JOHNS HOPKINS UNIVERSITY

JOHNS HOPKINS UNIVERSITY

Promoting Positive Protective Factors and Ethnic Identity for Reducing Behavioral Health Disparities Among American Indian Adolescents Francene Larzlere, BA, MPC (Exp 2017)

DISCLOSURE SLIDE I, Francene Larzelere, 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

OUTLINE Background on Johns Hopkins Center for American Indian Health Understanding Current Behavioral and Mental Health Disparities Our Approach to Research, Evaluation and Dissemination Results Supporting Strength- Based Work Conclusion

Background on Johns Hopkins Center for American Indian Health

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

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

The Center s work now serves tribal communities across states. 75+ 15

FACTS ABOUT OUR CENTER

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

How Do Behavioral/Mental Health Disparities Manifest Among Adolescents?

A Downward Trajectory Early Child Neglect Obesity Poor school readiness Drop-out Unplanned pregnancy Substance Use Diabetes Suicide/Violent Behavior

Current National Disparities Among Adolescents Death Rate (0-25 yrs): 3.2x higher Suicide Rate (15-24): 2-3x higher Alcohol-Related Deaths: 7x higher Obesity/Diabetes: 3x higher School Readiness: <50% High School Drop-Out: >50% Teen Childbearing: 2x higher HIV Infection: 20x higher STIs: 6-10x higher

Our Center s Approach to Prevention Arrowhead Business Group Entrepreneurship Education Together on Diabetes Family Health Coach Model Adulthood Educational Scholarships Respecting the Circle of Life Teen Pregnancy/STI prevention Celebrating Life Suicide Prevention Feast for the Future Nutrition Promotion Birth Early Childhood Middle Childhood Family Spirit 0-3: Early Childhood Home Visiting Adolescence Native Vision Sports and Fitness Promotion EMPWR Risk Reduction & Counseling Bright Horizons Binge Substance Use Prevention

RESEARCH SUPPORTING STRENGTHS-BASED APPROACH

RESPECTING THE CIRCLE OF LIFE: SEXUAL AND REPRODUCTIVE HEALTH PROGRAM Comprehensive Education & Training: 8 sessions taught to peer groups at summer sports camp 1 session taught to youth & family member at home Information regarding STIs, HIV/AIDS Communication, sexual decisionmaking skills Condom & contraceptive use skills Decision making Values clarification & goal setting

RESPECTING THE CIRCLE OF LIFE IMPACTS KNOWLEDGE & ATTITUDES 1,2,3,4 HIV/STI prevention & transmission knowledge Condom use self-efficacy Condom use intention Belief condoms are effective SKILLS & BEHAVIORS Talking with family about HIV/AIDS Partner negotiation on sex THEORETICAL PROTECTIVE FACTORS Self-efficacy: (ability to engage in behaviors to protect against infection & pregnancy, i.e. condom use) Response efficacy: (effectiveness of protective methods to prevent infection & pregnancy, i.e. belief condoms work) Response cost: (perceptions of negative consequences associated with protective behavior, i.e. downside of 1. Tingey et al. (2015). The Respecting the Circle of Life Trial for American Indian Adolescents. AIDS Care. 2. Tingey et al. (2015). Respecting the Circle of Life: One Year Outcomes. AIDS Care. 3. Chambers et al. (2016). Exploring Sexual Risk Taking Among American Indian Adolescents AIDS Care. 4. Tingey et al. (in press). The impact of a sexual and reproductive health intervention for American Indian adolescents.jo Adol Health

RESPECTING THE CIRCLE OF LIFE IMPACT

HEALTHY CHOICES: BINGE SUBSTANCE USE PREVENTION Case-control evaluation: Ages 10-19 Case: Binge alcohol/drug use, past 90 days Control: No lifetime binge use Quantitative and qualitative data collection Analysis: Individual, peer, family, cultural/ community levels Risk and protective factors

Results: Individual/Peer 1 = risk = protective 1. Tingey et al. (2016). Risk and Protective Factors for Heavy Binge Alcohol Use.American Journal of Drug and Alcohol Abuse

Results: Family/Culture/Community 1 = risk = protective 1. Tingey et al. (2016). Risk and Protective Factors for Heavy Binge Alcohol Use.American Journal of Drug and Alcohol Abuse

Results: Strengths Buffer Risk for Binge Substance Use 1 1. Tingey et al. (2016). Risk and Protective Factors for Heavy Binge Alcohol Use.American Journal of Drug and Alcohol Abuse

CASE CONTROL EVALUATION RESULTS 2 School connectedness is essential: Cases negative about school; many dropped out. Controls were strongly attached, viewed academics as a means to long-term goals. What do I like about myself? That I do well in school. (control) Both groups participate in traditional ceremonies & want to continue as adults: I love our culture. We re one of the few cultures left and need to take our traditions seriously. (control) Youth need structured activity: Controls described regular involvement (i.e. sports, clubs, camps); cases said often bored and are walking around; being everywhere. 2. Tingey et al. (2016). Motivators and Influences on Alcohol Use and Binge Behavior. Jo of Child and Adolescent Substance Abuse.

ARROWHEAD BUSINESS GROUP: YOUTH ENTREPRENEURSHIP EDUCATION 1 One-week residential camp Communication Coping/Problem Solving Goal setting Positive Cultural Identity Entrepreneurship Skill Development 6 months business plan development in small groups Adult/Elder mentors Business incubator and marketplace RCT (n=391) 13-16 years old 2:1 randomization Educational outcomes Work force development Behavior/mental health outcomes 1. Tingey et al. (2016). Entrepreneurship education: A strength-based approach to substance use and suicide prevention.american Indian Alaska Native Mental Health Research

ARROWHEAD BUSINESS GROUP: PRELIMINARY IMPACTS 3 GPA of Youth in Intervention/Comparison 2.6 +35% +8% 2.2 GPA 1.8 1.4 1 Baseline - Spring 2014 Fall 2014 Spring 2015 n=56 1.92 2.65 2.6 n=35 2.27 2.37 2.46

CONCLUSION & CHANGES TO PRACTICE Data shed light on cross-cutting constructs to cultivate behavioral/mental health: Problem solving Staying in school Family closeness and household stability Strong ethnic identity Having traditional values, engaging in traditional practices Programs designed to prevent substance use and promote sexual and reproductive health should strive to teach these core components and skills.

THANK YOU! Francene Larzelere, BA, MPC (Exp. 2017) Johns Hopkins Center for American Indian Health 308 Kuper St. Whiteriver, AZ 85941 Phone: (928) 558-5215 flarzel1@jhu.edu