Ellen Benoit

Organizing “Mountains of Words” for Data Analysis, both Qualitative and Quantitative

Qualitative research creates mountains of words. U.S. federal funding supports mostly structured qualitative research, which is designed to test hypotheses using semiquantitative coding and analysis. This article reports on strategies for planning, organizing, collecting, managing, storing, retrieving, analyzing, and writing about qualitative data so as to most efficiently manage the mountains of words collected in large-scale ethnographic projects. Multiple benefits accrue from this approach. Field expenditures are linked to units of work so productivity is measured, many staff in various locations have access to use and analyze the data, quantitative data can be derived from data that is primarily qualitative, and improved efficiencies of resources are developed.

Reaching and engaging non-gay identified, non-disclosing Black men who have sex with both men and women

Non-gay identified (NGI) Black men who have sex with both men and women (MSMW) and who use substances are at risk of acquiring and transmitting HIV to their partners. Homophobic community norms can discourage such men from disclosing their risk behaviour to female partners and others, including service providers. It is important to understand the dynamics of risk in this vulnerable population, but research is challenged by the mens need for secrecy. In this paper we report on successful efforts to recruit 33 non-disclosing, NGI Black MSMW for in-depth interviews concerning substance use, HIV risk and attitudes toward disclosing their risk behaviour. We employed targeted and referral sampling, with initial contacts and/or key informants drawn from several types of settings in New York City, including known gay venues, community organisations, neighbourhood networks and the Internet. Key informant gatekeepers and the ability to establish rapport proved central to success. Perceived stigma is a source of social isolation, but men are willing to discuss their risk behaviour when they trust interviewers to protect their privacy and engage with them in a non-judgemental manner. Findings imply that the most effective prevention approaches for this population may be those that target risk behaviours without focusing on disclosure of sexual identities.

Normalization of Violence: Experiences of Childhood Abuse by Inner-City Crack Users

An increasing literature mostly based on retrospective surveys has been consistently documenting a correlation between physical abuse in childhood (CPA) and substance abuse in adulthood (ASA). This article uses ethnographic data to reveal the processes behind and context of this linkage for one population—poor, inner-city New York residents who became crack users. Life in the inner city is qualitatively different than in more fortunate circumstances. CPA is but one of numerous stressors and factors contributing to ASA. Approximately half of the subjects reported clear recollections of being physically beaten by their mothers or their various male partners. Although several denied being beaten in childhood, they typically reported various forms of physical assaults that they “deserved.” Physical assaults, especially by mothers, were often understood as expressions of love. As such, these respondents viewed their ongoing physical assaults as an ordinary part of their childhood and adolescence. Such physical punishment also socialized and prepared children for the violence that would likely occur during their childhood in their inner-city communities. This analysis highlights how reducing substance abuse in the inner city may require a much more comprehensive effort than a focus on reducing CPA. These findings also have important implications for quantitative research regarding CPA and ASA. Such studies should subdivide their analyses by socioeconomic status to more clearly measure how much of a risk factor CPA represents among wealthier populations and how much not being abused may serve as a protective factor among poor inner-city populations.

Perspectives on substance use and disclosure among behaviorally bisexual black men with female primary partners.

Black men who have sex with men and women (MSMW) are believed to be a bridge to HIV infection among heterosexual Black women, and substance use can increase the risk of infection among men. However, empirical evidence on the social context of MSMWs sexual behavior and substance use is needed. This study examines the perspectives of Black MSMW with female primary partners on the role of substance use in their sexual encounters with men and their reasons for disclosing or not disclosing this behavior to their female partners. Findings can inform culturally relevant HIV prevention interventions for this population.

Childhood sexual experiences among substance-using non-gay identified Black men who have sex with men and women

This study explored potential variations in childhood sexual abuse (CSA) by examining qualitative accounts of first sexual experiences among non-disclosing, non-gay identified Black men who have sex with men and women (MSMW). We analyzed data from semi-structured qualitative interviews with 33 MSMW who described first sexual experiences with male and female partners. Thematic analysis revealed four patterns of first sexual experiences including: unwanted sexual experiences with a male or female consistent with definitions of childhood sexual abuse; consensual sex with an older male or female; bodily exploration with another male or female child; and consensual sex with a peer-age female. Most of the experiences described by participants as consensual with an older male or female, however, met criteria for childhood sexual abuse found in the extant literature. Several men discussed childhood sexual experiences (CSE) relative to their experiences with alcohol, drugs, and same-sex behavior as adults. Findings suggest that the relationship between CSE and risk-taking behavior may be shaped by whether men perceive their experiences as abusive or consensual, and have implications for researchers, treatment providers and counselors.

Drug use and conflict in inner-city African-American relationships in the 2000s.

Abstract Inner-city relationships face numerous challenges including illegal drug use and its consequences. The nature of this challenge, however, has changed dramatically with a shift from the crack subculture of the 1980s and early 1990s to the subsequent marijuana/blunts subculture. This study presents data concerning 95 inner-city relationships where illegal drug use was present from people who were interviewed in 2004–2006 and reinterviewed in 2008. Hard drug use was still problematic in the 2000s even with the passing of the crack epidemic and its associated behavioral norms. Hard drug (primarily crack) users reported drug use was a problem, reported conflict over drugs, reported higher levels of conflict than others and were the most likely to have broken up with their partner. On the other hand, the experiences and subcultural norms associated with marijuana use appeared to be much less detrimental to relationship harmony. Subjects who used marijuana but not hard drugs reported much less relationship conflict. Indeed, many reported that they enjoyed using marijuana with their partner. These subcultural insights further the understanding that young adults have constructed a much more socially productive subculture regarding marijuana use than their predecessors had constructed around use of crack.

The impact of welfare reform on methadone treatment: Policy lessons from service providers in New York City

This article explores the impact of recent changes in welfare policy on public assistance recipients who are in methadone maintenance treatment, from the perspective of methadone service providers. Data were collected between late 2000 and early 2002, and included in-depth interviews with 11 providers from three methadone treatment programs in New York city, contextual interviews with three welfare agency personnel and three patient advocates, and participant-observation in trainings and clinical meetings related to vocational services and public assistance for methadone patients. Because service providers are front-line implementers of new welfare regulations, their experiences, and insights should be consulted by policymakers as welfare policy continues to evolve.

The provider perception inventory: psychometrics of a scale designed to measure provider stigma about HIV, substance abuse, and MSM behavior.

Abstract Nongay identified men who have sex with men and women (NGI MSMW) and who use alcohol and other drugs are a vulnerable, understudied, and undertreated population. Little is known about the stigma faced by this population or about the way that health service providers view and serve these stigmatized clients. The provider perception inventory (PPI) is a 39-item scale that measures health services providers’ stigma about HIV/AIDS, substance use, and MSM behavior. The PPI is unique in that it was developed to include service provider stigma targeted at NGI MSMW individuals. PPI was developed through a mixed methods approach. Items were developed based on existing measures and findings from focus groups with 18 HIV and substance abuse treatment providers. Exploratory factor analysis using data from 212 health service providers yielded a two dimensional scale: (1) individual attitudes (19 items) and (2) agency environment (11 items). Structural equation modeling analysis supported the scales predictive validity (N=190 sufficiently complete cases). Overall findings indicate initial support for the psychometrics of the PPI as a measure of service provider stigma pertaining to the intersection of HIV/AIDS, substance use, and MSM behavior. Limitations and implications to future research are discussed.

Community Wise: The Development of an Anti-Oppression Model to Promote Individual and Community Health

Communities with histories of oppression have shown great resilience, yet few health interventions focus on structural oppression as a contributor to health problems in these communities. This article describes the development and active ingredients of Community Wise, a unique behavioral health intervention designed to reduce substance use frequency, related health risk behaviors, and recidivism among individuals with a history of incarceration and substance abuse residing in distressed and predominantly African American communities. Community Wise, developed through the collaborative efforts of a board of service providers, researchers, consumers, and government officials, is a 12-week group intervention that aims to address behavioral health problems by raising critical consciousness in distressed communities.

Developing PeerLink to engage out-of-care HIV+ substance users: Training peers to deliver a peer-led motivational intervention with fidelity

Substance use among HIV+ individuals can be a barrier to HIV care, resulting in poor health outcomes. Motivational interviewing (MI) is an effective intervention to reduce substance abuse and increase HIV-related health. Healthcare workers from various backgrounds can be effectively trained in delivering MI interventions; however, there has been limited evidence that peers can effectively deliver MI interventions with fidelity. Peers have traditionally worked in HIV care settings and represent a valid context for a peer-delivered intervention focused on motivational issues. We trained four peers in MI. In this paper, we describe the intervention, explain the MI training methods, and investigate whether peers can be trained in MI with fidelity. The MI training included didactic instruction, group workshops, and individual feedback sessions. Two of four peers achieved MI treatment fidelity as measured by the Motivational Interviewing Treatment Integrity Code Version 3.0. Overall, peers had difficulty using open-ended questions and querying pros and cons, skills thought necessary to elicit change talk. They also tended to give too much direct advice where reflections would have been appropriate. A challenge was training peers to change familiar ways of communicating. Nonetheless, they did well at assessing and highlighting motivation to change. The total training hours (40 h) was long compared with other published MI studies. However, the intervention included several components with two targeted change behaviors. It is likely that peers can be trained in MI with fidelity in less time given a more streamlined intervention. When working with peers who have life stressors similar to the target group, it is important to be flexible in the training.