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Tingey L, Rosenstock S, Chambers R, Patel H, Melgar L, Slimp A, Lee A, Cwik M, Rompalo A, Gaydos C. Empowering our people: Predictors of retention in an STI risk reduction program among rural Native Americans with binge substance use. J Rural Health 2021; 38:323-335. [PMID: 34028866 DOI: 10.1111/jrh.12589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Substance use and sexual risk-taking have been shown to co-occur. Programs focused on sexually transmitted infections (STIs) reduction may benefit substance-using, particularly binge substance-using, adults. This is especially true for rural Native American communities who endure sexual and substance use disparities and have few STI risk reduction programs. This study explores factors predicting retention in an STI risk reduction program among rural Native adults engaged in binge substance use. METHODS We analyzed data from 150 Native adults ages 18-55 participating in an evaluation of "EMPWR," a 2-session STI risk reduction program in a rural, reservation-based community. Multivariate logistic regression models were used to estimate associations between independent variables and program completion across demographics, sexual behaviors, substance use behaviors, mental health, recent health care utilization, and perceived enculturation and discrimination. FINDINGS The sample was 49.2% (n = 59) female with a mean age of 33.61 years (SD = 8.25). Twenty-six completed only the first EMPWR session, 94 completed both EMPWR sessions, and 30 were randomized but completed 0 sessions. Being married/cohabiting (adjusted odds ratio [AOR] = 6.40, P = .0063) and living with an older generation (AOR = 4.86, P = .0058) were significantly associated with higher odds of completing EMPWR. CONCLUSIONS Findings provide insight on factors driving retention of Natives with recent binge substance use in STI risk reduction programming. An important contribution to Native health literature is that living with an older generation positively predicted EMPWR program completion, suggesting that STI risk reduction programs should harness the strength of families to ensure program attendance and optimize impacts in rural reservation contexts.
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Affiliation(s)
- Lauren Tingey
- Johns Hopkins Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Summer Rosenstock
- Johns Hopkins Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rachel Chambers
- Johns Hopkins Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hima Patel
- Johns Hopkins Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Laura Melgar
- Johns Hopkins Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anna Slimp
- Johns Hopkins Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Angelita Lee
- Johns Hopkins Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mary Cwik
- Johns Hopkins Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anne Rompalo
- Center for the Development of Point of Care Tests for Sexually Transmitted Diseases, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Charlotte Gaydos
- Center for Global Health, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Chambers R, Tingey L, Beach A, Barlow A, Rompalo A. Testing the efficacy of a brief sexual risk reduction intervention among high-risk American Indian adults: study protocol for a randomized controlled trial. BMC Public Health 2016; 16:366. [PMID: 27129956 PMCID: PMC4850664 DOI: 10.1186/s12889-016-3040-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/26/2016] [Indexed: 04/17/2023] Open
Abstract
Background American Indian adults are more likely to experience co-occurring mental health and substance use disorders than adults of other racial/ethnic groups and are disproportionately burdened by the most common sexually transmitted infections, namely chlamydia and gonorrhea. Several behavioral interventions are proven efficacious in lowering risk for sexually transmitted infection in various populations and, if adapted to address barriers experienced by American Indian adults who suffer from mental health and substance use problems, may be useful for dissemination in American Indian communities. The proposed study aims to examine the efficacy of an adapted evidence-based intervention to increase condom use and decrease sexual risk-taking and substance use among American Indian adults living in a reservation-based community in the Southwestern United States. Methods/Design The proposed study is a randomized controlled trial to test the efficacy of an adapted evidence-based intervention compared to a control condition. Participants will be American Indian adults ages 18–49 years old who had a recent episode of binge substance use and/or suicide ideation. Participants will be randomized to the intervention, a two-session risk-reduction counseling intervention or the control condition, optimized standard care. All participants will be offered a self-administered sexually transmitted infection test. Participants will complete assessments at baseline, 3 and 6 months follow-up. The primary outcome measure is condom use at last sex. Discussion This is one of the first randomized controlled trials to assess the efficacy of an adapted evidence-based intervention for reducing sexual risk behaviors among AI adults with substance use and mental health problems. If proven successful, there will be an efficacious program for reducing risk behaviors among high-risk adults that can be disseminated in American Indian communities as well as other rural and under-resourced health systems. Trial Registration Clinical Trials NCT02513225
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Affiliation(s)
- Rachel Chambers
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, 415 North Washington Street Suite 400, Baltimore, Maryland, 21224, USA.
| | - Lauren Tingey
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, 415 North Washington Street Suite 400, Baltimore, Maryland, 21224, USA
| | - Anna Beach
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, 415 North Washington Street Suite 400, Baltimore, Maryland, 21224, USA
| | - Allison Barlow
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, 415 North Washington Street Suite 400, Baltimore, Maryland, 21224, USA
| | - Anne Rompalo
- Johns Hopkins School of Medicine, Johns Hopkins University, 415 North Washington Street Suite 400, Baltimore, Maryland, 21224, USA
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Tingey L, Strom R, Hastings R, Parker A, Barlow A, Rompalo A, Gaydos C. Self-administered sample collection for screening of sexually transmitted infection among reservation-based American Indian youth. Int J STD AIDS 2014; 26:661-6. [PMID: 25228666 DOI: 10.1177/0956462414552139] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 08/25/2014] [Indexed: 11/15/2022]
Abstract
American Indians suffer a disproportionate burden of sexually transmitted infection, particularly adolescents. Screening access barriers in rural and reservation-based communities necessitate alternatives to clinic-based options. Self-administered screening for three sexually transmitted infections was piloted among 32 American Indian adolescents aged 18 to 19. Participants self-collected in a private location; specimens were processed by trained, American Indian paraprofessionals and analysis was conducted by an outside laboratory. Participants testing positive were treated by a Public Health Nurse from the Indian Health Service. Results suggest high overall acceptability: 69% preferred a self-administered method over clinic-based screening, 75% would encourage their friends to use this method and 100% would use it again. A self-administered screening method has the ability to reach this and other high-risk populations that might not otherwise access screening, with added potential within the Indian Health Services system for uptake and dissemination in rural, reservation communities facing significant screening barriers.
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Affiliation(s)
- Lauren Tingey
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Baltimore, MD, USA
| | - Rachel Strom
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ranelda Hastings
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Baltimore, MD, USA
| | - Anthony Parker
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Baltimore, MD, USA
| | - Allison Barlow
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Baltimore, MD, USA
| | - Anne Rompalo
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Baltimore, MD, USA
| | - Charlotte Gaydos
- International Sexually Transmitted Diseases Research Laboratory, Johns Hopkins University, Baltimore, MD, USA
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