Sexual health education for young people is crucial not only for development of norms but also for protection against vulnerabilities during this stage in life. Although several systematic reviews have examined the effectiveness of peer-led sex education, none have focused on the extent of peer participation. The purpose of this review was to evaluate peer-led sexual health education interventions in More Developed Countries (MDC). Electronic and hand searches across five social science,

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... on, and medical databases were conducted. Fifteen articles were selected in total. Most (10/15) studies gave low or no responsibility to peers. The majority of articles found improvements in sexual health knowledge (13/14) and attitudes (11/15) at post-intervention stages. Two studies showed improved selfefficacy and three showed behavioural changes. A preliminary synthesis of effectiveness and level of participation was done. Meta-analysis revealed a large effect on knowledge change (Hedges' g=0.84, 95% CI: 0.43-1.25) and a medium effect on attitude change (Hedges' g=0.49, 95% CI: 0.19-0.80). Peer-led interventions could be a powerful tool. This review shows that this approach is effective in changing knowledge and attitude but not behaviours. Further research and action are needed to understand the optimal implementation. Participation in Peer-led Sexual Health Education