Developing partnerships to promote innovative approaches

to prevent teen pregnancy among American Indian & Alaska Native youth

Alaska Native Tribal Health ConsortiumInter Tribal Council Of Arizona, Inc.

Northwest Portland Area Indian Health BoardUniversity Of Texas Prevention Research Center

Saturday April.02.2011Sex::Tech Conference 2011

Funded by the Centers for Disease Control & Prevention (SIP10-033)

Emerging Partnerships

Official partnership pending regional review board approvals

Cornelia Jessen

Stephanie Craig-RushingJessica Leston

Gwenda GormanJohn Lewis

Ross ShegogChristine Markham

Melissa PeskinSusan Tortolero

Inter Tribal Council of Arizona, Inc.

CDCHeather Tevendale

Indian Health ServiceLori de RavelloScott Tulloch

ConsultantsWilliam Lambert, Oregon Health

& Sciences University PRCCarol Kaufman, University of

Colorado

Other Partners & Consultants

To adapt and evaluate the effectiveness of an Internet-based HIV/STI & pregnancy

prevention program for middle school-aged youth (12-14 years old) in three

geographically dispersed AI/AN communities in Alaska, Arizona & Pacific Northwest (Idaho,

Oregon, Washington State)

GOAL:

Overview

Background Youth PerspectiveIt’s Your Game…Keep It Real (IYG)IYG-AIAN: Building the partnership

Background

AI/AN Youth: Sexual HealthCompared to Non-AI/AN Peers AI/AN youth

have:

› Higher birth rates› Higher rates of Chlamydia and gonorrhea› Earlier sexual debut (which is associated with increased risk of STI’s and pregnancy)› Lower condom and contraceptive use› 19% of AI/AN HIV/AIDS cases are among youth

(<25)› The need or effective sexual health is indicated

CDC 2009; CDC, Indian Health Service, 2007; Hamilton B. MMWR. 2011;59:1-29

Youth Technology Use AI/AN youth use media technology at higher

rates than national average› 75% use internet/iPods on daily or weekly

basis6

› 87% have a social networking page (i.e. Facebook)1

Use to: create social networks, & share culture within and beyond local community 2

› Rezkast (www.rezkast.com)› RezLifeYouth www.rezlifeyouth.ning.com)› NativeTube (www.nativetube.com)

1 Craig Rushing, Doctoral dissertation. 2010; 2 Project Red Talon (2009) .

The potential for a technology based channel for sexual health education is indicated

Youth PerspectiveLeonard Edmo Jr.

It’s Your Game…Keep It Real: An Evidence-based Approach

It’s Your Game…Keep It Real

Theory-based, multimedia program› Designed for 7th & 8th

grade students› Two randomized

controlled trials (NIH, CDC funded)

› Effective outcomes by follow-up at 9th grade

1

› OAH effective program

Theme: “How do you keep your game

real?”Respect yourself and

respecting othersPlay by your rules

© 2004, Tortolero, Markham, Shegog & Peskin. All Rights Reserved.

1 Tortolero, SR et. al. Journal of Adolescent Health. 2010

•Select Your Personal Rules ahead of time

Select

•Detect signs or situations that may challenge your rules

•Identify Risky Situations

Detect

•Use Refusal Skills or Alternative Actions to avoid or get out of Risky Situations

Protect

IYG Decision-Making Paradigm

© 2004, Tortolero, Markham, Shegog & Peskin. All Rights Reserved.

1 Introduce IYG program; determine personal strengths

2 Characteristics of healthy and unhealthy friendships

3 Introduce “Select, Detect, Protect”: Identify personal rules & risky situations

4 Characteristics of clearly saying “no” . Effective/ineffective refusal skills

5 Anatomy, physiology, and reproduction

6 Characteristics of health/unhealthy dating relationships; respecting others’ rules

7 Social, emotional, physical consequences of sex; reasons to wait

8 Communication & negotiation skills practice; Internet communication & safety

9 Consequences of teen pregnancy

10 Consequences of STI/HIV & the importance of testing

11 Condom and contraception knowledge and skills

12 “Select, Detect, Protect” review; condom negotiations

13 Review of IYG; personalize reasons for not having sex

IYG Tech: Lessons & Topics

© 2011 Peskin, Shegog, Markham & Tortolero. All Rights Reserved.Funding: NIH NIMH R01

Lesson Sequence

Lesson Objectives

Serial: Peer Modeling

IA: Information Transfer

Recap of Previous Lesson

Interactive Activities (IA): Peer Video

IA: Skills Training

Serial Questions

Serial ConclusionLesson Recap

© 2011 Peskin, Shegog, Markham & Tortolero. All Rights Reserved.

Cast of Characters

© 2011 Peskin, Shegog, Markham & Tortolero. All Rights Reserved.

Information Transfer

Modeling

Teen Talk: Peers

Reel Life Serial

Skill-building& Practice

Activities

© 2011 Peskin, Shegog, Markham & Tortolero. All Rights Reserved.

IYG-AIAN: Building the partnership

It’s Your Game…Keep It Real for American Indian/Alaska Native Youth

Funded by the Centers for Disease Control & Prevention (SIP10-033)

Project Premise Internet-based programs have the ability to

reduce health disparities by providing rural and underserved communities with access to state-of-the-art health interventions.

Adapting interventions for cultural appropriateness requires the use of multiple research strategies and community based participatory research activities.

Strong, multi-site partnerships can successfully build local capacity and support development of sexual health resources in underserved communities.

Study Activities

PHASE1

PHASE2

Year 1› Gain Community Support› Review Existing Resources for AI/AN

youth› Usability Testing of IYG-Tech

Year 2› Adaptation› Usability Testing of IYG-AIAN

Year 3 › Efficacy Trial – RCT (5 month F/U)› 1200 AI/AN youth (12-14 yo)

Year 4› Complete efficacy trial (16 month

F/U)› Dissemination of Results› Form partnerships with youth-

popular websites

Regional PerspectiveGwenda Gorman, ITCA

Collaborative Agreements

Certificate of Confidentiality

(pending acceptance)A Certificate of

Confidentiality from the CDC prevents the research team from being forced to share data about the community

and its individuals, including if by legal order. This

protection is permanent, even if a participant leaves

the study or dies.

Data Sharing Agreement & Publication Protocol

Protocol for use and reporting of data – decision-making partnership.

IRB approval (tribal health council and health research review committees)

Human Subjects Review ensuring ethical conduct of research.

Potential Benefits

AI/AN Youth Delay initiation of any kind

of sex Reduce:

› Sexual activity› Drug and alcohol use

Increase/improve:› Use of protection during sex› Overall emotional well-

being Long-term benefits:

Reduce the number of AI/AN teen pregnancies

Reduce AI/AN youth’s rates of HIV and other STIs

AI/AN Community A community-centered

online sexual health curriculum for AI/AN youth.

Increased universal awareness for AI/AN issues

Multi-region participation ensures a diversified voice to represent each group

Build Relationships & significant support from research investigators and collaborative partners for the future

Dissemination of Results

Results sharing:› Tribal communities› Research community

If intervention is effective, encourage widespread adoption across tribal communities

Investigate partnerships with websites popular with AI/AN youth

Questions?

Sex::Tech Conference 2011

1. CDC. Youth Risk Behavior Surveillance Survey – United States, 2009. MMWR 2010;59(SS-5):1–142.

2. De Ravello L, Personal Communication 4-8-2010 3. Hamilton B, et al. Births: Preliminary Data for 2009 . MMWR. 2011;59:1-29.4. CDC, Indian Health Service. Indian health surveillance report—sexually

transmitted diseases 2007. Atlanta, GA: U.S. Department of Health and Human Services.

5. CDC. Cases of HIV infection and AIDS in the United States and dependent areas, by race/ethnicity, 2003–2007. 14th ed. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2009.

6. Craig Rushing S. Media technology use among Native American teens and young adults: Evaluating their utility for designing culturally-appropriate sexual health interventions targeting Native American youth in the Pacific Northwest. Doctoral dissertation. 2010.

7. Project Red Talon (2009) , 400 Native youth (age 13-21 years) living in Oregon, Washington, and Idaho.

8. Tortolero, SR, Markham, CM, Peskin, MF, Shegog, R, Addy, RC, Escobar-Chaves, SL, Baumler, ER. It's Your Game, Keep It Real: Delaying Sexual Behavior with an Effective Middle School Program. Journal of Adolescent Health. 2010; 46(2):169-179. Published online: 18 August 2009. Saturday

April.02.2011

References