Prevention of Sexually Transmitted Diseases and Pregnancy Prevention Among Native American Youths: A Randomized Controlled Trial, 2016-2018.

To evaluate the efficacy of the Respecting the Circle of Life program (RCL) among Native American youths 11 to 19 years of age residing in a rural reservation community in the southwestern United States. Between 2016 and 2018, we conducted a randomized controlled trial of the RCL program with 534 Native youths. Participants completed assessments at baseline and 9 and 12 months after the intervention. We conducted intention-to-treat analyses based on study group randomization. At 9 months, intervention participants had significantly better condom use self-efficacy (< .001), higher intentions to use condoms ( = .024) and abstain from sex ( = .008), and better contraceptive use self-efficacy ( < .001) than control participants, as well as better condom use ( = .032) and contraceptive use ( = .002) negotiation skills. At 12 months, intervention participants had significantly better sexual and reproductive health knowledge ( = .021), condom use self-efficacy ( < .001), contraceptive use self-efficacy ( < .001), and contraceptive use negotiation skills ( = .004) than control participants. Intervention participants reported significantly more communication with their parents about sexual and reproductive health than control participants at both 9 and 12 months ( = .042 and  = .001, respectively). The RCL program has a significant impact on key factors associated with pregnancy prevention among Native youths and should be used as an adolescent pregnancy prevention strategy.  Clinical Trials.gov identifier: NCT02904629. (. 2021;111(10): 1874-1884. https://doi.org/10.2105/AJPH.2021.306447).