Culture, context, and sexual risk among Northern Plains American Indian Youth

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Abstract

American Indian adolescents have two to four times the rate of sexually transmitted diseases (STDs) compared to whites nationally, they shoulder twice the proportion of AIDS compared to their national counterparts, and they have a 25% higher level of teen births. Yet little is known about the contemporary expectations, pressures, and norms that influence American Indian youth or how those might be shaped by today's lived cultural experiences, which frustrates attempts to mitigate the apparent disparity in sexual health. This paper used data from focus groups, in-depth interviews, and surveys with American Indian adolescents and young male and female adults from a Northern Plains tribe to contextualize sexual risk (and avoidance). Placing the findings within an adapted indigenist stress-coping framework, we found that youth faced intense pressures for early sex, often associated with substance use. Condoms were not associated with stigma, yet few seemed to value their importance for disease prevention. Youth encountered few economic or social recriminations for a teen birth. As such, cultural influences are important to American Indian sexual health and could be a key part of prevention strategies.

Section snippets

Conceptual framework of health for American Indian youth

Walters and Simoni (2002) propose a theoretical framework, based on the work of Dinges and Joos (1988) and Krieger (1999), specifically developed to address Native women's health. In it, they propose a stress-coping model that explicitly incorporates historical and contemporary forces of stress and cultural buffers, such as ethnic identity or spiritual practices. These forces moderate or mediate stressors and strengthen psychological and emotional health and, in turn, mitigate poor health

Data and methods

We drew primarily from a series of focus groups discussions and in-depth interviews conducted on the reservation from 1993 to 2000. These discussions were particularly useful in that they were embedded within a project collecting quantitative data. We followed a cohort of 518 youth (ages 14–19) annually over 7 years, under three linked projects: The Voices of Indian Teens (VOICES, 1993–1995), Pathways of Choices (CHOICES, 1996–1999), and Healthy Ways (HW, 1999–2000). This series of studies

Risk context and early sexual activity among Northern Plains youth

Historically, opportunities for male and female socializing were limited. Courting, for those who had reached puberty and had passed through ceremonies marking adulthood, was strictly supervised. While premarital sex was not unheard of, and was tolerated if a couple had committed to marriage, virginity until marriage was valued (Bataille & Mullen Sands, 1984). Currently, few threads of traditional courtship remained and puberty rites have virtually disappeared.

Well, you know around here it's,

Discussion

The conversations with these American Indian youth indicated both promising paths of prevention, and apparent conflicts in context and consequences of sexual activities. Virtually all participants made a link between alcohol or drugs and sexual activity; many youth noted strategies they try to use to protect themselves in risky situations that included substances. Similarly, condom use appeared to be increasingly associated with respect, both for self and for one's partner, even though condom

Conclusions

In this paper, we have used the words of youth themselves to frame the statistics from surveys. Such an approach is not without limitations. Our data represent only one tribe, and our findings are not likely to be generalizable to other tribes. However, these American Indian youth faced many challenges that often transcend tribal differences. Those participating in our discussions were not randomly selected, and so their views also were not likely to be representative of all youth within this

Acknowledgements

We would like to thank the Voices of Indian Teens, Pathways of Choices, and Healthy Ways Project Teams. We are also indebted to many participants who so generously gave their time to openly share with us their thoughts and experiences. This research was supported by the National Institute on Alcohol Abuse and Alcoholism grant R01 AA08474, National Institute on Child Health and Human Development grant R01 HD33275, a supplement to HD33275 from the National Institute of General Medical Sciences,

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