A sex education program delivered in the setting of a two-week summer basketball camp in Arizona significantly impacted key factors associated with pregnancy prevention among Native American teens, researchers at the Johns Hopkins Bloomberg School of Public Health show in a new study.
The findings, published online September 16, 2021 in the American Journal of Public Health, show the program provides Native teens with effective skills to avoid both pregnancy and sexually transmitted infections (STIs) .
Despite recent declines, U.S. rates of teen pregnancy are higher than any other developed nations, with 19 births per 1,000 girls, according to the Centers for Disease Control and Prevention. The rates for Native American teen births are nearly twice that, at 33 births per 1,000 girls, the highest teen birth rate in the U.S.
"Native teens need programs that are specifically designed for them and proven to work, which is what makes the results from this study so exciting," says Lauren Tingey, associate director of the Johns Hopkins Center for American Indian Health and associate scientist in the Bloomberg School's Department of International Health. Such teen births have numerous consequences to these young parents and society, notes Tingey. For example, babies born to teen mothers are more likely to be premature or of low birth weight, resulting in long-term health problems. Teen parents are more likely to live in poverty; drop out of high school; be incarcerated as teens; and their children are more likely to become teen parents themselves.
Although the majority of U.S. teens receive school-based sexual health education aimed at preventing teen pregnancy and sexually transmitted infections, it is not required in Arizona. Fewer than one-third of Arizona schools offer sexual health programs, and parents are allowed to opt their children out.
Seeking a better way to deliver sex education to tribal members, a Native American tribe in Arizona approached the Johns Hopkins Center for American Indian Health to develop a program specific to Native youth. After meetings and focus groups with stakeholders, including tribal youth, parents, public health experts, and health care providers, Tingey and colleagues adapted an existing intervention that includes nine different lessons aimed at increasing sexual health knowledge, self-efficacy, intention, and communication. The new curriculum, known as Respecting the Circle of Life, is culturally tailored to Native communities and recognizes their unique strengths and challenges, Tingey explains.
To increase participant retention, the researchers delivered the first eight lessons during free two-week summer basketball camps in 2016, 2017, and 2018, rather than over eight weeks specified in the original program. A "control" group of participants in the same camps received eight lessons on topics unrelated to sexual health, such as nutrition, fitness, outdoor recreation, and nature. All participants received a ninth lesson at home three months after camp ended that incorporated a parent or other trusted adult.
Before these lessons began and at 9 and 12 months after the camp ended, the 534 study participants filled out questionnaires that assessed a broad range of sexual health knowledge, attitudes, and behaviors. Results show that nine months after completing the lessons, those who received the Respecting the Circle of Life curriculum had significantly higher condom use self-efficacy, intention, and negotiation skills; other contraceptive use self-efficacy and negotiation skills; and intention to abstain from sex compared to those who received a separate curriculum on non-sexual topics.
The results also showed longer-term impacts of the program. At nine months after the program ended, youth who received the Respecting the Circle of Life curriculum reported having more conversations with their parents about sexual and reproductive health. One year after completion, youth who participated in the Respecting the Circle of Life program had higher sexual and reproductive health knowledge scores and continued to have more communication with their family about sexual and reproductive health.
Tingey notes that it's yet unknown whether the education and skills imparted by Respecting the Circle of Life program will affect teen pregnancy rates and STI rates, something they plan to evaluate in the coming years. However, she says, the findings show promise in giving Native teens the knowledge and skills they need to accomplish this goal.
"We think this program has real potential to empower Native youth to take control over their sexual and reproductive health," Tingey says. "The program is being used in several other states and we think given this success it can be applied to even more."
More information: Lauren Tingey et al, Prevention of Sexually Transmitted Diseases and Pregnancy Prevention Among Native American Youths: A Randomized Controlled Trial, 2016–2018, American Journal of Public Health (2021). DOI: 10.2105/AJPH.2021.306447
Journal information: American Journal of Public Health