Internet-Based Sexual Health Education for Middle School Native American Youth

The goal of this four year research project is to adapt and evaluate the effectiveness of an
Internet-based HIV/STI, and pregnancy prevention curriculum for American Indian/Alaska
Native (AI/AN) middle school-aged youth (12-14 years). This curriculum will be adapted from
a successful, Internet-accessible, prevention program, It's Your Game…Keep it Real (IYG).

During year 1 (Fall 2010 through Spring 2011) of this project, the study team will test the
usability of the existing IYG program, while performing an assessment of existing programs
for cultural of the IYG intervention. In year 2 (beginning Fall 2011), the project team
plans to initiate and complete development of the cultural-adapted IYG intervention for
AI/AN youth (IYG-AI/AN). Starting in year 3 (Fall 2012), the study efficacy trial will
commence to evaluate the effectiveness of IYG-AI/AN on sexual behaviors and psychosocial
determinants of those behaviors among AI/AN youth in three regions (Alaska, the Pacific
Northwest, including Idaho, Oregon, and Washington state, and Arizona) relative to a
comparison condition. Recruitment sites will be middle schools and Boys and Girls Clubs
(BGCs), identified through their affiliations with the Alaska Native Tribal Health
Consortium (ANTHC), the Pacific Northwest Tribal Epicenter (the Epicenter) and the Inter
Tribal Council of Arizona (ITCA). Randomization will occur regionally, at the site (schools
and BGCs) level, to one of two conditions: IYG-AI/AN and a comparison condition. The
comparison condition will consist of two web-based educational programs unrelated to sexual
health. The IYG-AI/AN intervention will be compared against the comparison condition. The
efficacy trial will continue for 16 months into year 4 (2013).

The primary hypothesis to be tested is: (1) youth who receive the IYG-AI/AN intervention
will delay sexual activity relative to those who receive the comparison condition. The major
dependent variable is the proportion of AI/AN youth initiating sexual activity (vaginal,
oral, or anal sex). Secondary hypotheses will examine the effect of the intervention on
specific types of sex (e.g., vaginal, oral, anal) and psychosocial variables such as youth
intentions, knowledge, self-efficacy, attitudes, and perceived norms related to sexual
risk-taking behavior. Secondary hypotheses will also examine the effect of the intervention
on the proportion of AI/AN youth who are sexually active, occurrences of unprotected sexual
intercourse and the number of sexual partners among these AI/AN youth.

Inclusion Criteria:

- American Indian or Alaska Native descent and/or tribal affiliation

- Youth ages 12-14 attending regular classes in regional middle schools or youth
attending after-school programs and/or Boys and Girls Clubs

- English-speaking

Exclusion Criteria:

- Youth who are not of American Indian or Alaska Native descent

- Any physical or mental condition that would inhibit the ability to complete surveys
and use computer programs, such as cognitive impairment, motor disorders (e.g.
quadriplegia), learning difficulties or psychiatric/behavioral problems (e.g. autism,
attention deficit disorder)

- Students will be informed that the surveys and intervention materials will only be
available in English and will be asked to consider their comfort level with
participating in the study