An examination of bystander opportunity and behavior among adolescents on an Indian reservation.

OBJECTIVE: The present study documented the extent to which Native American youth reported opportunities to intervene in situations of sexual assault and harassment, the types of behaviors that youth engaged in when given the opportunity to intervene, and whether youth were engaging in proactive behaviors to change social norms to be intolerant of these forms of aggression. METHOD: Data come from a survey of 144 Native American middle and high school youth living on an Indian reservation. RESULTS: Analyses revealed that in the past 6 months, 59.1% of participants had opportunity to intervene in a sexual assault and harassment. Opportunity to intervene in sexual assault or harassment was associated with lower feelings of mattering and being older. Among participants who reported bystander opportunity to intervene in sexual assault or harassment, 26.3% reported engaging in positive bystander behavior (e.g., trying to get help or using distraction to help). A closer connection to culture was related to a higher likelihood of engaging in positive bystander action. Roughly half of the participants reported engaging in proactive bystander behavior (e.g., efforts to promote intolerance of these forms of aggression) even in the absence of opportunity. Older youth were more likely to engage in proactive bystander behavior than younger youth. CONCLUSIONS: Bystander-focused programs may be an effective tool to prevent sexual harassment and sexual assault among Native American youth, especially those that include culturally relevant content that helps to strength connections to culture and equipping younger youth with skills to engage in proactive bystander behavior. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

"I learned that I am worth defending": A process evaluation of a sexual assault prevention program implemented on an Indian reservation.

A great deal of programming has been developed to prevent sexual assault (SA) among adolescents. Few studies examine programming implementation among minority groups and present information about program acceptability among participants and community stakeholders. The purpose of the current study was to examine the acceptability of implementing an empowerment SA self-defense program for adolescent girls on an Indian reservation. Data for the study came from posttest surveys of Native American adolescent girls who participated in an SA prevention program (N = 102) and interviews with community stakeholders, including program participants (N = 18). Results showed that acceptability was high among program participants and community stakeholders. Program participants noted that they liked the program overall and liked components of the programming. Participants noted that they disliked pressure to participate, program length, and missing class. Among community stakeholders, all expressed an overall positive impression of the program, felt that the program had a positive impact on program participants, and appreciated that girls learned to use refusal skills. Community stakeholders provided several programming improvement ideas such as incorporating culturally specific content into the program for future implementation. These findings can be used by other researchers, schools, and practitioners implementing prevention programs with Native American girls.

Efficacy of a Sexual Abuse Prevention Program with Children on an Indian Reservation.

American Indian youth experience high rates of child sexual abuse (CSA). To date, however, we are aware of no programs that have assessed outcomes associated with an evidence-based CSA prevention program among American Indian children. The purpose of the proposed study was to assess the preliminary acceptability and efficacy of IMpower, a 12-hour curriculum that teaches children how to identify their anatomy, recognize risk, say "no," and tell others if they are being hurt. Using a non-randomized, single-arm pilot trial methodology (N = 48 4th and 5th graders), we found that some domains of children's knowledge of CSA as well as their efficacy to resist an attack increased from pre- to posttest. Moreover, 83% of children reported that they liked IMpower, and 96% of children reported that IMpower helped keep them safe. These data provide preliminary evidence that IMpower is an acceptable and effective CSA prevention initiative that requires further evaluation with American Indian children.

Reality Versus Grant Application Research "Plans".

This article describes the implementation of the American Indian mHealth Smoking Dependence Study focusing on the differences between what was written in the grant application compared to what happened in reality. The study was designed to evaluate a multicomponent intervention involving 256 participants randomly assigned to one of 15 groups. Participants received either a minimal or an intense level of four intervention components: (1) nicotine replacement therapy, (2) precessation counseling, (3) cessation counseling, and (4) mHealth text messaging. The project team met via biweekly webinars as well as one to two in-person meetings per year throughout the study. The project team openly shared progress and challenges and collaborated to find proactive solutions to address challenges as compared to what was planned in the original grant application. The project team used multiple strategies to overcome unanticipated intervention issues: (1) cell phone challenges, (2) making difficult staffing decisions, (3) survey lessons, (4) nicotine replacement therapy, (5) mHealth text messages, (6) motivational interviewing counseling sessions, and (7) use of e-cigarettes. Smoking cessation studies should be designed based on the grant plans. However, on the ground reality issues needed to be addressed to assure the scientific rigor and innovativeness of this study.

Dating Violence, Sexual Assault, and Sexual Harassment Victimization Among Girls on an Indian Reservation: An Examination of Rates and Risk and Protective Factors.

We documented the scope and correlates of past 6-month victimization among middle and high school girls on an Indian Reservation. Participants were 102 Native American girls in Grades 6-12. Rates of all forms of past 6-month victimization were higher for high school girls compared with middle school girls. In regression analyses, binge drinking related to higher rates of sexual assault and sexual harassment. Furthermore, connection to culture related to lower rates of sexual harassment, and efficacy to resist a sexual assault was related to lower rates of sexual assault and sexual harassment.

Reactions to Participating in Sexual and Dating Violence Research Among Native American Youth.

The purpose of the current study was to explore the reactions of Native American adolescents to participating in survey research on sexual and dating violence. Participants were 149 Native American adolescents who completed a survey in school. Survey items included sexual assault, dating violence, sexual harassment, and demographic questions. At the end of the survey, participants were asked if they were upset by the survey. Results showed that almost a quarter of youth were upset by the survey (24.2%), victims were more likely than non-victims to be upset by the survey, perpetrators were more likely than non-perpetrators to be upset by the survey, and sexual minorities were more likely than non-sexual minorities to be upset by the survey. Sex and age did not emerge as significantly associated with being upset. Participants were asked to describe why they were upset, and a content analysis revealed four categories of responses (i.e., feeling awkward or weird, topic of the survey, reminders, and "other"). Overall, although the research was well tolerated by most of the participants, researchers should consider adding information about what might increase feelings of upset in parental consent and youth assent forms, such as being reminded of a past upsetting experience and/or feeling awkward or weird because of some of the questions.

Effectiveness of a Sexual Assault Self-defense Program for American Indian Girls.

This study evaluated the effectiveness of a 6-session (12-hour) empowerment self-defense classroom delivered curriculum (i.e., IMpower) among American Indian girls. Girls (N = 74) in one middle school and two high schools on an Indian Reservation in the Great Plains region of the United States received the intervention and completed a pre-test and a post-test six months following the final program session. The surveys administered assessed hypothesized intermediary (i.e., efficacy to resist a sexual assault, self-defense knowledge), primary (i.e., sexual violence victimization), and secondary (i.e., physical dating violence, sexual harassment) outcomes. Native American girls (N = 181) in five middle schools and three high schools in a nearby city where there was no sexual assault prevention occurring completed surveys assessing sexual violence, physical dating violence, and sexual harassment victimization approximately six months apart, thus serving as a comparison to girls in the treatment condition on primary and secondary outcomes. Girls exposed to the IMpower program reported significant increases over time in efficacy to resist a sexual assault and knowledge of effective resistance strategies. Furthermore, propensity score analyses suggested that girls who received the IMpower program reported significantly fewer types of sexual assault and sexual harassment at follow-up compared to girls in the control condition. However, no effect was found for physical dating violence. These data suggest that empowerment self-defense is a promising approach in preventing sexual assault and sexual harassment among American Indian girls.

Not a One-Size-Fits-All Approach: Building Tribal Infrastructure for Research Through CRCAIH.

The Collaborative Research Center for American Indian Health (CRCAIH) was created to foster tribal partnerships in the Minnesota, North Dakota, and South Dakota regions to increase capacity for tribal research. Since 2013, through community engagement and technical assistance from CRCAIH's cores and divisions, seven tribal partners have expanded research infrastructure and recognize the benefits of an established tribal research office. This manuscript showcases the unique approaches individual CRCAIH tribal partners have taken to build tribal research infrastructure. The unique experiences of the CRCAIH tribal partnership holds valuable lessons for other tribes interested in increasing research capacity through research review, regulation, and data management.

A randomized trial to reduce smoking among American Indians in South Dakota: The walking forward study.

BACKGROUND: Lung cancer is an important public health issue, particularly among American Indians (AIs). The reported decline in tobacco use for most racial/ethnic groups is not observed among AIs. This project was designed to address the research question, "Why don't more Northern Plains American Indians alter tobacco use behaviors known to increase the risk of cancer?" METHODS: Guided by the Theory of Planned Behavior, a multi-component intervention study was implemented. Adult AIs, age 18 years or older and currently smoking, were enrolled. Eligible subjects were randomized to one of 15 groups and exposed to either a MINIMAL or an INTENSE level of 4 intervention components. The intervention was delivered face-to-face or via telephone by Patient Navigators (PN). The primary outcome was self-reported abstinence from smoking verified by carbon monoxide measurement. RESULTS: At 18 months post-quit date, 88% of those who were still in the study were abstinent. This included 6% of all participants who enrolled in the study (14/254) and 13% of those who made it to the quit date (14/108). No intervention groups were found to have significant proportions of participants who were abstinent from smoking at the quit date (visit 5) or primary outcome visit (18 months post-quit date, visit 11), but use of pharmacologic support for abstinence was found to be an effective strategy for individuals who continued participation throughout the study. Those who remained in the study received more visits and were more likely to be abstinent. CONCLUSIONS: Use of NRT increased the odds of not smoking, as assessed at the 18-month follow-up visit, but no other interventions were found to significantly contribute to abstinence from smoking. Although the intervention protocol included numerous points of contact between CRRs and participants (11 visits) loss to follow-up was extensive with only 16/254 remaining enrolled. Additional research is needed to improve understanding of factors that influence enrollment and retention in smoking cessation interventions for AI and other populations.