1. Teens and Sex: Among Native Americans What We Need To Know Frances R. Ruiz-Nakai Health Educator ruiz@email.arizona.edu

2. Why are Native Americans at Risk? One study of Alaska Native drug users found that alcohol use was the factor that put Native Americans at greatest risk of sexual behaviors. Many individuals reported blacking out while drinking and later learned that they had unprotected sex with complete strangers or persons they would not otherwise accept as partners.

3. According to 2005 surveillance data by race/ethnicity, the 2nd highest rates of gonorrhea and Chlamydia trachomatis infection were those for American Indians and Alaska Natives. The 3rd highest rate of syphilis was that for American Indians and Alaska Natives.

4. Statistics High School Students Compared to the national average, Native American high school students are more likely to have had sexual intercourse. The teen birth rate for Native Americans is higher than the national average.

7. Cultural Diversity The Native American population makes up 562 federally recognized tribes plus at least 50 state- recognized tribes. Because each tribe has its own culture, beliefs, and practices and these tribes may be subdivided into language groups, it can be challenging to create effective programs.

8. Therefore, prevention programs that can be adapted to individual tribal cultures and beliefs are critically important. Current programs emphasize traditional teachings and the importance of the community

9. Successful Program It can be useful to incorporate educational information with other training programs to increase the dissemination of important material (e.g., collaborating with diabetes education, alcohol and substance abuse programs, prenatal classes). It is important to adopt culturally competent approaches in an effort to increase the quality of care received by Native Americans.

10. Effective Sex Education Programs 1. Offer age- and culturally appropriate sexual health information in a safe environment for participants; 2. Are developed in cooperation with members of the target community, especially young people; 3. Assist youth to clarify their individual, family, and community values; 4. Assist youth to develop skills in communication, refusal, and negotiation; 5. Provide medically accurate information about both abstinence and also contraception, including condoms;

11. 6. Have clear goals for preventing HIV, other STIs, and/or teen pregnancy; 7. Focus on specific health behaviors related to the goals, with clear messages about these behaviors; 8. Address psychosocial risk and protective factors with activities to change each targeted risk and to promote each protective factor; 9. Respect community values and respond to community needs; 10. Rely on participatory teaching methods, implemented by trained educators and using all the activities as designed

12. Program I Pregnancy Prevention – Teen Voices  Limited access to pregnancy prevention info community-based programs contraceptives  Suggestions Show consequences of teen pregnancy Have more programs in schools and community Improve access to contraceptives Discuss teen pregnancy with Native youth Messages & the media

13. Program II Questions about sex -> presentations  Reproduction  Sexuality  Contraception  Anatomy  Venereal disease  Pregnancy  Abortion  Hygiene

14. Program III New Image Teen Theater  Uses peer education and theater Results  Teens more willing to discuss sex  Greater intentions to use birth control  Greater sexual knowledge

15. Research Adult Supervision Results: Youth who are supervised MAY be less likely to participated in sexual activity due to associations with…  Positive role models  Family communication  School connectedness  Constructive use of time  Aspirations for the future

16. Library’s Role in Sex Education Analyze, organize and manage information services, resources, or materials for those with information needs Provide most recent, updated information available

17. Library’s Role in Sex Education Materials available on topics of interest, eg  Reproduction, sexuality, contraception, anatomy, hygiene, etc.  Provide a place for programs, discussions, theater, support groups

18. Library’s Role in Sex Education Information of current events Reference to community services  Clinics, Hospitals, Program Centers

19. Sexuality Education Integral part of positive development Should be based on the value of honesty, respect for diverse values, and responsibility. Guided by research that is community based and culturally appropriate.

20. Comprehensive sex education is effective at assisting young people to make healthy decisions about sex and to adopt healthy sexual behaviors. Comprehensive sex education prevention programs show that they do not increase rates of sexual initiation, do not lower the age at which youth initiate sex, and do not increase the frequency of sex or the number of sex partners among sexually active youth.

21. References Hamilton, B.E., Ventura, S.J., & Martin, J.A.. (2007). Preliminary Births for 2006. NCHS Health E-Stats retrieved December 12, 2007 from http://www.cdc.gov/nchs/products/pubs/pubd/nvsr/nvsr.htm#vol56; Martin, J.A., Hamilton, B.E., Sutton, P.D., Ventura, S.J., Menacker, F., Munson, M.L., & Munson, M.L. (2005). Births: Final data for 2005. National Vital Statistics Reports: 56 (6). Office of Indian Education Programs, Bureau of Indian Affairs. (n.d.) 2001 Youth risk behavior survey of high school students attending Bureau funded schools. Available: www.oiep.bia.edu/docs/hsyrbs_2001.pdf. Centers for Disease Control and Prevention. (2002, June 28). Youth risk behavior surveillance – United States, 2001. Morbidity and Mortality Weekly Report, 51(SS-4).; National Center for Chronic Disease Prevention and Health Promotion (2007). Youth Risk Behavior Surveillance System: 2005 Sexual Behaviors Navajo Nations. Fleming DT, Wasserheit JN. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sexually Transmitted Infections 1999;75:3–17. CDC. Sexually Transmitted Disease Surveillance 2004. Atlanta: US Department of Health and Human Services, CDC; September 2005: Tables 11B, 21B, 34B. Also available at http://www.cdc.gov/std/stats/toc2004.htm. Accessed April 6, 2006.

22. McNaghten AD, Neal JJ, Li J, Fleming PL. Epidemiologic profile of HIV and AIDS among American Indians/Alaska Natives in the USA through 2000. Ethnicity and Health 2005;10:55–71. Simoni, JM, Sehgal S, Walters KL. 'Triangle of risk: urban American Indian women's sexual trauma, injection drug use, and HIV sexual risk behaviors' AIDS and Behavior. 2004 March 8(1): 33-45. Vernon, IS. Killing Us Quietly: Native Americans and HIV/AIDS. University of Nebraska Press. 2001. Kirby D. Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy. Washington, DC: National Campaign to Prevent Teen Pregnancy, 2001. Kirby D et al. Impact of Sex and HIV Education Programs on Sexual Behaviors of Youth in Developing and Developed Countries. [Youth Research Working Paper, No. 2] Research Triangle Park, NC: Family Health International, 2005. Alford S. Science and Success: Sex Education and Other Programs that Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections. Washington, DC: Advocates for Youth, 2003. Alford S. Science and Success, Second Edition: Programs that Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections. Washington, DC: Advocates for Youth, 2008.

23. Questions? Comments? Frances R. Ruiz-Nakai ruiz@email.arizona.edu