ArticlePLOS global public health2026
"Getting pregnant at a young age doesn't mean your life's going to end": A qualitative inquiry with older AI/AN youth participants of an evidence-based teen pregnancy prevention program.
Article in PLOS global public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
AI/AN youth experience inequities in sexual health outcomes, including higher rates of sexually transmitted infections (STIs) and teen pregnancies, that are compounded by barriers to healthcare access and a lack of culturally competent services. Navajo Nation youth follow the same trends of overall AI/AN youth with high rates of STIs, teen pregnancies, and behaviors that predict such outcomes, such as early sexual initiation and early substance use initiation. These alarming reproductive health inequities call for urgent and culturally tailored sexual health education for Navajo and AI/AN youth. Respecting the Circle of Life (RCL) is one of the first sexual and reproductive health programs to be developed and rigorously evaluated with AI/AN youth. Previous evaluations of RCL on the Navajo Nation found the program to be most effective with younger youth, aged 11-14. To better understand how the program can serve older youth, we investigated the experiences of youth aged 15-19 on the Navajo Nation who had previously participated in the RCL program as part of a demonstration study during and after the COVID-19 pandemic. A purposive sample of AI/AN youth participants (n = 6) was interviewed to solicit feedback and experiences from the program. Our thematic analysis revealed four key themes that reflect the experiences of older youth (ages 15 - 19) who previously participated in the RCL program: (1) interactive and group-based learning, (2) peer and facilitator dynamics, (3) balanced and culturally relevant content, and (4) shifts in knowledge and attitudes. Youth reported meaningful shifts in knowledge, confidence, and perspective regarding their sexual health. They also expressed a clear need for deeper cultural alignment and age-relevant content. As Indigenous communities continue to reclaim and revitalize their approaches to sexual and reproductive health, programs like RCL must evolve to reflect the realities, resilience, and aspirations of all youth.
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