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About This Program

Updated: 04/26/2017

Multimedia Circle of Life (mCOL) is a sexual risk-reduction program designed specifically for American Indian youth ages 10-12 years. mCOL teaches skills such as goal setting, decision making, and standing up to peer pressure. Prevention topics include: how diseases are spread; the health effects of HIV, AIDS, and sexually transmitted infections; and ways youth can protect themselves from these diseases. The content also addresses teen pregnancy prevention.

Age Group Designed For:

Middle School

LGBT Inclusive:


Program Setting:



7 online lessons @ 20 min each + 7 group lessons @ 45 min each

Cost to Purchase:


Teacher Training or Certification Required:


Student to Teacher Ratio:


Program Outcomes:

Delayed sexual initiation, Reduced teen pregnancy, Precursors to sexual behavior (knowledge, self-efficacy and volition)

Evidence of Effectiveness:

Leading Practice


Office of Minority Health

Program Contact Information

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Teacher Training or Certification Requirements:

All training materials, including videos showing how to teach each class, are located in the Teacher's Circle of Life Portal, available at:


Lesson Plans


Class Handouts & Worksheets:

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Supporting Materials

Cultural Relevance

Cultural Alignment, Adaptation or Tailoring Process

mCOL is the multimedia adaptation of Circle of Life (COL), a sexual risk reduction program that was developed by ORBIS Associates, an American Indian owned and operated company. COL was not an adaptation of an intervention used in another setting. It was developed from the ground up with extensive input from American Indian community members, education experts and health professionals across the country. In 2010, the Office of Minority Health Resource Center, the Indian Health Service HIV/AIDS Program, and the Centers for American Indian and Alaska Native Health at the University of Colorado partnered to adapt COL to a multimedia format. Since COL was found to be effective in delaying sexual activity at young ages, the content was revised to be age appropriate for 10-12 year-olds.

Like COL, mCOL’s theoretical model is based on the Medicine Wheel, a Native American cultural symbol, and undergirded by behavioral theories including Social Cognitive Theory, Theory of Reasoned Action, and Theory of Planned Behavior. The Medicine Wheel is divided into four equal parts, representing the mental, physical, emotional, and spiritual aspects of well-being. Youth learn that all people have volition, the power to make their own decisions. Youth can stay healthy by using their volition to strengthen and balance their own Medicine Wheel. This strength helps them to empower themselves and honor their families and communities. mCOL teaches skills such as goal setting, decision making, and standing up to peer pressure. Prevention topics include how diseases are spread, the health effects of HIV, AIDS, and sexually transmitted infections, and ways in which youth can protect themselves from these diseases. With the multimedia adaptation, the content was expanded to include new topics such as teen pregnancy prevention and hepatitis B and C. The online program has 6 regionalized visual representations; each was created by a Native American artist and reflects each region’s unique artistic style and symbolism. So too, the mCOL logo was created by a Native American artist.

mCOL contains seven chapters. To complete each chapter, youth go through the online lesson independently (about 20 minutes). In addition, mCOL includes a series of companion in-person activities for a group or class. Activities are interactive and include discussions, instruction, demonstrations, games, and crafts. Either component of the intervention can be presented alone, but combining online lessons with in-person classes provide youth with opportunities to ask questions, discuss the online content, and reinforce curriculum concepts.



Evaluation Methods and Findings

COL was evaluated from 2006 to 2009 in a group-randomized controlled trial with 13 middle schools (youth ages ranged from 11 to 16 years at baseline) in a Northern Plains tribal community. Results showed COL was effective for delaying the onset of sexual activity among AIAN youth who received the program when they were young adolescents compared to those who received it at older ages or not at all.1

With funding from the Office of Adolescent Health, mCOL was evaluated in a cluster randomized controlled design with 15 Native Boys and Girls Clubs in the Northern Plains (TP2AH000003; Kaufman, PI).2 With the young age of participants (10-12 yr. at baseline) and relatively small sample size, the study was not designed to detect behavior change.3 However, at post-intervention and a 9-month follow-up, mCOL was found to have effects on precursors to sexual behavior, including self-efficacy and volition, which may lead to less risky sexual behavior in later years. Additionally, the program was well received by Club staff as important and easy to use, while most youth indicated they would recommend it to their friends.4

1. Kaufman, C.E., Whitesell, N.R., Keane, E.M., Desserich, J.A., Giago, C., Sam, A., and Mitchell, C.M. Effectiveness of Circle of Life, an HIV-Preventive Intervention for American Indian Middle School Youths: A Group Randomized Trial in a Northern Plains Tribe. American Journal of Public Health: June 2014, Vol. 104, No. 6, pp. e106-e112. doi: 10.2105/AJPH.2013.301822

2. Black, K.J., Morse, B.M., Tuitt, N. R., Big Crow, C., Shangreau, C., and Kaufman, C.E. Beyond content: Cultural perspectives on using the Internet to deliver a sexual health intervention to American Indian youth. (Under Review)

3. Kaufman, C.E., Black, K., Keane, E., Big Crow, C.K., Shangreau, C., Arthur-Asmah, R., Keith, C., Morse, B., Schaffer, G., Tuitt, N. Planning for a Group-Randomized Trial with American Indian Youth. Journal of Adolescent Health. Special Supplement, Vol 54, Issue 3S, March 2014. doi: 10.1016/j.jadohealth.2013.12.028

4. Kaufman, C.E., Schwinn, T.M., Black, K., Keane, E.M., Big Crow, C.K., Shangreau, C., Tuitt, N.R., Arthur-Asmah, R., Morse, B. Precursors to Sexual Behavior Change Among Young American Indian Adolescents of the Northern Plains: A Cluster Randomized Controlled Trial. (Under review.)


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