The respecting the circle of life teen pregnancy prevention intervention: Its impact among different subgroups of Native American youth

Purpose: This study reports the differential impact of an evidence-based teen pregnancy prevention program among subgroups of participating Native American youth. Methods: This randomized controlled trial included N = 534 Native Americans ages 11–19. Participants were randomly assigned 1:1 (intervention: 266; control: 268) to the Respecting the Circle of Life intervention (RCL) versus a control condition. Logistic and linear regression was used to examine intervention impact at 9- and 12- months post-intervention among the subgroups of males, females, younger (11–14 years) and older (15–19 years) youth. Results: Girls and boys in the intervention group (RCL) had improved condom self-efficacy (Adjusted mean difference (AMD) and 95% CI girls: 0.56 (0.34–0.79); boys: 0.55 (0.32–0.77); both p < 0.0001) and contraceptive use self-efficacy at 9 months (AMD (95% CI) girls: 0.40 (0.16–0.63); boys: 0.40 (0.17–0.63); girls p = 0.001, boys p = 0.0009) compared to those in the control group. Study group differences were sustained for girls at 12 months but not for boys (condom use self-efficacy AMD (95% CI) girls: 0.54 (0.34–0.75); contraceptive use self-efficacy girls: 0.47 (0.24–0.70); both p < 0.0001). Boys in the RCL group had higher 12-month sexual/reproductive health knowledge (AMD (95% CI) boys: 2.15 (0.45–3.85); p = 0.01) compared to those in the control group, but girls did not. Girls in the RCL group had increased intention to use a condom at 12 months (OR (95 %CI): 1.69 (1.00–2.86); p = 0.05) compared to those in the control group, whereas boys in the RCL group had decreased intention to have sex in the next year at 9 months (OR (95% CI): 0.39 (0.21–0.73); p = 0.003) compared to boys in the control group. RCL Participants ages 11–14 had improved sexual/reproductive health knowledge at 12 months (AMD (95% CI): 1.96 (0.79–3.13); p = 0.001) compared to control participants of the same age. They also had improved condom and contraceptive use self-efficacy at 9 months (condom use self-efficacy AMD (95% CI): 0.65 (0.46–0.83); contraceptive use self-efficacy: 0.47 (0.28–0.65); both p < 0.0001) and 12-months (AMD (95% CI): 0.43 (0.25–0.61); 0.35 (0.16–0.54); p < 0.0001 and p = 0.0004, respectively) compared to control participants of the same age. There were no statistically significant impacts among participants ages 15–19. Conclusion: This is one of the first analyses of the differential impact of an evidence-based teen pregnancy prevention program conducted among subgroups of Native youth. Results guide dissemination and future research efforts, including that RCL is particularly effective among youth who are under the age of 15 at the time of participation, and that additional tailoring will optimize this program for older adolescents.