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

我们现在在这里——针对美洲印第安人青少年的多层次、多组成部分的性健康和生殖健康干预

• 批准号: 10058214
• 负责人: Elizabeth Lynne Rink
• 金额: $ 62.44万
• 依托单位: MONTANA STATE UNIVERSITY - BOZEMAN
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-01 至 2022-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10058214
• 关键词: 18 year old; Address; Adolescent; Adult; Affect; Alcohol or Other Drugs use; American Indians; Belief; Caucasians; Child; Coitus; Communication; Communities; Complex; Data Collection; Ecosystem; Ectopic Pregnancy; Education; Educational Curriculum; Elderly; Ensure; Ethnic group; Family; Family member; Focus Groups; Frequencies; Future Generations; Goals; Group Interviews; HIV; Health; Hepatitis C virus; Home; Incidence; Individual; Infrastructure; Intervention; Lead; Legal Guardians; Low Birth Weight Infant; Manuals; Measures; Mentors; Montana; Outcome; Parents; Population; Pregnancy Histories; Pregnancy in Adolescence; Premature Birth; Prevention; Public Health; Qualitative Methods; Race; Randomized; Reporting; Reproductive Health; Reproductive Health Services; Research; Research Personnel; Reservations; Risk Behaviors; STI prevention; Schools; Sexual Health; Sexual Partners; Sexually Transmitted Diseases; Sioux Indians; Social Work; Societies; Spontaneous abortion; Students; Surveys; System; Systems Theory; Time; Tribes; United States; Universities; Voice; Work; Youth; base; birth control; community based participatory research; condoms; cultural health; cultural values; delay sexual debut; design; early onset; efficacy testing; health care service; health disparity; high school; improved; meetings; multi-component intervention; novel; primary outcome; programs; reproductive health intervention; secondary outcome; service organization; service providers; sex; sexual risk behavior; substance use; teen birth; tribal community; tribal member

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.

项目概要/摘要 美国 (US) 的美洲印第安人 (AI) 社区受到性和性行为的影响尤为严重。 与其他人群相比，生殖健康差异使当前和未来几代人工智能 社会处于危险之中。我们的研究“Nen ŨnkUmbi/EdaHiYedo（N/E - “我们现在在这里”）”利用了文化 量身定制的生态干预措施，其中预防人工智能青少年中导致性危险的行为 性传播感染、艾滋病毒、丙型肝炎病毒和青少年怀孕问题得到解决。 N/E 发生在佩克堡保留地 蒙大拿州东北部。 N/E 是一项基于社区的参与性研究性与生殖健康 (SRH) 干预，建立在生态系统理论的基础上。基于佩克堡部落成员的愿望 对部落青年实施全面的性健康和生殖健康干预措施，不包括： 1) 以学校为基础的性健康和生殖健康课程 称为 Native Stand，旨在解决导致危险行为的个人因素； 2）家庭层面 名为 Native Voices 的课程，旨在增加成年家庭成员和青少年之间的沟通 关于性健康和生殖健康主题； 3) 社区层面的文化指导部分，将人工智能青年与成年人配对， 长辈讨论关于性健康和生殖健康的传统人工智能信念和实践； 4）系统级策略来激活 当地青年服务组织的多部门网络，以协调性健康和生殖健康服务。总体目标 该提案的目的是完善和定制 N/E 的组件并评估其功效。 N/E 是一项为期 5 年的研究 涉及 456 名 15 至 18 岁的 AI 青少年及其父母/法定监护人。 AIM 1 从一年的形成期开始 致力于完善和定制 N/E 的组件。我们的社区咨询委员会和位于佩克堡的 密歇根州立大学的研究团队将为 N/E 的 4 个级别设计适合文化的适应性。 AIM 2 测试 使用集群随机阶梯楔形设计 (SWD) 来评估 N/E 的有效性，其中 5 所高中 参加的 Peck 青少年每次被随机分配 1 人接受干预。 N/E 的主要结果增加 性交时使用安全套。次要结果是性交延迟、数量 性伴侣的数量、性交频率、怀孕史、期间持续使用节育措施 性交，以及性交期间是否使用酒精和/或其他药物。第三 结果是增加了父母/法定监护人与儿童关于性健康和生殖健康主题的沟通， 了解与 SRH 相关的传统 AI 信念相关的文化价值观，并增加 SRH 的使用 服务。定量数据收集包括：基线、3、9和12个月的学生调查；父母/法律人 基线、9 个月和 12 个月时的监护人调查。定性数据收集包括 SRH 服务提供商 在基线时进行讨论组，此后在 5 年的研究中每年一次，并使用日志来跟踪协调情况 以及基线和第 3、6、9 和 12 个月的实施情况。 AIM 3 将评估以下内容的保真度和可接受性 N/E 包含焦点小组、活动日志、员工会议记录和员工现场记录。