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Evans GS, McCurdy S, Schultz K, Peskin MF, Tingey L, Markham C. 'Trauma sits in your body and makes you shut down:' sexual and reproductive health professionals' views of the impact of trauma on the sexual health of Native American older adolescent and young adult women. CULTURE, HEALTH & SEXUALITY 2024:1-16. [PMID: 38995980 DOI: 10.1080/13691058.2024.2374939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 06/27/2024] [Indexed: 07/14/2024]
Abstract
A history of colonisation and corresponding traumas has resulted in disparate rates of violence and sexual health inequities among many Native American populations. As a result, Native American adolescents and young adults specifically, experience higher rates of STIs, HIV and unintended pregnancy relative to their non-Hispanic White counterparts. To address these inequities, sexual health education programmes should reflect Native American cultural values and traditional teachings to align with community assets and protective factors. The objective of this study was to describe sexual and reproductive health professionals' perspectives on how trauma collectively affects the sexual health of older adolescents and young adult Native American women between the ages of 15-25 years. We purposively sampled sexual and reproductive health professionals who worked with members of this priority population. Individual in-depth interviews were conducted, recorded, and transcribed. Transcripts were analysed using thematic analysis. The themes identified in the interviews include the impact of trauma and colonisation on sexual health, strategies for combatting trauma, promoting sexual health, and supporting the development of culturally congruent sexual health education curricula. Findings point to the need for culturally relevant, trauma-informed sexual health education interventions to help promote sexual and reproductive health equity for Native American adolescent and young adult women.
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Affiliation(s)
- Gabrielle S Evans
- Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sheryl McCurdy
- Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Katie Schultz
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Melissa F Peskin
- Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Christine Markham
- Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, 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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Markham CM, Rushing SC, Manthei J, Singer M, Jessen C, Gorman G, Peskin MF, Hernandez BF, Sacca L, Evans GS, Luna-Meza C, Merritt Z, Shegog R. The Healthy Native Youth Implementation Toolbox: Using Implementation Mapping to adapt an online decision support system to promote culturally-relevant sexual health education for American Indian and Alaska Native youth. Front Public Health 2022; 10:889924. [PMID: 36388328 PMCID: PMC9659648 DOI: 10.3389/fpubh.2022.889924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 10/03/2022] [Indexed: 01/21/2023] Open
Abstract
Background American Indian and Alaska Native (AI/AN) youth experience serious disparities in sexual and reproductive health, including the highest teen birth rate among racial/ethnic groups, and disproportionate rates of sexually transmitted infections (STI), including HIV. A growing number of evidence-based programs (EBPs) that integrate the strengths and cultural teachings of Native communities exist. Yet, multiple factors, including lack of trained personnel, limited resources, and geographic isolation, may hinder their adoption and implementation. Innovative implementation strategies that facilitate the adoption and implementation of sexual health EBPs in Native communities may help reduce these disparities. Methods We applied Implementation Mapping, a systematic planning framework that utilizes theory, empirical evidence, and community input, to adapt a theory-based, online decision support system, iCHAMPSS (CHoosing And Maintaining Effective Programs for Sex Education in Schools), to support underlying dissemination and implementation processes unique to Native communities. We used an iterative design process, incorporating input from Native practitioners and academicians, to ensure that the adapted decision support system reflects cultural identification, community values, and experiences. Results Grounded in diffusion of innovations, organizational stage theory, and social cognitive theory, the Healthy Native Youth Implementation Toolbox supports Native practitioners through five phases (Gather, Choose, Prepare, Implement, and Grow) to adopt, implement, and maintain a culturally-relevant, age-appropriate sexual health EBP. The Toolbox provides tools, ready-to-use templates, and guidance to plan, implement, and grow a culturally-relevant adolescent health program with their Tribe or community. Hosted within the Healthy Native Youth website (www.healthynativeyouth.org), the Toolbox comprises: (1) a curriculum portal with access to 15 culturally-relevant, age-appropriate evidence-based health promotion programs for AI/AN youth; (2) a "resource library" comprising 20+ support tools, templates, and links to external resources, and (3) "stories from the field" comprising testimonials from experienced Native educators, who have implemented sexual health programs. Conclusion There is a continued need to design, test, and evaluate D&I strategies that are relevant to Native communities. The Healthy Native Youth Implementation Toolbox contributes to the dissemination and implementation of evidence-based, culturally-relevant sexual health education programs in diverse Native communities. Implementation Mapping provided a systematic approach to guide the adaptation process and integrate community voice with the ultimate goal of enhancing sexual health equity among AI/AN youth.
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Affiliation(s)
- Christine M. Markham
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center Houston, Houston, TX, United States
| | | | - Jane Manthei
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Michelle Singer
- Northwest Portland Area Indian Health Board, Portland, OR, 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
| | - Melissa F. Peskin
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center Houston, Houston, TX, United States
| | - Belinda F. Hernandez
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center Houston, San Antonio, TX, United States
| | - Lea Sacca
- College of Medicine, Florida International University, Miami, FL, United States
| | - Gabrielle S. Evans
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center Houston, Houston, TX, United States
| | - Claudia Luna-Meza
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center Houston, Houston, TX, United States
| | - Zoe Merritt
- Alaska Native Tribal Health Consortium, Anchorage, AK, United States
| | - Ross Shegog
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center Houston, Houston, TX, United States
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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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Leston J, Wenger H, Reilley B, Craig Rushing S, Rink E, Warren H, Howe J, Bloomquist P, Tah T, Jeffries I, Iralu J, Thorpe P, Apostolou A, Taylor MM. Creating a path forward: understanding the context of sexual health and sexually transmitted infections in American Indian/Alaska Native populations – a review. Sex Health 2022; 19:286-298. [PMID: 35760766 PMCID: PMC11081199 DOI: 10.1071/sh22040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022]
Abstract
This review assessed sexual health and sexually transmitted infection (STI) burden among American Indian/Alaska Native (AI/AN) peoples within the context of current clinical and public health services. We conducted a review of published literature about sexual health and bacterial STIs among AI/AN populations in the United States using Medline (OVID), CINAHL (EbscoHost) and Scopus. Peer-reviewed journals published during 1 January 2005-2 December 2021 were included and supplemented by other publicly available literature. A total of 138 articles from reference lists met inclusion criteria, including 85 peer-review articles and 53 additional references. Results indicate a disproportionate burden of STIs is carried by AI/AN populations compared to non-Hispanic Whites. Risk for STIs in AI/AN people has origins in historical trauma and structural and social determinants of health. STI services are available for AI/AN populations, but many barriers to care exist. Community-based sexual health programming has been successful, but has thus far focused primarily on adolescents and young adults. A myriad of factors contributes to high rates of STIs among AI/AN populations. Longstanding disparities show a clear need to increase the availability of integrated, low-barrier STI prevention and treatment services. Implementation of multi-level (individual, physician, clinic, healthcare organisation, and/or community level), culturally relevant sexual health and STI interventions should be community-based and person-centred, acknowledge social determinants of health, and grounded in deep respect and understanding of AI/AN histories and cultures.
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Affiliation(s)
- Jessica Leston
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | | | - Brigg Reilley
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | | | | | - Hannah Warren
- Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Jean Howe
- Northern Navajo Medical Center, Indian Health Service, Shiprock, NM, USA
| | | | - Tina Tah
- Indian Health Service Headquarters, Rockville, MD, USA
| | - Itai Jeffries
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Jonathan Iralu
- Gallup Indian Medical Center, Indian Health Service, Gallup, NM, USA
| | - Phoebe Thorpe
- U.S. Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, GA, USA
| | | | - Melanie M. Taylor
- U.S. Centers for Disease Control and Prevention, Division of HIV Prevention, Atlanta, GA, USA
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Rink E, Firemoon P, Anastario M, Johnson O, GrowingThunder R, Ricker A, Peterson M, Baldwin J. Rationale, Design, and Methods for Nen Unkumbi/Edahiyedo ("We Are Here Now"): A Multi-Level Randomized Controlled Trial to Improve Sexual and Reproductive Health Outcomes in a Northern Plains American Indian Reservation Community. Front Public Health 2022; 10:823228. [PMID: 35910931 PMCID: PMC9326233 DOI: 10.3389/fpubh.2022.823228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/29/2022] [Indexed: 12/01/2022] Open
Abstract
American Indian (AI) youth in the United States experience disproportionate sexual and reproductive health (SRH) disparities relative to their non-Indigenous, white counterparts, including increased rates of sexually transmitted infections (STIs), earlier sexual debut, increased rates of teen birth, and reduced access to SRH services. Past research shows that to improve SRH outcomes for AI youth in reservation communities, interventions must address complex factors and multiple levels of community that influence sexual risk behaviors. Here, we describe development of a multi-level, multi-component randomized controlled trial (RCT) to intervene upon SRH outcomes in a Northern Plains American Indian reservation community. Our intervention is rooted in a community based participatory research framework and is evaluated with a stepped wedge design that integrates 5 reservation high schools into a 5-year, cluster-randomized RCT. Ecological Systems Theory was used to design the intervention that includes (1) an individual level component of culturally specific SRH curriculum in school, (2) a parental component of education to improve parent-child communication about SRH and healthy relationships, (3) a community component of cultural mentorship, and (4) a systems-level component to improve delivery of SRH services from reservation healthcare agencies. In this article we present the rationale and details of our research design, instrumentation, data collection protocol, analytical methods, and community participation in the intervention. Our intervention builds upon existing community strengths and integrates traditional Indigenous knowledge and values with current public health knowledge to reduce SRH disparities.
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Affiliation(s)
- Elizabeth Rink
- Department of Health and Human Development, Montana State University, Bozeman, MT, United States
| | | | - Michael Anastario
- AHC5, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, United States
| | | | - Ramey GrowingThunder
- Language and Culture Department, Fort Peck Assiniboine and Sioux Tribes, Poplar, MT, United States
| | - Adriann Ricker
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Malory Peterson
- Department of Health and Human Development, Montana State University, Bozeman, MT, United States
| | - Julie Baldwin
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
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Sacca L, Markham C, Hernandez B, Shegog R, Peskin M, Craig Rushing S, Warren H, Tsosie M. The Impact of COVID-19 on the Delivery of Educational Programs in Native American Communities: Qualitative Study. JMIR Form Res 2022; 6:e32325. [PMID: 35348464 PMCID: PMC9004623 DOI: 10.2196/32325] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 03/02/2022] [Accepted: 03/18/2022] [Indexed: 11/24/2022] Open
Abstract
Background Despite the availability of culturally responsive sexual health educational programs for American Indian and Alaska Native (AI/AN) youth, barriers to their uptake and utilization persist in tribal communities. These challenges were exacerbated by the COVID-19 pandemic, which required flexible program delivery using both in-person and virtual classrooms. Objective This exploratory study provides a preliminary understanding of the extent to which pre-existing challenges impact the delivery of culturally responsive sexual health education programs in Native communities and to what extent they were exacerbated by the COVID-19 pandemic. It also highlights the challenges faced by adolescent health advocates when adapting culturally responsive health curricula to online platforms. Finally, this study discloses major socioeconomic, health, and mental challenges experienced by AI/AN youth during the pandemic. Methods An exploratory, descriptive, qualitative design approach was adopted to carry out 5 individual and 1 collective in-depth key informant interviews. A total of 8 Native and non-Native sexual health educators served as key informants and shared their personal experiences with the delivery of sexual health education programs for youth during the COVID-19 pandemic. The interviews were conducted virtually from October to November 2020 using Zoom to reach participants dispersed across different regions of the United States. We followed the consolidated criteria for reporting qualitative research (COREQ) as a reference for the study methodology. We also used the Braun and Clarke framework (2006) to conduct a thematic analysis. Results Experts’ opinions were structured according to 5 main themes: (1) competing community priorities during COVID-19; (2) moving to web-based programming: skills, training, support; (3) recruiting youth; and (4) challenges for implementation in a household environment; and (5) recommendations to overcome implementation challenges. These themes are complementary, connected, and should be considered holistically for the development, dissemination, and implementation of online sexual health programs for AI/AN youth, specifically during the COVID-19 pandemic. The results raised the following points for discussion: (1) Building partnerships with schools and community organizations facilitates program adaptation and implementation, (2) there is a need to adopt a holistic approach when addressing youth sexual health in AI/AN communities, (3) a systematic and culturally responsive adaptation approach ensures effective virtual program delivery, and (4) community and youth engagement is essential for the success of virtual sexual health programs. Conclusions Findings can provide recommendations on actions to be taken by sexual health educators and guidelines to follow to ensure cultural sensitivity, effective adaptation, and successful implementation when setting out to advocate for online sexual health programs for AI/AN youth.
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Affiliation(s)
- Lea Sacca
- Center for Health Promotion and Disease Prevention, University of Texas Health Science Center Houston, Houston, TX, United States
| | - Christine Markham
- Center for Health Promotion and Disease Prevention, University of Texas Health Science Center Houston, Houston, TX, United States
| | - Belinda Hernandez
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Ross Shegog
- Center for Health Promotion and Disease Prevention, University of Texas Health Science Center Houston, Houston, TX, United States
| | - Melissa Peskin
- Center for Health Promotion and Disease Prevention, University of Texas Health Science Center Houston, Houston, TX, United States
| | | | - Hannah Warren
- Alaska Native Tribal Health Consortium, Anchorage, AK, United States
| | - Monique Tsosie
- Inter Tribal Council of Arizona, Phoenix, AZ, United States
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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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Sacca L, Shegog R, Hernandez B, Peskin M, Rushing SC, Jessen C, Lane T, Markham C. Barriers, frameworks, and mitigating strategies influencing the dissemination and implementation of health promotion interventions in indigenous communities: a scoping review. Implement Sci 2022; 17:18. [PMID: 35189904 PMCID: PMC8862215 DOI: 10.1186/s13012-022-01190-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 01/18/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Many Indigenous communities across the USA and Canada experience a disproportionate burden of health disparities. Effective programs and interventions are essential to build protective skills for different age groups to improve health outcomes. Understanding the relevant barriers and facilitators to the successful dissemination, implementation, and retention of evidence-based interventions and/or evidence-informed programs in Indigenous communities can help guide their dissemination. PURPOSE To identify common barriers to dissemination and implementation (D&I) and effective mitigating frameworks and strategies used to successfully disseminate and implement evidence-based interventions and/or evidence-informed programs in American Indian/Alaska Native (AI/AN), Native Hawaiian/Pacific Islander (NH/PI), and Canadian Indigenous communities. METHODS A scoping review, informed by the York methodology, comprised five steps: (1) identification of the research questions; (2) searching for relevant studies; (3) selection of studies relevant to the research questions; (4) data charting; and (5) collation, summarization, and reporting of results. The established D&I SISTER strategy taxonomy provided criteria for categorizing reported strategies. RESULTS Candidate studies that met inclusion/exclusion criteria were extracted from PubMed (n = 19), Embase (n = 18), and Scopus (n = 1). Seventeen studies were excluded following full review resulting in 21 included studies. The most frequently cited category of barriers was "Social Determinants of Health in Communities." Forty-three percent of barriers were categorized in this community/society-policy level of the SEM and most studies (n = 12, 57%) cited this category. Sixteen studies (76%) used a D&I framework or model (mainly CBPR) to disseminate and implement health promotion evidence-based programs in Indigenous communities. Most highly ranked strategies (80%) corresponded with those previously identified as "important" and "feasible" for D&I The most commonly reported SISTER strategy was "Build partnerships (i.e., coalitions) to support implementation" (86%). CONCLUSION D&I frameworks and strategies are increasingly cited as informing the adoption, implementation, and sustainability of evidence-based programs within Indigenous communities. This study contributes towards identifying barriers and effective D&I frameworks and strategies critical to improving reach and sustainability of evidence-based programs in Indigenous communities. REGISTRATION NUMBER N/A (scoping review).
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Affiliation(s)
- Lea Sacca
- grid.267308.80000 0000 9206 2401Center for Health Promotion and Disease Prevention, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin, Houston, TX 77030 USA
| | - Ross Shegog
- grid.267308.80000 0000 9206 2401Center for Health Promotion and Disease Prevention, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin, Houston, TX 77030 USA
| | - Belinda Hernandez
- grid.267309.90000 0001 0629 5880Center for Health Promotion and Disease Prevention, University of Texas Health Science Center School of Public Health in San Antonio, 7411 John Smith Drive, Suite 1100, San Antonio, TX 78229 USA
| | - Melissa Peskin
- grid.267308.80000 0000 9206 2401Center for Health Promotion and Disease Prevention, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin, Houston, TX 77030 USA
| | - Stephanie Craig Rushing
- grid.422837.80000 0000 9966 8676Northwest Portland Area Indian Health Board, 2121 SW Broadway Suite 300, Portland, OR 97201 USA
| | - Cornelia Jessen
- grid.413552.40000 0000 9894 0703Alaska Native Tribal Health Consortium, 4000 Ambassador Drive, Anchorage, AK 99508 USA
| | - Travis Lane
- grid.470274.20000 0001 0023 3814Inter Tribal Council of Arizona, Inc., 2214 North Central Avenue, Phoenix, AZ 85004 USA
| | - Christine Markham
- grid.267308.80000 0000 9206 2401Center for Health Promotion and Disease Prevention, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin, Houston, TX 77030 USA
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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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Sacca L, Craig Rushing S, Markham C, Shegog R, Peskin M, Hernandez B, Gaston A, Singer M, Trevino N, Correa CC, Jessen C, Williamson J, Thomas J. Assessment of the Reach, Usability, and Perceived Impact of " Talking Is Power": A Parental Sexual Health Text-Messaging Service and Web-Based Resource to Empower Sensitive Conversations with American Indian and Alaska Native Teens. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9126. [PMID: 34501715 PMCID: PMC8431363 DOI: 10.3390/ijerph18179126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Early sexual debut among American Indian and Alaska Native (AI/AN) adolescents has been associated with an increased risk of teenage pregnancies and sexually transmitted infections, along with an increased risk of having multiple lifetime sexual partners, and engaging in greater frequency of sex, substance abuse, and lack of condom use. A major protective factor against early sexual debut among AI/AN youth is the familial system. Interventions aiming to improve parent-child communication and parental warmth toward adolescent sexual health topics were reported to contribute to positive youth sexual health outcomes, specifically among minority youth. Healthy Native Youth thus developed the Talking is Power text-messaging service to guide parents and caring adults on how to initiate sensitive topics with youth and how to support them in making informed decisions regarding sex and healthy relationships. METHODS Descriptive statistics were used to demonstrate website analytics and reach per views and time spent on each page, and for displaying participants' responses to the questions on the usability of the Talking is Power text-messaging series. To assess the perceived impact of the series, the differences in mean percentage scores of the question assessing parental comfort in engaging in sexual health topics with youth between pre- and post-intervention were calculated using two-sample t-tests of equal variances. Descriptive content analysis was adopted to highlight emerging themes from open-ended items. RESULTS When looking at reach, 862 entrances were recorded during the specified time period (5.8% of total entrances to HNY website), while the bounce rate was set at 73.1% (22.6% greater than the industry average), and the exit rate was 54.3% (15.2% greater than the industry average). Series usability was highly ranked on the 5-Likert scale in terms of signing up for a similar series on a different topic, quality of images, texts, and links, relating to prompts, and change in sparking sensitive conversations with youth. High likelihood of recommending the series to a friend or colleague was also reported by participants (0-10). No significant difference in parental comfort levels was reported (p = 0.78 > 0.05). Main themes provided suggestions for improving the series mode of delivery, while others included positive feedback about the material, with the possibility of expanding the series to other adolescent health topics. CONCLUSION Lessons learned during the design, dissemination, and evaluation of the resource's usability, reach, and perceived impact may be of interest to other Indigenous communities who are in the process of adapting and/or implementing similar approaches.
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Affiliation(s)
- Lea Sacca
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (C.M.); (R.S.); (M.P.); (C.C.C.)
| | - Stephanie Craig Rushing
- Northwest Portland Area Indian Health Board, Portland, OR 97201, USA; (A.G.); (M.S.); (N.T.)
| | - Christine Markham
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (C.M.); (R.S.); (M.P.); (C.C.C.)
| | - Ross Shegog
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (C.M.); (R.S.); (M.P.); (C.C.C.)
| | - Melissa Peskin
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (C.M.); (R.S.); (M.P.); (C.C.C.)
| | - Belinda Hernandez
- School of Public Health, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA;
| | - Amanda Gaston
- Northwest Portland Area Indian Health Board, Portland, OR 97201, USA; (A.G.); (M.S.); (N.T.)
| | - Michelle Singer
- Northwest Portland Area Indian Health Board, Portland, OR 97201, USA; (A.G.); (M.S.); (N.T.)
| | - Nicole Trevino
- Northwest Portland Area Indian Health Board, Portland, OR 97201, USA; (A.G.); (M.S.); (N.T.)
| | - Chrystial C. Correa
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (C.M.); (R.S.); (M.P.); (C.C.C.)
| | - Cornelia Jessen
- Alaska Native Tribal Health Consortium, Anchorage, AK 99508, USA; (C.J.); (J.W.)
| | - Jennifer Williamson
- Alaska Native Tribal Health Consortium, Anchorage, AK 99508, USA; (C.J.); (J.W.)
| | - Jerri Thomas
- Inter Tribal Council of Arizona, Inc., Phoenix, AZ 85004, USA;
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Sethi S, Poirier B, Canfell K, Smith M, Garvey G, Hedges J, Ju X, Jamieson LM. Working towards a comprehensive understanding of HPV and cervical cancer among Indigenous women: a qualitative systematic review. BMJ Open 2021; 11:e050113. [PMID: 34193502 PMCID: PMC8246376 DOI: 10.1136/bmjopen-2021-050113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Indigenous peoples carry a disproportionate burden of infectious diseases and cancers and are over-represented among the socially disadvantaged of most countries. Human papillomavirus (HPV) is a risk factor and causative agent of cervical, oropharyngeal and other cancers. Recent literature shows evidence of Indigenous populations being at increased risk of HPV infections and its associated cancers. OBJECTIVE This is a qualitative systematic review. The objective of this study was to explore the experiences and barriers Indigenous women face in relation to HPV awareness, knowledge and cervical screening, in order to better understand factors that may mitigate against or facilitate prevention efforts for HPV infection and associated cancers. METHODS Two investigators independently searched MEDLINE, PubMed, SCOPUS and Web of Science databases (for articles published from inception until 30 June 2020) using a prespecified search strategy to identify qualitative studies on narratives of Indigenous women regarding HPV infection awareness, knowledge and cervical screening, across all geographic and income-level settings. Using a 'meta-study' approach, a social ecological model of cervical screening, infection and associated cancer prevention among Indigenous populations was formulated. RESULTS Five core themes were identified and formulated within the social ecological model; intrapersonal factors, interpersonal factors, institutional/organisational factors, sociocultural/community factors and public policy. These collectively formed the proposed social ecological model of HPV infection awareness and cervical cancer prevention among Indigenous women. This model has been synthesised by taking into account personal stories of Indigenous women and healthcare workers, thus offering a more nuanced, organised, structured and culturally sensitive approach to policy translation. CONCLUSION The social ecological model of HPV infection awareness and cervical cancer prevention among Indigenous women offers a holistic and practical approach for Indigenous health policy makers. It clearly addresses the high risk of Indigenous populations at a global level in experience of both HPV infection and HPV-related cancers. PROSPERO REGISTRATION NUMBER CRD42020207643.
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Affiliation(s)
- Sneha Sethi
- Australian Research Centre for Population Oral Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Brianna Poirier
- Australian Research Centre for Population Oral Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council New South Wales, Woolloomooloo, New South Wales, Australia
| | - Megan Smith
- Cancer Research Division, Cancer Council New South Wales, Woolloomooloo, New South Wales, Australia
| | - Gail Garvey
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research Brisbane Office, Brisbane, Queensland, Australia
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Xiangqun Ju
- Australian Research Centre for Population Oral Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lisa M Jamieson
- Australian Research Centre for Population Oral Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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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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Sethi S, Ali A, Ju X, Antonsson A, Logan R, Canfell K, Smith M, Garvey G, Hedges J, Jamieson L. A systematic review and meta-analysis of the prevalence of human papillomavirus infection in Indigenous populations - A Global Picture. J Oral Pathol Med 2021; 50:843-854. [PMID: 34008187 DOI: 10.1111/jop.13201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIM Recent trends have shown a decline in the rates of human papillomavirus (HPV)-associated cervical cancer in the vaccinated population but there has been a spike in the HPV-associated oropharyngeal, anal and penile cancers in the majority of the unvaccinated population which are young and middle-aged males. Indigenous populations at an international level carry a disproportionate burden of most diseases. The aim of this meta-analysis was to ascertain the worldwide prevalence of HPV infection in Indigenous populations stratified by sex and site and to document the most commonly reported HPV types. METHODS Published articles on HPV infection in Indigenous populations from PubMed, Scopus, EMBASE and Web of Science were systematically searched from inception until 23 December 2019. RESULTS A total of 41 studies were included in the final analysis. The pooled worldwide prevalence of HPV infection (for both oral and genital sites, both males and females) in Indigenous populations was 34.2% (95% CI: 28.9%-39.8%). Subgroup analysis (geographical) showed that the pooled prevalence for African Indigenous, American Indigenous and Asian-Oceanic Indigenous populations were 33.0% (95% CI: 12.8%-57.1%), 33.0% (95% CI: 27.4%-38.9%) and 33.3% (95% CI: 0.17.5%-51.3%), respectively. CONCLUSION There are not enough data on the burden of the infection carried by males especially with respect to highly suspicious sites like oropharynx. Also, we conclude an overall high prevalence of HPV infection in the Indigenous populations and increasing their susceptibility to benign and malignant manifestations of HPV.
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Affiliation(s)
- Sneha Sethi
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, SA, Australia
| | - Anna Ali
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Xiangqun Ju
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, SA, Australia
| | - Annika Antonsson
- QIMR Berghofer Medical Research Institute, QIMR Berghofer Medical Research Institute, Brisbane, Qld, Australia
| | - Richard Logan
- Adelaide Dental School, University of Adelaide, Adelaide, SA, Australia
| | - Karen Canfell
- Cancer Council of New South Wales, Sydney, NSW, Australia
| | - Megan Smith
- Cancer Council of New South Wales, Sydney, NSW, Australia
| | - Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, SA, Australia
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, SA, Australia
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