Effectiveness of Native STAND: A Five-Year Study of a Culturally Relevant Sexual Health Intervention
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Data
2.2. Study Participants and Setting
2.3. Data Collection and Management
2.4. Native STAND Intervention
2.5. Outcome Measures
2.6. Data Analysis
3. Results
3.1. Demographics, Culture, and Drug or Alcohol Misuse
3.2. Predictors of Sexual Behavior
3.3. Predictors of Sexual Behavior
3.4. Multivariable Modeling Sensitivity Analyses
3.5. Dose Moderation Analyses
4. Discussion
4.1. Limitations
4.2. Next Steps
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Measure | Baseline | Follow-Up | Test | p-Value |
---|---|---|---|---|
Demographics Characteristics (Bonferroni α = 0.0100) | ||||
1. Gender | BST | 0.53 | ||
Female | 495 (51.6) | 491 (51.2) | ||
Male | 424 (44.2) | 428 (44.6) | ||
Transgender/other | 12 (1.3) | 12 (1.3) | ||
Missing | 29 (3.0) | 29 (3.0) | ||
2. Sexual orientation | BST | 0.002 | ||
Straight/Heterosexual | 688 (71.7) | 717 (74.7) | ||
LGBTQ2S+ | 80 (8.3) | 93 (9.7) | ||
Unsure | 127 (13.2) | 95 (9.9) | ||
missing | 65 (6.8) | 55 (5.7) | ||
3. Race/Ethnicity: American Indian/Alaska Native | 811 (84.5) | 799 (83.2) | MCN | 0.24 |
4. Age (years) | 14.8 ± 1.6 | 15.1 ± 1.6 | WSR | <0.001 |
5. Last grade level completed | 8.5 ± 1.5 | 8.7 ± 1.6 | WSR | <0.001 |
Sexual behaviors (Bonferroni α = 0.0015) | ||||
1. Serious convo about sex w/friends | BST | <0.001 | ||
No | 511 (53.2) | 453 (47.2) | ||
Yes | 267 (27.8) | 345 (35.9) | ||
Decline to answer | 68 (7.1) | 42 (4.4) | ||
missing | 114 (11.9) | 120 (12.5) | ||
2. In convo, think about learned in NS? | BST | <0.001 | ||
No | 134 (14.0) | 78 (8.1) | ||
Yes | 71 (7.4) | 230 (24.0) | ||
Haven’t talked friends about sex | 54 (5.6) | 32 (3.3) | ||
Missing | 701 (73.0) | 620 (64.6) | ||
3. In convo, share info learned in NS? | BST | <0.001 | ||
No | 174 (18.1) | 125 (13.0) | ||
Yes | 40 (4.2) | 200 (20.8) | ||
Haven’t talked friends about sex | 44 (4.6) | 15 (1.6) | ||
Missing | 702 (73.1) | 620 (64.6) | ||
4. Ever oral sex | MCN | 0.13 | ||
No | 633 (65.9) | 616 (64.2) | ||
Yes | 168 (17.5) | 195 (20.3) | ||
Decline to answer | 68 (7.1) | 61 (6.4) | ||
Missing | 91 (9.5) | 88 (9.2) | ||
5. How old oral sex first time | 14.1 ± 1.6 | 14.2 ± 2.1 | WSR | 0.02 |
6. Ever vaginal sex | MCN | 0.32 | ||
No | 572 (59.6) | 564 (58.8) | ||
Yes | 216 (22.5) | 239 (24.9) | ||
Decline to answer | 65 (6.8) | 61 (10.0) | ||
Missing | 107 (11.2) | 96 (6.4) | ||
7. How old vaginal sex first time | 14.1 ± 1.8 | 14.4 ± 1.8 | WSR | 0.87 |
8. Last year vaginal sex | MCN | 0.83 | ||
No | 612 (63.8) | 610 (63.5) | ||
Yes | 166 (17.3) | 183 (19.1) | ||
Decline to answer | 8 (0.8) | 6 (0.6) | ||
Missing | 174 (18.1) | 161 (16.8) | ||
9. Last month vaginal sex | MCN | 0.73 | ||
No | 694 (72.3) | 699 (72.8) | ||
Yes | 88 (9.2) | 95 (9.9) | ||
Decline to answer | 6 (0.6) | 6 (0.6) | ||
Missing | 172 (17.9) | 160 (16.7) | ||
10. Last month vaginal sex no b.control | MCN | 0.77 | ||
No | 708 (73.8) | 711 (74.1) | ||
Yes | 43 (4.5) | 55 (5.7) | ||
Not sure | 19 (2.0) | 18 (1.9) | ||
Decline to answer | 14 (1.5) | 13 (1.4) | ||
Missing | 176 (18.3) | 163 (17.0) | ||
11. Use condom last time had sex | MCN | 0.38 | ||
No | 86 (9.0) | 91 (9.5) | ||
Yes | 110 (11.5) | 131 (13.7) | ||
Decline to answer | 18 (1.9) | 2 (1.3) | ||
Missing | 746 (77.7) | 726 (75.6) | ||
12. How often use condom vaginal sex | BST | 0.06 | ||
Never | 25 (2.6) | 38 (4.0) | ||
Sometimes | 91 (9.5) | 87 (9.1) | ||
Always | 84 (8.8) | 95 (9.9) | ||
Decline to answer | 15 (1.6) | 15 (1.6) | ||
Missing | 745 (77.6) | 725 (75.5) | ||
13. Ever anal sex | MCN | 0.89 | ||
No | 756 (78.8) | 767 (79.9) | ||
Yes | 57 (5.9) | 59 (6.2) | ||
Decline to answer | 55 (5.7) | 54 (5.6) | ||
Missing | 92 (9.6) | 80 (8.3) | ||
14. How old anal sex first time | 14.4 ± 1.8 | 14.7 ± 1.9 | WSR | 0.12 |
15. Last year anal sex | MCN | 0.61 | ||
No | 779 (81.2) | 787 (82.0) | ||
Yes | 29 (3.0) | 37 (3.9) | ||
Decline to answer | 4 (0.4) | 1 (0.1) | ||
Missing | 148 (15.4) | 135 (14.1) | ||
16. Last month anal sex | MCN | 0.48 | ||
No | 797 (83.0) | 804 (83.8) | ||
Yes | 12 (1.3) | 19 (2.0) | ||
Decline to answer | 4 (0.4) | 1 (0.1) | ||
Missing | 147 (15.3) | 136 (14.2) | ||
17. Use condom last time anal sex | MCN | 0.38 | ||
No | 25 (2.6) | 25 (2.6) | ||
Yes | 22 (2.3) | 27 (2.8) | ||
Decline to answer | 9 (0.9) | 5 (0.5) | ||
Missing | 904 (94.2) | 903 (94.1) | ||
18. How often use condom anal sex | BST | 0.25 | ||
Never | 13 (1.4) | 17 (1.8) | ||
Sometimes | 11 (1.2) | 15 (1.6) | ||
Always | 19 (2.0) | 19 (2.0) | ||
Decline to answer | 12 (1.3) | 6 (0.6) | ||
Missing | 905 (94.3) | 903 (94.1) | ||
19. Forms of b control used | ||||
Don’t use | 309 (32.2) | 321 (33.4) | MCN | 0.32 |
Oral | 44 (4.6) | 43 (4.5) | MCN | 0.86 |
Condom | 68 (7.1) | 67 (7.0) | MCN | 0.90 |
Shot | 32 (3.3) | 35 (3.7) | MCN | 0.56 |
Patch | 2 (0.2) | 2 (0.2) | MCN | 1.00 |
Ring | 1 (0.1) | 0 (0.0) | n/a | n/a |
IUD | 7 (0.7) | 10 (1.0) | MCN | 0.26 |
Implant | 17 (1.8) | 25 (2.6) | MCN | 0.07 |
Morning after | 9 (0.9) | 7 (0.7) | MCN | 0.59 |
Other | 10 (1.0) | 11 (1.2) | MCN | 0.81 |
20. Ever pregnant or someone pregnant | MCN | 0.21 | ||
No | 795 (82.8) | 783 (81.6) | ||
Yes | 21 (2.2) | 34 (3.5) | ||
Don’t know | 19 (2.0) | 20 (2.1) | ||
Decline to answer | 44 (4.6) | 47 (4.9) | ||
Missing | 81 (8.4) | 76 (7.9) | ||
21. Last year been or got pregnant | n/a | n/a | ||
No | 801 (83.4) | 809 (84.3) | ||
Yes | 13 (1.4) | 0 (0.0) | ||
Don’t know | 0 (0.0) | 7 (0.7) | ||
Decline to answer | 1 (0.1) | 1 (0.1) | ||
Missing | 145 (15.1) | 143 (14.9) | ||
22. Ever tested STD/STI | MCN | 0.52 | ||
No | 726 (75.6) | 706 (73.5) | ||
Yes | 76 (7.9) | 93 (9.7) | ||
Don’t know | 38 (4.0) | 38 (4.0) | ||
Decline to answer | 31 (3.2) | 36 (3.8) | ||
Missing | 89 (9.3) | 87 (9.1) | ||
23. Last year tested STD/STI | MCN | 0.07 | ||
No | 747 (77.8) | 724 (75.4) | ||
Yes | 50 (5.2) | 66 (6.9) | ||
Don’t know | 1 (0.1) | 8 (0.8) | ||
Decline to answer | 2 (0.2) | 1 (0.1) | ||
Missing | 160 (16.7) | 161 (16.8) | ||
24. Ever tested positive STD/STI | MCN | 0.18 | ||
No | 783 (81.6) | 782 (81.5) | ||
Yes | 16 (1.7) | 10 (1.0) | ||
Don’t know | 0 (0.0) | 3 (0.3) | ||
Decline to answer | 2 (0.2) | 3 (0.3) | ||
Missing | 159 (16.6) | 162 (16.9) | ||
25. Last year tested positive STD/STI | n/a | n/a | ||
No | 789 (82.2) | 786 (81.9) | ||
Yes | 0 (0.0) | 0 (0.0) | ||
Don’t know | 8 (0.8) | 6 (0.6) | ||
Decline to answer | 1 (0.1) | 1 (0.1) | ||
Missing | 162 (16.9) | 167 (17.4) | ||
26. Believe wait older to have sex | 3.1 ± 0.9 | 3.1 ± 0.8 | BST | 0.02 |
27. Believe OK to have sex if condom | 3.2 ± 1.3 | 3.5 ± 1.2 | BST | <0.001 |
28. Believe OK to have sex w/a steady partner | 2.5 ± 0.9 | 2.7 ± 0.9 | BST | <0.001 |
29. Believe condoms should always use | 3.2 ± 0.8 | 3.3 ± 0.7 | BST | 0.02 |
30. How sure tell partner start condoms | BST | 0.02 | ||
Not sure at all | 113 (11.8) | 97 (10.1) | ||
Kind of sure | 116 (12.1) | 144 (15.0) | ||
Definitely sure | 511 (53.2) | 571 (59.5) | ||
Decline to answer | 172 (17.9) | 120 (12.5) | ||
Missing | 48 (5.0) | 28 (2.9) | ||
31. How sure tell new person condoms | BST | 0.002 | ||
Not sure at all | 92 (9.6) | 88 (9.2) | ||
Kind of sure | 76 (7.9) | 96 (10.0) | ||
Definitely sure | 598 (62.3) | 628 (65.4) | ||
Decline to answer | 143 (14.9) | 118 (12.3) | ||
Missing | 51 (5.3) | 30 (3.1) | ||
32. How sure can use condom correctly | BST | <0.001 | ||
Not sure at all | 147 (15.3) | 76 (7.9) | ||
Kind of sure | 204 (21.3) | 171 (17.8) | ||
Definitely sure | 376 (39.2) | 549 (57.2) | ||
Decline to answer | 179 (18.7) | 132 (13.8) | ||
Missing | 54 (5.6) | 32 (3.3) | ||
33. If wanted, how sure get condom | BST | <0.001 | ||
Not sure at all | 190 (19.8) | 104 (10.8) | ||
Kind of sure | 188 (19.6) | 199 (20.7) | ||
Definitely sure | 396 (41.3) | 522 (54.4) | ||
Decline to answer | 130 (13.5) | 97 (10.1) | ||
Missing | 56 (5.8) | 38 (4.0) | ||
Harm-bullying (Bonferroni α = 0.0250) | ||||
1. Past year, been bullied | MCN | <0.001 | ||
No | 533 (55.5) | 581 (60.5) | ||
Yes | 350 (36.5) | 293 (30.5) | ||
Decline to answer | 39 (4.1) | 60 (6.3) | ||
Missing | 38 (4.0) | 26 (2.7) | ||
2. Past year, been emotionally abused by intimate partner | MCN | 0.12 | ||
No | ||||
Yes | 783 (81.6) | 754 (78.5) | ||
Decline to answer | 97 (10.1) | 121 (12.6) | ||
Missing | 42 (4.4) | 56 (5.8) | ||
38 (4.0) | 29 (3.0) | |||
Harm-physical abuse (Bonferroni α = 0.0500) | ||||
1. Past year, hit, slapped, physically hurt by intimate partner | MCN | 0.39 | ||
No | ||||
Yes | 791 (82.4) | 791 (82.4) | ||
Decline to answer | 93 (9.7) | 84 (8.8) | ||
Missing | 39 (4.1) | 53 (5.5) | ||
37 (3.9) | 32 (3.3) | |||
Harm-depression (Bonferroni α = 0.0500) | ||||
1. Past year, felt sad, lost, hopeless, lonely, or depressed | MCN | 0.70 | ||
No | ||||
Yes | 475 (49.5) | 488 (50.8) | ||
Decline to answer | 333 (34.7) | 341 (35.5) | ||
Missing | 88 (9.2) | 85 (8.9) | ||
64 (6.7) | 46 (4.8) | |||
Harm-suicidal thoughts/attempt (Bonferroni α = 0.0167) | ||||
1. Ever thought about suicide | MCN | 0.60 | ||
No | 541 (56.4) | 536 (55.8) | ||
Yes | 287 (29.9) | 289 (30.1) | ||
Decline to answer | 90 (9.4) | 106 (11.0) | ||
Missing | 42 (4.4) | 29 (3.0) | ||
2. Ever attempted suicide | MCN | 0.13 | ||
No | 662 (69.0) | 664 (69.2) | ||
Yes | 187 (19.5) | 175 (18.2) | ||
Decline to answer | 68 (7.1) | 90 (9.4) | ||
missing | 43 (4.5) | 31 (3.2) | ||
3. Last year attempted suicide | MCN | 0.57 | ||
No | 737 (76.8) | 733 (76.4) | ||
Yes | 101 (10.5) | 95 (9.9) | ||
Decline to answer | 9 (0.9) | 11 (1.2) | ||
missing | 113 (11.8) | 121 (12.6) | ||
Social support (Likert 1 = Strongly Disagree-5 = Strongly Agree) (Bonferroni α = 0.0083) | ||||
1. Ask help family | 3.7 ± 1.1 | 3.8 ± 1.1 | WSR | 0.38 |
2. Share thoughts/feelings family | 3.8 ± 1.1 | 3.7 ± 1.1 | WSR | 0.48 |
3. Support from friends | 4.1 ± 0.9 | 4.1 ± 0.9 | WSR | 0.11 |
4. Talk problems with friends | 3.6 ± 1.1 | 3.7 ± 1.1 | WSR | 0.03 |
5. Factor 1 (2 items; α = 0.732): | 3.8 ± 1.0 | 3.8 ± 1.1 | WSR | 0.95 |
6. Factor 2 (2 items; α = 0.862): | 3.8 ± 0.9 | 3.9 ± 0.9 | WSR | 0.02 |
Community safety/community (Likert 1 = Strongly Disagree-5 = Strongly Agree) (Bonferroni α = 0.0125) | ||||
1. Feel safe | 3.9 ± 0.9 | 3.9 ± 0.9 | WSR | 0.55 |
2. Would miss | 3.9 ± 1.1 | 4.0 ± 1.1 | WSR | 0.07 |
3. Home | 4.4 ± 0.8 | 4.3 ± 0.8 | WSR | 0.02 |
4. Factor (3 items; α = 0.635): | 4.1 ± 0.7 | 4.1 ± 0.7 | WSR | 0.61 |
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Share and Cite
Skye, M.; McCoy, T.; Kelley, A.; Singer, M.; Rushing, S.C.; Donald, C.; Rajani, K.; Morgan, B.; Zaback, T.; Lambert, W. Effectiveness of Native STAND: A Five-Year Study of a Culturally Relevant Sexual Health Intervention. Adolescents 2021, 1, 321-334. https://doi.org/10.3390/adolescents1030024
Skye M, McCoy T, Kelley A, Singer M, Rushing SC, Donald C, Rajani K, Morgan B, Zaback T, Lambert W. Effectiveness of Native STAND: A Five-Year Study of a Culturally Relevant Sexual Health Intervention. Adolescents. 2021; 1(3):321-334. https://doi.org/10.3390/adolescents1030024
Chicago/Turabian StyleSkye, Megan, Thomas McCoy, Allyson Kelley, Michelle Singer, Stephanie Craig Rushing, Caitlin Donald, Kavita Rajani, Brittany Morgan, Tosha Zaback, and William Lambert. 2021. "Effectiveness of Native STAND: A Five-Year Study of a Culturally Relevant Sexual Health Intervention" Adolescents 1, no. 3: 321-334. https://doi.org/10.3390/adolescents1030024