We are here now - a multi-level, multi-component sexual and reproductive health intervention for American Indian youth

项目摘要/摘要 美国的美国印第安人(AI)社区不成比例地受到性和性别的影响 生殖健康差距，与其他人口相比，将当代和未来几代人工智能 社会处于危险之中。我们的研究NenŨnkUmbi/EdaHiYedo(N/E-“我们现在在这里”)使用了一种文化 量身定做的生态干预措施，防止人工智能青年中导致 内容涉及性传播感染、艾滋病毒、丙型肝炎病毒和青少年怀孕。N/E在佩克堡保留地举行 蒙大拿州东北部。N/E是一项以社区为基础的参与性健康和生殖健康研究(SRH) 干预，建立在生态系统理论的基础上。根据派克堡部落成员的愿望 对部落青年实施全面的SRH干预，N/E包括：1)校本SRH课程 被称为原生立场，旨在解决导致危险行为的个人层面的因素；2)家庭层面 名为《原住民之声》的课程，旨在加强成年家庭成员与青少年之间的沟通 关于SRH主题；3)社区一级的文化辅导部分，将AI青年与成年人配对，并 长辈们讨论关于SRH的传统人工智能信念和实践；以及4)系统级战略，以激活 地方青年服务组织的多部门网络，以协调SRH服务。最重要的目标 这项提议的目的是改进和调整国家工作队的构成部分，并评估其效力。N/E是一个为期5年的研究 涉及456名15至18岁的人工智能青少年及其父母/法定监护人。目标1从一年的形成期开始 努力完善和定制N/E的组件。我们的社区咨询委员会和基于派克堡的 密歇根州立大学的研究团队将为N/E的4个级别设计文化上合适的适应。AIM 2测试 使用整群随机阶梯楔形设计(SWD)的N/E有效性，其中5所高中是Fort 将参加干预的青年随机分为干预组，每次1人。N/E的主要结果是增加 性交时使用避孕套。次要结果是性交开始时间延迟，数量 性伴侣、性交频率、孕产史、持续使用节育措施 性交，以及在性交期间是否使用酒精和/或其他药物。三级 结果是增加了关于SRH话题的父母/合法监护人-孩子的沟通，增加了 理解与SRH相关的传统人工智能信念的文化价值，并增加对SRH的使用 服务。定量数据收集包括：基线、3个月、9个月和12个月的学生调查；家长/法律 在基线、9个月和12个月时进行监护人调查。定性数据收集包括SRH服务提供商 在为期5年的研究中，讨论小组以基线为基准，此后每年一次，并使用日志跟踪协调情况 以及基线和3、6、9和12个月的执行情况。目标3将评估数据的保真度和可接受性 N/E，包括焦点小组、活动日志、工作人员会议记录和工作人员实地记录。

Project Summary/Abstract American Indian (AI) communities in the United States (US) are disproportionately affected by sexual and reproductive health disparities, compared to other populations, placing current and future generations of AI societies in jeopardy. Our study, “Nen ŨnkUmbi/EdaHiYedo (N/E - “We are Here Now”)”, utilizes a culturally tailored ecological intervention in which the prevention of sexual-risk behaviors among AI youth that lead to STIs, HIV, HCV, and teen pregnancy are addressed. N/E takes place on the Fort Peck Reservation in northeastern Montana. N/E is a community-based participatory research sexual and reproductive health (SRH) intervention, constructed on Ecological Systems Theory. Based on Fort Peck tribal members' desire to implement a holistic SRH intervention for the tribes' youth, N/E includes: 1) A school-based SRH curriculum called Native Stand, designed to address individual-level factors that lead to risky behaviors; 2) a family-level curriculum called Native Voices, tailored to increase communication between adult family members and youth about SRH topics; 3) a cultural mentoring component at the community-level that pairs AI youth with adults and elders to discuss traditional AI beliefs and practices about SRH; and 4) a systems-level strategy to activate a multi-sectoral network of local youth servicing organizations to coordinate SRH services. The overarching aim of this proposal is to refine and tailor the components of N/E and evaluate its efficacy. N/E is a 5-year study involving 456 15- to 18-year-old AI youth and their parent/legal guardian. AIM 1 begins with a year of formative work to refine and tailor the components of N/E. Our community advisory board and the Fort Peck-based and MSU-based research team will design culturally appropriate adaptations for N/E's 4 levels. AIM 2 tests the efficacy of N/E using a cluster-randomized stepped-wedge design (SWD), in which the 5 high schools that Fort Peck youth attend are randomized into the intervention 1 at a time. N/E's primary outcome is increased condom use during sexual intercourse. Secondary outcomes are delayed onset of sexual intercourse, number of sex partners, frequency of sexual intercourse, pregnancy history, consistent use of birth control during sexual intercourse, and whether alcohol and/or other drugs are used during sexual intercourse. Tertiary outcomes are increased parent/legal guardian-child communication about SRH topics, increased understanding of cultural values related to traditional AI beliefs regarding SRH, and increased use of SRH services. Quantitative data collection includes: student surveys at baseline, 3, 9 and 12 months; parent/legal guardian surveys at baseline, 9 and 12 months. Qualitative data collection includes SRH service provider discussion groups at baseline and thereafter once a year over the 5-year study, with logs to track coordination and implementation at baseline and 3, 6, 9 and 12 months. AIM 3 will evaluate the fidelity and acceptability of N/E with focus groups, activity logs, and staff meeting notes and staff field notes.