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Magarati M, Chambers RS, Yenokyan G, Rosenstock S, Walls M, Slimp A, Larzelere F, Lee A, Pinal L, Tingey L. Predictors of STD Screening From the Indigenist Stress-Coping Model Among Native Adults With Binge Substance Use. Front Public Health 2022; 10:829539. [PMID: 36033733 PMCID: PMC9411734 DOI: 10.3389/fpubh.2022.829539] [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: 12/05/2021] [Accepted: 06/02/2022] [Indexed: 01/21/2023] Open
Abstract
Objective The American Indian/Alaska Native (AI/AN) population in the U.S. is thriving in spite of settler colonialist efforts of erasure. AI/AN people, however, continue to experience persistent health disparities including a disproportionate burden of substance use and sexually transmitted diseases/infections (STDs/STIs), as well as a disproportionate lack of public health STD screening services and STD prevention interventions grounded in AI/AN social contexts, experiences, and epistemologies. The present study explored how stressors and protective factors based on the Indigenist Stress Coping framework predict STD screening outcomes among Native adults. Methods We analyzed baseline self-report data from 254 Native adults ages 18-55 years with recent binge substance use who were enrolled in an evaluation of "EMPWR," a two-session STD risk reduction program in a rural, reservation-based community in the U.S. Southwest. Logistic regression models with robust variance were used to estimate odds ratios of lifetime STD testing for the theoretical stressors and cultural buffers. Results A little over half the sample were males (52.5%, n = 136), with a mean age of 33.6 years (SD = 8.8). The majority (76.7%, n = 195) reported having ever been screened for STD in their life. Discrimination score were significantly associated with lifetime STD testing: The higher discrimination was associated with lower odds of STD testing in the fully adjusted model (aOR = 0.40, 95%CI: 0.18, 0.92). The effects of AI/AN-specific cultural buffer such as participation in traditional practices on STD testing outcomes was in the expected positive direction, even though the association was not statistically significant. Household size was significantly associated with STD screening: The higher the number of people lived together in the house, the higher the odds of STD testing in the fully adjusted model (aOR = 1.19, 95%CI: 1.04, 1.38). Conclusion Our findings suggest that STD prevention programs should take into consideration AI/AN-specific historical traumatic stressors such as lifetime discrimination encounters and how these interact to drive or discourage sexual health services at local clinics. In addition, larger household size may be a protective factor functioning as a form of social support, and the extended family's role should be taken into consideration. Future research should consider improvement in measurements of AI/AN enculturation constructs.
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Affiliation(s)
- Maya Magarati
- Seven Directions, A Center for Indigenous Public Health, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States,*Correspondence: Maya Magarati
| | - Rachel Strom Chambers
- Department of International Health, Johns Hopkins Center for American Indian Health, Whiteriver, AZ, United States
| | - Gayane Yenokyan
- Johns Hopkins Biostatistics Center, Baltimore, MD, United States
| | - Summer Rosenstock
- Department of International Health, Johns Hopkins Center for American Indian Health, Whiteriver, AZ, United States
| | - Melissa Walls
- Department of International Health, John Hopkins Center for American Indian Health, Great Lakes Hub, Duluth, MN, United States
| | - Anna Slimp
- Department of International Health, Johns Hopkins Center for American Indian Health, Whiteriver, AZ, United States
| | - Francene Larzelere
- Department of International Health, Johns Hopkins Center for American Indian Health, Whiteriver, AZ, United States
| | - Angelita Lee
- Department of International Health, Johns Hopkins Center for American Indian Health, Whiteriver, AZ, United States
| | - Laura Pinal
- Department of International Health, Johns Hopkins Center for American Indian Health, Whiteriver, AZ, United States
| | - Lauren Tingey
- Department of International Health, Johns Hopkins Center for American Indian Health, Whiteriver, AZ, United States
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Tingey L, Chambers R, Littlepage S, Lee A, Slimp A, Melgar L, Cwik M, Gaydos C, Rompalo A, Rosenstock S. "Empowering Our People": Impact of a Culturally Adapted Evidence-Based Intervention on Sexually Transmitted Infection Risks Among Native Americans With Binge Substance Use. Sex Transm Dis 2021; 48:622-628. [PMID: 34110742 DOI: 10.1097/olq.0000000000001418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The objective of this study was to evaluate a culturally adapted evidence-based intervention called EMPWR (Educate, Motivate, Protect, Wellness and Respect) for impacts on sexually transmitted infection (STI) screening and sexual health risk behaviors. METHODS We enrolled Native American adults with recent binge substance use from a rural, reservation community in the Southwest into a 1:1 randomized controlled trial conducted on July 2015 to June 2019. All participants were offered non-clinic-based self-administered STI screening. Data were collected via self-report at baseline, 3 months, and 6 months after the intervention. Baseline and end line data are presented. RESULTS Three hundred one participants were enrolled and had a mean age of 33.8 years; 46.5% of the sample were female, and 9.1% were employed at baseline. EMPWR participants were more likely to complete STI self-screening than control participants (38.2% vs. 23.8%, P = 0.0275). EMPWR participants reported fewer unprotected sex acts in the past 3 months (9.3 vs. 16.0, P = 0.001) and were more likely to refuse sex if their partner was not tested (23.6% vs. 12.4%, P = 0.049). The between-group difference in STI positivity 1 year after study completion was nearing statistical significance (intervention: 39.5% vs. control: 59.6%, P = 0.0575). CONCLUSIONS The culturally adapted evidence-based intervention, EMPWR, increased uptake of STI screening and refusal of sex if partner was not STI tested and decreased the frequency of unprotected sex acts among Native American adults with recent binge substance use living on a rural reservation. Future research is needed to examine EMPWR impacts among other Native American subgroups and its potential for advancing sexual health equity in this high-priority population.
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Affiliation(s)
| | | | | | | | - Anna Slimp
- From the Center for American Indian Health
| | | | - Mary Cwik
- From the Center for American Indian Health
| | - Charlotte Gaydos
- Center for Point-of-Care Technologies Research for Sexually Transmitted Diseases, Johns Hopkins University, Baltimore, MD
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Strathdee SA, Bristow CC, Gaines T, Shoptaw S. Collateral Damage: A Narrative Review on Epidemics of Substance Use Disorders and Their Relationships to Sexually Transmitted Infections in the United States. Sex Transm Dis 2021; 48:466-473. [PMID: 33315749 PMCID: PMC8184578 DOI: 10.1097/olq.0000000000001341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
ABSTRACT Associations between substance use disorders and outbreaks of HIV and acute viral hepatitis have received considerable attention, but less research has focused on links between substance use disorders and sexually transmitted infections, apart from alcohol misuse. This narrative review describes the history of this public health crisis in the United States and direct and indirect effects opioids and specific stimulants have on high-risk sexual behaviors. We also review the epidemiology of sexually transmitted infections associated with opioids and stimulants in the United States and discuss opportunities for integrated interventions.
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Affiliation(s)
- Steffanie Ann Strathdee
- From the Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla
| | - Claire C Bristow
- From the Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla
| | - Tommi Gaines
- From the Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla
| | - Steven Shoptaw
- Department of Family Medicine, Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA
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Armenta RF, Kellogg D, Montoya JL, Romero R, Armao S, Calac D, Gaines TL. "There Is a Lot of Practice in Not Thinking about That": Structural, Interpersonal, and Individual-Level Barriers to HIV/STI Prevention among Reservation Based American Indians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3566. [PMID: 33808175 PMCID: PMC8037532 DOI: 10.3390/ijerph18073566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 11/17/2022]
Abstract
American Indians (AI) face significant disparities in HIV/STI morbidity and mortality, and historical, structural, interpersonal, and individual level barriers stymie prevention efforts. The objective of this paper is to examine barriers to HIV/STI prevention among reservation-based AI. We conducted face-to-face qualitative interviews with 17 reservation-based AI community leaders and community members in Southern California on HIV/STI knowledge and attitudes and barriers to prevention. The disruption of traditional coping mechanisms and healing processes were compromised by historical trauma, and this allowed stigmas to exist where they did not exist before. This impacted access to healthcare services and trust in medicine, and is linked to individuals adopting negative coping behaviors that confer risk for HIV/STI transmission (e.g., substance use and sexual behaviors). Most of the participants reported that HIV/STIs were not discussed in their reservation-based communities, and many participants had a misperception of transmission risk. Stigma was also linked to a lack of knowledge and awareness of HIV/STI's. Limited available services, remoteness of communities, perceived lack of privacy, and low cultural competency among providers further hindered the access and use of HIV/STI prevention services. These findings highlight the need to address the historical, structural, and interpersonal factors impacting individual-level behaviors that can increase HIV/STI transmission among reservation-based AIs. Prevention work should build on community strengths to increase HIV/STI knowledge, reduce stigma, and increase access to preventative care while using culturally grounded methodologies.
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Affiliation(s)
- Richard F Armenta
- Department of Kinesiology, California State University, San Marcos, CA 92078, USA
| | - Daniel Kellogg
- School of Public Health, San Diego State University, San Diego, CA 92182, USA;
| | - Jessica L Montoya
- Department of Psychiatry, University of California, La Jolla, San Diego, CA 92093, USA;
| | - Rick Romero
- Southern California Tribal Health Center, San Diego, CA 92539, USA; (R.R.); (S.A.); (D.C.)
| | - Shandiin Armao
- Southern California Tribal Health Center, San Diego, CA 92539, USA; (R.R.); (S.A.); (D.C.)
| | - Daniel Calac
- Southern California Tribal Health Center, San Diego, CA 92539, USA; (R.R.); (S.A.); (D.C.)
| | - Tommi L Gaines
- Division of Infectious Diseases and Global Public Health, Department of Medicine, School of Medicine, University of California, La Jolla, CA 92093, USA;
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Hughes MS, Apostolou A, Reilley B, Leston J, McCollum J, Iralu J. Electronic Health Record Reminders for Chlamydia Screening in an American Indian Population. Public Health Rep 2020; 136:320-326. [PMID: 33301693 DOI: 10.1177/0033354920970947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Indian Health Service (IHS) screening rates for Chlamydia trachomatis are lower than national rates of chlamydia screening in the Southwest. We describe and evaluate the effect of a public health intervention consisting of electronic health record (EHR) reminders to alert health care providers to screen for chlamydia at an IHS facility. We also conducted an awareness presentation among health care providers on chlamydia screening. METHODS We conducted our intervention from November 1, 2013, through October 31, 2015, at an IHS facility in the Southwest. We implemented algorithms that queried database values to assess chlamydia screening performance in 6 clinical departments. We presented data on the screening performance of clinical departments and health care providers (de-identified) in the awareness presentations. We re-queried database values 1 and 2 years after implementation of the EHR reminder intervention to evaluate before-and-after screening rates, comparing data among all patients and among female patients only. RESULTS We found small, sustained relative increases in chlamydia screening rates during the 2012-2015 evaluation period: 20.8% pre-intervention to 24.9% and 24.2% one and two years postintervention, respectively, across all patients; 32.3% preintervention to 36.6% and 35.6% one and two years postintervention, respectively, among female patients. Increases in clinical department-specific screening rates varied and were most prominent in internal medicine (35.8% preintervention to peak 65.8% postintervention). The 1 clinic (obstetrics-gynecology) that did not receive an awareness presentation showed a consistent downward trend in screening rates, although absolute rates were consistently higher in that clinic than in other clinics. CONCLUSIONS Awareness presentations that offer feedback to health care providers on screening performance, heighten provider awareness of the importance of chlamydia screening, and promote development of novel provider-initiated screening protocols may help to increase screening rates when combined with EHR reminders.
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Affiliation(s)
| | - Andria Apostolou
- 1246 Indian Health Service, Rockville, MD, USA.,SciMetrika, LLC, McLean, VA, USA
| | - Brigg Reilley
- 23762 Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Jessica Leston
- 23762 Northwest Portland Area Indian Health Board, Portland, OR, USA
| | | | - Jonathan Iralu
- 1811 Harvard Medical School, Boston, MA, USA.,1246 Indian Health Service, Gallup, NM, USA
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Lauren T, Catherine S, Rachel C, Hima P, Angelita L, Shauntel L, Laura M, Anna S, Anne R, Mariddie C, Charlotte G. Protecting our future generation: study protocol for a randomized controlled trial evaluating a sexual health self-care intervention with Native American youth and young adults. BMC Public Health 2019; 19:1614. [PMID: 31791323 PMCID: PMC6888928 DOI: 10.1186/s12889-019-7956-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 11/18/2019] [Indexed: 01/01/2023] Open
Abstract
Background Disparities in sexually transmitted infections (STI) are an urgent problem among Native American youth and young adults which are not fully explained by different sexual or related behaviors. These sexual health disparities are more likely attributed to social environments and structural determinants such as a shortage of sexual healthcare providers, lower socioeconomic status, and access barriers to STI screening and treatment, including geographic isolation and confidentiality concerns. Innovative, non-clinic based alternatives to promote STI screening and treatment are essential for alleviating these disparities. Self-care, or the care taken by individuals towards their own health and well-being may be such a strategy. This study will assess the efficacy of a self-care intervention, called Protecting Our Future Generation, for increasing uptake of STI screening and impacting sexual risk and protective behaviors among Native American youth and young adults living in a reservation-based community in the Southwestern United States. Methods The proposed study is a randomized controlled trial to test the efficacy of a self-care intervention compared to a control condition. Participants will be Native Americans ages 14–26 years old who have had vaginal or anal sex at least once in their lifetime. Participants will be randomized to the intervention which includes: 1) a sexual health self-assessment with embedded clinical prediction tool predicting STI positivity, and 2) personalized messaging with key steps to lower risk for STIs, or the control condition which includes: 1) a self-assessment about water, soda and sugar sweetened beverage consumption, and 2) personalized messaging to meet recommended daily intake. All participants will be offered a self-administered STI test. Participants will complete assessments at baseline, 3- and 6-months follow-up. The primary outcome measure is completion of STI screening. Discussion Protecting Our Future Generation is among the first self-care interventions uniquely focused on sexual health among a Native American population, who endure significant sexual health disparities and are under-represented in research. If efficacious, the intervention will be a model of sexual health self-care for Native American youth and young adults adaptable for use in healthcare and community-based settings. Trial registration Clinical Trials: http://clinicaltrials.gov; NCT03895320; Registered 03/28/2019.
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Affiliation(s)
- Tingey Lauren
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Bloomberg School of Public Health, 415 N. Washington St., Baltimore, MD, 21231, USA.
| | - Sutcliffe Catherine
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Bloomberg School of Public Health, 415 N. Washington St., Baltimore, MD, 21231, USA
| | - Chambers Rachel
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Bloomberg School of Public Health, 415 N. Washington St., Baltimore, MD, 21231, USA
| | - Patel Hima
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Bloomberg School of Public Health, 415 N. Washington St., Baltimore, MD, 21231, USA
| | - Lee Angelita
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Bloomberg School of Public Health, 308 Kuper St., Whiteriver, AZ, 85941, USA
| | - Lee Shauntel
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Bloomberg School of Public Health, 308 Kuper St., Whiteriver, AZ, 85941, USA
| | - Melgar Laura
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Bloomberg School of Public Health, 308 Kuper St., Whiteriver, AZ, 85941, USA
| | - Slimp Anna
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Bloomberg School of Public Health, 308 Kuper St., Whiteriver, AZ, 85941, USA
| | - Rompalo Anne
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Bloomberg School of Public Health, 415 N. Washington St., Baltimore, MD, 21231, USA
| | - Craig Mariddie
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Bloomberg School of Public Health, 308 Kuper St., Whiteriver, AZ, 85941, USA
| | - Gaydos Charlotte
- Johns Hopkins Center for the Development of Point Of Care Tests for Sexually Transmitted Diseases, Johns Hopkins University, Bloomberg School of Public Health, 855 N. Wolfe St., Baltimore, MD, 21205, USA
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Woodbury RB, Ketchum S, Hiratsuka VY, Spicer P. Health-Related Participatory Research in American Indian and Alaska Native Communities: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2969. [PMID: 31426579 PMCID: PMC6719130 DOI: 10.3390/ijerph16162969] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/15/2019] [Accepted: 08/15/2019] [Indexed: 12/15/2022]
Abstract
A scoping review was conducted to assess the state of the literature on health-related participatory research involving American Indian and Alaska Native communities. Online databases were searched for relevant articles published between 1/1/2000 and 5/31/2017. 10,000+ data points relevant to community-level engagement in and regulation of research, community research capacity and cultural adaptation were extracted from 178 articles. Community engagement varied across study components: 136 (76%) articles reported community participation in research-related meetings and other events and 49 (27%) articles reported community involvement in initiation of research. 156 (88%) articles reported use of community-level tools to guide or regulate research. 93 (52%) articles reported that community members received research-related training. 147 (82%) articles described some type of cultural adaptation. Across all articles, data points on community engagement were not reported in 3061 (40%) out of 7740 cases. Findings suggest a need for increased community engagement in early stages of the research process and for reporting guidelines for participatory research involving American Indian and Alaska Native communities. There is also need to further existing research on the impact of different components of participatory research on process and outcome measures and to develop funding mechanisms that account for the time and resource intensive nature of participatory research.
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Affiliation(s)
- R Brian Woodbury
- Southcentral Foundation Research Department, 4085 Tudor Centre Dr., Anchorage, AK 99508, USA.
| | - Scott Ketchum
- University of Oklahoma, 5 Partners Place, Stephenson Pkwy, Suite 4100, Norman, OK 73019, USA
| | - Vanessa Y Hiratsuka
- Southcentral Foundation Research Department, 4085 Tudor Centre Dr., Anchorage, AK 99508, USA
| | - Paul Spicer
- Department of Anthropology, University of Oklahoma, 5 Partners Place, 201 Stephenson Pkwy, Suite 4100, Norman, OK 73019, USA
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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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Yao P, Fu R, Craig Rushing S, Stephens D, Ash JS, Eden KB. Texting 4 Sexual Health: Improving Attitudes, Intention, and Behavior Among American Indian and Alaska Native Youth. Health Promot Pract 2018; 19:833-843. [PMID: 29557176 DOI: 10.1177/1524839918761872] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE To design and test the effectiveness of a text messaging intervention to promote condom use and STI/HIV testing among American Indian and Alaska Native youth. METHOD A total of 408 study participants, 15 to 24 years old, were recruited, consented, surveyed, were sent intervention messages, and were incentivized via text message over a 9-month period. Complete pre- and postsurvey data were collected from 192 participants using SMS short codes. A mixed-effects logistic regression model was used to analyze before-after change in responses assessing sexual health knowledge, attitude, self-efficacy, intention, and behavior. RESULTS Participants' condom use attitude, condom use behavior, and STI/HIV testing intention improved after the intervention ( p < .05). Frequent condom use increased from 30% to 42% and was retained by participants at least 3 months postintervention, and the intervention improved participants' intention to get tested for STI/HIV after changing sexual partners, increasing from 46% to 58% postintervention. CONCLUSIONS Given the widespread use of cell phones by youth, text-based interventions may offer a feasible and effective tool to promote condom use and STI/HIV testing.
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Affiliation(s)
- Patricia Yao
- 1 Oregon Health & Science University, Portland, OR, USA
| | - Rongwei Fu
- 1 Oregon Health & Science University, Portland, OR, USA
| | | | - David Stephens
- 2 Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Joan S Ash
- 1 Oregon Health & Science University, Portland, OR, USA
| | - Karen B Eden
- 1 Oregon Health & Science University, Portland, OR, USA
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Roth A, Tran NK, Chavis M, Van Der Pol B. Examining unmet needs: a cross-sectional study exploring knowledge, attitudes and sexually transmitted infection screening preferences among persons who inject drugs in Camden, New Jersey. Sex Transm Infect 2018; 94:598-603. [PMID: 29960982 DOI: 10.1136/sextrans-2017-053498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 04/24/2018] [Accepted: 06/07/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To inform the development of targeted sexually transmitted infection (STI) control programmes for persons who inject drugs (PWID). METHODS We recruited 116 PWID (aged ≥ 18 years) from a community-based syringe exchange programme (SEP) and assessed their STI knowledge and screening preferences via technology assisted self-interview. We estimated prevalence of STI transmission knowledge, attitudes and screening preferences as well as the association between reported sexual behaviours (past 6 months) and willingness to self-collect specimens. RESULTS Participants were white (77%), female (51%) and heterosexual (77%). STI knowledge regarding transmission and testing was high among the sample. More than 70% of participants were aware extragenital infections were possible and were least likely to know urine tests do not detect rectal infections (40.9%). Site-specific specimen collection was highly reflective of reported sexual behaviour. PWID who reported receptive sex (36% vs 5%, p<0.01) and insertive anal sex (31% vs 6%, p=0.01) were more likely to collect rectal specimens than those who did not. A similar trend was seen for oral sex performance on men and self-collection of oropharyngeal swabs (15% vs 3%, p=0.04). In addition, participants preferred collecting their own sample to having a clinician collect it for them (69% vs 31%, p<0.01) and testing at the SEP compared with a STI clinic (86% vs 14%, p<0.01). CONCLUSION Our findings suggest site-specific specimen collection may be a proxy for risk behaviour engagement in this fairly knowledgeable high-risk population. To increase case finding, STI control programmes should educate patients about site-specific screening and pair outreach with the infrastructure provided by SEPs, in settings where these programmes exist.
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Affiliation(s)
- Alexis Roth
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Nguyen Khai Tran
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Martha Chavis
- Camden Area Health Education Center, Camden, NJ, USA
| | - Barbara Van Der Pol
- Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
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Ong JJ, Fu H, Smith MK, Tucker JD. Expanding syphilis testing: a scoping review of syphilis testing interventions among key populations. Expert Rev Anti Infect Ther 2018; 16:423-432. [PMID: 29633888 PMCID: PMC6046060 DOI: 10.1080/14787210.2018.1463846] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Syphilis is an important sexually transmitted infection (STI). Despite inexpensive and effective treatment, few key populations receive syphilis testing. Innovative strategies are needed to increase syphilis testing among key populations. Areas covered: This scoping review focused on strategies to increase syphilis testing in key populations (men who have sex with men (MSM), sex workers, people who use drugs, transgender people, and incarcerated individuals). Expert commentary: We identified many promising syphilis testing strategies, particularly among MSM. These innovations are separated into diagnostic, clinic-based, and non-clinic based strategies. In terms of diagnostics, self-testing, dried blood spots, and point-of-care testing can decentralize syphilis testing. Effective syphilis self-testing pilots suggest the need for further attention and research. In terms of clinic-based strategies, modifying default clinical procedures can nudge physicians to more frequently recommend syphilis testing. In terms of non-clinic based strategies, venue-based screening (e.g. in correctional facilities, drug rehabilitation centres) and mobile testing units have been successfully implemented in a variety of settings. Integration of syphilis with HIV testing may facilitate implementation in settings where individuals have increased sexual risk. There is a strong need for further syphilis testing research and programs.
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Affiliation(s)
- Jason J. Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Central Clinical School, Monash University, Victoria, Australia
| | - Hongyun Fu
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Eastern Virginia Medical School, Norfolk, USA
| | - M. Kumi Smith
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- University of North Carolina at Chapel Hill, North Carolina, USA
| | - Joseph D. Tucker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- University of North Carolina at Chapel Hill, North Carolina, USA
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12
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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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13
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Smartlowit-Briggs L, Pearson C, Whitefoot P, Altamirano BN, Womack M, Bastin M, Dombrowski JC. Community-Based Assessment to Inform a Chlamydia Screening Program for Women in a Rural American Indian Community. Sex Transm Dis 2016; 43:390-5. [PMID: 27196261 PMCID: PMC5446671 DOI: 10.1097/olq.0000000000000456] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rates of chlamydial infection in American Indian/Alaska Native women in the United States are approximately 4-fold those in non-Hispanic white women. We conducted a community-based survey of self-identified American Indian/Alaska Native women 14 to 25 years of age on a reservation in the Northwestern United States to inform a chlamydia screening strategy. METHODS The anonymous survey assessed respondents' knowledge, perceptions, and preferences related to chlamydia screening, results receipt, and partner notification. We recruited women using respondent-driven sampling, school-based sampling, and direct recruitment through social media and fliers. Participants in schools completed the survey as a paper-based, self-administered survey. Other participants could complete the survey in person, by phone as an interviewer-administered survey, or online. RESULTS We recruited 162 participants, most in schools (n = 83; 51%) or by peer referral (n = 55; 34%). Only 1 woman completed the survey online. Thirty-one respondents (19%) reported a history of an unplanned first pregnancy, and 19 (12%) reported a history of a diagnosed sexually transmitted disease. Most women (n = 98; 63%) recognized the potential impact of Chlamydia trachomatis on fertility. The preferred site for chlamydia screening was the Indian Health Service Clinic (n = 114; 70%), but 79 women (41%) would accept a C. trachomatis test at a nonclinical testing site. Of the 56 women (35%) who would accept home testing, most preferred to get the test kit from a clinic. CONCLUSIONS Our results suggest that Indian Health Service efforts to increase chlamydia screening in the clinic and through outreach may be more successful than promotion of home testing in this population.
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Affiliation(s)
| | - Cynthia Pearson
- Indigenous Wellness Research Center, University of Washington, Seattle, WA
- Toppenish School District, Toppenish, WA
| | | | | | | | - Marie Bastin
- Indian Health Services, Yakama Nation, Toppenish, WA
| | - Julia C. Dombrowski
- Center for AIDS and STD, University of Washington, Seattle, WA
- Public Health–Seattle & King County HIV/STD Program, Seattle, WA
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14
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Chambers R, Tingey L, Beach A, Barlow A, Rompalo A. Testing the efficacy of a brief sexual risk reduction intervention among high-risk American Indian adults: study protocol for a randomized controlled trial. BMC Public Health 2016; 16:366. [PMID: 27129956 PMCID: PMC4850664 DOI: 10.1186/s12889-016-3040-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/26/2016] [Indexed: 04/17/2023] Open
Abstract
Background American Indian adults are more likely to experience co-occurring mental health and substance use disorders than adults of other racial/ethnic groups and are disproportionately burdened by the most common sexually transmitted infections, namely chlamydia and gonorrhea. Several behavioral interventions are proven efficacious in lowering risk for sexually transmitted infection in various populations and, if adapted to address barriers experienced by American Indian adults who suffer from mental health and substance use problems, may be useful for dissemination in American Indian communities. The proposed study aims to examine the efficacy of an adapted evidence-based intervention to increase condom use and decrease sexual risk-taking and substance use among American Indian adults living in a reservation-based community in the Southwestern United States. Methods/Design The proposed study is a randomized controlled trial to test the efficacy of an adapted evidence-based intervention compared to a control condition. Participants will be American Indian adults ages 18–49 years old who had a recent episode of binge substance use and/or suicide ideation. Participants will be randomized to the intervention, a two-session risk-reduction counseling intervention or the control condition, optimized standard care. All participants will be offered a self-administered sexually transmitted infection test. Participants will complete assessments at baseline, 3 and 6 months follow-up. The primary outcome measure is condom use at last sex. Discussion This is one of the first randomized controlled trials to assess the efficacy of an adapted evidence-based intervention for reducing sexual risk behaviors among AI adults with substance use and mental health problems. If proven successful, there will be an efficacious program for reducing risk behaviors among high-risk adults that can be disseminated in American Indian communities as well as other rural and under-resourced health systems. Trial Registration Clinical Trials NCT02513225
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Affiliation(s)
- Rachel Chambers
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, 415 North Washington Street Suite 400, Baltimore, Maryland, 21224, USA.
| | - Lauren Tingey
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, 415 North Washington Street Suite 400, Baltimore, Maryland, 21224, USA
| | - Anna Beach
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, 415 North Washington Street Suite 400, Baltimore, Maryland, 21224, USA
| | - Allison Barlow
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, 415 North Washington Street Suite 400, Baltimore, Maryland, 21224, USA
| | - Anne Rompalo
- Johns Hopkins School of Medicine, Johns Hopkins University, 415 North Washington Street Suite 400, Baltimore, Maryland, 21224, USA
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