JOHNS HOPKINS UNIVERSITY

Transcription

1 JOHNS HOPKINS UNIVERSITY

2 Socicognitive Predictors of Condom Use Intention Using Protection Motivation Theory Among American Indian Adolescents Angelita Lee

3 DISCLOSURE SLIDE I, Angelita Lee, have no relevant financial relationships with the manufacturer(s) of commercial services discussed in this CME activity I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation

4 OUTLINE Background on Johns Hopkins Center for American Indian Health Describe development and evaluation of Respecting the Circle of Life (RCL) program Present results of RCL on condom use intention Discussion

5 Background on Johns Hopkins Center for American Indian Health

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7 Johns Hopkins Center for American Indian Founded in 1991 by Dr. Mathu Santosham, based on 10+ years work with Southwest tribes Mission: To work in partnership with American Indian and Alaska Native communities to raise AI/AN health status, self-sufficiency and health leadership of AI/AN people to the highest possible level

8 NINE OFFICES SERVING RESERVATION COMMUNITIES Navajo Nation Hopi White Mountain Apache Santo Domingo Pueblo Arizona Chinle Fort Defiance Tuba City Whiteriver Fort Apache New Mexico Albuquerque Gallup Santo Domingo Shiprock UTAH ARIZONA Phoenix Tucson COLORADO Albuquerque NEW MEXICO

9 The Center s work now serves tribal communities across states

10 FACTS ABOUT OUR CENTER

11 Our Center s Core Programs Training & Scholarships Infectious Disease Prevention Behavioral and Mental Health Promotion

12 Respecting the Circle of Life: Mind, Body and Spirit

13 Program Development Culturally adapt an evidence-based intervention (EBI) for sexual and reproductive health promotion EBI selection: Focus on Youth with ImPACT Promotes positive, protective factors Skills-based curriculum Non-school based setting Delivered by trained community members Includes parents/trusted adults Successful cross-cultural replication

14 Cultural Adaptation Formative qualitative research 18 focus groups with youth & parents 5 round-table discussions with leaders & stakeholders Content Adaptations: Added in-depth reproductive health lesson Language/terminology Culturally relevant examples Delivery Adaptations: 8 weeks to 8 days Community centers to summer basketball camp Renamed: Respecting the Circle of Life: Mind, Body & Spirit (RCL)

15 RCL 8 lessons for same age/sex peer-groups All lessons delivered by 2 community health workers: Sexual & reproductive health information Information regarding STIs, HIV/AIDS Communication and sexual decision-making skills Condom & contraceptive use skill building Decision making Problem solving Values clarification Goal setting

16 Evaluation Randomized controlled trial Peer-group clusters RCL and control programs delivered at camp Separate facilities to decrease contamination Baseline, post, 6-, 12- month assessments Adapted Youth Health Risk Behavior Inventory

17 Baseline Characteristics N=267 participants 138 intervention, 129 control Mean age = 15.1 years (SD=1.7) 44% male 93% currently in school 25% ever suspended 35% have boyfriend/girlfriend 22% ever had sex (vaginal)

18 Results Condom use intention (yes/no) RCL N=138 n (%) Baseline Control N=129 p- n (%) RR a value RCL N=131 n (%) Post-camp Control N=126 p- n (%) RR a value Overall 75 (52.7%) 72 (58.3%) (69.6%) 62 (50.3%) Girls 46 (58.0%) 40 (58.9%) (79.5%) 31 (44.5%) Boys 29 (45.7%) 32 (57.1%) (56.6%) 31 (56.5%) yrs 44 (48.2%) 56 (55.1%) (68.9%) 48 (48.6%) yrs 31 (65.5%) 16 (66.2%) (71.6%) 14 (56.3%)

19 Results Predictive Model of Condom Use Intention at Baseline Full Model Final Model IRR 95% CI IRR 95% CI Age at baseline HIV prevention/transmission Knowledge Self-Efficacy Response Efficacy Extrinsic Reward Severity Had sex in the last 6 months No Yes Ref Ref Condom Use Self-Efficacy

20 Results 0.68*** 4.50 [VALUE]*** [VALUE]* [VALUE]* *** [VALUE]*** Control RCL Control RCL Control RCL Response Efficacy Severity Condom Use Self Efficacy Baseline Post Camp

21 Conclusions & Changes to Practice RCL significantly improved condom use intention, condom use self-efficacy and response efficacy. Condom use self-efficacy and response efficacy are both positive protective factors associated with condom use intention at baseline. Some research shows programs promoting positive protective factors have more impact in American Indian populations than programs focused on risk. Enhancing condom use self-efficacy and response efficacy through programs such as RCL, may be an effective way to improve condom use-related knowledge, intentions and behaviors among adolescents.

22 Thank you! Angelita Lee Johns Hopkins Center for American Indian Health 308 Kuper St. Whiteriver, AZ Phone: (928)