Effectiveness of Native STAND: A Five-Year Study of a Culturally Relevant Sexual Health Intervention

Abstract

Culturally relevant interventions have the potential to improve adolescent health and protective factors associated with sexual risk taking. We evaluated the impact of the Native STAND curriculum with American Indian and Alaska Native (AI/AN or Native) high school students living across the U.S. using a pre-post evaluation design. Native STAND is a comprehensive sexual health curriculum for Native high school students that focuses on sexually transmitted infections, HIV/AIDS, and teen pregnancy prevention, while also covering drug and alcohol use, suicide, and dating violence. The curriculum was implemented in 48 AI/AN communities from 2014 to 2019. A significantly higher percentage of youth reported at post-test having a serious conversation about sex with their friends (post 36% vs. pre 28%, p < 0.001), thinking about lessons learned (post 24% vs. pre 7%, p < 0.0001), and sharing lessons learned during the conversation (post 21% vs. pre 4%, p < 0.001). A lower percentage of AI/AN youth reported being bullied in the last year (post 31% vs. pre 37%, p < 0.001). Family social support was moderated by dose, with subscale scores of 3.75 at post-with <27 sessions vs. 3.96 at post-with all 27 sessions (p = 0.02). The results demonstrate the effectiveness of Native STAND when delivered in a variety of settings. Efforts are now underway to update Native STAND for medical accuracy, improve alignment with typical class periods, and promote its use and an effective EBI for AI/AN youth.

A Qualitative Review of Barriers and Facilitators Identified While Implementing the Native Students Together Against Negative Decisions Curriculum in a Multisite Dissemination and Implementation Study

“…Native STAND was successfully implemented in 48 diverse AI/AN community settings across the United States. Although implementation methods varied greatly, educators maintained strong fidelity to the curriculum itself (Skye et al, 2021).…”

“…Native STAND was successfully implemented in 48 diverse AI/AN community settings across the United States. Although implementation methods varied greatly, educators maintained strong fidelity to the curriculum itself (Skye et al, 2021). The curriculum was delivered to over 2,000 students by a diverse cadre of community health advocates—ranging from trained educators to youth prevention specialists.…”

“…The barriers and facilitators described in this article share important lessons learned for D&I research teams, as they design strategies to disseminate and grow adolescent health programs. Other publications by our team describe the positive impacts of the Native STAND curriculum on student learning and health behavior (Skye et al, 2021). Together, these qualitative and quantitative findings provide strong evidence of effectiveness for Native STAND as a sexual health program that reflects the unique needs and experiences of AI/AN youth.…”

The Healthy Native Youth Implementation Toolbox: Using Implementation Mapping to adapt an online decision support system to promote culturally-relevant sexual health education for American Indian and Alaska Native youth

“…These health disparities may be ameliorated by the implementation of effective, culturally-relevant sexual health education programs (7). A growing number of evidence-based programs (EBPs) (8) that integrate the strengths and cultural teachings of Native communities have been developed or adapted for AI/AN youth (9)(10)(11)(12)(13)(14). In 2016, our research team, in collaboration with AI/AN advisors, developed the Healthy Native Youth website (www.healthynativeyouth.org) to increase access to these culturally-relevant EBPs (15).…”