Addressing health disparities in teen pregnancy, STIs, and HIV among U.S. Pacific Island populations: CDC's Adaptation Guidelines and adapting a science-based sex education curriculum to fit Hawaiian youth

Although U.S. teen pregnancy and birth rates are about 33% lower now than fifteen years ago, the birth rate for 15-19 year old females rose 3% between 2005 and 2006, from 40.5 to 41.9 per 1,000 women in this age group – the first increase since 1991. Significant racial and ethnic disparities exist in these rates, and in adolescent sexual and reproductive health overall. Nationally, Asian/Pacific Islanders (A/PI) have the lowest teen birth rate of all reported racial and ethnic groups. However, the teen birth rate among Hawaiian A/PIs is more than twice that of the U.S. A/PI rate (39/1,000 in Hawaii versus 17/1,000 in the U.S., 2005), and it is higher than Hawaii's overall teen birth rate (36/1,000). With 74% of teen births in Hawaii being to A/PI mothers, addressing the unique cultural contexts of these youth is critical to the success of prevention programming. While many comprehensive sex education curricula have been proven to promote adolescent sexual and reproductive health through the reduction of behavioral risk factors, none have been developed for and evaluated with Hawaiian youth. Disparities in adolescent sexual and reproductive health will be discussed, using concepts of cultural adaptation with evaluation as a necessary strategy to reducing disparities. Adaptation Guidelines developed by the Centers for Disease Control and ETR Associates will be presented. In the context of these Guidelines, Hawaii Youth Services Network will present process and content details of their adaptation of Making Proud Choices, including showing a local version of one of the curriculum's teaching videos. Outcome evaluation data was collected from 187 12-13 year olds (47.1% female; 52.9% male; 55% Native Hawaiian, A/PI, or Asian) from one middle school, including pre-, post-, and follow-up data on knowledge, attitude, and intention to engage in sex, and showed strong positive results. For example, the number of students who felt that being a teen parent would make it harder to reach their goals increased by 25 percentage points at 3 month follow-up over pre-test responses.