Circle of Life: Rationale, Design, and Baseline Results of an HIV Prevention Intervention Among Young American Indian Adolescents of the Northern Plains

Abstract

In spite of significant disparities in sexual health outcomes for American Indian youth, no studies exist examining the effectiveness of HIV-prevention interventions. Circle of Life is an HIV-prevention intervention specifically developed for American Indian middle-school youth. We describe the rationale, methodology, and baseline results of a longitudinal randomized trial of Circle of Life conducted among American Indian youth aged 11–15 in a reservation community. The innovative design includes two pre-intervention waves to determine patterns of behavior prior to the intervention that might be associated with a differential impact of the intervention on sexual risk. We used one-way analysis of variance and chi-square tests to test for significant differences between randomized group assignment at each baseline wave and generalized estimating equations (GEE) to test significant differences in the rate of change in outcomes by group longitudinally. We present the collaborative and adaptive strategies for consenting, assenting, and data collection methodology in this community. Achieved response rates are comparable to other similar studies. Results from the two baseline waves indicate that few outcomes significantly varied by randomized intervention assignment. Ten percent of youth reported having had sex at Wave 1, rising to 15% at Wave 2. Among those who had had sex, the majority (>70%) reported using a condom at last sex. The project is well positioned to carry out the longitudinal assessments of the intervention to determine the overall impact of the Circle of Life and the differential impact by pre-intervention patterns of behavior across youth.

Trajectories of Substance Use Among Young American Indian Adolescents: Patterns and Predictors

“…The overall sample constituted 71% of the middle-school population on the reservation at Wave 1 (W1). A total of 81% of parents/guardians were located and asked to allow their children to participate; 98% of these provided consent; 90% of these youth then assented to participate (Kaufman et al, 2010). The subsample reported on here ( N =381) included students attending seven of the participating schools that were randomly selected for this component of the study and data from only the first four waves of the study were analyzed (spring of 2006, fall of 2006, spring of 2007, and fall of 2007).…”

Effectiveness of Circle of Life, an HIV-Preventive Intervention for American Indian Middle School Youths: A Group Randomized Trial in a Northern Plains Tribe

“…Details of the overall project rationale and design are available elsewhere. 23 In brief, the design allowed us to address 2 sets of hypotheses. The first set, and the focus here, concerned the overall intervention effect hypothesized to lower sexual risk among youths who received COL compared with those who did not receive it.…”

“…2 Once diagnosed with AIDS, AI/AN persons have the lowest survival rate at 12, 24, and 36 months compared with all other race groups. 1 Moreover, for AI/AN individuals, the epidemic is disproportionately borne by youths, with 23.1% of all HIV diagnoses among this group occurring among those younger than age 25 years. 1 Coupled with high levels of sexually transmitted infections (STIs), early age of first sexual activity, and early onset of substance use, 3---5 AI/AN youths are vulnerable to HIV.…”

Child Development Research in North American Native Communities—Looking Back and Moving Forward: Introduction

“…Identifying problems among Native youth will not serve them well unless effective and appropriate interventions are made available to them. Culturally based interventions are only beginning to acquire the “evidence” needed to demonstrate to funders the value in supporting their implementation (Barlow et al., 2006; Kaufman et al., 2010; Novins & Fickenscher, 2009). Much work needs to be done in helping communities understand the value of documenting intervention effectiveness and in adapting methodologies that can provide such evidence while at the same time being responsive to community values.…”

“…Much work needs to be done in helping communities understand the value of documenting intervention effectiveness and in adapting methodologies that can provide such evidence while at the same time being responsive to community values. For example, the gold standard of randomized control trials for demonstrating intervention effectiveness is often unrealistic in communities, where problem rates are high and denying a potentially protective program to half of community youth is considered unacceptable; compromises such as wait‐listed comparison designs have proven a successful compromise (Kaufman et al., 2010).…”