Nen ?nkUmbi/EdaHiYedo Plus (NE+): a multi-level intervention to reduce health disparities among American Indian youth

We Are Here Now – Plus (WAHN+) aims to improve health among American Indian (AI) youth, which are compounded by sexual risk behaviors, substance use and mental health challenges (syndemic health factors). WAHN+ will be implemented using a multilevel intervention. Our study will test the efficacy of WAHN+ using a randomized staircase design, comparing outcomes between AI youth who receive the intervention and those who do not. WAHN+ braids our proven community engagement practices, mixed methods approaches, and local methods grounded in how the participating AI communities make decisions and speak about their community. WAHN+ will aim to prevent syndemic health factors and unintended pregnancy (UIP), STIs and HIV by: 1) expanding the age of participating AI youth from 14-18 years to include 12-13-year-olds and their caregivers; 2) train school personnel in community-specific communication skills around syndemic health factors and UIP/STIs/HIV as an added school level to our first trial’s four levels (individual, family, community, health care system); 3) enhance intervention content for youth, caregivers, and school personnel about syndemic health factors and UIP/STIs/HIV; and 4) integrate content specific to age as well as biological sex (boys and girls). WAHN+ will demonstrate how to intervene at multiple levels with practices tailored to age and adolescent boys and girls, that are community congruent and strength-based to prevent syndemic health factors and UIP/STIs/HIV among 12-to-18-year-old AI youth. Our primary outcomes include decreases in sexual risk behaviors, substance use, and mental health issues, while secondary outcomes focus on improved communication with caregivers and school personnel, increased knowledge and skills in self-efficacy for prevention of pregnancy, STIs, and HIV, and increased knowledge and use of community-centered values, beliefs, and practices. Tertiary outcomes will measure improvements in healthcare access, including pregnancy testing, contraception counseling, and STI and HIV testing/treatment. WAHN+ also includes an evaluation of fidelity and acceptability, using Western and community-centered evaluation methods to assess the local alignment and community acceptance of the intervention. Additionally, the research will develop a strategy for scalability and sustainability, working with AI communities to tailor and adapt WAHN+ for wider implementation. The long-term goal is to create a sustainable, evidence-based intervention that can be disseminated across tribal communities to improve health and promote overall well-being among AI youth.