We Are Here Now of N/E

• In Event: National Institute of Health Funding to Address Pediatric Health Disparities

Abstract

Introduction. NenUnkUmbi/EdaHiYedo (“We Are Here Now” of N/E) tests the efficacy of a multi-level, multi-component intervention to reduce sexual risk behavior and teen pregnancy as American Indian (AI) youth enter into adulthood. N/E includes: 1) A school-based SRH curriculum called Native Stand, designed to address individual-level factors that lead to sexual risk behaviors; 2) a family-level curriculum called Native Voices, tailored to increase communication between adult family members and youth about sexual and reproductive health (SRH) topics; 3) a cultural mentoring component at the community level that pairs AI youth with elders to discuss traditional AI beliefs and practices about SRH; and 4) the mobilization of a multi-sectoral network of youth-servicing organizations at the systems level to coordinate SRH services for AI youth. N/E includes three major sets of hypotheses, two of which are presented here. H1: AI youth who participate in N/E will demonstrate increased condom use at 3, 9, and 12 months; H2: AI youth who participate in N/E will demonstrate increased use of other birth control, a reduced number of sex partners, delayed onset of sexual intercourse, and decreased substance use during sex, at 3, 9, and 12 months. Our third hypothesis concerns parent/youth communication and youth service utilization.
Study Population. N/E is a 5-year study involving 456 14- to 18-year-old AI youth and their parents/legal guardians living on the Fort Peck Reservation.
Methods. N/E is a community based participatory research study using mixed quantitative and qualitative methods. We use a cluster-randomized stepped-wedge design (SWD), in which the 5 schools that AI youth from Fort Peck attend are the clusters randomized into N/E, with all schools eventually randomized to the intervention. Youth and parent data is collected at baseline, 3, 9 and 12 months with a survey, and qualitative analyses are used to address systems level data. Here, we present initial baseline factors associated with the primary outcome variable (the number of protected anal or vaginal sexual intercourse acts reported during the month preceding the survey). We used zero-inflated negative binomial regression to evaluate a negative binomial equation (for youth in the non-0 group), and a logit equation (predicting membership in the zero group).
Results. 445 (223 girls and 222 boys) were sampled. The average number of lifetime partners was 1.0 (SD=1.7). Each additional lifetime partner was associated with a 50% increase in the number of protected sexual acts (IRR=1.5, 95% CI 1.1-1.9) as well as more than a 2-fold increase in the likelihood of not having any protected sexual acts (aOR=2.6, 95% CI 1.3-5.1). Each additional number of substances used in youths’ lifetime was associated with an increased likelihood of not having any protected sexual acts (aOR=1.2, 95% CI 1.0-1.5). In boys, each one standard deviation increase in depression severity was associated with a 50% reduction in the number of times a condom was used (aIRR=0.5, 95% CI 0.4-0.6, p<0.001). Each 1-unit increase in positive prospections of pregnancy was associated with a pronounced decrease likelihood of not having any protected sexual acts (aOR=0.01, 95% CI 0.0-0.1).

Authors

• Elizabeth Lynne Rink, Other (Montana State University)
  Presenting Author

• Paula Firemoon, Fort Peck Community College
  Non-Presenting Author

• Olivia Johnson, Fort Peck Community College
  Non-Presenting Author

• Genevieve Cox, Montana State University
  Non-Presenting Author

• Mike Anastario, Florida International University
  Non-Presenting Author

• Beda Jean-Francois, NIH/NCCIH
  Non-Presenting Author

• Courtney Aklin, NIH/NIMHD
  Non-Presenting Author

• Gina Roussos, NIH/NIMHD
  Non-Presenting Author

• Tilda Farhat, NIH/NIMHD
  Non-Presenting Author

• Simrann Sidhu, NIH/NIMHD
  Non-Presenting Author