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Rink E, Stotz SA, Johnson-Jennings M, Huyser K, Collins K, Manson SM, Berkowitz SA, Hebert L, Byker Shanks C, Begay K, Hicks T, Dennison M, Jiang L, Firemoon P, Johnson O, Anastario M, Ricker A, GrowingThunder R, Baldwin J. "We don't separate out these things. Everything is related": Partnerships with Indigenous Communities to Design, Implement, and Evaluate Multilevel Interventions to Reduce Health Disparities. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024:10.1007/s11121-024-01668-9. [PMID: 38598040 DOI: 10.1007/s11121-024-01668-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
Multilevel interventions (MLIs) are appropriate to reduce health disparities among Indigenous peoples because of their ability to address these communities' diverse histories, dynamics, cultures, politics, and environments. Intervention science has highlighted the importance of context-sensitive MLIs in Indigenous communities that can prioritize Indigenous and local knowledge systems and emphasize the collective versus the individual. This paradigm shift away from individual-level focus interventions to community-level focus interventions underscores the need for community engagement and diverse partnerships in MLI design, implementation, and evaluation. In this paper, we discuss three case studies addressing how Indigenous partners collaborated with researchers in each stage of the design, implementation, and evaluation of MLIs to reduce health disparities impacting their communities. We highlight the following: (1) collaborations with multiple, diverse tribal partners to carry out MLIs which require iterative, consistent conversations over time; (2) inclusion of qualitative and Indigenous research methods in MLIs as a way to honor Indigenous and local knowledge systems as well as a way to understand a health disparity phenomenon in a community; and (3) relationship building, maintenance, and mutual respect among MLI partners to reconcile past research abuses, prevent extractive research practices, decolonize research processes, and generate co-created knowledge between Indigenous and academic communities.
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Affiliation(s)
- Elizabeth Rink
- Department of Health and Human Development, Montana State University, 312 Herrick Hall, Bozeman, MT, 59715, USA.
| | - Sarah A Stotz
- Department of Food Science and Human Nutrition, Colorado State University, 502 West Lake Street, Fort Collins, CO, 80526, USA
| | - Michelle Johnson-Jennings
- Division of Indigenous Environmental Health and Land-Based Healing, Indigenous Wellness Research Institute, University of Washington, Gergerding Hall GBO, Box 351202, Seattle, WA, USA
| | - Kimberly Huyser
- Department of Sociology, Research, and Development/CIEDAR Center, COVID-19 Indigenous Engagement, University of British Columbia, 310-6251 Cecil Green Park Road, Vancouver, BC, V6T 1Z1, Canada
| | - Katie Collins
- CIEDAR co-Lead. Department of Psychology, University of Saskatchewan, 9 Campus Drive, 154 Arts, Saskatoon, SK, S7N 5A5, Canada
| | - Spero M Manson
- Colorado School of Public Health, Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, 13055 East 17th Avenue, Aurora, CO, 80045, USA
| | - Seth A Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 M.L.K. Jr Blvd, Chapel Hill, NC, 27516, USA
| | - Luciana Hebert
- Institute for Research and Education to Advance Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, 1100 Olive Way #1200, Seattle, WA, 98101, USA
| | - Carmen Byker Shanks
- Gretchen Swanson Center for Nutrition, 14301 FNB Pkwy #100, Omaha, NE, 68154, USA
| | - Kelli Begay
- Maven Collective Consulting, LLC, 15712 N Pennsylvania Avenue Cube 5, Edmond, OK, 73013, USA
| | - Teresa Hicks
- Teresa Hicks Consulting, 1107 East Babcock Street, Bozeman, MT, 59715, USA
| | - Michelle Dennison
- Oklahoma City Indian Clinic, 4913 W Reno Ave, 856 Health Sciences Quad, Suite 3400, Oklahoma City, OK, 73127, USA
| | - Luohua Jiang
- Department of Epidemiology and Biostatistics; UCI Health Sciences Complex, University of California Irvine, Program in Public Health, 856 Health Sciences Quad, Suite 3400, Irvine, CA, 92617, USA
| | - Paula Firemoon
- Fort Peck Community College, 605 Indian Ave.,, Poplar, MT, 59255, USA
| | - Olivia Johnson
- Fort Peck Community College, 605 Indian Ave.,, Poplar, MT, 59255, USA
| | - Mike Anastario
- Center for Health Equity Research, Northern Arizona University, P.O. Box 4065, Suite 120, Flagstaff, AZ, 86011-4065, USA
| | - Adriann Ricker
- Fort Peck Tribal Health Department, 501 Medicine Bear Road, Poplar, MT, 59255, USA
| | - Ramey GrowingThunder
- Fort Peck Tribes Language and Culture Department, 603 Court Ave., Poplar, MT, 59255, USA
| | - Julie Baldwin
- Center for Health Equity Research, Northern Arizona University, P.O. Box 4065, Suite 120, Flagstaff, AZ, 86011-4065, USA
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Kulis SS, Tsethlikai M, Ayers SL, Gresenz KE. Parenting in 2 Worlds: Testing improved parent-adolescent communication about sexuality in Urban American Indian families. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2024; 34:56-68. [PMID: 37957746 PMCID: PMC10926230 DOI: 10.1111/jora.12900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 10/10/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023]
Abstract
Urban American Indian (AI) adolescents are more likely than non-Natives to have early sexual debut, teen pregnancies, sexually transmitted infections, and inadequate sexual health information. A RCT in three Arizona cities, with 585 parents of urban AI adolescents, tested whether a culturally tailored parenting intervention for urban AI families, Parenting in 2 Worlds (P2W), increased parent-adolescent communication about sexuality, compared to an informational family health intervention that was not culturally tailored. P2W produced significantly larger increases on two measures: communication about general sexual health and about sexual decision-making. The desired effects of P2W on the first measure were stronger short-term for cross-gender dyads, while for the second measure, they were stronger long-term for both mothers and fathers of adolescent sons.
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Affiliation(s)
- Stephen S. Kulis
- School of Social and Family Dynamics, Arizona State
University
- Global Center for Applied Health Research, Arizona State
University
| | | | | | - Kyle E. Gresenz
- School of Social and Family Dynamics, Arizona State
University
- Global Center for Applied Health Research, Arizona State
University
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Rink E, Anastario M, Peterson M, FireMoon P, Johnson O, GrowingThunder R, Ricker A, Cox G, Holder S, Baldwin JA. Baseline results from NenŨnkUmbi/EdaHiYedo: A randomized clinical trial to improve sexual and reproductive health among American Indian adolescents. J Adolesc 2023. [PMID: 36890753 DOI: 10.1002/jad.12158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 03/10/2023]
Abstract
We report on baseline findings from NenUnkUmbi/EdaHiYedo, a community based participatory research randomized controlled trial with American Indian adolescents to reduce sexual and reproductive health disparities. American Indian adolescents aged 13-19 years participated in a baseline survey that was administered in five schools. We used zero-inflated negative binomial regression to evaluate how the count of protected sexual acts was associated with independent variables of interest. We stratified models by self-reported gender of adolescents and tested for a two-way interaction effect between gender and the independent variable of interest. Two hundred twenty-three girls and 222 boys (n = 445) were sampled. The average number of lifetime partners was 1.0 (standard deviation = 1.7). Each additional lifetime partner was associated with a 50% increase in the number of protected sexual acts incident rate ratio (IRR = 1.5, 95% confidence interval [CI] 1.1-1.9) and more than a twofold increase in the likelihood of not having protected sexual acts (adjusted odd ratio [aOR] = 2.6, 95% CI 1.3-5.1). Each additional number of substances used in adolescentss' lifetime was associated with an increased likelihood of not having protected sexual acts (aOR = 1.2, 95% CI 1.0-1.5). In boys, each one standard deviation increase in depression severity was associated with a 50% reduction in the number of times a condom was used adjusted IRR (aIRR = 0.5, 95% CI 0.4-0.6, p < .001). Each 1-unit increase in positive prospections of pregnancy was associated with a pronounced decrease likelihood of not having protected sexual acts (aOR = 0.01, 95% CI 0.0-0.1). Findings support the importance of tribally driven tailoring of sexual and reproducive health interventions and services for American Indian adolescents.
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Affiliation(s)
- Elizabeth Rink
- Department of Health and Human Development, Montana State University, Bozeman, Montana, USA
| | - Mike Anastario
- Robert Stempel College of Public Health & Social Work, Florida International University, Florida, Miami, USA
| | - Malory Peterson
- Department of Health and Human Development, Montana State University, Bozeman, Montana, USA
| | | | | | - Ramey GrowingThunder
- Language and Culture Department, Fort Peck Assiniboine and Sioux Tribes, Poplar, Montana, USA
| | - Adriann Ricker
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Genevieve Cox
- Department of Health and Human Development, Montana State University, Bozeman, Montana, USA
| | - Shannon Holder
- Department of Health and Human Development, Montana State University, Bozeman, Montana, USA
| | - Julie A Baldwin
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
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Costa SFD, Moraes CLD, Taquette SR, Marques ES. Social vulnerabilities and sexual initiation of 10- to 14-year-old pupils in the city of Rio de Janeiro, Brazil. CIENCIA & SAUDE COLETIVA 2022; 27:2763-2776. [PMID: 35730845 DOI: 10.1590/1413-81232022277.20892021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/18/2022] [Indexed: 11/22/2022] Open
Abstract
This study aimed to estimate the prevalence of sexual initiation of pupils aged 10 to 14 who attended the second year of public and private high school in the IX Administrative Region of the city of Rio de Janeiro, Brazil and to identify the most vulnerable subgroups. The sample consisted of 694 pupils who were selected through cluster-based and stratified sampling by considering school type (public or private) and course type (daytime or evening). Information was collected by means of a structured self-administered questionnaire. The chi-square test (χ2) and 95% confidence intervals were used to assess the heterogeneity of proportions among subgroups. The prevalence of the event was 18.4%; it was higher in boys, in subgroups of greater social vulnerability, among those who hooked up/dated up to 14 years of age, in victims of sexual violence in affective-sexual relationships and in pupils showing health risk behaviors. The high rate of sexual initiation in early adolescence, especially in more vulnerable groups, shows that the situation must be understood and addressed by means of intersectoral public policies that take into account a social context of multiple needs rather than reproductive health alone.
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Affiliation(s)
- Simoni Furtado da Costa
- Departamento de Enfermagem Materno-Infantil, Faculdade de Enfermagem, Universidade do Estado do Rio de Janeiro (UERJ). R. São Francisco Xavier 524, Maracanã. 20550-090 Rio de Janeiro RJ Brasil.
| | | | - Stella Regina Taquette
- Departamento de Pediatria, Faculdade de Ciências Médicas, UERJ. Rio de Janeiro RJ Brasil
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Tingey L, Chambers R, Littlepage S, Slimp A, Lee A, Lee S, Melgar L, O'Keefe V, Craig M, Gaydos C, Rompalo A. 'Empowering our people' to address depression, violence, and sexual risk among Native Americans with recent binge alcohol use. ETHNICITY & HEALTH 2022; 27:733-747. [PMID: 32223325 DOI: 10.1080/13557858.2020.1740177] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 03/03/2020] [Indexed: 06/10/2023]
Abstract
Background: This study was launched in response to an American Indian (AI) community's concern regarding the comorbid occurrence of substance use, poor mental health, and other risk factors on sexual health. The purpose of this manuscript was to assess the relationship between alcohol use, violence, depression and STI/HIV risk behaviors on the frequency of unprotected sex acts and number of sexual partners among AI adults.Methods: Specifically, this analysis examines sociodemographic characteristics, experience of sexual and physical violence, binge drinking, depression, and sexual risk taking among n = 281 AI adults ages 18-55. Regression models examine associations between the aforementioned risk factors, number of sex partners and number of unprotected sex acts, by depression status and sex, among participants.Results: Frequent binge drinking predicted frequency of unprotected sex for both males and females; ever experiencing physical violence was a powerful predictor of unprotected sex for females, but not males. Ever experiencing physical violence strongly predicted having multiple sexual partners for females but was related to decreased number of sexual partners for males. Females ever experiencing sexual violence had more sexual partners; this was not observed for males. Binge drinking predicted frequency of unprotected sex acts, regardless of depression status.Discussion: Interventions for AI adults seeking to reduce sexual health risk should reflect past violence victimization in sexual decision making, primarily among women. The significant role of binge alcohol use for modifying sexual decisions should be of prime focus and interventions should be personalized to address individuals' own alcohol use patterns. Additional research should explore how binge alcohol use moderates the relationship between depression and sexual risk.
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Affiliation(s)
- Lauren Tingey
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Rachel Chambers
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Shea Littlepage
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Anna Slimp
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Angelita Lee
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Shauntel Lee
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Laura Melgar
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Victoria O'Keefe
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Mariddie Craig
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Charlotte Gaydos
- Center for the Development of Point of Care Tests for Sexually Transmitted Diseases, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Anne Rompalo
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Peterson M, Rink E, Schure M, Mikkelsen K, Longtree H, FireMoon P, Johnson O. Early childbearing, family support, and staying in school in a Northern Plains American Indian reservation. AMERICAN JOURNAL OF SEXUALITY EDUCATION 2022; 17:510-535. [PMID: 37427389 PMCID: PMC10328454 DOI: 10.1080/15546128.2022.2053258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
American Indian youth experience teen birth and school dropout at higher rates than other racial and ethnic groups in the United States. Early childbearing is associated with adverse health and socioeconomic outcomes, including attenuated education. However, kinship childrearing norms among Northern Plains tribes can support positive experiences of early childbearing. Using a community based participatory research framework, this mixed methods exploratory study engaged high school students from a Northern Plains reservation community to examine youth perceptions of family support and belief in ability to stay in school should they have a child. We elicited youth observations of facilitators and inhibitors to academic achievement for young parents. This research supports the need for strengths-based, gender specific, and family inclusive sexuality education to support young people in their reproductive choices in reservation settings. We highlight the utility of including youth as co-authors and co-researchers in future studies.
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Affiliation(s)
- Malory Peterson
- Department of Health and Human Development, Montana State University, Bozeman, Montana, USA
| | - Elizabeth Rink
- Department of Health and Human Development, Montana State University, Bozeman, Montana, USA
| | - Mark Schure
- Department of Health and Human Development, Montana State University, Bozeman, Montana, USA
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Costa SFD, Moraes CLD, Taquette SR, Marques ES. Social vulnerabilities and sexual initiation of 10- to 14-year-old pupils in the city of Rio de Janeiro, Brazil. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-81232022277.20892021en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract This study aimed to estimate the prevalence of sexual initiation of pupils aged 10 to 14 who attended the second year of public and private high school in the IX Administrative Region of the city of Rio de Janeiro, Brazil and to identify the most vulnerable subgroups. The sample consisted of 694 pupils who were selected through cluster-based and stratified sampling by considering school type (public or private) and course type (daytime or evening). Information was collected by means of a structured self-administered questionnaire. The chi-square test (χ2) and 95% confidence intervals were used to assess the heterogeneity of proportions among subgroups. The prevalence of the event was 18.4%; it was higher in boys, in subgroups of greater social vulnerability, among those who hooked up/dated up to 14 years of age, in victims of sexual violence in affective-sexual relationships and in pupils showing health risk behaviors. The high rate of sexual initiation in early adolescence, especially in more vulnerable groups, shows that the situation must be understood and addressed by means of intersectoral public policies that take into account a social context of multiple needs rather than reproductive health alone.
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Impacts of the respecting the circle of life teen pregnancy prevention program on risk and protective factors for early substance use among native American youth. Drug Alcohol Depend 2021; 228:109024. [PMID: 34536716 DOI: 10.1016/j.drugalcdep.2021.109024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/06/2021] [Accepted: 07/21/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Early substance use disproportionately impacts Native American (Native) youth and increases their risk for future abuse and dependence. The literature urges for interventions to move beyond focusing on single risk behaviors (e.g. substance use) and instead have capacity to improve health risk behaviors co-occuring during adolescence, particularly among Native populations for whom few evidence-based interventions (EBI) exist. We evaluated the effectiveness of the Respecting the Circle of Life program (RCL) on risk and protective factors for early substance use. RCL is a culturally tailored EBI shown to improve sexual health outcomes among Native youth. METHODS We conducted secondary analyses of data collected through a community-based randomized controlled trial of RCL evaluated among Native youth (ages 11-19) residing on a rural reservation between 2015-2020 (N = 534, 47.4 % male). We used linear regression, controlling for baseline age and sex, to test between study group differences in outcomes at 3-, 9-, and 12-month post-intervention. Models were stratified by sex and age (11-12, 13-14, and 15+ years of age) to examine differences within these subgroups. RESULTS Youth receiving RCL reported lower intention to use substances through 12-months follow-up (p = 0.006). Statistically significant improvements were also observed across peer, parent, and sexual partner risk and protective factors to delay substance use initiation, with notable differences among boys and participants ages 13-14. CONCLUSIONS RCL is a primary prevention, skills-based program effective in preventing risks for substance use. This evaluation underscores the value in developing programs that influence concurrent adolescent risk behaviors, especially for Native communities who endure multiple health disparities.
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Tingey L, Chambers R, Patel H, Littlepage S, Lee S, Lee A, Susan D, Melgar L, Slimp A, Rosenstock S. Prevention of Sexually Transmitted Diseases and Pregnancy Prevention Among Native American Youths: A Randomized Controlled Trial, 2016-2018. Am J Public Health 2021; 111:1874-1884. [PMID: 34529503 PMCID: PMC8561210 DOI: 10.2105/ajph.2021.306447] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To evaluate the efficacy of the Respecting the Circle of Life program (RCL) among Native American youths 11 to 19 years of age residing in a rural reservation community in the southwestern United States. Methods. Between 2016 and 2018, we conducted a randomized controlled trial of the RCL program with 534 Native youths. Participants completed assessments at baseline and 9 and 12 months after the intervention. We conducted intention-to-treat analyses based on study group randomization. Results. At 9 months, intervention participants had significantly better condom use self-efficacy (P < .001), higher intentions to use condoms (P = .024) and abstain from sex (P = .008), and better contraceptive use self-efficacy (P < .001) than control participants, as well as better condom use (P = .032) and contraceptive use (P = .002) negotiation skills. At 12 months, intervention participants had significantly better sexual and reproductive health knowledge (P = .021), condom use self-efficacy (P < .001), contraceptive use self-efficacy (P < .001), and contraceptive use negotiation skills (P = .004) than control participants. Intervention participants reported significantly more communication with their parents about sexual and reproductive health than control participants at both 9 and 12 months (P = .042 and P = .001, respectively). Conclusions. The RCL program has a significant impact on key factors associated with pregnancy prevention among Native youths and should be used as an adolescent pregnancy prevention strategy. Trial Registration. Clinical Trials.gov identifier: NCT02904629. (Am J Public Health. 2021;111(10): 1874-1884. https://doi.org/10.2105/AJPH.2021.306447).
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Affiliation(s)
- Lauren Tingey
- The authors are with the Bloomberg School of Public Health, Center for American Indian Health, Johns Hopkins University, Baltimore, MD
| | - Rachel Chambers
- The authors are with the Bloomberg School of Public Health, Center for American Indian Health, Johns Hopkins University, Baltimore, MD
| | - Hima Patel
- The authors are with the Bloomberg School of Public Health, Center for American Indian Health, Johns Hopkins University, Baltimore, MD
| | - Shea Littlepage
- The authors are with the Bloomberg School of Public Health, Center for American Indian Health, Johns Hopkins University, Baltimore, MD
| | - Shauntel Lee
- The authors are with the Bloomberg School of Public Health, Center for American Indian Health, Johns Hopkins University, Baltimore, MD
| | - Angelita Lee
- The authors are with the Bloomberg School of Public Health, Center for American Indian Health, Johns Hopkins University, Baltimore, MD
| | - Davette Susan
- The authors are with the Bloomberg School of Public Health, Center for American Indian Health, Johns Hopkins University, Baltimore, MD
| | - Laura Melgar
- The authors are with the Bloomberg School of Public Health, Center for American Indian Health, Johns Hopkins University, Baltimore, MD
| | - Anna Slimp
- The authors are with the Bloomberg School of Public Health, Center for American Indian Health, Johns Hopkins University, Baltimore, MD
| | - Summer Rosenstock
- The authors are with the Bloomberg School of Public Health, Center for American Indian Health, Johns Hopkins University, Baltimore, MD
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Richards J, Chambers RS, Begay JL, Jackson K, Tingey L, Patel H, Carvajal S, Carroll SR, Teufel-Shone N, Barlow A. Diné (Navajo) female perspectives on mother-daughter communication and cultural assets around the transition to womanhood: a cross-sectional survey. BMC WOMENS HEALTH 2021; 21:341. [PMID: 34563201 PMCID: PMC8466980 DOI: 10.1186/s12905-021-01473-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 09/07/2021] [Indexed: 11/21/2022]
Abstract
Background The inclusion of protective factors (“assets”) are increasingly supported in developing culturally grounded interventions for American Indian (AI) populations. This study sought to explore AI women’s cultural assets, perspectives, and teachings to inform the development of a culturally grounded, intergenerational intervention to prevent substance abuse and teenage pregnancy among AI females. Methods Adult self-identified AI women (N = 201) who reside on the Navajo Nation completed a cross-sectional survey between May and October 2018. The 21-question survey explored health communication around the transition to womanhood, cultural assets, perceptions of mother–daughter reproductive health communication, and intervention health topics. Univariate descriptive analyses, chi squared, and fisher’s exact tests were conducted. Results Respondents ranged in age from 18 to 82 years, with a mean age of 44 ± 15.5 years. Women self-identified as mothers (95; 48%), aunts (59; 30%), older sisters (55; 28%), grandmothers (37; 19%), and/or all of the aforementioned (50; 25%). 66% (N = 95) of women admired their mother/grandmother most during puberty; 29% (N = 58) of women were 10–11 years old when someone first spoke to them about menarche; and 86% (N=172) felt their culture was a source of strength. 70% (N = 139) would have liked to learn more about reproductive health when they were a teenager; 67% (N = 134) felt Diné mothers are able to provide reproductive health education; 51% (N = 101) reported having a rite of passage event, with younger women desiring an event significantly more than older women. Responses also indicate a disruption of cultural practices due to government assimilation policies, as well as the support of male relatives during puberty. Conclusions Results informed intervention content and delivery, including target age group, expanded caregiver eligibility criteria, lesson delivery structure and format, and protective cultural teachings. Other implications include the development of a complementary fatherhood and/or family-based intervention to prevent Native girls’ substance use and teen pregnancy. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01473-4.
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Affiliation(s)
- Jennifer Richards
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Tuba City, AZ, 86045, USA.
| | - Rachel Strom Chambers
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21231, USA
| | - Jaime Lynn Begay
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Tuba City, AZ, 86045, USA
| | - Kendrea Jackson
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Chinle, AZ, 86503, USA
| | - Lauren Tingey
- Center for American Indian Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Hima Patel
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Scott Carvajal
- Health Behavior Health Promotion, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, 85724, USA
| | - Stephanie Russo Carroll
- Public Health Policy and Management, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, 85724, USA
| | | | - Allison Barlow
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Chambers RA, Begay J, Patel H, Richards J, Nelson D, Rosenstock S, Huskon R, Mitchell K, Begay T, Tingey L. Rigorous evaluation of a substance use and teen pregnancy prevention program for American Indian girls and their female caregivers: a study protocol for a randomized controlled trial. BMC Public Health 2021; 21:1179. [PMID: 34154552 PMCID: PMC8218410 DOI: 10.1186/s12889-021-11131-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Early sexual initiation is associated with higher risk for sexually transmitted infection, teen pregnancy, domestic violence and substance use in later adolescence and early adulthood. Native American adolescents are more likely to have early sexual initiation compared to other racial/ethnic groups. Few programs designed with and for Native adolescents to delay sexual initiation and substance use have been tested through rigorous evaluations. This is the protocol for the randomized controlled trial of the Asdzáán Be’eena’ program, a teen pregnancy and substance use prevention program for young Native girls and their female caregivers. Methods N = 410 female adolescents ages 10–14 and their female caregivers will be enrolled in the study and randomized to the intervention or control arm. The intervention consists of the 11-session Asdzáán Be’eena’ program. The control arm consists of mailed non-monetary incentives. All participants will complete evaluations at baseline and 3 follow-up timepoints (immediate, 6 and 12 months post intervention). Evaluations include measures to assess protective factors associated with delayed sexual initiation and substance use. Discussion This is one of the first rigorous evaluations of a gender-specific, culturally tailored teen pregnancy and substance use primary prevention program for Native girls and their female caregivers. If proven efficacious, Native communities will have a culturally appropriate program for promoting protective factors associated with delayed substance use and sexual risk taking. Trial registration NCT04863729; April 27, 2021.
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Affiliation(s)
- Rachel A Chambers
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA.
| | - Jaime Begay
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA
| | - Hima Patel
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA
| | - Jennifer Richards
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA
| | - Danielle Nelson
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA
| | - Summer Rosenstock
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA
| | - Ronni Huskon
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA
| | - Kristin Mitchell
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA
| | - Tiffani Begay
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA
| | - Lauren Tingey
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA
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Sexual Health, STI and HIV Risk, and Risk Perceptions Among American Indian and Alaska Native Emerging Adults. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 20:331-341. [PMID: 30006906 DOI: 10.1007/s11121-018-0920-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Emerging adulthood (18-25) is a period of increased risk for adverse sexual health outcomes. While anyone in this age group is at elevated risk, American Indian and Alaska Native (AI/AN) youth and emerging adults face unique factors that influence their risk for sexually transmitted infections (STIs). To address this increased risk among AI/AN youth, culturally appropriate interventions are necessary. This study reports the results of a video-based sexual health intervention designed specifically for AI/AN youth and emerging adults (15-24 years old) on risk changing perceptions. This intervention was evaluated using a group-randomized design with three conditions: (1) fact sheet alone, (2) fact sheet and video, and (3) fact sheet, video, and facilitated discussion. Using data from 199 AI/AN emerging adults (18-24 years old) who participated in the Native VOICES evaluation, we used multiple multinomial logistic regressions to determine if changes in risk perceptions were significantly different between study arms from baseline to post-intervention, and from post-intervention to 6-month follow-up. Few differences in STI risk perceptions were found at baseline and observed differences in STI risk perceptions between study arms disappeared after including baseline risk perceptions in the model. Similarly, few differences in HIV risk perceptions between study arms were observed at baseline, and all differences in HIV risk perceptions between study arms disappeared after controlling for baseline risk perceptions, demographics, and baseline sexual risk factors. Overall, this study points to the need for interventions that specifically address the behaviors, social and sexual contexts, and risk perceptions of AI/AN emerging adults, an age group for whom few culturally relevant sexual health interventions exist.
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Hanson JD, Weber TL, Shrestha U, Bares VJ, Seiber M, Ingersoll K. Acceptability of an eHealth Intervention to Prevent Alcohol-Exposed Pregnancy Among American Indian/Alaska Native Teens. Alcohol Clin Exp Res 2020; 44:196-202. [PMID: 31693195 PMCID: PMC6980937 DOI: 10.1111/acer.14229] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/26/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND A tribally led Changing High-Risk Alcohol Use and Increasing Contraception Effectiveness Study (CHOICES) Program has successfully decreased the risk of alcohol-exposed pregnancies (AEPs) among adult American Indian/Alaska Native (AI/AN) women by either reducing risky drinking or increasing contraception use. However, a community needs assessment revealed a need to implement a similar intervention with AI/AN teens. The goal of the project was to develop and establish the acceptability of CHOICES for AI/AN teens. METHODS Key informant interviews were conducted to review the existing OST CHOICES intervention. After modifications to the existing program, focus groups with AI/AN teens were conducted to ensure validity and to finalize the OST CHAT (CHOICES for American Indian Teens) intervention. RESULTS Key informant (N = 15) participants suggested that a Web-based intervention may increase teen engagement by making the intervention more interactive and visually stimulating. Based on this formative research, CHAT was developed via Research Electronic Data Capture (REDCap). Feedback on the online CHAT curriculum was given by focus groups comprised of AI/AN adolescents, and participants felt that this type of intervention would be both acceptable and able to implement with a community of reservation-based teens. CONCLUSIONS This study outlines the development of a Web-based intervention for an AEP intervention for AI/AN teens and will inform future prevention efforts. Implications include an expansion of the evidence-based CHOICES intervention for AI/AN teens and also development of a Web-based intervention for rural, reservation-based AI/AN communities.
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Affiliation(s)
| | | | | | | | | | - Karen Ingersoll
- University of Virginia School of Medicine, Charlottesville, VA USA
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14
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Kim SJ, Cho KW. Interaction Between Smoking Cigarettes and Alcohol Consumption on Sexual Experience in High School Students. Osong Public Health Res Perspect 2019; 10:274-280. [PMID: 31673488 PMCID: PMC6816361 DOI: 10.24171/j.phrp.2019.10.5.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives This study aimed to analyze nationwide representative data from the 11th Korean Youth Health Risk Behavior Web-Based Survey to determine whether factors including socio-demographics, smoking and alcohol consumption, were factors related to high school students that had experienced sexual intercourse. Methods A total of 33,744 students (17,346 boys and 16,398 girls) in 1st, 2nd, and 3rd grade at high school were analyzed. SPSS complex samples methods were used for analyses. Socio-demographic and health risk behaviors (type of region of residence, family structure, and economic status, student academic achievement, gender, high school grade, pocket money, student smoking, alcohol consumption, and having engaged in sexual intercourse) were considered as independent variables. Results There were 3.6% of girls and 9.9% of boys in high school that were sexually active. This behavior and the average number of cigarettes smoked daily, and alcohol consumed weekly, represented a dose-response relationship, after considering confounding factors. Compared with students that did not smoke or consume alcohol, smoking 1–9 cigarettes per day and consuming 1–6 cups of alcohol and group “smoking more than 10 cigarettes per day and consuming more than 7 cups of alcohol, had a 5.94 and 22.25 higher risk of having had sexual intercourse, respectively. Conclusion Cigarette smoking and alcohol consumption were associated with an increased likelihood of high school students engaging in sexual intercourse.
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Tuitt NR, Rumbaugh Whitesell N, Asdigian NL, Kaufman CE. Frequent residential mobility among American Indians and early indications of sexual risk among young adolescents. PLoS One 2019; 14:e0218445. [PMID: 31206559 PMCID: PMC6576762 DOI: 10.1371/journal.pone.0218445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/03/2019] [Indexed: 12/02/2022] Open
Abstract
American Indian and Alaska Native (AI/AN) youth are more likely to ever have had sex, and to have engaged in sexual activity prior to age 13 compared to all other race groups. It is essential to understand the development of skills to refuse sexual experience in early adolescence in order to reduce disparities associated with early sexual debut among AI/AN youth. Familial, social, and individual factors can act as protective influences on adolescent sexual experience; however, in other settings, research has shown that frequent residential mobility disrupts these protective influences and may increase the likelihood of adolescent sexual activity. AI/AN youth are highly mobile, and, as a result, may be especially vulnerable to increased sexual risk. To date, no prior study has considered the impact of residential mobility on AI/AN youth sexual experience, nor the influence on precursors that reduce initiation of sex. We used data from a longitudinal study of AI/AN youth attending all middle schools from a Northern Plains reservation from 2006-2009 to estimate a structural equation model based on a cultural and age adapted theoretical framework. The tested model included frequent residential mobility as the independent variable and sex refusal self-efficacy as the dependent variable. Mediating variables included factors related to individual risks, psychological well-being, and social supports. Results indicate a direct association between residential mobility and sex refusal self-efficacy (-.29, p = 0.05) and an indirect association mediated by deviant peers (-.08, p = .05). Other mediating variables did not provide insight on the mechanism by which residential mobility influences skills to refuse sexual intercourse among AI/AN youth in early adolescence. Findings provide evidence for an association between residential mobility and precursors to sexual experience suggesting augmenting sexual health interventions for highly mobile youth.
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Affiliation(s)
- Nicole R. Tuitt
- School of Public Health, University of California Berkeley, Berkeley, California, United States of America
- Prevention Research Center—Pacific Institute for Research and Evaluation, Berkeley, California, United States of America
| | - Nancy Rumbaugh Whitesell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Nancy L. Asdigian
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Carol E. Kaufman
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
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16
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Saftner MA, Pruitt KS, McRee AL. Conversation, Condoms, and Contraception: How Does Communication With Sexual Partners Affect Safer Sexual Behaviors Among American Indian Youth? J Sch Nurs 2019; 37:109-116. [DOI: 10.1177/1059840519849097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Communication with sexual partners about protection against sexually transmitted infections (STIs) is associated with safer sexual behaviors among general populations of youth, but little is known about partner communication among American Indian youth. We assessed the prevalence of adolescents’ communication with sexual partners about STI prevention and used multivariable logistic regression to examine associations between communication and safer sexual behaviors (condom use, reliable contraceptive use, and dual method use) among a statewide sample of in-school, American Indian youth in Minnesota in 2013 and 2016 ( n = 739). Half (49.5%) of sexually experienced American Indian youth reported talking about STI prevention at least once with every sexual partner. Communication was associated with all examined safer sexual behaviors among females and only with condom use among males. Study findings highlight the importance of school nurses, health educators, and other clinicians addressing partner communication when counseling adolescent patients.
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Affiliation(s)
| | - Kelsey S. Pruitt
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
- Division of General Pediatrics and Adolescent Health, Medical School, University of Minnesota, Duluth, MN, USA
| | - Annie-Laurie McRee
- Division of General Pediatrics and Adolescent Health, Medical School, University of Minnesota, Duluth, MN, USA
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17
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Chambers RS, Rosenstock S, Lee A, Goklish N, Larzelere F, Tingey L. Exploring the Role of Sex and Sexual Experience in Predicting American Indian Adolescent Condom Use Intention Using Protection Motivation Theory. Front Public Health 2018; 6:318. [PMID: 30483489 PMCID: PMC6240587 DOI: 10.3389/fpubh.2018.00318] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 10/19/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: American Indian (AI) youth experience poor sexual health outcomes. Research indicates the Protection Motivation Theory (PMT) is a robust model for understanding how sexual risk and protective behaviors are associated with condom use intention (CUI). Studies indicate the constructs of the PMT which influence CUI vary by sex and sexual experience. This analysis explores associations between PMT constructs and CUI by sex and sexual experience among AI youth who participated in the Respecting the Circle of Life (RCL) trial, a sexual and reproductive health intervention. Methods: We analyzed baseline data from the sample of 267 AIs, ages 13-19, who participated in the evaluation. We examined CUI and PMT construct scores by sex and sexual experience utilizing generalized estimated equations and multiple regression models to test which PMT constructs were associated with CUI across sex and sexual experience. Results: Twenty-two percentage of participants were sexually experienced; 56.8% reported CUI at baseline. We found several differences in scores in PMT constructs by sex and sexual experience including self-efficacy, response efficacy, vulnerability, severity, and extrinsic rewards. We also found constructs varied that were associated with CUI varied across sex and sexual experience. No PMT constructs were associated with CUI among sexually experienced youth. Conclusion: Results provide support for developing, selecting and delivering sexual health programs by sex and sexual experience in American Indian communities. Girls programs should focus on internal satisfaction and self-worth while boys should focus on negative impacts of not using condoms. Programs for youth who are not sexually active should focus on negative impacts of not using condoms. Programs for sexually inactive youth should work to change peer norms around condom use and improve knowledge about the efficacy of condom use.
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Affiliation(s)
- Rachel Strom Chambers
- International Health, Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, United States
| | - Summer Rosenstock
- International Health, Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, United States
| | - Angie Lee
- International Health, Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, United States
| | - Novalene Goklish
- International Health, Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, United States
| | - Francene Larzelere
- International Health, Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, United States
| | - Lauren Tingey
- International Health, Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, United States
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Craig Rushing S, Stephens D, Shegog R, Torres J, Gorman G, Jessen C, Gaston A, Williamson J, Tingey L, Lee C, Apostolou A, Kaufman C, Markham CM. Healthy Native Youth: Improving Access to Effective, Culturally-Relevant Sexual Health Curricula. Front Public Health 2018; 6:225. [PMID: 30175091 PMCID: PMC6107849 DOI: 10.3389/fpubh.2018.00225] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/25/2018] [Indexed: 11/13/2022] Open
Abstract
Tribal health educators across the United States have found it challenging to locate engaging, culturally-relevant sexual health curricula for American Indian and Alaska Native (AI/AN) youth. Healthy Native Youth is a new online resource that provides a "one-stop-shop" for tribal health advocates to access age-appropriate curricula. The site was designed by a team of advisers representing a diverse group of tribal communities, using a collaborative planning process. The website content and navigation was then refined through usability testing with the target audience. The portal allows users to filter and compare curricula on multiple dimensions, including: age, delivery setting, duration, cost, and evidence of effectiveness, to determine best-fit. It includes all materials needed for implementation free-of-charge, including: facilitator training tools, lesson plans, materials to support participant marketing and recruitment, information about each program's cultural relevance, evaluation methods and findings, and references to publications and reports. The website currently includes mCircle of Life, Native It's Your Game, Native STAND, Native VOICES, and Safe in the Village, among others. Since its launch in August 2016, the site has had over 31,000 page views in all 50 States. The Healthy Native Youth portal provides educators in rural communities a promising new tool to support the dissemination and implementation of evidence-based health curricula in geographically-disbursed AI/AN communities. Lessons learned during the design and dissemination of the Healthy Native Youth website may be of value to other Indigenous populations interested in our approach and our findings.
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Affiliation(s)
| | - David Stephens
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Ross Shegog
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jennifer Torres
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Gwenda Gorman
- Inter Tribal Council of Arizona, Inc., Phoenix, AZ, United States
| | - Cornelia Jessen
- Division of Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, United States
| | - Amanda Gaston
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Jennifer Williamson
- Division of Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, United States
| | - Lauren Tingey
- Johns Hopkins Center for American Indian Health, Baltimore, MD, United States
| | - Crystal Lee
- UCLA David Geffen School of Medicine, Semel Institute for Neuroscience and Human Behavior, Global Center for Children and Families, Los Angeles, CA, United States
| | - Andria Apostolou
- Division of Epidemiology and Disease Prevention, Indian Health Service, Rockville, MD, United States
| | - Carol Kaufman
- Colorado School of Public Health, Centers for American Indian and Alaska Native Health, Aurora, CO, United States
| | - Christine Margaret Markham
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
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Tingey L, Chambers R, Rosenstock S, Larzelere F, Goklish N, Lee A, Rompalo A. Risk and Protective Factors Associated With Lifetime Sexual Experience Among Rural, Reservation-Based American Indian Youth. J Prim Prev 2018; 39:401-420. [PMID: 30046947 DOI: 10.1007/s10935-018-0517-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Early sexual initiation is a catalyst for sexually transmitted infection and unintended pregnancy. American Indian/Alaska Native (AI/AN) youth initiate sex prior to age 13 more often than other U.S. youth, contributing to current inequalities in sexual health. Identifying what factors were associated with lifetime sexual experience among AI/AN youth can inform the development of primary prevention programming to delay sexual initiation, alleviate the costs of early sexual activity, and improve sexual health outcomes in this population. We analyzed cross-sectional data from 267 AI youth ages 13-19, recruited from a rural, reservation-based community. We used multivariate logistic regression models to estimate associations between independent variables and lifetime sexual experience (vaginal and/or anal sex) across the following categories: sociodemographic, knowledge, attitudes/perceptions, beliefs, intentions, skills, behaviors, and theoretical constructs. The sample was 56.2% female, mean age 15.1 years (SD = 1.7), and 22.5% were sexually experienced. In our final model, condom use self-efficacy (attitude/perception factor) and intentions to remain abstinent until marriage (intention factor) were associated with lower odds of lifetime sexual experience. Age (sociodemographic factor), intention to have sex (intention factor), use of any contraception (behavior factor), and higher response efficacy (theoretical construct) were associated with lifetime sexual experience. Of these, intention to have sex was the strongest indicator. These results both corroborate and contrast with other research conducted among rural, reservation-based AI/AN youth. Our findings show programs targeting intentions may have the greatest impact among reservation-based AI youth, and justify program delivery stratified by age group in this setting.
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Affiliation(s)
- Lauren Tingey
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, John Hopkins University, 415 N. Washington St., 4th Floor, Baltimore, MD, 21231, USA.
| | - Rachel Chambers
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, John Hopkins University, 415 N. Washington St., 4th Floor, Baltimore, MD, 21231, USA
| | - Summer Rosenstock
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, John Hopkins University, 415 N. Washington St., 4th Floor, Baltimore, MD, 21231, USA
| | - Francene Larzelere
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, John Hopkins University, 415 N. Washington St., 4th Floor, Baltimore, MD, 21231, USA
| | - Novalene Goklish
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, John Hopkins University, 415 N. Washington St., 4th Floor, Baltimore, MD, 21231, USA
| | - Angelita Lee
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, John Hopkins University, 415 N. Washington St., 4th Floor, Baltimore, MD, 21231, USA
| | - Anne Rompalo
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, John Hopkins University, 415 N. Washington St., 4th Floor, Baltimore, MD, 21231, USA
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20
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Tingey L, Chambers R, Rosenstock S, Lee A, Goklish N, Larzelere F. The Impact of a Sexual and Reproductive Health Intervention for American Indian Adolescents on Predictors of Condom Use Intention. J Adolesc Health 2017; 60:284-291. [PMID: 28034609 PMCID: PMC5326598 DOI: 10.1016/j.jadohealth.2016.08.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/04/2016] [Accepted: 08/15/2016] [Indexed: 01/05/2023]
Abstract
PURPOSE American Indian (AI) adolescents experience inequalities in sexual health, in particular, early sexual initiation. Condom use intention is an established predictor of condom use and is an important construct for evaluating interventions among adolescents who are not yet sexually active. This analysis evaluated the impact of Respecting the Circle of Life (RCL), a sexual and reproductive health intervention for AI adolescents, on predictors of condom use intention. METHODS We utilized a cluster randomized controlled trial design to evaluate RCL among 267 AIs ages 13-19. We examined baseline psychosocial and theoretical variables associated with condom use intention. Generalized estimating equation regression models determined which baseline variables predictive of condom use intention were impacted. RESULTS Mean sample age was 15.1 years (standard deviation 1.7) and 56% were female; 22% had initiated sex. A larger proportion of RCL versus control participants had condom use intention post intervention (relative risk [RR] = 1.39, p = .008), especially younger (ages 13-15; RR = 1.42, p = .007) and sexually inexperienced adolescents (RR = 1.44, p = .01); these differences attenuated at additional follow-up. Baseline predictors of condom use intention included being sexually experienced, having condom use self-efficacy, as well as response efficacy and severity (both theoretical constructs). Of these, the RCL intervention significantly impacted condom use self-efficacy and response efficacy. CONCLUSIONS Results demonstrate RCL intervention efficacy impacting variables predictive of condom use intention at baseline, with greater differences among younger, sexually inexperienced adolescents. To sustain intervention impact, future RCL implementation should reinforce education and training in condom use self-efficacy and response efficacy and recruit younger, sexually inexperienced AI adolescents.
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Affiliation(s)
- Lauren Tingey
- Department of International Health, Johns Hopkins Center for American Indian Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
| | - Rachel Chambers
- Department of International Health, Johns Hopkins Center for American Indian Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Summer Rosenstock
- Department of International Health, Johns Hopkins Center for American Indian Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Angelita Lee
- Department of International Health, Johns Hopkins Center for American Indian Health, Johns Hopkins University Bloomberg School of Public Health, Whiteriver, Arizona
| | - Novalene Goklish
- Department of International Health, Johns Hopkins Center for American Indian Health, Johns Hopkins University Bloomberg School of Public Health, Whiteriver, Arizona
| | - Francene Larzelere
- Department of International Health, Johns Hopkins Center for American Indian Health, Johns Hopkins University Bloomberg School of Public Health, Whiteriver, Arizona
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21
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Markham CM, Craig Rushing S, Jessen C, Gorman G, Torres J, Lambert WE, Prokhorov AV, Miller L, Allums-Featherston K, Addy RC, Peskin MF, Shegog R. Internet-Based Delivery of Evidence-Based Health Promotion Programs Among American Indian and Alaska Native Youth: A Case Study. JMIR Res Protoc 2016; 5:e225. [PMID: 27872037 PMCID: PMC5138449 DOI: 10.2196/resprot.6017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 10/15/2016] [Accepted: 10/28/2016] [Indexed: 11/29/2022] Open
Abstract
Background American Indian and Alaska Native (AI/AN) youth face multiple health challenges compared to other racial/ethnic groups, which could potentially be ameliorated by the dissemination of evidence-based adolescent health promotion programs. Previous studies have indicated that limited trained personnel, cultural barriers, and geographic isolation may hinder the reach and implementation of evidence-based health promotion programs among AI/AN youth. Although Internet access is variable in AI/AN communities across the United States, it is swiftly and steadily improving, and it may provide a viable strategy to disseminate evidence-based health promotion programs to this underserved population. Objective We explored the potential of using the Internet to disseminate evidence-based health promotion programs on multiple health topics to AI/AN youth living in diverse communities across 3 geographically dispersed regions of the United States. Specifically, we assessed the Internet’s potential to increase the reach and implementation of evidence-based health promotion programs for AI/AN youth, and to engage AI/AN youth. Methods This randomized controlled trial was conducted in 25 participating sites in Alaska, Arizona, and the Pacific Northwest. Predominantly AI/AN youth, aged 12-14 years, accessed 6 evidence-based health promotion programs delivered via the Internet, which focused on sexual health, hearing loss, alcohol use, tobacco use, drug use, and nutrition and physical activity. Adult site coordinators completed computer-based education inventory surveys, connectivity and bandwidth testing to assess parameters related to program reach (computer access, connectivity, and bandwidth), and implementation logs to assess barriers to implementation (program errors and delivery issues). We assessed youths’ perceptions of program engagement via ratings on ease of use, understandability, credibility, likeability, perceived impact, and motivational appeal, using previously established measures. Results Sites had sufficient computer access and Internet connectivity to implement the 6 programs with adequate fidelity; however, variable bandwidth (ranging from 0.24 to 93.5 megabits per second; mean 25.6) and technical issues led some sites to access programs via back-up modalities (eg, uploading the programs from a Universal Serial Bus drive). The number of youth providing engagement ratings varied by program (n=40-191; 48-60% female, 85-90% self-identified AI/AN). Across programs, youth rated the programs as easy to use (68-91%), trustworthy (61-89%), likeable (59-87%), and impactful (63-91%). Most youth understood the words in the programs (60-83%), although some needed hints to complete the programs (16-49%). Overall, 37-66% of the participants would recommend the programs to a classmate, and 62-87% found the programs enjoyable when compared to other school lessons. Conclusions Findings demonstrate the potential of the Internet to enhance the reach and implementation of evidence-based health promotion programs, and to engage AI/AN youth. Provision of back-up modalities is recommended to address possible connectivity or technical issues. The dissemination of Internet-based health promotion programs may be a promising strategy to address health disparities for this underserved population. Trial Registration Clinicaltrials.gov NCT01303575; https://clinicaltrials.gov/ct2/show/NCT01303575 (Archived by WebCite at http://www.webcitation.org/6m7DO4g7c)
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Affiliation(s)
- Christine M Markham
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | | | - Cornelia Jessen
- Alaska Native Tribal Health Consortium, Anchorage, AK, United States
| | - Gwenda Gorman
- Inter Tribal Council of Arizona, Inc., Phoenix, AZ, United States
| | - Jennifer Torres
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | | | | | | | | | - Robert C Addy
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Melissa F Peskin
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Ross Shegog
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
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Kaufman CE, Schwinn TM, Black K, Keane EM, Big Crow CK. The Promise of Technology to Advance Rigorous Evaluation of Adolescent Pregnancy Prevention Programs in American Indian and Alaska Native Tribal Communities. Am J Public Health 2016; 106:S18-S20. [PMID: 27689483 DOI: 10.2105/ajph.2016.303335] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Carol E Kaufman
- Carol E. Kaufman, Kirsten Black, and Ellen M. Keane are with the Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Traci M. Schwinn is with the School of Social Work, Columbia University, New York, NY. Cecelia K. Big Crow is with the Northern Plains Field Office, Centers for American Indian and Alaska Native Health, University of Colorado, Pine Ridge, SD
| | - Traci M Schwinn
- Carol E. Kaufman, Kirsten Black, and Ellen M. Keane are with the Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Traci M. Schwinn is with the School of Social Work, Columbia University, New York, NY. Cecelia K. Big Crow is with the Northern Plains Field Office, Centers for American Indian and Alaska Native Health, University of Colorado, Pine Ridge, SD
| | - Kirsten Black
- Carol E. Kaufman, Kirsten Black, and Ellen M. Keane are with the Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Traci M. Schwinn is with the School of Social Work, Columbia University, New York, NY. Cecelia K. Big Crow is with the Northern Plains Field Office, Centers for American Indian and Alaska Native Health, University of Colorado, Pine Ridge, SD
| | - Ellen M Keane
- Carol E. Kaufman, Kirsten Black, and Ellen M. Keane are with the Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Traci M. Schwinn is with the School of Social Work, Columbia University, New York, NY. Cecelia K. Big Crow is with the Northern Plains Field Office, Centers for American Indian and Alaska Native Health, University of Colorado, Pine Ridge, SD
| | - Cecelia K Big Crow
- Carol E. Kaufman, Kirsten Black, and Ellen M. Keane are with the Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Traci M. Schwinn is with the School of Social Work, Columbia University, New York, NY. Cecelia K. Big Crow is with the Northern Plains Field Office, Centers for American Indian and Alaska Native Health, University of Colorado, Pine Ridge, SD
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