Peer-led health education in school is widely used. Advocates suggest it is an effective method based on the belief that information, particularly sensitive information, is more easily shared between people of a similar age. Critics suggest that this is a method not based on sound theory or evidence of effectiveness. This review evaluates school-based health education programmes which have set out to compare the effects of peers or adults delivering the same material. The identified studies indicated that peer leaders were at least as, or more, effective than adults. Although this suggests that peer-led programmes can be effective, methodological difficulties and analytical problems indicate that this is not an easy area to investigate, and research so far has not provided a definitive answer.

There are, and have been, many school-based sex education projects in this country which have used peer leaders (students delivering an educational programme who are of similar, or slightly older, age than the students receiving the programme). Rigorous evaluation of the methodology remains scant. This paper describes a comparative investigation of peer-led and adult-led sex education in National Curriculum Year 9 (aged 13/14 years). The results from this study suggest that peer leaders appear to be more effective in establishing conservative norms and attitudes related to sexual behaviour than the adults. Peer leaders were less effective than adults in imparting factual information and getting students involved in classroom activities. These findings suggest that both adult-led and peer-led methods may have a place in effective sex education--the challenge being to determine which areas are best dealt with by whom.

Objectives-To develop and teach a school sex education programme that will lead to a decrease in sexual activity.Design-A matched internal and external control experiment, comparing control populations which received their own sex education programmes with populations which received a novel sex education intervention that included medical and peer led teaching.Setting-Comprehensive secondary schools; control and intervention populations within Devon, and distant controls from rural, semiurban, and urban areas of England excluding major conurbations.Subjects-Schoolchildren were taught from age 12 to 16; three successive cohorts of students were evaluated in school year 11 (mean age 16.0).Main outcome measures-Questionnaire conducted under "examination conditions" and invigilated by the research team and other trained medical staff. Results-In the intervention population, progressive increase in knowledge related to contraception, sexually transmitted diseases, and prevalence of sexual activity (X2 (trend) P<0-001 for all three series); relative increase between intervention and control populations in knowledge, relative decrease in attitudes suggesting that sexual intercourse is of itself beneficial to teenagers and their relationships, relative decrease in sexual activity, and relative increase in approval of their "sex education" (relative risk > 1-00 with 95% confidence limits not including 1 00 for all series and for comparisons with both control populations); odds ratio (control v programme) for sexual activity of 1*45, controlling for sociodemographic variables.Conclusion-School sex education that includes specific targeted methods with the direct use of medical staff and peers can produce behavioural changes that lead to health benefit.

In 1992 and 1993, 66 selected, trained peer leaders (aged 16-17 years) worked with 38 secondary school classes in the Southwest of England. Questionnaires elicited the views of the class teachers (N = 12), peer leaders (N = 54) and pupils (N = 884; 98 per cent). The majority of the pupils (aged 13-14 years), including those with low self-esteem or special needs, participated in discussion (90 per cent) and role plays (83 per cent), and talked about the programme (with friends: 66 per cent; parents: 24 per cent). Responses indicate that the programme positively affected the pupils' knowledge, skills, and beliefs relating to social norms; peer leaders gained knowledge, skills and self-confidence. Peer education in school could be extended, benefiting both peer leaders and the recipients.

fractions of palliative radiotherapy for these two conditions before the audit and their practice did not subsequently change and a few continued to use five or more fractions despite the recommendations of audit. We noted, however, that most changed their prescribing practices after the first audit meeting.