Tucker 2006.

Methods	Controlled before and after study. Data were collected at baseline (2001) and two years later (2003). Collaborating partners Lead agency: Local health board. Strategic involvement (policy making and service planning): Health Board. Commissioning (implementing strategy taking account of resources available): Health Board and the Local Education Authority. Operational (providing services directly): Health promotion, Local Education Authority and voluntary agencies. Set in UK.
Participants	Secondary school Year 3 and 4 students (average age 14 years and 6 months) from all 10 Healthy Respect SHARE schools in Lothian region (intervention schools) and 5 comparison schools in Grampian region, with standard sexual health education programmes. In 2001 of 5237 eligible children 2760 (80%) responded in Lothian and 1564 (87%) responded in Grampian. In 2003, of 5193 eligible children 2796 (83%) responded in Lothian and 1583 (86%) responded in Grampian.
Interventions	Ten schools implemented the Sexual Health And Relationships Education (SHARE) project developed as part of the Healthy Respect programme through a partnership between health, education and voluntary sector agencies in the Lothian Health Board region. The programme involved multidisciplinary staff training, planned multidisciplinary classroom delivery by teachers and nurses, alongside access to sexual health services at drop‐in centres for pupils located in or close to schools.
Outcomes	Primary outcomes were self‐reported sexual intercourse at <16 years, and knowledge, attitudes and intentions about sexually transmitted diseases and condom use: knowledge that sexually transmitted infections (STI) might be asymptomatic belief that condom use reduces the chance of contracting an STI belief that condoms are effective in preventing HIV/AIDS belief in planning protection from STIs before sex no embarrassment about using a condom no belief that condoms reduce sexual enjoyment no belief that condoms are too expensive self‐efficacy: easy to get a condom self‐efficacy: easy to use a condom intention to discuss use of condoms with partner intention to obtain own condoms.
Notes	Power calculations suggested they needed 2700 participants in the intervention schools and 1350 in the control schools, which they achieved. Service provision was noted as patchy. Drop‐in centres were available in Grampian, but were not linked to schools. Evaluation report notes that a relatively small proportion of young people in the intervention (Lothian) catchment (about 20%) were actually exposed to it.  Although the paper's title refers to Healthy Respect, it only looks at one aspect of this demonstration project: SHARE (Sexual Health and Relationships Education). The authors concluded that these findings raise questions about the likely and achievable sexual health gains for teenagers from school‐based interventions. It appears that phase 2 of this project is currently being evaluated. See interim report: http://www.healthscotland.com/uploads/documents/8835‐Evaluation%20of%20HRPhase2Interim.pdf Exact costs unclear though additional costs for training and new drop‐in centres. Overall risk of bias was 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	High risk	No blinding
Incomplete outcome data (attrition bias) All outcomes	Low risk	not applicable
Selective reporting (reporting bias)	Low risk	No published protocol but the paper is specific that changes were made following previous study and that pre‐defined questions were used in the evaluation. Only 5/17 potential comparison schools agreed to participate and these may have been more confident in their sexual education services.
Other bias	High risk	Authors note some limitations lack of classroom observation to explore the actual implementation of the new programme and possible selection bias arising from both volunteer schools in Lothian and low recruitment of schools in Grampian.
Randomisation adequately described/protected?	High risk	not applicable
Protection against contamination?	Low risk	Some practices may have leaked to control schools.
Follow‐up rate adequate?	Low risk	Follow‐up at population level. Different students surveyed at each round (high school years 3 and 4 in 2001 and again in 2003). Response rate in first survey (2001) was 83% (80% in intervention schools and 87% in control schools). Response rate to the second survey (2003) was 84% (83% in intervention schools and 86% in control schools).
Reliable primary outcome measure?	Low risk	As good as could be arranged for this topic.
Groups measured at baseline?	Low risk	Groups not balanced.
Appropriate choice of controls (CBA studies only)?	High risk	Through no fault of the study team. Potential for selection bias. Only 5/17 potential comparison schools agreed to participate and these may have been more confident in their sexual education services.  Some difference in baseline socio‐demographic variables. Where differences were significant (e.g. accommodation, religion, parental education and employment) they were adjusted for in the multivariate models.
Contemporaneous data collection (CBA studies only)?	Low risk	No contemporaneous data collection is identified in the paper.
IS THE STUDY AT LOW RISK OF BIAS?	High risk	OVERALL RISK OF BIAS WAS HIGH