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Abstract

Background: Few HIV/STI and pregnancy prevention programs for youth in American Indian and Alaska Native (AI/AN) communities have been rigorously evaluated despite sexual health disparities in this population. This study reports the evaluation of a culturally adapted Internet-based HIV/STI and pregnancy prevention program for AI/AN youth, Native It’s Your Game (Native IYG).

Methods: A randomized study was conducted with 523 youth (12 to 14 years old), recruited from 25 tribal sites in Alaska, Arizona, and the Pacific Northwest. Participants were surveyed at baseline and upon completion of treatment or comparison interventions. Multivariable linear regression models were used to assess impact on short term psychosocial determinants of sexual initiation.

Results: A sample of 402 intervention (n=290) and comparison (n=112) youth completed the post-intervention survey (76.9% retention) from 1 to 462 days post-baseline (mean = 114, SD = ±96.67). Participants were 55.5% female, mean age of 13.0 (± 0.97) years with 86.1% self-reporting as AI/AN. Reasons not to have sex, STI knowledge, condom knowledge, condom availability self-efficacy, and condom use self-efficacy were significantly impacted (all P ≤ .01). Limitations included variability in intervention exposure and time between data collection time points.

Conclusions: Native IYG demonstrated efficacy to impact short-term psychosocial determinants of sexual behavior in a sample of predominantly AI/AN middle school youth.

Key Take Away Points

  • The Internet is a feasible channel for sexual health education for American Indian / Alaska Native (AI/AN) youth
  • Native IYG is an Internet-based sexual health program adapted for youth in AI/AN communities
  • In a 25 site RCT with 523 youth (12-14) in AI/AN communities in Alaska, Arizona, and the Pacific Northwest, Native IYG positively effected short-term psychosocial determinants of sexual initiation comprising reasons not to have sex, STI knowledge, condom knowledge, condom availability self-efficacy, and condom use self-efficacy.
  • Challenges to the present study included youth recruitment and retention, imbalanced study design, and intervention exposure.

Author Biography

Ross Shegog served as joint Principal Investigator with Dr. Markham on the conceptualization and design of the study. He drafted the initial manuscript and approved the final manuscript as submitted. Stephanie Craig Rushing, Cornelia Jessen, Gwenda Gorman, and Travis L. Lane served as Regional Principal Investigators for the study, contributed to the intervention design, coordinated site recruitment in their respective regions, co-designed the data collection instrument, critically reviewed and revised the manuscript, and approved the final manuscript as submitted. Amanda Gaston, Taija Koogei Revels, and Jennifer Williamson contributed to the intervention design, co-designed the data collection instrument, coordinated and supervised data collection at sites in their respective regions, critically reviewed and revised the manuscript, and approved the final manuscript as submitted. Jennifer Torres coordinated intervention development, data collection across all three regions, assisted in data cleaning and initial analyses, drafted sections of the initial manuscript, critically reviewed and revised the manuscript, and approved the final manuscript as submitted. Elizabeth Baumler and Robert Addy conducted statistical analyses, critically reviewed and revised the manuscript, and approved the final manuscript as submitted. Melissa Peskin and Susan Tortolero Emory co-designed the data collection instrument, study design, and analyses. They critically reviewed and revised the manuscript and approved the final manuscript as submitted. Christine M. Markham served as joint Principal Investigator with Dr. Shegog on the conceptualization and design of the study. She critically reviewed and revised the manuscript, and approved the final manuscript as submitted.

Acknowledgements

Acknowledgements: All authors contributed to the concept and design of the study and the process of drafting and revising the manuscript. No authors have any potential conflicts of interest. This study was funded by the Centers for Disease Control and Prevention (CDC) (#5U48DP001949-02). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC. The study is registered at www.clinicaltrials.gov. We would like to thank the youth and site coordinators for their participation in the study, Heather Tevendale for her guidance as our CDC project officer, and Carol Kaufman and William Lambert for their review of the survey instrument and insight on partnering with Native communities.

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