Native STAND


Updated: 09/20/2022

Native STAND is a comprehensive sexual health curriculum for Native high school students that focuses on sexually transmitted infections, HIV/AIDS, and teen pregnancy prevention, while also covering drug and alcohol use, suicide, and dating violence. Twenty-seven sessions support healthy decision-making through interactive discussions and activities that promote diversity, self-esteem, goals and values, team building, negotiation and refusal skills, and effective communication. The 1.5 hour lessons contain stories from tribal communities that ground learning in cultural teachings.

  • Age Group Designed For:

    High School
  • LGBT Inclusive:

  • Trauma Informed:

  • Program Setting:

  • Health Topics Covered:

    Healthy Relationships, Other Healthy Life-Skills, Sexual Health
  • Duration:

    27 sessions (90 minutes each)
  • Cost to purchase:

    Free (plus cost of materials for class activities, roughly $500)
  • Teacher Training or Certification Required:

  • Student to Teacher Ratio:

  • Program Outcomes:

    Delayed sexual initiation
  • Endorsements:


Program Contact Information


Downloadable Training Materials:

Teacher Training or Certification Requirements:

Formal training is not required to implement the Native STAND curriculum. If you would like to request training on Native STAND, you can do so through our TA Request Form.

Cultural Relevance



Native STAND is an inter-tribal curriculum for high school-aged teens (14-18 years old) that draws on cultural teachings and values from across Indian Country and Alaska. We hope that learning other Native cultures, traditions, and perspectives will serve to strengthen a sense of pride, not only for one’s own tribe, but for all Native American tribes. The curriculum is flexible and can be easily adapted to include specific stories and traditions from your own community. The Native STAND curriculum was adapted by the Indian Health Service, the National Coalition of STD Directors, and the Centers for Disease Control and Prevention from an evidence-based intervention: Students Together Against Negative Decisions (STAND). The original STAND was developed for rural youth to promote healthy decision making around sexually transmitted infections, HIV/AIDS, and teen pregnancy prevention, by Dr. Mike Smith at the Mercer University School of Medicine in Macon, Georgia. The adaptation process for Native STAND included:

  • convening a multi-disciplinary workgroup with AI/AN representation
  • convening a workgroup to review an initial draft of the curriculum
  • conducting pilot classes using adapted lessons with AI/AN youth groups
  • convening a second workgroup to review the revised curriculum
  • sending the curriculum to outside expert reviewers
  • identifying pilot sites
  • supporting pilot sites to implement the curriculum
  • evaluating program outcomes and impacts at pilot sites
  • finalizing the curriculum
  • disseminating and marketing the curriculum



Native STAND is based on the Transtheoretical Model (Stages of Change). Evaluation data show that participation in Native STAND can lead to increased communication about sexual health topics, improvements in knowledge and self-efficacy, and substantial adoption of risk-reducing behaviors among teens who complete the program. Evaluation results demonstrate the effectiveness of Native STAND when delivered in a wide variety of settings.

Recent Evaluations

From 2015-2019, the Prevention Research Center at Oregon Health & Sciences University and the Northwest Portland Area Indian Health Board teamed up to evaluate the implementation and dissemination of Native STAND across the U.S. Over three years, 48 sites signed up to participate in the study.

At the end of the project, site facilitators reported strong community support for the Native STAND program:

  • 43% of participating sites “Strongly Agreed” their organization was committed to implementing Native STAND
  • 65% of participating sites implemented the curricula within 1 year of training
  • 23% of participating sites implemented the program within 2 or 3 years

During the study, over 925 AI/AN youth completed pre- and post-surveys:

  • Youth reported improved confidence using a condom correctly after completing the Native STAND program.
  • We observed encouraging shifts in attitudes and knowledge towards condom use. This was especially true for girls who reported higher levels of confidence being able to negotiate condom use with steady partners and new partners.
  • There was a positive shift in the number of youth who reported getting tested for STIs; an indicator of youth taking responsibility for their health and the health of their partners.
  • Additionally, more youth reported having a conversation about sex with their friends after completing Native STAND, compared to before.

This was the first sufficiently powered study to evaluate the impact of Native STAND. The results demonstrate it had an immediate post-intervention effect on important psycho-social predictors of sexual health outcomes for AI/AN youth, including peer and family communication skills and condom use intention and self-efficacy. The Native STAND curriculum helps fill a critical gap in evidence-based sexual health programs that reflects the unique needs and experiences of AI/AN youth.

Native STAND Findings: Healthy Native Youth YouTube Channel

Early Evaluations

In 2010, a mixed-methods study was conducted to evaluate Native STAND in four Bureau of Indian Education (BIE) boarding schools. Eighty students were selected by fellow students to be trained as peer educators using the curriculum. Native STAND was delivered in 1½ hour classes by two or three adult staff at each school, each of whom had been trained to facilitate the curriculum. A comprehensive pre- and post- computer assisted self-interview (CASI) survey was administered to participating students to assess changes in knowledge, attitudes, intentions, behaviors, and skills over time. At the end of the program, a series of focus groups and key informant interviews were also carried out with separate groups of students, facilitators, and school staff not directly involved in the program to identify programmatic strengths and weaknesses and to inform final program revisions.

Using similar methods, OHSU’s Prevention Research Center, a Northwest Tribe, and the Northwest Portland Area Indian Health Board collaborated to evaluate Native STAND in a tribal Jr High/High School between 2010-2012. In each study:

  • Teens demonstrated significant and consistent improvements in knowledge of STD/HIV prevention, reproductive health, and healthy relationships.
  • Teens reported sharing information they learned in the class with other teens.
  • Adults who facilitated the curriculum learned strategies to better communicate with teens and teach sensitive health topics.
  • School staff and administrators felt Native STAND was addressing critical gaps in sexual health education that were present in their schools.

Evaluation Tools:

Curriculum Endorsements

Native STAND

Marsha Lovato, Santo Domingo Tribe Kewa Wellness Center

At first I didn’t know what I was to be doing because the Native STAND curriculum was given to me and I didn’t have any idea what I was getting myself into with the program.  As I worked and communicated with other educators, it was great that others were willing to share what and how they have been implementing Native STAND in their communities. Since our tribal program had strong collaborations with the local and neighboring schools, we decided to implement Native STAND at these three sites.  Working with students at all three school was a great experience! I, too, had learned from the students as they taught me new teen vocabulary about sex which changed a lot since my days in school! We had the chance to build a great relationship, the trust they had in us as educators was strong, and all the students started to open up more.  They talked about anything they wanted to talk about -- Native STAND class was an open and safe place for them to learn about sensitive topics -- not one student at any of the schools were left but used their voice.  The Native STAND curriculum has given me the opportunity to be more confident in what I do at work, while also opening me up on how to communicate and work with students.  It also taught me how to gain trust. Implementing Native STAND was extremely awesome! I’m really happy that I was the one to implement this curriculum.  We will keep continuing to implement Native STAND!