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This article describes the objectives, theoretical bases, development process, and evaluation efforts to-date for the Circle of Life (COL) curricula, HIV/AIDS prevention interventions designed for American Indian and Alaska Native (AI/AN) youth. The curricula are based on Indigenous models of learning and behavior encompassing concepts of Western theories of health behavior change. The curricula underwent extensive national and community review. Subsequent advances include the development of a computer-based version of the intervention. (Contains 1 footnote, 1 table, and 1 figure.)

We assessed the effectiveness of a culturally grounded, multimedia, sexual risk reduction intervention called Circle of Life (mCOL), designed to increase knowledge and self-efficacy among preteen American Indians and Alaska Natives. Partnering with Native Boys and Girls Clubs in 15 communities across six Northern Plains reservations, we conducted a cluster randomized controlled trial among 10- to 12-year-olds (n = 167; mean age = 11.2). Club units were randomly assigned to mCOL (n = 8) or the attention-control program, After-School Science Plus (AS+; n = 7). Compared with the AS+ group, mCOL youth scored significantly higher on HIV/sexually transmitted infection (STI) knowledge questions at both follow-ups; self-efficacy to avoid peer pressure and self-efficacy to avoid sex were significantly higher at posttest; self-perceived volition was significantly higher at 9-month follow-up; and no differences were found for behavioral precursors to sex. mCOL had modest effects on precursors to sexual behavior, which may lead to less risky sexual behavior in later years.

Evidence-based interventions hold promise for reducing gaps in health equity across diverse populations, but evidence about effectiveness within these populations lags behind the mainstream, often leaving opportunities to fulfill this promise unrealized. Mismatch between standard intervention outcomes research methods and the cultural and community contexts of populations at greatest risk presents additional challenges in designing and implementing rigorous studies; these challenges too often impede efforts to generate needed evidence. We draw on experiences with American Indian and Alaska Native communities to illustrate how consideration of culture and context can constructively shape intervention research and improve the quality of evidence produced. Case examples from a partnership with one American Indian community highlight opportunities for increasing alignment in intervention development, research design, and study implementation to maximize both validity and feasibility. We suggest that responsively tailoring intervention outcomes research to cultural and community contexts is fundamental to supporting health equity.

ObjectiveDepression is a major debilitating disease. For American Indians living in tribal reservations, who endure disproportionately high levels of stress and poverty often associated with depression, determining the patterns and correlates is key to appropriate clinical assessment and intervention development. Yet little attention has been given to the cultural context of correlates for depression, including the influence of family, cultural traditions or practices, or community conditions.MethodWe used data from a large representative psychiatric epidemiological study among American Indians in 2 reservation communities to estimate nested individual and multilevel models of past-year major depressive episode (MDE) accounting for family, cultural, and community conditions.ResultsWe found that models including culturally informed individual-level measures significantly improved the model fit over demographics alone. We found significant community-level variation in the probability of past-year MDE diagnosis in 1 tribe even after accounting for individual-level characteristics.ConclusionsAccounting for culture, family, and community context will facilitate research, clinician assessment, and treatment of depression in diverse settings.

Alcohol use is cited as a risk factor for exposure to HIV infection through risky sexual behavior, especially among adolescents. From Social Cognitive Theory, positive outcome expectancies about the use of alcohol have often been presented as a critical aspect of alcohol use. Yet little is known about how they might be related to different aspects of HIV risk. Using latent growth curve modeling with data from 292 American Indian youth across seven years, both alcohol use and positive expectancies increased significantly; a lower-risk group showed significantly slower increases in both. Changes in alcohol use and outcome expectancies were significantly interrelated, providing support for reciprocal influence between the two constructs. Positive alcohol outcome expectancies may provide a preventive intervention point worthy of further consideration as influencing alcohol use and lowering HIV sexual risk among adolescents.

Contracting a sexually transmitted disease (STD) is one of the most serious public health issues for adolescents and young adults; rates of STDs among American Indian youth are among the highest of any racial or ethnic group in the United States. Although it is one of the key risk factors for spreading STDs, little is known about individual development of multiple sexual partners in any ethnic group. Drawing from social cognitive theory, this study used latent growth curve modeling with a sample of 518 American Indian adolescents and young adults to delineate the relationship across 4 years between youths' confidence in resisting risk and the number of sexual partners they had. The development of resistive efficacy was similar across genders: Although women reported higher levels at all time points, both genders increased across time. Men reported relatively stable levels of sexual partners; women had fewer sexual partners initially, but the number increased significantly and then decelerated. Further, the 2 trajectories had significant interdependence: Both intercepts and slopes were negatively related to each other across construct, suggesting that increasing resistive efficacy was related to decreasing number of sexual partners. (Contains 4 tables and 2 figures.)