1. Implementation of Draw the Line/Respect the Line in Great Plains Tribal Communities Kaitlyn Ciampaglio Public Health Associate Office for State, Tribal, Local and Territorial Support Centers for Disease Control and Prevention PHAP Summer Seminar May 17 th, 2016 Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support

2. Background  Tribal sovereignty and data ownership  Sexually transmitted infection (STI) rates in American Indian/Alaska Native (AI/AN) populations are often higher compared to other populations and the U.S. as a whole (Kaufman et al., 2007)  Teen birth rates in the U.S. have decreased over the past few decades (Wingo et al., 2011)  With AI/AN teens, numbers remain consistently higher than the country as a whole  Culturally sensitive and evidence-based programming are needed to educate teens on how to prevent unintended pregnancy and STIs (Harris & Allgood, 2009)

3. Teen Birth Rates in Counties that Fall within Districts of Tribal Nations in the Northern Great Plains Region *Rates are per 1,000 live births State Vital Records for SD, NE, IA (2014) South Dakota Teen Birth Rates,* 15-17, 2014 County X, SD55.2 County Y, SD45.8 South Dakota (overall)14.8 Nebraska % Teen Births,* under 20, 2014 County X, NE10.6 Nebraska (overall)5.3 Iowa Teen Birth Rates,* under 20, 2014 County X, IA63.8 Nebraska (overall)52.1

4. AI/AN and White STI Rates for South Dakota, Iowa, and Nebraska *Rates per 100,000 1.South Dakota DOH. (2014). Infectious Diseases in South Dakota, 2014. 2.Harms et al. (2011). Epidemiological Profile for Iowa: HIV, AIDS, Sexually Transmitted Diseases, and Viral Hepatitis. 3.Zhang, A. (2011). Health Status of American Indians in Nebraska. South Dakota 2014 Gonorrhea/Chlamydia Rates* by Race 1 GonorrheaChlamydia AI/AN387.61650 White17.6190.6 Iowa, 2011 Gonorrhea/Chlamydia Rates* by Race 2 GonorrheaChlamydia AI/AN53427 White29244 Nebraska, 2006-2010 Gonorrhea/Chlamydia Rates* by Race 3 GonorrheaChlamydia AI/AN140.1821.8 White29.7185.1

5. “Setting Limits to Prevent HIV, STD, and Pregnancy”  Helps students “develop personal sexual limits and practice the skills needed to maintain those limits when challenged”  Selected by tribal advisory groups from each participating community Coyle et al. (2003). Draw the Line/Respect the Line: Setting Limits to Prevent HIV, STD, and Pregnancy.

6. Who’s Involved?  Great Plains Tribal Chairmen’s Health Board (GPTCHB)  Sanford Research  Tribal Schools and Community Members

7. Curriculum  Developed for 6 th – 8 th grade classes  Cultural adaptation  Promotes abstinence (6 th -8 th ) and contraceptives (7 th and 8 th )  Provides knowledge and skills to prevent STIs and pregnancy  Modeling and practice of communication skills  6 th : Covers limit setting and refusal skills in a nonsexual context  7 th : Examines consequences of unplanned sex, information about STIs, and applying refusal skills in a party context  8 th : Features practice of refusal skills in a dating context and a condom demonstration Coyle et al. (2003). Draw the Line/Respect the Line: Setting Limits to Prevent HIV, STD, and Pregnancy.

8. Methods  Participants from three tribes in South Dakota, Nebraska, and Iowa (Fall 2014 and Spring 2015)  Great Plains Tribal Chairmen’s Health Board:  Implementation: Staff members from GPTCHB central office in South Dakota travel to different tribal schools  Administer pre- and post-assessments: Test student knowledge and opinions on program  Sanford Research:  Evaluation: Analyze assessment data  Report Writing: Reports synthesized from evaluation for community members/schools

9. Methods Continued: Pre- and Post-Assessment  Demographic Variables: Age, grade, gender, race, ethnicity, tribe  Measures: Pre- and post-assessments measure student knowledge, student opinion on program, and presence of pro-social behaviors and positive relationships Assessed significant changes in knowledge, skills, and behaviors with paired-sample t-tests, (p < 0.05)  Assessment Question Categories: Positive Relationships: 7 questions Pro-Social Behavior: 8 questions Sexual Health Knowledge: 16 questions (7 th and 8 th grade only) DTL/RTL Vignettes: 3 questions DTL/RTL Self-efficacy: 2 questions

10. Results  Everyone look at me!  Mixed results, overall positive

11. Discussion  One of the main goals of the program is being met  To increase youths’ knowledge base in adulthood preparation and demonstrating fewer risk behaviors  Findings differ from those reported by Coyle et al., 2004 Coyle, K. K., Kirby, D. B., Marín, B. V., Gómez, C. A., & Gregorich, S. E. (2004). Draw the Line/Respect the Line: A randomized trial of a middle school intervention to reduce sexual risk behaviors. American Journal of Public Health, 94(5), 843-851.

12. Conclusions  Results suggest the program is effective with AI/AN youth  Future analyses will analyze longitudinal data to determine 3 year program impact  The need for culturally tailored, evidence-based programming specifically for AI/AN youth remains

13. Acknowledgements This project is supported by the Tribal Personal Responsibility Education Program, US Department of Health and Human Services, Administration for Children & Families (#90AT0010). Thank you to the people who helped make this project possible: Tribal Advisory Group Members, Tribal Partners, participating schools, Maylynn Warne, Lena Spears, Britney McCauley, Joetta Roberts, Derice Aragon, Farrah Big Crow, Ashley Miller, Cindy Giago, Martina Moves Camp, and Tracey McMahon.

14. For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support 4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: OSTLTSfeedback@cdc.govWeb: http://www.cdc.gov/stltpublichealthOSTLTSfeedback@cdc.govhttp://www.cdc.gov/stltpublichealth The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Questions? Contact Kaitlyn Ciampaglio lhq7@cdc.gov Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support