Teen Pregnancy Prevention Program Recommendations from Urban and Reservation Northern Plains American Indian Community Members

Abstract

Despite declines over the past few decades, the United States has one of the highest rates of teen pregnancy compared to other industrialized nations. American Indian youth have experienced higher rates of teen pregnancy compared to the overall population for decades. Although it's known that community and cultural adaptation enhance program effectiveness, few teen pregnancy prevention programs have published on recommendations for adapting these programs to address the specific needs of Northern Plains American Indian youth. We employed a mixed-methods analysis of 24 focus groups and 20 interviews with a combined total of 185 urban and reservation-based American Indian youth and elders, local health care providers, and local school personnel to detail recommendations for the cultural adaptation, content, and implementation of a teen pregnancy prevention program specific to this population.Gender differences and urban /reservation site differences in the types of recommendations offered and the potential reasons for these differences are discussed. This is an Open Access article. Non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly attributed, cited, and is not altered, transformed, or built upon in any way, is permitted. The moral rights of the named author(s) have been asserted. KEYWORDS American Indian, teen pregnancy prevention, program recommendations 218 Teen Pregnancy Prevention Program Recommendations 219 INTRODUCTIONAlthough adolescents of all races and ethnicities engage in behaviors such as unprotected sex and substance use that increase their risk for sexually transmitted infections (STIs) and teen pregnancies (Eaton et al., 2012), American Indian/Alaska Native (AI/AN) youth experience disproportionately higher rates of teen pregnancy compared with the overall population (de Ravello, Jones, Tulloch, Taylor, & Doshi, 2014). Furthermore, while the birth rate for U.S. teens aged 15-19 has dropped in 18 of the past 20 years, changes in the annual birth rates for AI/AN teens have been less consistent over the past two decades and have remained notably higher than those of non-Hispanic Whites and Asian/Pacific Islanders (Solomon-Fears, 2013). For example, in 2012, the birth rates for AI/AN teens was 34.9 per 1,000 live births while the national rate reached a historic low of 29.4 and the rate for non-Hispanic White teens was lower yet at 20.5 (Martin, Hamilton, Osterman, Curtin, & Mathew, 2013). AMERICAN INDIAN/ALASKA NATIVE SEXUAL RISK BEHAVIORSPrevious findings regarding adolescent sexual behavior also reveal that a greater proportion of urban AI/AN youth engage in sex at younger ages and are less often using any method of contraception compared to the overall population (de Ravello et al., 2014). Specifically, in a study examining the reproductive health and behaviors of urban AI/AN girls through data gathered from the 2002 National Survey of Family Growth (Rutman, Taualii, Ned, & Tetrick, 2012), findings revealed that approximately 33% of urban AI/...

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