title: The Impact of a Sexual and Reproductive Health Intervention for American Indian Adolescents on Predictors of Condom Use Intention.
abstract: OBJECTIVE
  American Indian (AI) adolescents experience inequalities in sexual health, in particular, early sexual initiation. Condom use intention is an established predictor of condom use and is an important construct for evaluating interventions among adolescents who are not yet sexually active. This analysis evaluated the impact of Respecting the Circle of Life (RCL), a sexual and reproductive health intervention for AI adolescents, on predictors of condom use intention.
  
  
  METHODS
  We utilized a cluster randomized controlled trial design to evaluate RCL among 267 AIs ages 13-19. We examined baseline psychosocial and theoretical variables associated with condom use intention. Generalized estimating equation regression models determined which baseline variables predictive of condom use intention were impacted.
  
  
  RESULTS
  Mean sample age was 15.1 years (standard deviation 1.7) and 56% were female; 22% had initiated sex. A larger proportion of RCL versus control participants had condom use intention post intervention (relative risk [RR] = 1.39, p = .008), especially younger (ages 13-15; RR = 1.42, p = .007) and sexually inexperienced adolescents (RR = 1.44, p = .01); these differences attenuated at additional follow-up. Baseline predictors of condom use intention included being sexually experienced, having condom use self-efficacy, as well as response efficacy and severity (both theoretical constructs). Of these, the RCL intervention significantly impacted condom use self-efficacy and response efficacy.
  
  
  CONCLUSIONS
  Results demonstrate RCL intervention efficacy impacting variables predictive of condom use intention at baseline, with greater differences among younger, sexually inexperienced adolescents. To sustain intervention impact, future RCL implementation should reinforce education and training in condom use self-efficacy and response efficacy and recruit younger, sexually inexperienced AI adolescents.
authors.affiliation: Department of International Health, Johns Hopkins Center for American Indian Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland. Electronic address: ltingey1@jhu.edu.
authors.forename: Lauren
authors.initials: L
authors.lastname: Tingey
authors.affiliation: Department of International Health, Johns Hopkins Center for American Indian Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Rachel
authors.initials: R
authors.lastname: Chambers
authors.affiliation: Department of International Health, Johns Hopkins Center for American Indian Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Summer
authors.initials: S
authors.lastname: Rosenstock
authors.affiliation: Department of International Health, Johns Hopkins Center for American Indian Health, Johns Hopkins University Bloomberg School of Public Health, Whiteriver, Arizona.
authors.forename: Angelita
authors.initials: A
authors.lastname: Lee
authors.affiliation: Department of International Health, Johns Hopkins Center for American Indian Health, Johns Hopkins University Bloomberg School of Public Health, Whiteriver, Arizona.
authors.forename: Novalene
authors.initials: N
authors.lastname: Goklish
authors.affiliation: Department of International Health, Johns Hopkins Center for American Indian Health, Johns Hopkins University Bloomberg School of Public Health, Whiteriver, Arizona.
authors.forename: Francene
authors.initials: F
authors.lastname: Larzelere
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D016000:Cluster Analysis; D017280:Condoms / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D033182:Intention; D008297:Male; D060728:Reproductive Health / Q000706:statistics & numerical data; D012736:Sex Education / Q000379:methods* / Q000706:statistics & numerical data; D012725:Sexual Behavior; D055815:Young Adult
keywords: Adolescent; American Indian; Condom use intention; Reproductive health; Sexual health