Tingey, L., Chambers, R., Patel, H., Littlepage, S., Lee, S., Lee, A., Susan, D., Melgar, L., Slimp, A., Rosenstock, S. (2021). Prevention of sexually transmitted diseases and pregnancy prevention among Native American youths: A randomized controlled trial, 2016–2018. American Journal of Public Health, 111(10), 1874–1884.

Program Name
Respecting the Circle of Life
Show Evidence of Effectiveness
Study Rating and Explanation
HighThis study received a high study quality rating because it is a low-attrition randomized controlled trial with no known issues that would suggest the findings cannot be attributed to the program

Program Information

Program Type
Sexual health education
Program Length
Fewer than 10 sessions

Evaluation Setting

Evaluation Setting
Summer camp

Study Sample

Average Age Group
13 or younger
Majority Racial/Ethnic Group
American Indian or Alaska Native
Youth of any gender

Research Design

Assignment Method
Randomized controlled trial
Sample Size
Number of Follow-Ups
Length of Last Follow-Up
12 months after end of intervention
Year of Last Data Collection

Study Findings

Result Sexual Activity
Indeterminate evidence
Reviewed Studies
High-Quality Randomized Trial
Protocol Version
Version 6.0
The Respecting the Circle of Life program was evaluated using a randomized controlled trial involving youth ages 11–19 who self-identified as American Indian and whose primary residence was on or near the rural Arizona reservation that was in the study. Youth were recruited through various community events, flyers, and radio advertisements. Participants were randomly assigned to either a treatment group that received the nine-session Respecting the Circle of Life program or a control group that received a similarly intense nutrition, fitness, and outdoor curriculum with a similar duration. Surveys were administered immediately before the program began (baseline), nine months after the program ended (nine-month follow-up), and again 12 months after the program ended (12-month follow-up). Nine and 12 months after the program ended, the study found no statistically significant program impacts on whether the youth had ever had vaginal sex. The study also examined program impacts on 10 additional measures that fell outside the scope of the review. These included knowledge of sexual and reproductive health, self-efficacy in condom use, intention to use a condom if having sex in next six months, intention to have sex in the next 12 months, self-efficacy in contraceptive use, perceived partner negotiation skills in condom use, perceived partner negotiation skills in contraceptive use, parent-adolescent communication, talking with parents about sexual and reproductive health, and talking with parents about drugs and alcohol in the past three months.
Effect Sizes
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NA = Not available. This means the authors did not report the information in the manuscripts associated with the studies we reviewed.

a This information was not available whenever authors did not report information for the treatment and comparison groups separately on outcome means, standard deviations, and/or sample sizes.

b Authors reported that the program effect (impact) estimate is statistically significant with a p-value of less than 0.05 based on a two-tailed test.

c For some outcomes, having less of that outcome is favorable. In those cases, an effect with a negative sign is favorable to the treatment group (that is, the treatment group had a more favorable outcome than the comparison group, on average).

d An effect shows credibly estimated, statistically significant evidence whenever it has a p-value of less than 0.05 based on a two-tailed test, includes the appropriate adjustment for clustering (if applicable), and it is not based on an endogenous subgroup.