Partnerships that Promote the Integration of HIV, STD and Teen Pregnancy Prevention was presented at Sex::Tech 2009 by Sandra Serna Smith of the National Coalition of STD Directors and Lisa Pressfield of the Association of Maternal and Child Health Programs.

1. 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 Funded by the Centers for Disease Control & Prevention (SIP10-033) Sex::Tech Conference 2011 Saturday April.02.2011

2. Emerging Partnerships Official partnership pending regional review board approvals Cornelia Jessen Stephanie Craig-Rushing Jessica Leston Gwenda Gorman John Lewis Ross Shegog Christine Markham Melissa Peskin Susan Tortolero Inter Tribal Council of Arizona, Inc.

3. CDC Heather Tevendale Indian Health Service Lori de Ravello Scott Tulloch Consultants William Lambert, Oregon Health & Sciences University PRC Carol Kaufman, University of Colorado Other Partners & Consultants

4. GOAL: 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)

5. Overview Background Youth Perspective It’s Your Game…Keep It Real (IYG) IYG-AIAN: Building the partnership

6. Background

7. AI/AN Youth: Sexual Health Compared 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

8. 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) RezLifeYouthwww.rezlifeyouth.ning.com) NativeTube(www.nativetube.com) The potential for a technology based channel for sexual health education is indicated 1 Craig Rushing, Doctoral dissertation. 2010; 2 Project Red Talon (2009) .

9. Youth PerspectiveLeonard Edmo Jr.

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

11. 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 others Play by your rules © 2004, Tortolero, Markham, Shegog & Peskin. All Rights Reserved. 1Tortolero, SR et. al. Journal of Adolescent Health. 2010

12. IYG Decision-Making Paradigm © 2004, Tortolero, Markham, Shegog & Peskin. All Rights Reserved.

13. IYG Tech: Lessons & Topics © 2011Peskin, Shegog, Markham & Tortolero. All Rights Reserved. Funding: NIH NIMH R01

14. Lesson Sequence Lesson Objectives Recap of Previous Lesson Serial: Peer Modeling Interactive Activities (IA): Peer Video IA: Information Transfer IA: Skills Training Serial Conclusion Lesson Recap Serial Questions © 2011Peskin, Shegog, Markham & Tortolero. All Rights Reserved.

15. Cast of Characters © 2011Peskin, Shegog, Markham & Tortolero. All Rights Reserved.

16. Activities Information Transfer Modeling Teen Talk: Peers Reel Life Serial Skill-building & Practice © 2011Peskin, Shegog, Markham & Tortolero. All Rights Reserved.

17. 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)

18. 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.

19. 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

20. Regional PerspectiveGwenda Gorman, ITCA

21. 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.

24. Increased universal awareness for AI/AN issues

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

27. Questions?

28. CDC. Youth Risk Behavior Surveillance Survey – United States, 2009. MMWR 2010;59(SS-5):1–142. De Ravello L, Personal Communication 4-8-2010 Hamilton B, et al. Births: Preliminary Data for 2009. MMWR. 2011;59:1-29. CDC, Indian Health Service. Indian health surveillance report—sexually transmitted diseases 2007. Atlanta, GA: U.S. Department of Health and Human Services. 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. 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. Project Red Talon (2009) , 400 Native youth (age 13-21 years) living in Oregon, Washington, and Idaho. 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 Sex::Tech Conference 2011 References