Improving communication between American Indian youth and caregivers to prevent teenage pregnancy

Caregiver-Youth Communication Patterns and Sexual and Reproductive Health Among American Indian Youth

Improving communication between American Indian caregivers and their youth has been suggested as an Indigenous-forward strategy to help alleviate the sexual and reproductive health (SRH) disparities faced by American Indian youth as a result of the legacy of colonial violence against American Indian communities. Studies with non-American Indian and American Indian populations suggest that effective communication about SRH between parents and youth plays a role in reducing sexual risk behaviors among youth. There is limited research that examines youth sexual risk behaviors in relation to communication patterns separately assessed in caregivers and youth. The current study aimed to examine the association between caregiver-youth communication patterns and engagement in sex, age at sexual debut, and condom use among American Indian youth in the United States. The study draws on baseline caregiver and youth data collected from Nen ŨnkUmbi/EdaHiYedo, a stepped wedge design trial with American Indian youth living on the Fort Peck Reservation in Montana. 113 caregiver responses were matched to 145 youth for the current study. Caregiver-youth communication patterns were examined in relation to youth engagement in sex, age at sexual debut, and number of protected acts of vaginal and/or anal sex. Multivariable models were used to adjust for confounders and to examine relationships between caregiver-youth communication and youth sexual risk outcomes. An increase in overall level of self-reported youth communication with caregivers about sexual and reproductive health topics was significantly associated with a greater likelihood of youth ever having engaged in sex. A significant interaction effect between youth communication and convergence with caregiver response was observed for the number of protected acts of vaginal and/or anal sex, where caregiver communication (regardless of self-reported youth communication with caregivers) was associated with a greater number of protected sex acts. This study fills a gap in the extant literature by reporting on relationships between communication about SRH, assessed separately in caregivers and youth, and youth sexual risk behaviors. Findings emphasize the importance of involving American Indian caregivers in SRH interventions to improve SRH outcomes among American Indian youth, and inform future experimental research that will evaluate how changes in caregiver communication potentially impact youth SRH.

The Associations Between Health-Related Knowledge and Health Beliefs Regarding Risk for Gestational Diabetes in American Indian and Alaska Native Female Adolescents and Young Adults at Risk for Gestational Diabetes and Their Female Caregivers: A Cross-Sectional Dyadic Analysis

INTRODUCTION

Research on associations between knowledge and health beliefs for women at risk for gestational diabetes mellitus (GDM) has focused on adults at risk for or having GDM. Gaps also exist in examining interpersonal associations with family members or peers. We examined dyadic associations between knowledge and health beliefs about the risk for GDM between and within American Indian and Alaska Native (AIAN) female adolescents and young adults (FAYAs) at risk for GDM and their mothers or adult female caregivers (FCs).

METHODS

Grounded in the Expanded Health Belief Model, we employed a cross-sectional design using baseline data from 147 dyads of AIAN FAYAs at risk for GDM and their FCs who participated in the Stopping GDM in Daughters and Mothers trial. FAYAs were 12.0 to 24.5 years of age, and 89.1% were students. FCs had a mean (SD) age of 44.0 (9.3) years, 87.0% were AIAN, 44.9% were college educated, 19.7% had ever had GDM, and 81.0% were the FAYA's mother. FAYAs and FCs completed surveys about knowledge and health beliefs (benefits, barriers, severity, susceptibility) regarding GDM risk and prevention. Bivariate correlational analyses were performed to examine associations between and within dyad members. Dyadic associations were investigated using actor-partner interdependence modeling (APIM) assuming distinguishable dyad members.

RESULTS

Compared with their FCs, FAYAs had lower health-related knowledge and perceived benefits of GDM prevention and susceptibility regarding GDM risk. APIM revealed actor and partner effects of health-related knowledge on health beliefs for dyads. In particular, positive actor effects were found for FAYAs and FCs for GDM-related knowledge with perceived benefits (P < .001), and positive partner effects of GDM-related knowledge for FCs were related to perceived susceptibility and severity for FAYAs (P < .05).

DISCUSSION

As shown in these AIAN dyads, FAYAs and their FCs, as members of one another's social network, may influence each other's health beliefs regarding GDM risk and prevention.

Assessing the Effectiveness of the Respecting the Circle of Life Project on Condom and Contraception Self-efficacy Among American Indian Youth

Respecting the Circle of Life (RCL) is a teen pregnancy prevention program that was evaluated for effectiveness on sexual health risk behaviors through a two-arm randomized control trial (RCT) with American Indian (AI) youth ages 11-19. The objective of this study is to investigate the effects of RCL compared to a control group on items of condom and contraception self-efficacy. Linear regression analysis was used to compare differences in each item that included condom and contraception self-efficacy scales among the intervention and control participants at baseline, 3 and 9 months post intervention. Youth enrolled in the intervention reported higher levels of condom and contraception self-efficacy across almost all individual items. Exceptions include items related to partner negotiation of condom self-efficacy at 3 months (p = 0.227) and 9 months (p = 0.074) post intervention. Findings indicate RCL is effective at improving overall condom and contraception self-efficacy but did not impact the specific component of partner negotiation for either condom or contraception self-efficacy. This inquiry provides rationale to further explore components of RCL related to partner negotiation.