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  • mCircle of Life

mCircle of Life (mCOL)

Logo for Circle of Life, After-School Science Plus

Description


The goal of this project was to scientifically evaluate the effectiveness of Circle of Life--a sexual risk reduction intervention designed specifically for Native youth--in reducing the probability of behavior resulting in pregnancy. The project partnered with Native Boys and Girls Clubs of the Northern Plains, located on highly rural tribal reservations areas. This project used a group-randomized design to assess the impact of a computerized, multimedia Circle of Life (mCOL) curriculum on the sexual risk behavior of 10-14 year-olds enrolled in after-school programs at the Native Boys and Girls clubs. Circle of Life is an evidence-based and theory-based innovative intervention the uses familiar symbols, stories, and ways of learning to build knowledge and skills to bring about behavior change in Native youth. In addition, the project included substantial focus on process and implementation parameters to ensure efficient adaptation and replication in similar settings. 

Partners 


 

  • Native Boys and Girls Clubs of the Northern Plains
  • Office of Minority Health
  • www.HealthyNativeYouth.org (mCOL hosting organization)
  • Indian Health Service, HIV Program
  • Kat Communications (multimedia developer)

Original Curriculum Developers (Circle of Life K-6, Circle of Life 6-7)

ORBIS Associates, with assistance and input from:

  • Bureau of Indian Education
  • Centers for Disease Control
  • FirstPic, Inc.
  • Indian Health Service
  • National Congress of American Indians

 

Specific aims


 

  1. Digitize a multimedia Circle of Life (mCOL) curriculum for computer-based learning and adapt components to accommodate shortened after-school programming and young adolescent age group.
  2. Evaluate mCOL in a group-randomized trial with youth attending Native Boys and Girls Clubs of the Northern Plains 
  3. Disseminate results and the computer-based Circle of Life, if shown to be effective.

 

Outcomes


 

Circle of Life was translated into a web-based program called multimedia Circle of Life (mCOL).  Teacher’s guidance and training materials were developed for access via internet resources (e.g., YouTube training videos).  Four of 8 mCOL units implemented 100% of online chapters and 100% of class activities. Across all mCOL units, 71% of possible activities were completed. At the individual level, only 30% of youth in the mCOL arm at baseline completed 70% of the program, mainly due to high attrition. We tested the effect of receiving mCOL on psychosocial and behavioral precursors to sex in this young adolescent population.  Compared with the control group, youth who received mCOL scored significantly higher on HIV/sexually transmitted infection (STI) knowledge questions at both 3-month and 9-month follow-ups; self-efficacy to avoid peer pressure and self-efficacy to avoid sex were significantly higher at posttest; self-perceived volition was significantly higher at 9-month follow-up; and no differences were found for behavioral precursors to sex. mCOL had modest effects on precursors to sexual behavior, which may lead to less risky sexual behavior in later years. Qualitative data from mCOL unit program staff and youth suggest the program was highly regarded.

Curriculum

mCOL and supporting materials are available for free on the HealthyNativeYouth portal.

Publications/presentations

Peer-reviewed publications

Kaufman, C.E., Litchfield, A., Schupman, E., & Mitchell, C.M., (2012). Development, Adaptation, and Technology: Evolution of Circle of Life, an HIV-prevention Intervention for Native Youth. American Indian & Alaska Native Mental Health Journal, 19(1), 140-153. doi: 10.5820/aian.1901.2012.140

Kaufman, C.E., Black, K., Keane, E.M., et al. (2014). Planning for a group-randomized trial with American Indian youth. Journal of Adolescent Health, 54(3), S59-63. doi: 10.1016/j.jadohealth.2013.12.028

Kaufman, C.E., Whitesell, N.R., Keane, E.M., Desserich, J.A., Giago, C., Sam, A., & Mitchell, C.M.  (2014). Effectiveness of Circle of Life, an HIV-preventive intervention for American Indian middle-school youth: A group-randomized trial in a Northern Plains Tribe.  American Journal of Public Health, 104(6), e106-e112. doi: 10.2105/AJPH.2013.301822

Kaufman, C.E., Schwinn, T.M., Black, K., Big Crow, C.K, & Keane, E.M., (2016). The promise of technology to advance rigorous evaluation of teen pregnancy prevention programs in American Indian and Alaskan Native tribal communities (peer-reviewed editorial). American Journal of Public Health, 106(S1), S18-S20. doi: 10.2105/AJPH.2016.303335

Kaufman, C.E., Schwinn, T.M., Black, K., et al. (2018). Impacting precursors to sexual behavior among young American Indian adolescents of the Northern Plains: A cluster randomized controlled trial. Journal of Early Adolescence, 38(7), 988-1007. doi: 10.1177/0272431617708055

Asdigian, N.L., Whitesell, N.R., Keane, E.M., Mousseau, A.C., & Kaufman, C.E. (2018).  Effects of the ‘Circle of Life’ HIV-prevention program on marijuana use among American Indian middle school youths: A group randomized trial in a Northern Plains Tribe. American Journal of Drug and Alcohol Abuse, 44(1), 120-128. doi: 10.1080/00952990.2016.1265122

Black, K., Kaufman, C.E., Morse, B., et al. (2018). Beyond content: Cultural perspectives on using the Internet to deliver a sexual health intervention to American Indian youth. Journal of Primary Prevention, 39(1), 59-70.

Craig Rushing, S., Stephens, D., Shegog, R., et al. (2018). Healthy Native Youth: Improving access to effective, culturally-relevant sexual health curricula. Frontiers in Public Health, 6(August), 225.

Technical report 

Schwinn, T., Kaufman, C.E., Black, K., Keane, E.M., Tuitt, N.R., Big Crow, C., Shangreau, C., Schaffer, G., & Schinke, S. (2015). Evaluation of mCircle of Life in Tribes of the Northern Plains: Findings from an Innovative Teen Pregnancy Prevention Program. Final behavioral impact report submitted to the Office of Adolescent Health.

Kaufman, C.E., Whitesell, N.R., Mitchell, C.M., et al., “Sexual risk interventions among Native youth: Collecting the evidence, translating the evidence.”  Native Children’s Research Exchange.  Denver, CO.  August 25-26, 2010. 

Kaufman, C.E., Black, K., Keane, E., Big Crow, C.K., Shangreau, C. “Intervening in American Indian early adolescent sexual risk:  Lessons learned from a group randomized trial,” Office of Adolescent Health, Third Annual Teen Pregnancy Prevention Grantee Conference: Ready, Set, Sustain: Continuing Our Success.  National Harbor, MD, May 21, 2013. 

Kaufman, C.E., Big Crow, C.K., Shangreau, C.  “Circle of Life:  A Promising Multimedia Curriculum to Help Native Youth Make Healthy Decisions.” Lakota Nations Education Conference, Rapid City, SD, December 18-19, 2014. 

Kaufman, C.E., Schwinn, T., Black, K., Big Crow, C.K., and Tuitt, N.  “Precursors to Sexual Behavior Change among Young American Indian Adolescents of the Northern Plains: Rationale and Preliminary Results of a Group Randomized Trial.”  Native Children’s Research Exchange.  Denver, CO.  September 11, 2015.

Black, K., Big Crow, C., Shangreau, C., Keane, E.M., Tuitt, N.R., and Kaufman, C.E. “A Promising Multimedia Curriculum to Help Native Youth Make Healthy Decisions.” Native Children’s Research Exchange.  Denver, CO.  September 11, 2015.

Gelman, K., Tuitt, N., Whitesell, N.R., Mousseau, A., Kaufman C.E.  “Measuring the role of culture in American Indian and Alaska Native adolescent health outcomes.” American Public Health Association meeting (Poster Session), Denver CO, November 1, 2016.

Tuitt, N., Asdigian, N., Whitesell, N.R., Kaufman C.E. (2016). “Frequent Residential Mobility and Precursors to Sexual Experience Among American Indian Youth in Early Adolescence.” Presented at the American Public Health Association meeting (Poster Session), Denver CO, November 1, 2016.

Gelman, K., Whitesell, N.R., Kaufman C.E, Brooks-Russell, Mousseau, A, Asdigian, N, Baron, A. “The Role of Ethnic Identity in the Development of Marijuana Use among Young Adolescents on a Northern Plains Reservation: Measurement, Findings, and Limitations.” Native Children’s Research Exchange.  Denver, CO. September 29, 2017.

Tuitt, N.,  Whitesell, N.R., Al-Tayyiv, A., Mousseau, A., Kaufman C.E. (2018). Intrapersonal Precursors to Sexual Risk-Taking in Early Adolescence and the Relevance to American Indian and Alaska Native Teens: A Review of the Literature. Poster presented at the Society of Prevention Research annual meetings. Washington DC, June 1-3.

Tuitt, N.R., Kaufman, C.E., Asdigian, N.A, Mousseau, A., Al-Tayyib, A., Whitesell, N.R. (2019, June). The Impact of Trauma on Alcohol Use and Precursors to Sexual Risk among American Indian Adolescents. Poster presented at the Research Society on Alcoholism Annual Meeting, Minneapolis, MN.

Kaufman, CE. “multimediaCircle of Life (mCOL): Program overview and key outcomes,” Healthy Native Youth Community of Learning, Northwest Portland Area Indian Health Board. February 13, 2019.

Funding Information

Sponsor: Office of Adolescent Health

Grant No.: TP2AH000003

Years Funded: 2010-2015

Principal Investigator: Carol Kaufman, PhD, CAIANH, University of Colorado

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