Smylie 2008.

Methods	A controlled before after trial run in schools (3 study and 3 control) in February 2005 and evaluated one month following the end of the programme. Collaborating partners Lead agency: Health Strategic involvement (policy making and service planning): public health, education, community organisations Commissioning (implementing strategy taking account of resources available): public health, education, community organisations Operational (providing services directly): secondary care health professionals, local authorities (teachers, social services) community organisations, peers. Set in Canada
Participants	427 Grade Nine students from six public schools participated in the programme, of which 240 (intervention = 124; control = 116) who had parental consent took part in the evaluation. Public schools in Windsor‐Essex County, Ontario were invited to participate and six principals responded. Three schools were designated as intervention and three as controls. Male 138 (42% intervention group, 74% control group)
Interventions	The intervention extended aspects of the basic sex education curriculum to cover areas in more depth. The in‐school classed‐ based learning consisted of a five‐session sexual health education programme covering anatomy and physiology of the reproductive system, STIs, HIV, building safe and healthy relationships and a teen panel discussion with personal stories from a teen mom, a teen dad and an HIV positive individual.  The sessions were delivered by a public health nurse, a health promoter from the local AIDS Committee and a social worker from the local Sexual Assault Crisis Centre.  A newsletter on teens interacting with parents about sexuality was distributed to parents and students and a workshop was run for parents to help them become more confident and approachable to their children in discussing matters of sexual health with them. Concerns and questions raised by the students through the course were incorporated directly into the programme and questions posted anonymously in a question box were answered daily through the programme. The programme was run in the intervention schools in February 2005 and evaluation completed by April 2005, following which the intervention was implemented in the control schools.  Baseline was measured in the intervention and control groups at the same time and immediately before the start of the programme.
Outcomes	Outcomes were measured one month after the end of the programme. Follow‐up data was obtained on 117 intervention and 116 control group students. However, results for the intervention group are only presented for the 95 students (81%) who reported attending at least one of the five classes. There were no primary outcomes on behaviour change. Secondary outcomes known to be associated with behaviour change were measured including knowledge of STI and HIV prevention, effectiveness and correct use of contraceptives,  risks of pregnancy (22 items) ; birth control attitudes (four items); contraceptive agency (four items); communication with others (six items); awareness of sexual response (three items); sex role attitudes (four items); sexual interaction values (five items).
Notes	The method of allocation of schools is not given. The total number of schools invited to participate is not given. 22 intervention group students responding to the follow‐up questionnaire reported not attending any class‐based sessions and their data are omitted from the results. However, the intervention included newsletter and workshop for the parents, which may have had an impact on those students who had not attended any class‐based sessions.  The routine sex education curriculum is usually delivered by physical education teachers and varied in time spent and style of delivery, whereas the intervention programme was highly structured. Overall risk of bias high
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	High risk	No concealment
Blinding (performance bias and detection bias) All outcomes	Low risk	No blinding at assessment but questionnaires were completed by students themselves so lack of blinding is unlikely to have affected the results.
Incomplete outcome data (attrition bias) All outcomes	High risk	Results for all items appear to be presented. As 95 of the 117 intervention students responding at follow‐up (81%) indicated that they had attended at least one class (78 attended all five classes), follow‐up results are only presented for these 95, not the full 117, though their results were available.
Selective reporting (reporting bias)	High risk	Follow‐up data on 22 students in the intervention group were not reported as they had not attended any class‐based sessions.
Other bias	Low risk	Good overall follow‐up rate and high rate of attendance at classes.
Randomisation adequately described/protected?	High risk	Not randomised
Protection against contamination?	Low risk	Intervention delivered in selected schools.
Follow‐up rate adequate?	Low risk	Adequate
Reliable primary outcome measure?	High risk	No primary outcome measure was possible as it was seen to be inappropriate to include questions on actual student sexual behaviour so measures associated with behaviour change were used.
Groups measured at baseline?	Low risk	Yes
Appropriate choice of controls (CBA studies only)?	Low risk	Yes
Contemporaneous data collection (CBA studies only)?	Low risk	Yes
IS THE STUDY AT LOW RISK OF BIAS?	High risk	OVERALL RISK OF BIAS WAS HIGH