title: Respecting the circle of life: one year outcomes from a randomized controlled comparison of an HIV risk reduction intervention for American Indian adolescents.
abstract: Potential for widespread transmission of HIV/AIDS among American Indian (AI) adolescents exists, yet no evidence-based interventions (EBIs) have been adapted and evaluated with this population. Intensive psychoeducation may improve knowledge and decision-making which could potentially translate to reductions in HIV risk behaviors. A peer group randomized controlled comparison of an adapted EBI vs. control was delivered over an eight-day summer basketball camp in one reservation-based tribal community to adolescents ages 13-19. Outcome data were gathered immediately post-camp and at 6 and 12 months follow-up. Self-selected peer groups were randomized to intervention (n = 138) or control (n = 129) conditions for a total sample of 267 participants (56.2% female), mean age 15.1 years (SD = 1.7). Intervention participants had better condom use self-efficacy post-camp (Adjusted Mean Difference [AMD] = -0.75, p < 0.005) and at 6 (AMD = -0.44, p < 0.005) and 12 months (AMD = -0.23, p < 0.05) follow-up. Intervention participants also had higher HIV prevention and transmission knowledge (post-camp: AMD = 0.07, p < 0.01; 6 months: AMD = 0.06, p < 0.01) were more likely to believe condoms prevent sexually transmitted infections (post-camp: RR = 1.41, p < 0.005; 6 months: RR = 1.34, p < 0.05), to talk with an adult about HIV/AIDS (post-camp: RR=1.78, p < 0.005; 6 months: RR = 1.14, p < 0.005), had higher partner negotiation efficacy related to substance use during sex (post-camp: AMD = 0.37, p < 0.01), and were more likely to intend to use a condom (post-camp: RR = 1.39, p < 0.01). The adapted intervention had short- and medium-term impacts on AI adolescent risk for HIV/AIDS, but attenuated at 12 months. Intervention delivery through a community-based camp is feasible and acceptable with strong retention. Additional study is needed to evaluate the adapted intervention's impact on sexual risk behaviors and if booster sessions and parent involvement translate to long-term impacts.
authors.affiliation: a Johns Hopkins Center for American Indian Health, Department of International Health , Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Tingey
authors.affiliation: a Johns Hopkins Center for American Indian Health, Department of International Health , Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Britta
authors.initials: B
authors.lastname: Mullany
authors.affiliation: a Johns Hopkins Center for American Indian Health, Department of International Health , Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Chambers
authors.affiliation: a Johns Hopkins Center for American Indian Health, Department of International Health , Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Ranelda
authors.initials: R
authors.lastname: Hastings
authors.affiliation: a Johns Hopkins Center for American Indian Health, Department of International Health , Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Angelita
authors.initials: A
authors.lastname: Lee
authors.affiliation: a Johns Hopkins Center for American Indian Health, Department of International Health , Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Parker
authors.affiliation: a Johns Hopkins Center for American Indian Health, Department of International Health , Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Barlow
authors.affiliation: a Johns Hopkins Center for American Indian Health, Department of International Health , Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Rompalo
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000208:ethnology; D000293:Adolescent; D000294:Adolescent Behavior / Q000208:ethnology; D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D003466:Cultural Characteristics; D005260:Female; D015658:HIV Infections / Q000208:ethnology / Q000517:prevention & control*; D006801:Humans; D007198:Indians, North American; D040242:Risk Reduction Behavior; D012749:Sexually Transmitted Diseases / Q000208:ethnology / Q000517:prevention & control; D016896:Treatment Outcome; D055815:Young Adult
keywords: American Indian; HIV/AIDS; adolescents; evidence-based intervention; randomized controlled comparison