Systemic inequities, including a lack of culturally appropriate sexual health education, put American Indian and Alaska Native (AI/AN) adolescents at higher-than-average risk for adverse sexual and reproductive health outcomes. For example, in 2013, the birth rate among AI/AN adolescents aged 15 to 19 years was 31.1 per 1000 individuals, compared with 18.6 for White adolescents. AI/AN youths report earlier onset of sexual activity and greater numbers of sexual partners than do youths in general. In 2011, among all races and ethnicities, AI/ANs had the second highest rates of chlamydia and gonorrhea and the third highest rates of primary and secondary syphilis. From 2011 through 2014, the US Department of Health and Human Services’ Family and Youth Services Bureau, through the Tribal Personal Responsibility Education Program (Tribal PREP), funded 14 tribes and tribal organizations to select, adapt, and implement culturally relevant, evidence-informed contraceptive and abstinence education curricula for their communities. Grantees also promoted successful transitions to adulthood by providing content on selected adulthood preparation subjects. Addressing these longstanding health inequities requires intervention and evaluation approaches that are culturally consonant with the tribal communities in which they will be used. An abundance of research emphasizes the importance of incorporating community-based participatory research approaches for culturally tailoring these interventions and evaluation methods. Drawing on this rich history, we extend the concept here by directly including the voices from front-line staff responsible for Tribal PREP program implementation as authors. Because there is little empirical research on evidence-based curricula and practices for AI/AN youths, the lessons learned by these program implementers offer firsthand experiences to further increase cultural awareness and improve future adolescent pregnancy prevention (APP) interventions for AI/AN adolescents, helping fill the gap in empirical research. (Author Introduction)
