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Tingey L.,Johns Hopkins Center for American Indian Health | Chambers R.,Johns Hopkins Center for American Indian Health | Goklish N.,Johns Hopkins Center for American Indian Health | Larzelere F.,Johns Hopkins Center for American Indian Health | And 5 more authors.
Trials | Year: 2017

Background: American Indian adolescents have one of the highest rates of teen pregnancy and repeat teen births in the US. Substance use is a significant risk factor for unprotected sex, and American Indian adolescents have the highest substance use-related morbidity and mortality of any US racial group. Despite these disparities, there are no existing, evidence-based programs for pregnancy prevention that have been rigorously evaluated among American Indian teens. Methods: The proposed study is a randomized controlled trial to test the efficacy of a comprehensive sexual and reproductive health program developed in partnership with an American Indian community. Participants will be American Indians ages 11-19 and their parent or trusted adult, randomized to receive the control condition or intervention called Respecting the Circle of Life: Mind, Body and Spirit. The intervention includes eight lessons delivered to self-selected peer groups during a summer basketball camp and one lesson delivered to the youth and parent/trusted adult together within 3 months after camp. All lessons are administered by trained community health workers from the participating American Indian community. Youth and parent/trusted adult participants will complete assessments at baseline, 3, 9, 12, 24 and 36 months post-intervention completion. The primary outcome variables are sexual/reproductive health knowledge, sexual initiation, condom use self-efficacy and intent to use a condom at next sex as changed from baseline to post-intervention between intervention and control participants. Selected primary outcomes are applicable to all study participants. Discussion: Currently there are no sexual and reproductive health programs designed specifically for American Indian youth that have been rigorously evaluated and found to have an evidence base. Respecting the Circle of Life is highly innovative by incorporating lesson delivery into a summer basketball camp and involving parents or other trusted adults in curriculum administration. If found successful, it will be the first evidence-based program for teen pregnancy prevention for American Indian youth and adolescents. Trial Registration: Clinicaltrials.gov, NCT02904629. Retrospectively registered on 23 September 2016. © 2017 The Author(s).


Millar E.V.,Johns Hopkins Center for American Indian Health | Pimenta F.C.,Centers for Disease Control and Prevention | Roundtree A.,Centers for Disease Control and Prevention | Jackson D.,Centers for Disease Control and Prevention | And 7 more authors.
Clinical Infectious Diseases | Year: 2010

Background. A second-generation 13-valent pneumococcal conjugate vaccine, PCV13, was recently licensed. Although PCV13 includes serotype 6A, the usefulness of that antigen may be limited by the emergence of a new serotype, 6C, which was identified among isolates initially characterized (Quellung reaction) as serotype 6A. The epidemiology of serotype 6C prior to and after 7-valent PCV (PCV7) introduction is incompletely understood. Methods. We analyzed conventionally serotyped 6A (CS6A) pneumococci from invasive disease case patients of all ages and carriage isolates from children and adults obtained in population-based studies among Navajo and White Mountain Apache communities during 1994-2009. Samples were tested by triplex polymerase chain reaction to resolve serotypes 6C and 6A. Results. A total of 74 invasive CS6A episodes occurred. All were retyped by polymerase chain reaction; 40 (54.1%) were serotype 6C. The mean annual incidence of serotype 6C invasive disease was 0.3 (95% confidence interval, 0.03-0.9), 0.7 (95% confidence interval, 0.2-1.3), and 1.5 (95% confidence interval, 1.0-2.1) cases per 100,000 population in the years prior to the PCV7 efficacy trial, during the time the PCV7 trial was conducted, and following PCV7 introduction and routine use, respectively (P = .01). In the routine vaccination era, 76% of invasive CS6As were serotype 6C; nearly all cases occurred in adults. The proportion of serotype 6C among CS6A carriage isolates increased from 42% to 61% to 94% in the prevaccine, early vaccine, and routine vaccination eras, respectively. Conclusion. In the PCV7 routine use era, virtually all serogroup 6 invasive pneumococcal disease and carriage strains among Navajo and White Mountain Apache communities are 6C. Monitoring and evaluation of this and other emerging serotypes among invasive disease and carriage isolates is warranted. © 2010 by the Infectious Diseases Society of America. All rights reserved.


News Article | November 23, 2016
Site: www.eurekalert.org

Deaths by suicide among the White Mountain Apache in Arizona dropped by nearly 40 percent between 2006 and 2012 compared to the previous six-year period, new research from the Johns Hopkins Bloomberg School of Public Health and the tribe finds. The substantial reduction came after tribal leaders responded to the high number of suicides occurring in their community by passing legislation to develop a surveillance system and intensive prevention program, which tracks and triages those with suicide attempts and suicidal thoughts. The findings are published in the November issue of the American Journal of Public Health. These results bolster the results of a handful of studies to show that suicide is preventable with comprehensive, community-based efforts, and one of the only to show reduction in both attempts and deaths. "Suicide is a public health problem that many don't see as preventable," says study leader Mary Cwik, PhD, a clinical psychologist and researcher at the Johns Hopkins Center for American Indian Health at the Bloomberg School. "In recent years, suicide deaths have surpassed deaths due to motor vehicle crashes, and suicide is the leading cause of death globally for girls between the ages of 15 and 19. This study shows how a courageous community, the White Mountain Apache Tribe, used legislation and community mental health workers to successfully address suicide as a public health crisis." The work of the tribe also included training for adults to identify at-risk youth; two school-based programs -- one enlisting elders to promote cultural engagement, and the other promoting coping and problem-solving skills -- screening and interventions in the tribe's emergency rooms to connect those who attempt suicide or experience a binge drinking or drugging episode with counseling; and a community-based media campaign to promote prevention education. "We are proud of our Tribal Council for passing a law in support of a community-based suicide prevention surveillance system," says Novalene Goklish, BS, outreach team supervisor and member of the White Mountain Apache Tribe who was involved in the study. "We are determined to let our Apache people who are hurting know that there is real help for them." From 2001 to 2006, the suicide rate among the White Mountain Apache members between the ages of 15 and 24 was 13 times that of the general U.S. population, and seven times the rate for all American Indians and Alaska Natives. When the tribe realized the extent of the disparity, they reached out to their long-time partner, the Johns Hopkins Center for American Indian Health, to analyze surveillance data and design and implement a comprehensive prevention program. The current study found that in the wake of the new programs, suicide deaths and attempts fell significantly among tribe members. Overall, they found, suicide rates dropped by 38.3 percent, while national rates remained stable or rose. This included a 60-percent decrease among the 25-to-34-year-old group and a 37-percent decline among those between the ages of 20 and 24. While the disparity remains, the trend is encouraging. From 2001 to 2006, 41 Apache tribal members died of suicide, while 29 died from 2007 to 2012. The downward trend in deaths during the study period appeared to be mirrored in suicide attempts. The annual number of attempts decreased from 75 in 2007 to 25 in 2012. To achieve these successes, the tribe developed a unique community surveillance system that tracks and triages suicide deaths, attempts, and suicidal thoughts with technical assistance from the Johns Hopkins researchers. After an incident is reported, Apache outreach workers follow up with in-person visits to verify what happened, listen to the individual's story, provide emotional support, and connect individuals to care. These staff members also follow up to monitor the individual's welfare over time. The secure, password-protected surveillance system allows the tribe to develop and deliver a comprehensive youth suicide prevention program, which they call Celebrating Life. Among the elements of the program: "Suicide is a multifaceted and complicated public health problem," Cwik says. "There is still a lot of work to do, particularly in understanding how to prevent clusters of deaths, or what we call 'contagion,' especially among young people. It is imperative to sustain locally driven efforts, especially after seeing these promising results. The surveillance system and linked prevention programs have shown they can save many young lives." The researchers and the tribe have been approached by at least 10 other tribes in need. They believe their program will not only help American Indians, but other communities at high risk for suicide. "Decreases in Suicide Deaths and Attempts Linked to the White Mountain Apache Suicide Surveillance and Prevention System, 2001- 2012" was written by Mary F. Cwik, PhD; Lauren Tingey, PhD; Alexandra Maschino, MPH; Novalene Goklish, BS; Francene Larzelere-Hinton, BA; John Walkup, MD; and Allison Barlow, PhD. This study was supported by the Native American Centers in Health initiative, which received grants from the National Institutes of Health's National Institute of General Medical Science and Indian Health Service (U26IHS300013, U26IHS300286 and U26IHS300414) and the Substance Abuse and Mental Health Services Administration's youth suicide prevention initiative (U79SM057835, U79SM059250, and U79SM061473).


Chambers R.,Johns Hopkins Center for American Indian Health | Tingey L.,Johns Hopkins Center for American Indian Health | Mullany B.,Johns Hopkins Center for American Indian Health | Parker S.,Johns Hopkins Center for American Indian Health | And 2 more authors.
AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV | Year: 2016

ABSTRACT: This paper examines decision-making around sexual behavior among reservation-based American Indian youth. Focus group discussions were conducted with youth ages 13–19 years old. Through these discussions, we explored youth’s knowledge, attitudes and behaviors related to sexual risk taking through the lens of the protection motivation theory to inform the adaptation of an evidence-based HIV prevention intervention. Findings suggest that condom use self-efficacy and HIV prevention knowledge is low, vulnerability to sexually transmitted infections is lacking and alcohol plays a significant role in sexual risk taking in this population. In addition, parental monitoring and peer influence may contribute to or protect against sexual risk taking. Results suggest that future HIV prevention interventions should be delivered to gender-specific peer groups, include a parental component, teach sexual health education and communication skills, integrate substance-use prevention, and work to remove stigma around obtaining and using condoms. © 2016 Informa UK Limited, trading as Taylor & Francis Group.


Mullany B.,Johns Hopkins Center for American Indian Health | Neault N.,Johns Hopkins Center for American Indian Health | Tsingine D.,Johns Hopkins Center for American Indian Health | Powers J.,Johns Hopkins Center for American Indian Health | And 6 more authors.
Public Health Nutrition | Year: 2013

Objective To identify factors associated with food insecurity and household eating patterns among American-Indian families with young children. Design Cross-sectional survey among households with young children that were receiving emergency food services. We collected information on food insecurity levels, household eating patterns, experiences with commercial and community food sources and demographics, and used multivariate regression techniques to examine associations among these variables. Setting Four Southwestern American-Indian reservation communities. Subjects A total of 425 parents/caregivers of young children completed the survey. Results Twenty-nine per cent of children and 45 % of adults from households participating in the survey were classified as 'food insecure'. Larger household size was associated with increased food insecurity and worse eating patterns. Older respondents were more likely than younger respondents to have children with food insecurity (relative risk = 2·19, P < 0·001) and less likely to have healthy foods available at home (relative risk = 0·45, P < 0·01). Consumption of food from food banks, gas station/convenience stores or fast-food restaurants was not associated with food insecurity levels. Respondents with transportation barriers were 1·46 times more likely to be adult food insecure than respondents without transportation barriers (P < 0·001). High food costs were significantly associated with greater likelihoods of adult (relative risk = 1·47, P < 0·001) and child (relative risk = 1·65, P < 0·001) food insecurity. Conclusions Interventions for American-Indian communities must address challenges such as expense and limited transportation to accessing healthy food. Results indicate a need for services targeted to older caregivers and larger households. Implications for innovative approaches to promoting nutrition among American-Indian communities, including mobile groceries and community gardening programmes, are discussed. © The Authors 2012.


Mullany B.,Johns Hopkins Center for American Indian Health | Barlow A.,Johns Hopkins Center for American Indian Health | Neault N.,Johns Hopkins Center for American Indian Health | Billy T.,Johns Hopkins Center for American Indian Health | And 7 more authors.
Prevention Science | Year: 2012

The purpose of this paper is to describe the rationale, design, methods and baseline results of the Family Spirit trial. The goal of the trial is to evaluate the impact of the paraprofessional-delivered "Family Spirit" home-visiting intervention to reduce health and behavioral risks for American Indian teen mothers and their children. A community based participatory research (CBPR) process shaped the design of the current randomized controlled trial of the Family Spirit intervention. Between 2006 and 2008, 322 pregnant teens were randomized to receive the Family Spirit intervention plus Optimized Standard Care, or Optimized Standard Care alone. The Family Spirit intervention is a 43-session home-visiting curriculum administered by American Indian paraprofessionals to teen mothers from 28 weeks gestation until the baby's third birthday. A mixed methods assessment administered at nine intervals measures intervention impact on parental competence, mother's and children's social, emotional and behavioral risks for drug use, and maladaptive functioning. Participants are young (mean age = 18. 1 years), predominantly primiparous, unmarried, and challenged by poverty, residential instability and low educational attainment. Lifetime and pregnancy drug use were ~2-4 times higher and ~5-6 times higher, respectively, than US All Races. Baseline characteristics were evenly distributed between groups, except for higher lifetime cigarette use and depressive symptoms among intervention mothers. If study aims are achieved, the public health field will have new evidence supporting multi-generational prevention of behavioral health disparities affecting young American Indian families and the utility of indigenous paraprofessional interventionists in under-resourced communities. © 2012 Society for Prevention Research.


PubMed | Johns Hopkins Center for American Indian Health
Type: Journal Article | Journal: The Diabetes educator | Year: 2016

The purpose of this study was to examine the impact of a home-based diabetes prevention and management program on high-risk American Indian youth.Together on Diabetes (TOD) was designed via a participatory approach with 4 tribal communities in the southwestern United States. A multisite pre- and postevaluation design was used to evaluate the efficacy of the TOD intervention on improving youths psychosocial, knowledge, behavioral, and physiological outcomes at 4 time points from baseline to 12 months postenrollment.A total of 256 youth and 225 support persons were enrolled in the TOD program. At 12 months postenrollment, improvements were observed in youths quality of life (P < .001), depressive symptoms (P < .001), knowledge related to TOD content (P < .001), standardized body mass index scores (P = .004), and hypertension (P = .026). Improvements in mean A1C were observed among diabetic youth with baseline A1C >6.5% (P = .036).The TOD program was feasible, acceptable, and effective in lowering diabetes risk among reservation-based American Indian youth. It is the first efficacious youth-focused diabetes prevention and management program developed and implemented in partnership with tribal communities.


PubMed | Johns Hopkins Center for American Indian Health
Type: Comparative Study | Journal: American Indian and Alaska native mental health research (Online) | Year: 2010

American Indian and Alaska Native (AI/AN) adolescents have high rates of pregnancy, as well as alcohol, marijuana, cocaine, and, increasingly, methamphetamine (meth) use. The progression of adolescent drug use to meth use could have devastating impacts on AI communities, particularly when youth are simultaneously at risk for teen childbearing. In order to inform future prevention efforts, this study explores correlates of meth use in a sample of pregnant AI teens, with a focus on sociodemographic, familial, and cultural factors and use of other drugs.


PubMed | Johns Hopkins Center for American Indian Health
Type: Journal Article | Journal: The American journal of drug and alcohol abuse | Year: 2016

American Indian (AI) adolescents are disproportionately burdened by alcohol abuse and heavy binge use, often leading to problematic drinking in adulthood. However, many AI communities also have large proportions of adults who abstain from alcohol.To understand these concurrent and divergent patterns, we explored the relationship between risk and protective factors for heavy binge alcohol use among a reservation-based sample of AI adolescents.Factors at individual, peer, family, and cultural/community levels were examined using a cross-sectional case-control study design. Cases were adolescents with recent heavy binge alcohol use that resulted in necessary medical care. Controls had no lifetime history of heavy binge alcohol use. 68 cases and 55 controls were recruited from emergency health services visits. Participants were 50% male; average age 15.4 years old, range 10 to 19. Independent variables were explored using logistic regression; those statistically significant were combined into a larger multivariate model.Exploratory analyses showed adolescents who were aggressive, impulsive, had deviant peers, poor family functioning or more people living at home were at greater risk for heavy binge alcohol use. Protective factors included attending school, family closeness, residential stability, social problem-solving skills, having traditional AI values and practices, and strong ethnic identity. Confirmatory analysis concluded that school attendance and residential stability reduce the probability of heavy binge alcohol use, even among those already at low risk.Findings deepen the understanding of AI adolescent heavy binge alcohol use and inform adolescent intervention development fostering trajectories to low-risk drinking and abstinence.


PubMed | Johns Hopkins Center for American Indian Health
Type: Journal Article | Journal: Prevention science : the official journal of the Society for Prevention Research | Year: 2012

The purpose of this paper is to describe the rationale, design, methods and baseline results of the Family Spirit trial. The goal of the trial is to evaluate the impact of the paraprofessional-delivered Family Spirit home-visiting intervention to reduce health and behavioral risks for American Indian teen mothers and their children. A community based participatory research (CBPR) process shaped the design of the current randomized controlled trial of the Family Spirit intervention. Between 2006 and 2008, 322 pregnant teens were randomized to receive the Family Spirit intervention plus Optimized Standard Care, or Optimized Standard Care alone. The Family Spirit intervention is a 43-session home-visiting curriculum administered by American Indian paraprofessionals to teen mothers from 28 weeks gestation until the babys third birthday. A mixed methods assessment administered at nine intervals measures intervention impact on parental competence, mothers and childrens social, emotional and behavioral risks for drug use, and maladaptive functioning. Participants are young (mean age=18.1 years), predominantly primiparous, unmarried, and challenged by poverty, residential instability and low educational attainment. Lifetime and pregnancy drug use were ~2-4 times higher and ~5-6 times higher, respectively, than US All Races. Baseline characteristics were evenly distributed between groups, except for higher lifetime cigarette use and depressive symptoms among intervention mothers. If study aims are achieved, the public health field will have new evidence supporting multi-generational prevention of behavioral health disparities affecting young American Indian families and the utility of indigenous paraprofessional interventionists in under-resourced communities.

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