A Culturally Tailored Approach to Addressing Risky Sexual Behavior in Urban American Indian Adolescents: Results from a Randomized Controlled Trial of the Parenting in 2 Worlds Intervention

Purpose: The rapidly growing majority of American Indians (AIs) (70%) who now live in cities are severely underserved by culturally appropriate prevention programs. Urban AI adolescents are more likely than their non-Native counterparts to have unprotected sex, multiple sex partners, and inadequate HIV and STI information, as well as higher rates of co-occurring substance use. Family connectedness is a documented protective factor for AI adolescents that promotes sexual abstinence, delay of sexual debut, and use of birth control. The culturally grounded parenting intervention, Parenting in 2 Worlds (P2W), was designed to strengthen protective family factors against risky sexual behaviors and substance use among urban AI youth. P2W addresses a constellation of social influences on urban AI families: cultural and familial disruption, high residential mobility, socioeconomic stressors, poor educational attainment, and resource strained urban social networks.  Through community-based participatory research in urban AI communities with diverse tribal backgrounds, the P2W curriculum systematically incorporated common AI teachings, cultural values and communication customs relating to parenting. This presentation reports on the efficacy of the P2W intervention in improving parent-child communication about sexuality and describes culturally grounded elements of the intervention that address ways to open communication channels with urban AI youth around risk behaviors.

Methods: Data come from 585 parents of AI children (ages 10-17) in a randomized controlled trial of P2W in three Arizona cities.  Parents were recruited through the auspices of urban Indan centers in their city, and were randomly assigned to P2W or to an informational family health curriculum, Healthy Families in 2 Worlds (HF2W) that was not culturally tailored.  Both the P2W and HF2W curricula consisted of 10 workshops delivered weekly by AI community facilitators. Participating parents received incentives for attendance and survey data collection: 98% consented to complete self-administered questionnaires. Pretests occurred at the first workshop and post-tests at the last workshop, measuring parenting skills, parent-child communication, and youth risk behaviors. We tested the efficacy of P2W versus HF2W through baseline adjusted regression models, employing random effects for city/site and facilitator and FIML missing data estimation, controlled for dosage (# workshops attended), and investigated whether intervention effects differed depending on the gender of the parent or of the adolescent.

Results: A majority of parent participants (77%) were female, either single (36%) or living with an unmarried partner (28%), and had annual incomes under $10,000 (56%). On average parents were 38 years old, had lived for 14 years on a reservation, and resided in the city for 18 years. They were affiliated with 31 different AI tribes. P2W parents reported significantly larger pretest to post-test increases than HF2W parents on measures of communication with their adolescents about sexuality, safe sex, and pubertal physical changes. These desired program effects for P2W participants achieved medium size and did not differ significantly for male and female parents, but effects were stronger for parents of adolescent sons than of daughters.

Conclusions: Culturally grounded parenting interventions like P2W effectively strengthen parenting practices among urban AI families that can reduce adolescent risky sexual behaviors.