1. CRISSY GARCIA, B.S. SCHOOL HEALTH SPECIALIST NIMIIPUU HEALTH CLINIC

2. Native It’s Your Game Tots to Tween Nez Perce Project Updates Native CARS

3. What is it?

4. Study Goal To adapt and evaluate the effectiveness of an Internet-based HIV/STI & pregnancy prevention program for middle school-aged youth (12-14 years old) in three geographically dispersed AI/AN communities in Alaska, Arizona & Pacific Northwest.

5. Example Lessons

6. Adaptations Elder Voice Holistic Health Story TellingDating Violence Fact Sheets

7. Parent-Child Communication Component

8. Effectiveness Study: By the Numbers  2 study arms: Native IYG and Control  25 Tribal Sites randomized  3 regions: AK, PNW, AZ  574 middle school aged youth enrolled  3 Surveys: Pre, Post, 12 month follow-up

9. RESULTS

10. Baseline: Factors Associated w/ Sexual Exp.  Participants were 12-14 years old  Sample was 55% female  Mean age was13.2 years  6.5% were sexually experienced

11. Short-Term Outcomes More reasons not to have sex Increased STI knowledge Increased condom knowledge More confidence about obtaining condoms More confidence about using condoms Youth who used Native IYG reported:

12. The team is: Creating a user’s guide and an online teacher’s interface for the NIYG program Creating a AI/AN Sexual Health Portal (Healthy Native Youth) linking users to sexual health resources interventions implementation tools across the lifespan Dissemination Plan

15. Native CARS: Overall Goal Design, implement and test effectiveness oftribal interventions to improve the use of child safety seats among AI/AN children via community-based participatory research (CBPR)

16. All Facets of the Study are Community Driven

17. Data Collection Methods Vehicle observations to determine baseline proper restraint Identified risk factors for being unrestrained or incorrectly restrained Focus groups and interviews to help understand community context

18. Nez Perce Intervention Activities Education Awareness Media – Tac’ Tito’ qan articles – Social media – Mass emails – Check inserts Policy – Updating Tribal law

19. TV & Radio PSAs

21. It 's the law. Use Child Safety Seats.- Nez Perce Tribe 4,....-;...) Northwest Portland -Q Ar a lncfuu1,...,)rralth no.rel NIMIIPUU HlALTH

22. Nez Perce Native CARS Evaluation 41 22 37 23 17 30 18 properly restrainedincorrectly restrainedunrestrained % Child restraint status at Nez Perce by year 200920112013 60 52

23. Nez Perce child safety seat distribution program Completed CPS tech certification Partnership with Moscow Police Department Established car seat distribution program Fall of 2013 $20 minimum donation Collaboration with WIC and MCH Distributed & checked over 250 car seats

24. Nez Perce child safety seat distribution program Recruited 6 CPS techs within the Nez Perce Tribe & Nimiipuu Health Awarded the Buckle Up For Life Grant from Toyota for 60 cars seats Awarded the BIA Indian Highway Safety grant for $9975 for car seats Safe Kids Inland Northwest (SKIN) Coalition

25. Nez Perce Next Steps Continue with the Distribution Program at Nez Perce Follow up with referrals from the Native CARS patch for Well Child appointments Continue reviewing/revising Native CARS atlas modules

26. Nez Perce Next Steps Sharing our successful work via Native CARS Atlas, currently under construction at nativecars.org If you are interested in testing the Native CARS Atlas please contact: Tam Lutz, Native CARS Project Director at tlutz@npaihb.org 503.416.3271

27. TOTS to Tweens Study

28. Original TOTs Goals Original TOTs Goals To prevent early childhood obesity in American Indian children To prevent early childhood caries in American Indian children

29. What did we do at Nez Perce? What did we do at Nez Perce? Enrolled pregnant moms Completed 8 home visits over 2 years Encouraged breastfeeding & water consumption Discouraged sugar beverages Recorded height/weight at WIC/MCH visits Recorded dental exams Breastfeeding Room

30. Fast Forward... Fast Forward... Children Born: 2003 - 2004 Children currently: 11 – 12 years old

31. Recruitment Methods Recruitment Methods Reviewed old TOTs files for current contact information Met with WIC and MCH for any updates Searched EHR Investigated through Social Media Contacted Elementary/Middle Schools across the reservation

32. Consent Process Consent Process Obtain consent from parent/guardian Fill out KAB questionnaire Inform parent of childs appointment o Gather height/weight measurements o Child Questionnaire o Dental screening

33. Screening Process Screening Process

34. Data Collection Data Collection Dentist and staff set up at the school and community center Screened 90 children Outcomes and urgent needs communicated to clinic and parents

35. Youth Incentives for participating... Youth Incentives for participating...

36. Parent Incentives for participating... Parent Incentives for participating...

37. Next Steps Next Steps Now in analysis phase for Nez Perce Qualitative work will come next o Focus groups o Help provide context for why we see what we see Data collection at other tribes- Nez Perce was first Overall study findings should help inform policy and practice.

38. Crissy Garcia, BS Nimiipuu Health School Health Specialist crissyg@nimiipuu.org crissyg@nimiipuu.org 208-621-4951 (phone) Qe’ci’ yew’yew’- Thank You!