Center for American Indian Health, Johns Hopkins University, Baltimore, MD 21231, USA.
Int J Environ Res Public Health. 2022 Apr 3;19(7):4283. doi: 10.3390/ijerph19074283.
Native American (NA) communities are disproportionately affected by the intersecting, synergistic epidemics of sexually transmitted infections (STIs) and substance use. Targeted approaches to addressing these syndemics are critical given the relative scarcity of mental health and behavioral specialists in NA communities. We conducted a series of moderation analyses using data from a randomized controlled trial of the EMPWR (Educate, Motivate, Protect, Wellness, Respect) intervention for reducing sexual risk behaviors, culturally adapted for NA adults with recent binge substance use living on rural reservations. We considered several potential moderators and substance use and sexual risk outcomes at 6- and 12-months post-baseline. Three hundred and one people participated in the study. Age, marital status, educational attainment, employment, and depressive symptoms were differentially associated with intervention effects. EMPWR could be strengthened with the incorporation of additional skills-building related to condom use negotiation with casual partners. For individuals with lower educational attainment or without employment, additional supports and approaches to intervention may be needed. Importantly, this study did not identify intersecting sexual risk and substance use behaviors as moderators of EMPWR effectiveness, suggesting that NA adults with varying levels of risk behavior may be equally likely to benefit from this intervention.
美国原住民（NA）社区受到性传播感染（STIs）和物质使用交叉、协同流行的不成比例影响。鉴于 NA 社区中精神健康和行为专家相对稀缺，针对这些综合征采取有针对性的方法至关重要。我们使用针对最近狂欢物质使用的农村保留地居住的 NA 成年人进行的 EMPWR（教育、激励、保护、健康、尊重）干预措施的随机对照试验的数据进行了一系列调节分析，该干预措施旨在减少性风险行为，针对这些综合征进行了文化调整。我们考虑了几种潜在的调节剂以及物质使用和性风险结果在基线后 6 个月和 12 个月的情况。有 310 人参加了这项研究。年龄、婚姻状况、教育程度、就业和抑郁症状与干预效果存在差异。可以通过纳入与偶然伴侣进行 condom 使用谈判相关的额外技能建设来加强 EMPWR。对于教育程度较低或没有就业的人，可能需要额外的支持和干预方法。重要的是，这项研究并没有将交叉性风险和物质使用行为确定为 EMPWR 有效性的调节剂，这表明具有不同风险行为水平的 NA 成年人可能同样受益于这种干预。
