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

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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.