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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