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

项目总结/摘要 美国的美洲印第安人（AI）社区不成比例地受到性和 与其他人群相比，生殖健康差异，使当前和未来几代AI 社会处于危险之中。我们的研究，“Nen nkUmbi/EdaHiYedo（N/E -“我们现在在这里”）"， 量身定制的生态干预，其中预防人工智能青少年的性风险行为， 性传播感染、艾滋病毒、丙型肝炎病毒和少女怀孕问题得到解决。N/E发生在佩克堡保留地， 蒙大拿州东北部N/E是一个基于社区的参与性研究性和生殖健康（SRH） 生态系统理论构建。根据佩克堡部落成员的愿望， 为部落青年实施全面的性健康和生殖健康干预措施，N/E包括：1）学校性健康和生殖健康课程 被称为原生林，旨在解决导致危险行为的个人层面因素; 2）家庭层面 一个名为“土著之声”的课程，专门为增加成年家庭成员和青年之间的沟通而设计 关于性健康和生殖健康主题; 3）社区一级的文化指导组成部分，将人工智能青年与成年人配对， 老年人讨论传统的人工智能信仰和实践的SRH;和4）系统级的战略，以激活一个 地方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。首要目标 该建议的主要目的是改进和调整N/E的组成部分，并评估其有效性。N/E是一项为期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/法律的监护人。AIM 1开始于一年的形成 努力完善和调整N/E的组成部分。我们的社区咨询委员会和位于佩克堡的 MSU的研究团队将为N/E的4个级别设计文化上适当的适应。AIM 2测试 N/E的有效性采用随机分组的阶梯楔形设计（SWD），其中5所高中， 派克青年参加随机进入干预1次。N/E的主要结局增加 性交时使用避孕套。次要结局是延迟性交发生， 性伴侣，性交频率，怀孕史，期间持续使用避孕措施 性交，以及在性交过程中是否使用酒精和/或其他药物。叔 成果是增加父母/法律的父母与子女之间关于性健康和生殖健康问题的沟通， 理解与关于性健康和生殖健康的传统人工智能信念有关的文化价值观，并增加性健康和生殖健康的使用 服务定量数据收集包括：基线、3、9和12个月时的学生调查;家长/法律的 在基线、9个月和12个月时进行监护人调查。定性数据收集包括性健康和生殖健康服务提供者 在基线时进行讨论组，此后在5年研究期间每年进行一次，并记录日志以跟踪协调情况 以及在基线和3、6、9和12个月时的执行情况。AIM 3将评估 N/E与焦点小组、活动日志、工作人员会议记录和工作人员现场记录。

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.