My Health, My Future: Promotion of Protective sexual health practices among Apache Youth and young adults through an assests-based self-care intervention

项目概要： 我的健康我的未来的目标是开发和测试自我护理干预的有效性， 美国印第安青年和年轻成年人之间的性健康促进通过一个基于资产的 approach.研究人群是白色山地阿帕奇部落（Apache），他们有30年的 与约翰霍普金斯美洲印第安人中心合作进行开创性研究的历史 健康（JHU）。这项干预措施将推动一系列新的性健康自我保健研究， 包括简短的自我评估，通过短信、电话 和电子邮件，以及性病筛查和HPV免疫接种的非诊所替代方案。的 干预将植根于资产理论，这与当地人对健康的信念一致， 积极的青年发展框架。11-26岁的阿帕奇人（n=312）将分别 随机接受自我护理干预或比较条件（标准护理）。我们将 评价自我护理干预与比较对STI主要结局的影响 在性活跃青年中进行筛查。次要结果将包括：a）性风险和 保护行为; B）HPV疫苗覆盖率（完成第2或第3剂）;以及c）心理社会 资产和资源。所有结果将通过音频计算机辅助自我访谈进行评估 基线和干预后6个月的技术。一个子集的成果将衡量双- 在整个随访期间，每周通过短信进行一次。这一建议具有紧迫性、创新性和 有可能产生重大影响，因为：1）美国印第安青年和年轻人有 美国性传播感染的发病率最高; 2）美国印第安人的宫颈癌发病率和死亡率很高 癌症，但青年人HPV疫苗接种率低; 3）替代提供者驱动，基于诊所的 在性健康差距因性别差异而长期存在的社区， 获得护理，地理隔离和保密问题;以及4）Apache-JHU研究 团队成功地证明了自我管理和资产的可行性和可接受性- 基于方法来改善过去的NATIONAL努力的健康结果。如果研究目的是 实现，我们将有一个新的，自我保健干预提供给美国印第安人社区， 寻求性保健的替代战略。

PROJECT SUMMARY: The goal of My Health My Future is to develop and test the efficacy of a self-care intervention for sexual health promotion among American Indian youth and young adults through an assets-based approach. The study population is the White Mountain Apache Tribe (Apache), who have a 30-year history of pioneering research in collaboration with the Johns Hopkins Center for American Indian Health (JHU). The intervention will advance a new line of sexual health self-care research and includes a brief self-assessment, corresponding personalized messaging delivered via text, phone and email, and non-clinic based alternatives for STI screening and HPV immunization. The intervention will be rooted in asset theory, which is congruent with Native beliefs about wellness, and a positive youth development framework. Apaches ages 11-26 (n=312) will be individually randomized to receive the self-care intervention or comparison condition (standard of care). We will evaluate the impact of the self-care intervention vs. comparison on the primary outcome of STI screening uptake among sexually active youth. Secondary outcomes will include: a) sexual risk and protective behaviors; b) HPV vaccine coverage (completion of doses 2 or 3); and c) psychosocial assets and resources. All outcomes will be evaluated via Audio Computer-Assisted Self-Interview technology at baseline and 6-months post-intervention. A subset of outcomes will be measured bi- weekly via text message throughout the follow-up time period. This proposal is urgent, innovative and has potential for significant impact because: 1) American Indian youth and young adults have the highest rates of STIs in the US; 2) American Indians have high incidence and mortality from cervical cancer but low uptake of HPV vaccination by youth; 3) alternatives to provider-driven, clinic-based treatment are needed in communities where sexual health disparities are perpetuated by differential access to care, geographic isolation and confidentiality concerns; and 4) the Apache-JHU research team has successfully demonstrated the feasibility and acceptability of self-management and assets- based approaches to improving health outcomes in past NARCH endeavors. If study aims are achieved, we will have a novel, self-care intervention available for American Indian communities that seek alternative strategies for sexual health care.