We Are Here Now - Plus (NE+) is a holistic, culturally centered, and multilevel intervention for American Indian youth to improve sexual health, mental health, and substance use outcomes. The goal of this intervention is to learn if NE+ can decrease substance use during sex, decrease sexual activity, increase condom use, increase positive mental health, increase caregiver(parent)-youth communication, increase communication between school personnel and youth, and increase utilization of clinical services. Researchers will compare one intervention arm to one control arm to see if the aforementioned indicators improve among the intervention arm for youth participants. Youth participants (ages 12-18) will participate in a 9-month educational program consisting of 18 modules that discuss healthy relationships, puberty \& physiology (separate girls \& boys), parenting, pregnancy and sexually transmitted infections (STIs) and Human Immunodeficiency Virus (HIV) prevention, sexual avoidant behaviors with a focus on abstinence, substance use prevention with a focus on abstinence and refusal skills, \& positive mental health, resources; skills (high school)- self-efficacy, refusal skills, decision making, communication, abstinence; skills (middle school) - health knowledge, self-efficacy, boundaries, communication, abstinence. Youth will also participate in six teachings offered by local cultural leaders that coincide with educational modules, including: kinship networks \& family; cultural values; 7 sacred roles of tribal members; ceremonies; cultural teachings and responsibilities of women \& men in tribe \& ceremonies; Indigenous worldview; skills - knowledge of traditional ways, language \& cultural people to go to for help; community members roles \& responsibilities in tribe \& ceremonies. Caregiver (parent) participants will participate in three in-person visits/meetings to discuss the following: visit 1 - age specific physical, cognitive, emotional, spiritual development; visit 2: prevention of substance use, promoting positive mental health, promotion of healthy relationships; skills -communication with youth; visit 3 - pregnancy and STIs/HIV prevention and abstinence from sex, parental monitoring, tribal resources. School personnel participants will participate in three workshops during teacher in-service training days, including the following information: Workshop 1 - cultural teachings on kinship \& family networks, cultural values, cultural age \& community roles; Workshop 2 - sexual risk avoidant behaviors, substance use prevention, positive mental health promotion, pregnancy STIs/HIV prevention, tribal resources; Workshop 3 - culturally respectful communication skills by age \& youth (boy/girl) and age \& caregiver (male/female); skills - knowledge of cultural ways, substance use prevention, positive mental health promotion, sexual risk avoidant behaviors, culturally respectful communication.
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Change from baseline in mean condom use frequency relative to sexual intercourse frequency in the past month
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of participants reporting if they have ever had sexual intercourse
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean age when participants first engage in sexual intercourse
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of lifetime sex partners
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of recent (past-month) sex partners
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of times participants recently (in the past month) engaged in sexual intercourse
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of times birth control was used during sexual intercourse
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean depressive symptoms score
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change in baseline in mean number of youth who have ever smoked a cigarette
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean anxiety score
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean age of youth initiating tobacco use
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of days (of past 30 days) youth reported smoking cigarettes
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of youth who reported ever using an electronic vapor product
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of times injection drugs were used in past 30 days
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of times injection drugs were used in lifetime
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of times hallucinogenic drugs were used in past 30 days
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of times ecstasy was used in past 30 days
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of times methamphetamines were used in past 30 days
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of times heroin was used in past 30 days
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of times glue, aerosol spray, or other inhalants were used in past 30 days
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of times cocaine was used in past 30 days
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of times hallucinogenic drugs (e.g., acid) were used in lifetime
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of times ecstasy was used in lifetime
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of times methamphetamines were used in lifetime
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of times heroin was used in lifetime
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of times glue, aerosol spray, or other inhalants were used in lifetime
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of times any form of cocaine has been used in lifetime
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of times prescription pain medicine without doctor's prescription was used in the past 30 days
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of times prescription pain medicine was used without a doctor's prescription in lifetime
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of times in the past 30 days youth reported using marijuana
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean age at which youth reported first using marijuana for the first time
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of times youth reported using marijuana in their life
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of drinks (in the past 30 days) that youth reported having in a row
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of days (in past 30 days) youth reported having 4 or more drinks of alcohol in a row (for males) or 5 or more drinks of alcohol in a row (for females)
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of days (in past 30 days) youth reported having at least one drink of alcohol
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in the mean age at which youth reported having alcohol for the first time
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline
Change from baseline in mean number of days (in past 30 days) youth reported using an electronic vapor product
Timeframe: From baseline to 9 months post-baseline, 14 months post-baseline, and 26 months post-baseline