no conoce muy bien a este amigo/a. Est preocupado porque piensa que es posible que algunos de los amigos de su hijo/a tengan relaciones sexuales. Una muchacha en la clase de su hijo/a est embarazada. Practique con otro padre/madre quien har de cuenta que es su hijo/a. A medida que habla con su "hijo/a", intente cubrir los 5 pasos.
Situacin 2
Situacin 2: Su hijo/a de 14 aos est mirando una telenovela en la televisin.
En el programa, hay una pareja sin ropa en la cama. Usted decide que ste es un buen momento para hablar con su hijo/a sobre las relaciones sexuales. Practique con otro padre/madre quien har de cuenta que es su hijo/a. A medida que habla con su "hijo/a", intente cubrir los 5 pasos.
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PARENT SESSION Evaluation Form

Location: _______________________________________ I am (circle one): Male Age Female Sex (M/F) Grade in School Date: ______________
My Children (please list from oldest to youngest):
I am (circle one): White, not Hispanic
Hispanic
Other
Please CIRCLE the answer that best matches how you feel. Please answer honestly. Your answers are CONFIDENTIAL. 1. After this session, I feel more confident about talking to my child about sex and relationships (circle one): Strongly Agree Agree Disagree Strongly Disagree 2. After this session, I will talk more with my child about sex and relationships (circle one): Strongly Agree Agree Disagree Strongly Disagree 3. Overall, this session was (circle one): Great Good OK Bad Horrible
4. Would you recommend this session to other parents (circle one)? Yes No 5. What did you LIKE about the session? _____________________________________ ______________________________________________________________________ 6. What did you DISLIKE about the session? __________________________________ ______________________________________________________________________
THANK YOU for Your Answers!
Parent Session Activity P.6 Evaluation Form

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SESIN PARA PADRES Formulario de Evaluacin

Localidad: _______________________________________ Soy (encierre uno con un crculo): Mis Hijo/a(s): Edad Sexo (M/F) Curso en la Escuela Masculino Fecha: ______________ Femenino
Soy (encierre uno con un crculo): Blanco, no hispano Hispano
Negro (Afro Americano)
Otro
Por favor MARQUE CON UN CIRCULO la respuesta que mejor describa su opinin. Por favor responda sinceramente. Sus respuestas son CONFIDENCIALES. 1. Despues de esta clase, tengo ms confianza en hablar con mi hijo/hija sobre relaciones romanticas y sexuales (encierre uno con un crculo): Totalmente de Acuerdo De Acuerdo En Desacuerdo Totalmente en Desacuerdo Despues de esta clase , hablar ms con mi hijo/hija sobre relaciones romanticas y sexuales (encierre uno con un crculo): Totalmente de Acuerdo De Acuerdo En Desacuerdo Totalmente en Desacuerdo En general, esta clase fue (encierre uno con un crculo): Excelente Muy buena OK Mala
2.
3.
Horrible
4.
Recomedaria esta clase a otros padres? (encierre uno con un crculo)? Si No Qu es lo que le gust de esta clase? _____________________________________ ______________________________________________________________________
5.
6.
Qu es lo que no le gust de esta clase? ___________________________________ ______________________________________________________________________ GRACIAS por sus Respuestas! Parent Session Activity P.6 Formulario de Evaluacin en Espaol
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KEY MESSAGES
KEY MESSAGES Poster
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MENSAJES CLAVES
Tener relaciones sexuales es una DECISIN GRANDE La ABSTINENCIA es la opcin ms saludable Adolescentes que tienen relaciones sexuales deben: usar CONDONES y ANTICONCEPTIVOS juntos Correctamente, CADA VEZ!
MENSAJES CLAVES Poster
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PARENT SESSION
Parent Session
Copyright 2006 - 2009 by Janet P. Realini, M.D., M.P.H. 241
1. REGLAS DEL JUEGO:

Crear un grupo respetuoso
Tomar el cuestionario antes de la participacin Dar una perspectiva general del curso Identificar el respeto como un valor clave para el grupo Establecer reglas bsicas para el grupo
Resumen del Curriculo

7. INFLUENCIAS: los amigos, la cultura,
los medios de comunicacin, y el sexo
Definir el trmino influencia y enumerar las cosas que influyen en los jvenes acerca del sexo Describir algunas influencias positivas de su cultura Identificar ejemplos de influencia de los medios de comunicacin y clasificarlos como positivos o negativos Describir cmo resistir a las influencias negativas acerca del sexo Imaginarse sus deseos para el futuro Entender cmo contraer un ETS o quedar embarazada afecta conseguir sus objectivos Personalizar los riesgos de tener un embarazo o una ETS Tomar su propia decisin personal de prevenir los embarazos y las ETS
2. ANATOMIA Y REPRODUCCIN:
Cmo funciona
Identificar los nombres y las funciones de las partes del cuerpo del hombre y la mujer Repasar cmo ocurre un embarazo Evaluar enunciados acerca de la reproduccin y determinar si son ciertas o falsas
3. LAS RELACIONES Y EL ROMANCE:

Qu es saludable? Qu es amor?
Identificar las caractersticas de las relaciones saludables y no saludables Considerar cmo tener relaciones sexuales puede causar problemas en las relaciones entre adolescentes. Aprender cmo la atraccin fsica (deseo) y el enamoramiento (encaprichamiento) son diferentes del amor maduro
8. DESEOS PARA EL FUTURO: Mi decisin

4. ENFERMEDADES DE TRANSMISIN
SEXUAL (ETS) (incluyendo VIH/SIDA)
Incrementar el conocimiento acerca de las ETS comunes, sus sntomas y posibles consecuencias Identificar maneras de cmo evitar contraer y propagar las ETS Reconocer la abstinencia como el mtodo ms efectivo para evitar las ETS. Conocer que los jovenes que han tenido el sexo requieren un anlisis de deteccin de ETS
9. EL PODER PARA DECIR NO:

Atenerme a mi decisin
Reforzar los estudiantes a las decisiones de cmo van a evitar el embarazo y las ETS Aprender que toda persona tiene el derecho a decir no Considerar formas efectivas para decir no cuando le presionen a tener relaciones sexuales Practicar decir no en situaciones de presin
10. CONCLUSIN Y EVALUACIN:

Cmo lo hicimos?
Enfatizar los mensajes claves y experiencias de las sesiones Obtener ms prctica en decir no Rellenar el Cuestionario Final
5. ABSTINENCIA: Por qu debo esperar?

Definir los trminos abstinencia y sexo Enumerar las ventajas de la abstinencia en los adolescentes Aprender que los adolescentes que escogen esperar merecen respeto Nombrar la razn(es) para esperar
6. ANTICONCEPTIVOS: Embarazo en el
momento adecuado
Considerar cuando es un buen tiempo para tener un embarazo Evaluar los mtodos anticonceptivos comnmente usados (incluyendo la abstinencia) por su efectividad para prevenir un embarazo (y las ETS) Reconocer que la abstinencia es la opcin ms saludable Comprender que las personas sexualmente activas deben tomar medidas para evitar un embarazo (y las ETS)
SESIN PARA PADRES

Describir como ayudar los jovenes que tomen decisiones saludables sobre el sexo Aprender los 5 pasos para hablar con los adolescentes Practicar hablar efectivamente con sus hijos/hijas sobre el sexo Si sus nio(a)s participarn en el programa GRANDES DECISIONES: o Examinar los mensajes claves y el resumen del curriculo o Tener la oportunidad de hacer preguntas sobre el programa
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Sample Parent Letter
Dear Parent/Guardian:
Date: ________________________
Your child has the opportunity to participate in BIG DECISIONS, a program designed to help young people make healthy and informed decisions about sex. BIG DECISIONS uses classroom activities to help students learn about healthy relationships and how bodies work. Students learn how sex has consequences, why abstinence is the best choice for teenagers, and how to resist pressure to have sex. They also learn about ways for sexually active people to reduce their chances of pregnancy and STDsincluding about birth control and condoms. Some schools and agencies include BIG DECISIONS Service-Learning lessons, too, ServiceLearning means young people do volunteer service so they can learn how they can help their community. BIG DECISIONS classes will plan, get ready for, and do community service work and then talk about their experiences. Students in the BIG DECISIONS program are expected to attend all the sessions, so they can get the programs full benefit. The lessons will occur on the following days & times: _____________________________________________________________________________________ In order to find out how well the program works to help young people, students will be asked to fill out a questionnaire at the beginning and at the end of the program. The lessons, activities, and questionnaires used in BIG DECISIONS are available for you to read on the internet (www.BIGDECISIONS.org) and also at the school or agency at: _______________________________ There will be a session for parents to learn more about BIG DECISIONS on _______ (date) at _____ (time) at ___________________ (location). We sincerely hope that you will come to this meeting. BIG DECISIONS recognizes that parents and families are essential to the success of young people, and we welcome your support and interest in the program. We hope you will sign and return the attached CONSENT FORM, so your child can participate in this important program. Sincerely,
The BIG DECISIONS Program Staff
FOR QUESTIONS CONTACT: ____________________________________________________________
Parent Session
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Ejemplo de Carta a los Padres
Fecha: ____________________ Estimado Padre/Guardin: Su hijo(a) tiene la oportunidad de participar en GRANDES DECISIONES, un programa designado para ayudar a la gente joven a hacer decisiones sanas e informadas sobre el sexo. GRANDES DECISIONES usa actividades en clase para ayudar a los estudiantes a aprender sobre relaciones sanas y como trabajan sus cuerpos. Los estudiantes aprenden cmo el tener sexo trae consecuencias, porqu la abstinencia es la mejor opcin para los adolescentes, y cmo resistir la presin de tener sexo. Ellos tambin aprenden modos entre gente que es sexualmente activa para reducir sus riesgos de un embarazo y enfermedades sexuales transmitidasincluso aprenden informacin sobre los condones y anticonceptivos. Algunas escuelas y agencias incluyen lecciones de Aprender-por-Servicio de GRANDES DECISIONES, tambin. Aprender-por-Servicio quiere decir que la gente joven hace servicio voluntario para aprender cmo pueden ayudar a su comunidad. Las clases de GRANDES DECISIONES planean, se alistan y prestan servicio comunitarioy luego hablan sobre sus experiencias. Se espera que los estudiantes del programa de GRANDES DECISIONES atiendan todas las sesiones, para que obtengan el mayor beneficio del programa. Las lecciones pueden ser en los siguientes das y horas: _______________________________________________________________________ Para saber qu tan bien est trabajando el programa para ayudar a la gente joven, se les pedir a los estudiantes que llenen un cuestionario al principio y al final del programa. Las lecciones, actividades, y cuestionarios usados en GRANDES DECISIONES estarn disponibles para que usted los lea en internet y tambin en la escuela o agencia en: ___________________ Habr una sesin para que los padres puedan aprender ms sobre GRANDES DECISIONES el ______ (da) a las _________ (horas) en __________________ (locacin). Sinceramente esperamos que atienda a esta junta. GRANDES DECISIONES reconoce que los padres y las familias son esenciales para el xito de la gente joven, y damos la bienvenida a su apoyo inters en el programa. Esperamos que usted firme y regrese la FORMA DE CONSENTIMIENTO adjunta, para que su nio(a) pueda participar en este importante programa. Sinceramente, El personal del Programa GRANDES DECISIONES PARA PREGUNTAS CONTACTE: _______________________________________________
244
Parent Session
Sample Consent Form
Parent/Guardian Consent Form

(Please Print All Information in Black Ink) Youths Name: _________________________________________________ Birth Date (MM/DD/YYYY): ____/___/________ Race/Ethnicity (circle one): African-American Gender (circle one): M / F
Anglo Hispanic Other
School: _______________________________________
Grade:________
Parent/Guardian (Name):_________________________________________ Address:______________________________________________________ Zip Code:_____________ Phone:___________________________
Yes, my child has my permission to participate in BIG DECISIONS as it is described in the BIG DECISIONS materials filed at the _________________ School/Agency. Also my child has permission to participate in the PreParticipation Questionnaire and the Post-Participation Questionnaire administered by the BIG DECISIONS staff. I also acknowledge that I am the parent or legal guardian of this child participant and I am able to execute this consent form. My signature on this form means that I have read and understood the information regarding this program and agree that my child may participate.
I also give permission for my child to participate in the Service-Learning activities of BIG DECISIONS (if those are provided) and for my child to be transported by school vehicles, if needed, for Service-Learning activities (if those are provided).
No, my child does not have my permission to participate in BIG DECISIONS.
Parent/Guardian Signature:_______________________________________ Date: _______________
Parent Session
245
Ejemplo de Forma de Consentimiento de los Padres
Forma de Consentimiento para Padre/Guardian

(Por Favor Use Letra de Imprenta en Tinta Negra) Nombre del Joven: _____________________________________________ Fecha de Nacimiento (M/D/A): ____/____/____ Raza/Etnicidad (marque uno): Africo-Americano(a) Sexo (marque uno): M / F Anglo Hispano Otro
Escuela: ________________________________ Grado: _______________ Nombre del Padre/Guardian: ______________________________________ Direccin: ____________________________________________________ Cdigo Postal: ____________ Telfono: ____________________________
S, mi hijo(a) tiene mi permiso de participar en GRANDES DECISIONES tl como se describe en el material de GRANDES DECISIONES archivado en la escuela o agencia __________________________. Tambin mi nio(a) tiene permiso de participar en los cuestionarios antes de la participacin y despus de la participacin, administrada por el personal de GRANDES DECISIONES. Tambin concuerdo que soy el padre o guardin legal de este nio(a) participante y puedo ejecutar este consentimiento. Mi firma en sta forma comprueba que he ledo y entendido mi informacin sobre este programa y estoy de acuerdo en que mi nio(a) participe.
Tambin doy permiso para que mi nio(a) participe en las actividades de aprender-por-servicio (si son ofrecidas), y que mi nio(a) sea transportado(a) en transporte escolar si se necesita para actividades de aprender-por-servicio (si son ofrecidas).
No, mi nio(a) no tiene permiso de participar en el programa GRANDES DECISIONES.
Firma del Padre/Guardian: _______________________________________ Fecha ________________________________________
246
Parent Session
Parent Session: List of Resources for Parents

1. Talking to Your Kids about SexProject WORTH Parent Guides, available in English and Spanish, at www.sanantonio.gov/projectworth/pdf/Brochure3sm.pdf and www.sanantonio.gov/projectworth/pdf/Brochure%20span2sm.pdf. 2. Materials from the National Campaign to Prevent Teen and Unplanned Pregnancy, available at: www.thenc.org
How Can Parents Talk to their Teens?/Como Pueden Hablar los Padres con sus Hijos Adolescentes? 10 Tips for Parents Parent Power El poder de los Padres Consejos a los padres para prevenir el embarazo en la adolescencia Talking Back: What Teens want Adults to Know about Teen Pregnancy Los Jovenes Responden: Diez Cosas que Desean que los Adultos Sepan sobre el Embarazo en la Adolescencia Parents Matter: Tips for Raising Teenagers
3. Search Institute: The 40 Developmental Assets

English version available at: www.search-institute.org/assets/40AssetsList.pdf. Available in Spanish at: www.search-institute.org/assets/40AssetsSpanish.pdf.
4. Journeyworks brochures, available at www.Journeyworks.com, for example:

Teaching Your Teen about Sexual Responsibility Encouraging Abstinence: Ten Tips for Parents (English and Spanish)
Parent Session
247
APPENDICES
1. 2. 3. 4. LOGICMODELS:Rationalebehindthe Curriculum HANDLINGQUESTIONS:AdviceforFacilitators TEXASHEALTHREQUIREMENTS:Coverageof theTexasEssentialKnowledgeandSkills(TEKS) ABOUTTHEAUTHOR
Appendices
249
Appendix 1A. BDI Logic Model for BIG DECISIONS Student Component Intervention Components
Consistent message that whether to be sexually active is a BIG DECISION that requires taking responsibility to reduce the risk of unplanned pregnancy and STDs Group discussion that highlights the costs of pregnancy, including effects on goals, relationships, and on the baby Group discussion that highlights the costs of STDs, including effects on goals, health, romantic relationships, and potentially on babies Highlight positive cultural influences
Corresponding Items on the PostParticipation Questionnaire in Blue
Individual Determinants
Behaviors
Goals
Increase motivation to avoid pregnancy Q3, STDs/HIV Q2 (I, #, C, P, STD)
Delay Initiation of sex (I)
Reduce teen pregnancy rates (P)
Increase positive attitudes about waiting to having sex (decrease permissive attitudes) (I, #) Q1 Increase perception that personal benefits of abstaining outweigh costs, and personal costs of having sex outweigh benefits (I) Q4, Q5 Increase Condom (& contraceptive) use among sexually active (C)
Caring facilitators endorsement of abstinence (waiting) as the best option Group discussions that recognize waiting as a viable (& increasingly popular) option Lesson that highlights waiting as a positive part of a healthy romantic relationship Group exercises that highlight the advantages of abstinence Reinforce attitudes of respect for teens who wait to have sex
Increase positive attitudes towards condoms/contraceptives for sexually active people(C) Increase perceived benefits & fewer costs/barriers to condoms/contraceptives for sexually active people (C) Q6, Q7
Reduce rates of teen STDs & HIV (STD)
Group exercise showing the likelihood of pregnancy with sex, abstinence, and condoms/contraception Group exercise to examine the risk of STDs with abstinence, condoms, and other contraceptive methods
Bolded letter codes indicate strong evidence that the factor influences the behavior or goal, per Kirby D, et al, 2005.
250 Appendix 1
Appendix 1A, cont. BDI Logic Model for BIG DECISIONS Student Component Intervention Components
Class discussions to identify situations which might lead to sex (or to unprotected sex if a person were sexually active) Develop scripts to say no to sex (and to sex without condoms and contraceptives, if a person were sexually active) Practice role-plays in saying no to sex (and to sex without condoms/contraceptives, if a person were sexually active)
Corresponding Items on the PostParticipation Questionnaire in Blue
Individual Determinants
Increase self-efficacy and skills to refuse sex (I, #, C) (Q9) Q10 Increase self-efficacy to refuse sex without condoms/contraceptives, if sexually active (C) Q11, Q12
Behaviors
Goals
Delay initiation of sex (I)
Facilitators and class foster an atmosphere of respect and acceptance Facilitators and class encourage participation for all students Service-Learning project is included when possible
Increase feeling of connectedness to school (I, #, P) Q13 Increase Condom (& contraceptive) use among sexually active (C) Reduce rates of teen STDs & HIV (STD)
Facilitator expresses disapproval of sexual abuse and coercion Exercises clarify that sexual coercion and abuse are not part of healthy romantic relationships Lessons are clear that abused people are not at fault, and that there is help for people who have been abused Facilitators are caring and helpful, and can refer students for additional services
Reduce likelihood of sexual abuse and coercion (I, #, C, P) Q8
Appendix 1
251
Appendix 1B: BDI Logic Model for BIG DECISIONS PARENT COMPONENT Intervention Components Inform parents how they can help their children postpone sexual involvement and avoid teen pregnancy and STDs Provide materials to help parents help their children postpone sexual involvement and avoid teen pregnancy and STDs Individual Determinants
Reinforce conservative parental attitudes about teens having sex (I, #)
Behaviors
Goals
Reinforce support for contraceptives for teens who have sex (I, #)
Delay initiation of sex (I)
Increase parent-child communication about sex, condoms, and contraception (I, C, #)
Increase parental support and family connectedness (I, P)
Increase parental supervision and monitoring (not excessively) (I, #, P)
Give parents guidance on talking effectively with their children about sex Practice Role-Plays of talking effectively with their children about sex
Discourage older partners (I, P)
Encourage daughters involvement in sports (I,C,P)
Protect children from sexual abuse and coercion (I, #, P)
Increase Condom (& contraceptive) use among sexually active (C)
Reduce rates of STDs & HIV in teens (STD)
252
Appendix 1
APPENDIX2 HANDLINGQUESTIONS: SuggestionsforFacilitators

A key component of BIG DECISIONS is forming a learning group based on respect, where each member feels they belong. Young people must feel they can express themselves and ask questions about issues that concern themwithout fear of ridicule or criticism. It is normal for adolescents to be concerned and have questions about their bodies and about sex, as well as about other sensitive topics. Sensitive issues concerning sexuality, drug use, depression, and violence may arise in the group discussions. In addition, youth who trust the facilitators may bring up sensitive questions or topics individually.
SuggestionsforAnsweringStudentQuestions:
Acknowledge the importance of the issue and the fact that it is normal for adolescents to be concerned about the issue. In addressing the issue, provide facts and emphasize health, respect, and good decisionmaking. When possible, involve the group in answering questions and help them to apply the principles of healthy relationships and good decision-making. Answer questions age-appropriately. Early adolescents need simpler, more concrete answers. Answer the question the best you can. Honesty is important. If you dont know the answer, say so. When possible, offer to find out the answer to a question and report back to the group. The facilitator should maintain a non-judgmental atmosphere, so that the group will remain a safe place for honesty and appropriate sharing.
Appendix 2
253
Encourage young people to discuss their concerns with a parent/guardian, or other trusted family member. Facilitators should not answer questions about their personal life. Let the students know that they can also speak to you privately outside of group sessions.
IfaStaffMemberBecomesAwareofaProblem:
Give appropriate advice and make appropriate referrals. Young people who are involved in risky behaviors, are depressed or potentially suicidal, or in need of medical care or counseling, should be referred to appropriate agencies. Young people who already have a relationship with a health care provider can be encouraged to seek help from that provider. Again, young people should be encouraged to discuss their problems with a parent or guardian, if possible.
Confidentiality:
In general, professional facilitator ethics require that adolescent concerns be kept confidential. However, facilitators are required by law to report to appropriate authorities if they become aware of or suspect child abuse (including sexual abuse), or if the young person seems to be a danger to him/herself or others. In Texas, suspected child abuse should be reported to the Texas Department of Family and Protective Services, 1-800-252-5400 or local law enforcement.
WaystoEncourageAskingQuestions
The primary way to encourage students to ask the questions that are on their minds is to create a safe and respectful atmosphere in the classroom. When Facilitators actively ask for questions during the lessons and respond in a positive and nonjudgmental fashion, students will be likely to ask questions in class. It is often difficult for the Facilitator to limit the time spent in answering questions so that the lesson materials can be covered. A balance between addressing questions and covering the material is important to achieve. Even in a carefully constructed environment, however, students may be reluctant or embarrassed to ask certain questions. Facilitators should consider offering the following additional methods for students to ask questions:
Index Cards: Students can be given blank index cards at the beginning of a lesson, and then encouraged to write any questions they have on them. At the end of the lesson,
254
Appendix 2
cards can be placed in an envelope or box, and the Facilitator can answer the questions at the end of the lesson, or the beginning of the next lesson. In order to protect confidentiality and reduce the chance that a student will not feel free to ask a question, some Facilitators prefer to ask every student to write something on a card (even if it is I have no questions) and deposit the card into an envelope or box.
Question Box: Facilitators can place a Question Box in a consistent location in the classroom and encourage students to drop written questions into the box. The box should be constructed so that students cannot easily remove the submitted questions. Facilitators should try to answer all the questions during a class, if possible. If a Question Box is used, the Facilitator should include a brief orientation to its use in LESSON 1. In addition, it is helpful to remind students about the Question Box in subsequent lessons. Office Hours: Facilitators can also offer Office Hours when students can come to talk individually with the Facilitator. Office Hours can be held before or after school, or during lunch periods, and should be held in a room or office that offers confidentiality for a conversation. Office Hours should be posted and/or announced in the classroom, to allow students the ability to plan to use them.
Appendix 2
255
APPENDIX3: TEXASHEALTH REQUIREMENTS:Coverage oftheTexasEssential KnowledgeandSkills(TEKS)

Appendix 3
257
BIG DECISIONS
Chapter 115. Texas Essential Knowledge and Skills for Health Education BIG DECISIONS Sexuality Curriculum (2009)
8th Grade
LESSON 1 TEKS 115.23(b) LESSON 2 LESSON 3 LESSON 4 LESSON 5
ABSTINENCE
1 of 4
LESSON 6
CONTRACEPTION
LESSON 7
INFLUENCE
LESSON 8
GOALS & DREAMS
LESSON 9
THE POWER TO SAY "NO"
LESSON 10
WRAP-UP & EVALUATION
SEXUALLY RULES OF THE ANATOMY & RELATIONSHIPS TRANSMITTED GAME REPRODUCTION & ROMANCE DISEASES
Health information. The student comprehends ways to enhance and maintain personal health throughout the life span. The student is expected to:
analyze the interrelationship of physical, (1)(A) mental, and social health identify and describe types of eating (1)(B) disorders such as bulimia, anorexia, or overeating identify and describe lifetime strategies for prevention and early identification of disorders such as depression and anxiety that may lead to long-term disability describe the life cycle of human beings including birth, dying, and death Health information. The student recognizes ways that body structure and function relate to personal health throughout the life span. The student is expected to:
(1)(C)
(1)(D) 2
explain how differences in growth patterns (2)(A) among adolescents such as onset of puberty may affect personal health (2)(B) (2)(C) describe the influence of the endocrine system on growth and development compare and contrast changes in males and females X
describe physiological and emotional (2)(D) changes that occur during pregnancy (2)(E) 3 examine physical and emotional development during adolescence Health information. The student comprehends and utilizes concepts relating to health promotion and disease prevention throughout the life span. The student is expected to:
explain the role of preventive health measures, immunizations, and treatment in (3)(A) disease prevention such as wellness exams and dental check-ups analyze risks for contracting specific diseases based on pathogenic, genetic, age, cultural, environmental, and behavioral factors
(3)(B)
distinguish risk factors associated with (3)(C) communicable and noncommunicable diseases summarize the facts related to Human (3)(D) Immunodeficiency Virus (HIV) infection and sexually transmitted diseases 4 X X
Health information. The student knows how to research, access, analyze, and use health information. The student is expected to: X X
use critical thinking to analyze and use (4)(A) health information such as interpreting media messages (4)(B) develop evaluation criteria for health information
258
X denotes that the lesson addresses the TEKS item, completely or partially
Appendix 3
BIG DECISIONS
2 of 4
8th Grade
ABSTINENCE
LESSON 6
CONTRACEPTION
LESSON 7
INFLUENCE
LESSON 8
GOALS & DREAMS
LESSON 9
LESSON 10
(4)(C) (4)(D) 5
demonstrate ways to use health information to help self and others discuss the legal implications regarding sexual activity as it relates to minor persons Health behaviors. The student engages in behaviors that reduce health risks throughout the life span. The student is expected to:
analyze and demonstrate strategies for (5)(A) preventing and responding to deliberate and accidental injuries (5)(B) describe the dangers associated with a variety of weapons X X X X X X X
identify strategies for prevention and (5)(C) intervention of emotional, physical, and sexual abuse (5)(D) identify information relating to abstinence analyze the importance of abstinence from sexual activity as the preferred choice of behavior in relationship to all sexual activity for unmarried persons of school age
(5)(E)
discuss abstinence from sexual activity as the only method that is 100% effective in preventing pregnancy, sexually transmitted (5)(F) diseases, and the sexual transmission of HIV or acquired immune deficiency syndrome, and the emotional trauma associated with adolescent sexual activity demonstrate basic first-aid procedures (5)(G) including Cardiopulmonary Resuscitation (CPR) and the choking rescue explain the impact of chemical dependency (5)(H) and addiction to tobacco, alcohol, drugs and other substances relate medicine and other drug use to communicable disease, prenatal health, (5)(I) health problems in later life, and other adverse consequences identify ways to prevent the use of tobacco, (5)(J) alcohol, and other drugs such as alternative activities (5)(K) apply strategies for avoiding violence, gangs, weapons and drugs explain the importance of complying with (5)(L) rules prohibiting possession of drugs and weapons 6
Influencing factors. The student understands how physical and social environmental factors can influence individual and community health throughout the life span. The student is expected to:
Appendix 3
259
BIG DECISIONS
3 of 4
8th Grade
ABSTINENCE
LESSON 6
CONTRACEPTION
LESSON 7
INFLUENCE
LESSON 8
GOALS & DREAMS
LESSON 9
LESSON 10
relate physical and social environmental (6)(A) factors to individual and community health such as climate and gangs describe the application of strategies for controlling the environment such as (6)(B) emission control, water quality, and waste management 7
Influencing factors. The student investigates positive and negative relationships that influence individual, family, and community health. The student is expected to:
analyze positive and negative relationships that influence individual and community health such as families, peers, and role models develop strategies for monitoring positive (7)(B) and negative relationships that influence health (7)(A) 8
Influencing factors. The student researches ways in which media and technology influence individual and community health throughout the life span. The student is expected to: explain the role of media and technology in influencing individuals and community health such as watching television or reading a newspaper and billboard explain how programmers develop media to influence buying decisions Influencing factors. The student understands how social factors impact personal, family, community, and world health. The student is expected to:
(8)(A)
(8)(B) 9
describe personal health behaviors and (9)(A) knowledge unique to different generations and populations describe characteristics that contribute to (9)(B) family health 10 (10)(A)
Personal/interpersonal skills. The student recognizes and uses communication skills in building and maintaining healthy relationships. The student is expected to: X X X X
differentiate between positive and negative peer pressure describe the application of effective coping (10)(B) skills distinguish between effective and ineffective (10)(C) listening such as paying attention to the speaker versus not making eye-contact summarize and relate conflict (10)(D) resolution/mediation skills to personal situations (10)(E) appraise the importance of social groups 11 (11)(A)
X X
Personal/interpersonal skills. The student understands, analyzes, and applies healthy ways to communicate consideration and respect for self, family, friends, and others. The student is expected to: X X X X X
describe techniques for responding to criticism demonstrate strategies for coping with (11)(B) problems and stress
260
Appendix 3
BIG DECISIONS
4 of 4
8th Grade
ABSTINENCE
LESSON 6
CONTRACEPTION
LESSON 7
INFLUENCE
LESSON 8
GOALS & DREAMS
LESSON 9
LESSON 10
describe strategies to show respect for (11)(C) individual differences including age X X X differences describe methods of communicating (11)(D) X emotions describe the effect of stress on personal and (11)(E) X family health describe the relationships between emotions (11)(F) and stress Personal/interpersonal skills. The student analyzes information and applies critical-thinking, decision-making, goal-setting and problem-solving skills for making health-promoting decisions. The student is 12 expected to: interpret critical issues related to solving (12)(A) health problems (12)(B) relate practices and steps necessary for making health decisions X X X X X X X X X X X X X
X X
X X X X
appraise the risks and benefits of decision(12)(C) making about personal health predict the consequences of refusal skills in (12)(D) various situations examine the effects of peer pressure on (12)(E) decision making develop strategies for setting long-term (12)(F) personal and vocational goals (12)(G) demonstrate time-management skills
Appendix 3
261
BIG DECISIONS
1 of 5
Chapter 115. Texas Essential Knowledge and Skills for Health Education BIG DECISIONS Sexuality Curriculum (2009) 9th - 10th Grade
LESSON 1 TEKS 115.32(b) LESSON 2 LESSON 3 LESSON 4
SEXUALLY TRANSMITTED DISEASES
LESSON 5
ABSTINENCE
LESSON 6
CONTRACEPTION
LESSON 7
INFLUENCE
LESSON 8
GOALS & DREAMS
LESSON 9
LESSON 10
RULES OF THE ANATOMY & RELATIONSHIPS GAME REPRODUCTION & ROMANCE
1 (1)(A) (1)(B)
Health information. The student analyzes health information and applies strategies for enhancing and maintaining personal health throughout the life span. The student is expected to: relate the nation's health goals and objectives to individual, family, and community health
examine the relationship among body composition, diet, and fitness explain the relationship between nutrition, (1)(C) quality of life, and disease describe the causes, symptoms, and (1)(D) treatment of eating disorders (1)(E) (1)(F) examine issues related to death and grieving
discuss health-related social issues such as organ donation and homelessness (1)(G) analyze strategies to prevent suicides examine causes and effects of stress and (1)(H) develop strategies for managing stress and coping with anxiety and depression describe the importance of taking responsibility for establishing and implementing health maintenance for individuals and family members of all ages
(1)(I)
2 (2)(A)
Health information. The student is health literate in disease prevention and health promotion throughout the life span. The student is expected to: analyze the relationship between health promotion and disease prevention
analyze the influence of laws, policies, and (2)(B) practices on health-related issues including those related to disease prevention identify, describe, and assess available health(2)(C) related services in the community that relate to disease prevention and health promotion develop and analyze strategies related to the (2)(D) prevention of communicable and noncommunicable diseases 3
Health information. The student recognizes the importance and significance of the reproductive process as it relates to the health of future generations. The student is expected to:
explain fetal development from conception (3)(A) through pregnancy and birth explain the importance of the role of prenatal care and proper nutrition in promoting optimal (3)(B) health for both the baby and the mother such as breast feeding analyze the harmful effects of certain substances on the fetus such as alcohol, (3)(C) tobacco, other drugs, and environmental hazards such as lead
262
Appendix 3
BIG DECISIONS
2 of 5
LESSON 5
ABSTINENCE
LESSON 6
CONTRACEPTION
LESSON 7
INFLUENCE
LESSON 8
GOALS & DREAMS
LESSON 9
LESSON 10
(3)(D) 4 (4)(A)
explain the significance of genetics and its role in fetal development Health information. The student investigates and evaluates the impact of media and technology on individual, family, community, and world health. The student is expected to: X
analyze the health messages delivered through media and technology explain how technology has impacted the (4)(B) health status of individuals, families, communities, and the world 5 (5)(A) (5)(B) Health information. The student understands how to evaluate health information for appropriateness. The student is expected to: develop evaluation criteria for health information demonstrate ways to utilize criteria to evaluate health information for appropriateness discuss the legal implications regarding sexual activity as it relates to minor persons demonstrate decision-making skills based on health information
X X
(5)(C) (5)(D) 6 (6)(A)
Health behaviors. The student assesses the relationship between body structure and function and personal health throughout the life span. The student is expected to: X X X X
examine the effects of health behaviors on body systems relate the importance of early detection and (6)(B) warning signs that prompt individuals of all ages to seek health care appraise the significance of body changes (6)(C) occurring during adolescence 7
Health behaviors. The student analyzes the relationship between unsafe behaviors and personal health and develops strategies to promote resiliency throughout the life span. The student is expected to:
analyze the harmful effects of alcohol, tobacco, drugs, and other substances such as physical, mental, social, and legal consequences explain the relationship between alcohol, tobacco, and other drugs and other substances used by adolescents and the role these substances play in unsafe situations (7)(B) such as Human Immunodeficiency Virus (HIV)/Sexually Transmitted Disease (STD), unplanned pregnancies, and motor vehicle accidents develop strategies for preventing use of (7)(C) tobacco, alcohol, and other addictive substances analyze the importance of alternatives to drug (7)(D) and substance use analyze and apply strategies for avoiding (7)(E) violence, gangs, weapons, and drugs (7)(A)
Appendix 3
263
BIG DECISIONS
3 of 5
LESSON 5
ABSTINENCE
LESSON 6
CONTRACEPTION
LESSON 7
INFLUENCE
LESSON 8
GOALS & DREAMS
LESSON 9
LESSON 10
(7)(F)
analyze strategies for preventing and responding to deliberate and accidental injuries X X
analyze the relationship between the use of (7)(G) refusal skills and the avoidance of unsafe situations such as sexual abstinence analyze the importance and benefits of abstinence as it relates to emotional health and the prevention of pregnancy and sexuallytransmitted diseases analyze the effectiveness and ineffectiveness of barrier protection and other contraceptive methods including the prevention of Sexually Transmitted Diseases (STDs), keeping in mind the effectiveness of remaining abstinent until marriage analyze the importance of healthy strategies that prevent physical, sexual, and emotional abuse such as date rape analyze the importance of abstinence from sexual activity as the preferred choice of behavior in relationship to all sexual activity for unmarried persons of school age discuss abstinence from sexual activity as the only method that is 100% effective in preventing pregnancy, sexually transmitted diseases, and the sexual transmission of HIV or acquired immune deficiency syndrome, and the emotional trauma associated with adolescent sexual activity X
(7)(H)
(7)(I)
(7)(J)
(7)(K)
(7)(L)
Influencing factors. The student analyzes the effect of relationships on health behaviors. The student is expected to: evaluate positive and negative effects of various relationships on physical and emotional health such as peers, family, and friends
(8)(A)
explain the benefits of positive relationships (8)(B) among community health professionals in promoting a healthy community 9 Influencing factors. The student differentiates between positive and negative family influences. The student is expected to: X X
describe the roles of parents, grandparents, (9)(A) and other family members in promoting a healthy family analyze the dynamics of family roles and (9)(B) responsibilities relating to health behavior 10 Influencing factors. The student evaluates the effect of a variety of environmental factors on community and world health. The student is expected to:
264
Appendix 3
BIG DECISIONS
4 of 5
LESSON 5
ABSTINENCE
LESSON 6
CONTRACEPTION
LESSON 7
INFLUENCE
LESSON 8
GOALS & DREAMS
LESSON 9
LESSON 10
(10)(A) (10)(B) (10)(C) 11
assess the impact of population and economy on community and world health analyze the impact of the availability of health services in the community and the world describe a variety of community and world environmental protection programs Influencing factors. The student understands how to access school and community health services for people of all ages. The student is expected to:
research various school and community health services for people of all ages such as (11)(A) vision and hearing screenings and immunization programs compare and analyze the cost, availability, (11)(B) and accessibility of health services for people of all ages 12
Influencing factors. The student understands situations in which people of all ages require professional health services. The student is expected to:
identify situations requiring professional (12)(A) health services for people of all ages such as primary, preventive, and emergency care (12)(B) 13 (13)(A) (13)(B) (13)(C) (13)(D) (13)(E) (13)(F) (13)(G) 14 (14)(A) explain how to access health services for people of all ages
Personal/interpersonal skills. The student analyzes, designs, and evaluates communication skills for building and maintaining healthy relationships throughout the life span. The student is expected to: demonstrate communication skills in building and maintaining healthy relationships distinguish between a dating relationship and a marriage analyze behavior in a dating relationship that will enhance the dignity, respect, and responsibility relating to marriage evaluate the effectiveness of conflict resolution techniques in various situations demonstrate refusal strategies explore methods for addressing critical-health issues evaluate the dynamics of social groups X X X X X X
Personal/interpersonal skills. The student analyzes, designs, and evaluates strategies for expressing needs, wants, and emotions in healthy ways. The student is expected to: demonstrate strategies for communicating needs, wants, and emotions X X X X
examine the legal and ethical ramifications of (14)(B) unacceptable behaviors such as harassment, acquaintance rape, and sexual abuse (14)(C) 15 communicate the importance of practicing abstinence
Personal/interpersonal skills. The student appraises communication skills that show consideration and respect for self, family, friends, and others. The student is expected to:
Appendix 3
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BIG DECISIONS
5 of 5
LESSON 5
ABSTINENCE
LESSON 6
CONTRACEPTION
LESSON 7
INFLUENCE
LESSON 8
GOALS & DREAMS
LESSON 9
LESSON 10
apply communication skills that demonstrate (15)(A) consideration and respect for self, family, and X X X X others (15)(B) demonstrate empathy towards others X analyze ways to show disapproval of (15)(C) X X X inconsiderate and disrespectful behavior Personal/interpersonal skills. The student synthesizes information and applies critical-thinking, decision-making, and problem-solving skills for making health-promoting decisions throughout the life span. The student is 16 expected to: (16)(A) identify decision-making skills that promote individual, family, and community health X X X X X X X X
summarize the advantages of seeking advice (16)(B) and feedback regarding the use of decisionmaking and problem-solving skills classify forms of communication such as passive, aggressive, or assertive associate risk-taking with consequences such (16)(D) as drinking and driving (16)(C) 17 (17)(A)
Personal/interpersonal skills. The student applies strategies for advocating and evaluating outcomes for health issues. The student is expected to:
research information about a personal health concern demonstrate knowledge about personal and (17)(B) family health concerns develop strategies to evaluate information (17)(C) relating to a variety of critical health issues
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Appendix 3
BIG DECISIONS
1 of 4
Chapter 115. Texas Essential Knowledge and Skills for Health Education BIG DECISIONS Sexuality Curriculum (2009) 11th to 12th Grade
LESSON 1 TEKS 115.33(c) LESSON 2 LESSON 3 LESSON 4
LESSON 5
ABSTINENCE
LESSON 6
CONTRACEPTION
LESSON 7
INFLUENCE
LESSON 8
GOALS & DREAMS
LESSON 9
LESSON 10
Health information. The student applies technology to analyze and appraise personal health. The student is expected to: generate a personal-health profile using appropriate technology such as stress reduction, body fat composition, and nutritional analysis X X
(1)(A)
(1)(B) explain how technology can influence health 2 (2)(A)
Health information. The student researches and analyzes information in the management of health promotion and disease prevention. The student is expected to: investigate various sources in the community that promote health and prevent disease
(2)(B) design health promotion materials 3 (3)(A) Health information. The student investigates the importance and significance of the reproductive process as it relates to the health of future generations. The student is expected to: analyze problems during various stages of fetal development investigate the role of prenatal care and proper nutrition in promoting optimal health for both the baby and the mother such as breast feeding describe the harmful effects of certain substances on the fetus such as alcohol, tobacco, environmental hazards such as lead, and other drugs analyze roles of relationships and responsibilities relating to marriage analyze behavior in romantic relationships that enhance dignity, respect, and responsibility
(3)(B)
(3)(C)
(3)(D) (3)(E) 4
X X X X
Health information. The student evaluates the validity of health information. The student is expected to:
research current health-related standards related to health information and products (4)(A) from valid sources such as the Centers for Disease Control and Prevention and the Food and Drug Administration analyze health information based on health(4)(B) related standards evaluate the impact of laws relating to the use (4)(C) of medication, alcohol, tobacco, and other drugs/substances 5 (5)(A) (5)(B) 6 Health information. The student describes the effect of marketing and advertising on health behavior. The student is expected to: analyze marketing and advertising techniques in health-product and service promotion apply marketing and advertising techniques to health promotion Health information. The student evaluates and utilizes communication skills in building and maintaining healthy relationships. The student is expected to: X
Appendix 3
X denotes that the lesson addresses the TEKS item, completely or partially.
267
BIG DECISIONS
2 of 4
LESSON 5
ABSTINENCE
LESSON 6
CONTRACEPTION
LESSON 7
INFLUENCE
LESSON 8
GOALS & DREAMS
LESSON 9
LESSON 10
(6)(A)
apply effective communication skills for building and maintaining healthy relationships design strategies for implementing effective conflict resolution/mediation strategies present a model for effective communication skills
(6)(B) (6)(C) 7 (7)(A)
Health behaviors. The student generates strategies that address health-risk behaviors. The student is expected to:
participate in school-related efforts to address health-risk behaviors develop a plan to participate in community (7)(B) efforts to address health-risk behaviors develop educational-safety models for (7)(C) children and adults for use at home, school, and in the community (7)(D) evaluate the impact of laws relating to tobacco, alcohol, drugs and other substances
(7)(E) investigate treatment plans for drug addiction describe the interrelatedness of alcohol and other drugs to health problems such as drugs (7)(F) and date rape, Human Immunodeficiency Virus (HIV)/Sexually Transmitted Disease (STD), and drinking and driving 8
Influencing factors. The student researches and evaluates a variety of environmental factors that impact personal and community health. The student is expected to:
analyze the impact of environmental factors such as air, water, or noise on the health of (8)(A) the community such as air pollution affecting asthma and drought conditions affecting water supplies formulate strategies for combating (8)(B) environmental factors that have a detrimental effect on the health of a community develop strategies for aiding in the (8)(C) implementation of a community environmental health plan 9 Influencing factors. The student assesses the impact of the economy on community and world health. The student is expected to: X
relate economic status to availability of health (9)(A) services within the community analyze health care costs of various health (9)(B) services in different countries 10
Influencing factors. The student recognizes the importance of personal contributions to the health of the community. The student is expected to:
268
Appendix 3
BIG DECISIONS
3 of 4
LESSON 5
ABSTINENCE
LESSON 6
CONTRACEPTION
LESSON 7
INFLUENCE
LESSON 8
GOALS & DREAMS
LESSON 9
LESSON 10
research and/or participate in community health programs that benefit various (10)(A) populations such as volunteering for teen health lines and volunteering in nursing homes participate in a presentation to educate others about a variety of health issues such as panel (10)(B) discussions and role plays or skits to inform younger students about the dangers of drug use or smoking Influencing factors. The student understands issues related to community health services. The student is expected to: 11 analyze how the cost, availability, and (11)(A) accessibility of health-care services affects the community evaluate how the selection of health care (11)(B) services, products, and information affects the community 12 Influencing factors. The student investigates technological advances in the community that impact the health of individuals, families, and communities. The student is expected to: describe technological advances available in the community that treat health problems such as medical procedures at local hospitals for treating heart disease and cancer locate health care facilities at which members of the community can obtain medical care X X
(12)(A)
(12)(B) 13 (13)(A) (13)(B)
Personal/interpersonal skills. The student analyzes, designs, and evaluates strategies for expressing needs, wants, and emotions in healthy ways. The student is expected to: create and apply strategies for communicating emotions, needs, and wants X X X X
demonstrate leadership skills for advocating health investigate and summarize current laws relating to unacceptable behaviors such as (13)(C) harassment, acquaintance and statutory rape, and sexual abuse create strategies that promote the advantages (13)(D) of abstinence 14
Personal/interpersonal skills. The student evaluates communication skills that show consideration and respect for self, family, friends, and others. The student is expected to: X X X X X X X X X X
appraise effective communication skills that (14)(A) demonstrate consideration and respect for self, family, and others associate effective communication with (14)(B) success in school and the workplace explain the detrimental effects of (14)(C) inconsiderate and disrespectful behavior (14)(D) apply criteria for using passive, aggressive, and assertive communication in relationships
Appendix 3
269
BIG DECISIONS
4 of 4
LESSON 5
ABSTINENCE
LESSON 6
CONTRACEPTION
LESSON 7
INFLUENCE
LESSON 8
GOALS & DREAMS
LESSON 9
LESSON 10
(14)(E)
analyze the importance of abstinence from sexual activity as the preferred choice of behavior in relationship to all sexual activity for unmarried persons of school age
discuss abstinence from sexual activity as the only method that is 100% effective in preventing pregnancy, sexually transmitted (14)(F) diseases, and the sexual transmission of HIV or acquired immune deficiency syndrome, and the emotional trauma associated with adolescent sexual activity 15 (15)(A)
Personal/interpersonal skills. The student synthesizes information and applies strategies for making health-promoting decisions. The student is expected to: X X X X X X X X
apply decision-making skills to healthpromoting decisions interpret information provided by parents and (15)(B) other adults determine causal connections that promote (15)(C) health in relationships 16
Personal/interpersonal skills. The student applies strategies for advocating and evaluating outcomes for health issues. The student is expected to:
research information regarding personal and (16)(A) family health concerns (16)(B) design materials for health advocacy apply the concept of research and evaluation (16)(C) for determining health information for special populations
Appendix 3
269
APPENDIX4: AbouttheAuthor
JanetP.Realini,M.D.,M.P.H.
isarecognizedleaderinteenandunplanned pregnancypreventioninTexas.Dr.Realinihasa passionforyoungpeople,andherdedicationto helpingteens,parents,andyoungadultsledherto establishHealthyFutures,thenewnonprofit organization. Dr.Realinireceivedhermedicaldegreeatthe UniversityofCaliforniaSanFranciscoandher MastersinPublicHealthfromtheUniversityof TexasSchoolofPublicHealth.Shecompletedher FamilyMedicineresidencyattheUniversityof TexasHealthScienceCenteratSanAntonioandis boardcertifiedinFamilyMedicine.Dr.Realini servesasClinicalProfessorofFamilyand CommunityMedicineattheUTHSCSAandAdjunctProfessorofPublicHealthatthe UTSPH. Afterasuccessfulcareerinacademicfamilymedicine,Dr.Realiniserved10yearsas theMedicalDirectoroftheSanAntonioMetropolitanHealthDistrictFamilyPlanning Program.AtSAMHD,shefoundedtheCityofSanAntoniosteenpregnancy preventionprogram,ProjectWORTH. Dr.RealiniisalsotheauthorofBIGDECISIONS,aTexasfriendlyAbstinencePlus teensexeducationprogram,whichshegivesawayfreeontheinternet.AsofFall 2009,BIGDECISIONSisbeingimplementedin7Texasschooldistricts,aswellas numerouscommunityagencies. AsPresidentofHealthyFutures,Dr.Realiniprovidesleadershipandsupportforthe HealthyFuturesAlliance(HFA),acommunitycoalitiondedicatedtoreducingteen andunplannedpregnancy.Dr.Realinishonorsincludethe2008PublicHealthAward fromtheAmericanAcademyofFamilyPhysicians,andthe2002LewisW.Mondy AwardforoutstandingservicefromtheWomensHealthandFamilyPlanning AssociationofTexas.ShealsoservesontheBoardofDirectorsoftheTexasCampaign toPreventTeenPregnancy,aswellasontheAdvisoryGrouponStateandLocal ActionoftheNationalCampaigntoPreventTeenandUnplannedPregnancy.
Appendix 4
271

BIG DecisionsCurriculum

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Making Healthy, Informed Choices about Sex

By Janet P. Realini, M.D., M.P.H.

Copyright 2006 - 2009 by Janet P. Realini, M.D., M.P.H.

Illustrations by Lea Hernandez

Document of External Origin

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Document of External Origin

1. RULES OF THE GAME: Forming a Respectful Group

Sexuality Curriculum Outline

2. ANATOMY AND REPRODUCTION: How it Works

3. RELATIONSHIPS AND ROMANCE: What is Healthy? What is Love?

8. GOALS AND DREAMS: My Decision

4. SEXUALLY TRANSMITTED DISEASES (including HIV/AIDS)

9. THE POWER TO SAY NO: Sticking to My Decision

5. ABSTINENCE: Why Should I Wait?

10. WRAP-UP AND EVALUATION: How Did We Do?

6. CONTRACEPTION: Pregnancy at the RIGHT Time

Have a chance to ask questions and to view the entire curriculum

Copyright 2006 - 2009 by Janet P. Realini, M.D., M.P.H.

Curriculum of Outline Document External Origin

1. REGLAS DEL JUEGO:

Resumen del Curriculo

3. LAS RELACIONES Y EL ROMANCE:

8. DESEOS PARA EL FUTURO: Mi decisin

9. EL PODER PARA DECIR NO:

10. CONCLUSIN Y EVALUACIN:

5. ABSTINENCIA: Por qu debo esperar?

SESIN PARA PADRES

Copyright 2006 - 2009 by Janet P. Realini, M.D., M.P.H.

vi Document of External Origin

Document of External Origin

Copyright 2009 Janet P. Realini, MD, MPH

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Document of External Origin

Document of External Origin

ABSTINENCE is the healthiest choice

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Document of External Origin

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How to Use This Curriculum

Document of External Origin

Document of External Origin

How to Use This Curriculum

How to Use This Curriculum

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Document of External Origin

How to Use This Curriculum

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Document of External Origin

Document of External Origin

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LESSON1 RULESOFTHEGAME: FormingaRespectfulGroup

Notes for Facilitators