Jean J. Schensul

High Risk Drug Use Sites, Meaning and Practice: Implications for AidS Prevention

A study of drug use locations in Hartford, CT, Is designed to understand the environmental and social conditions within “high risk sites” where drug users inject drugs or smoke crack, In order to develop AIDS prevention models that build upon the physical and social organization of these locations. The study assesses high-risk sites characterized on the basis of type of location or structure, presence and strength of gatekeepers, and presence and strength of HIV prevention opportunities and pressures. A combination of ethnographic, epidemiological, and social network methods are used to document the characteristics, social organization, natural history, and dynamics of these sites, the network relations of site users, and the various opportunities for, or barriers to, on-site social-level HIV prevention intervention. This paper provides an overview of the study and presents preliminary findings, Including the degree to which drug injectors and crack smokers use specific types of sites in Hartford. The paper also discusses the ways these findings Inform development of on-site, type-specific and peer-led or structural HIV-prevention Interventions.

The high, the money, and the fame: The emergent social context of “new marijuana” use among urban youth

This paper describes cultural factors associated with the use of high‐potency marijuana among inner‐city youth in a midsized northeastern city. While high‐potency marijuana has been available and used nationally for over a decade, surveys of drug use do not include items on what “new marijuana” contains and how and under what circumstances it is used. Few studies of marijuana use have been conducted in recent years. This paper, based on ongoing ethnographic and epidemiological study of pathways to heavy drug use among youth and young adults in Hartford, examines the sociocultural context of new marijuana use as an emergent trend. After considering the street market for high‐potency marijuana, social rituals and meanings surrounding its distribution and use, and links with hip hop culture, the paper concludes with a critical analysis of the ways in which the drug market drives drug sales, drug use, and drug‐use sequencing in inner‐city neighborhoods.

Vulnerability, Social Networks, Sites, and Selling as Predictors of Drug use among Urban African American and Puerto Rican Emerging Adults

This paper reviews the results of research conducted with African American and Puerto Rican emerging adults between the ages of 18 and 25 whose life experiences increase vulnerability to drug use and pose some significant challenges in achieving milestones widely recognized as important in achieving adult status. Literature on drug use in adolescence suggests that personal vulnerability accounts for most experimental and problem drug use. Included in the vulnerability construct are religiosity, perceived risk, social influence, drug access, social norms, and social risk defined primarily as exposure to various forms of violence. This study shows that personal vulnerability explains only some of the variance in use and predicts variance differently with respect to different specific drugs and polydrug use. Further, it argues that additional contextual factors including social networks, party and club attendance, and drug selling activities, all typical of emerging adulthood and urban lifestyle, are also important factors in enhancing potential for accelerated drug use during this developmental period. Finally, it notes that the consequences of these activities have implications for further economic and social marginalization of urban, multiethnic low income emerging adults.

Community-Based Sexual Risk Prevention Program for SRI Lankan Youth: Influencing Sexual-Risk Decision Making

This article describes the design, implementation, and evaluation of a sexual-risk prevention program focused on the development of individual competencies and cultural norms promoting healthy sexual decision making. The community-based peer-facilitated intervention targeted adolescents and young adult men and women in Sri Lanka, who participated in small-group activities targeting sexual knowledge, attitudes, and practices; risk perception; and sexual-risk decision making. The intervention and evaluation tools were based on formative research data collected from members of the target population. Researchers from Sri Lanka and North America collaborated with local community health workers and community members in formative data collection and program development. The pilot intervention project was successful in improving sexual-risk perception and decision making, and (for women) knowledge of condoms and sexual terminology. The use of group process showed promise as a tool for fostering negotiation of perspectives and consensus building regarding sexuality and sexual risks. The lessons learned from this project can inform the development of culture-specific sexual-risk prevention programs worldwide.

Learning about Sexual Meaning and Decision-Making from Urban Adolescents

This article uses examples of research conducted by teams of urban youth researchers assisted by adult social scientists to illustrate the utility of two approaches to cultural research on sexuality, narrative research, and scripting theory. Narrative research is based on analysis of personal stories of life experiences; scripting theory points to cultural scripts as important in shaping and changing sexual norms. Examples of youth studies demonstrate how sexuality is situated among other issues in the life of urban teens, define sexual norms by age and gender, and identify scripted patterns of sexual sequencing. Methods used in conceptualization and data collection model negotiation skills needed for successful sexual decision making. The article concludes with a discussion of the relative merits of involving youth as partners in exploring adolescent sexuality. It describes how such partnerships can be created so that cultural research can be conducted from a youth perspective, and new knowledge integrated into socially constructed approaches to understanding and preventing risky sexual behaviors in young people.

Perceived Environmental Stress, Depression, and Quality of Life in Older, Low Income, Minority Urban Adults

In this chapter we explore the predictors of perceived environmental stress (PES) and depression as indicators of quality of life (QoL) among older adults living in low-income subsidised senior housing in buildings with challenging social environments. We demonstrate that there is considerable variation in the ways that residents of these buildings respond to their environment that are closely linked to their mental health status and their perception of the stressors in their immediate environment. Research has shown substantial effects of environmental stressors on mental and physical well-being, especially among residents of impoverished urban areas (Bullinger, 1989; Eriksson, 1999; Evans, 2003; Feldman and Steptoe, 2004; Garland, 1990; Krause, 1996; Levitt et al., 1987; Shipp and Branch, 1999; Svanborg and Djurfeldt, 1987). These studies present evidence showing that factors including high levels of pollution, low socio-economic status, substandard living conditions, high potential for exposure to violence, limited access to social and health resources, and population density significantly contribute to QoL. In these studies, QoL is measured in a number of ways including indicators of mental and physical health distress. Relationships between contextual factors and these QoL indicators are often non-linear and very complex (Evans, 2003; Krause, 1996). The goal of this chapter is to discuss some of the major factors related to QoL as measured by PES and mental health status, in a sample of older, low-income, minority urban adults from a medium-sized city in north-eastern USA and to explain apparent gender differences.

Community Involvement in Health Systems Strengthening to Improve Global Health Outcomes: A Review of Guidelines and Potential Roles

Definitions of health systems strengthening (HSS) have been limited in their inclusion of communities, despite evidence that community involvement improves program effectiveness for many health interventions. We review 15 frameworks for HSS, highlighting how communities are represented and find few delineated roles for community members or organizations. This review raises the need for a cohesive definition of community involvement in HSS and well-described activities that communities can play in the process. We discuss how communities can engage with HSS in four different areas—planning and priority-setting; program implementation; monitoring, evaluation, and quality improvement; and advocacy—and how these activities could be better incorporated into key HSS frameworks. We argue for more carefully designed interactions between health systems policies and structures, planned health systems improvements, and local communities. These interactions should consider local community inputs, strengths, cultural and social assets, as well as limitations in and opportunities for increasing capacity for better health outcomes.

COLLABORATION OF COMMUNITY AND UNIVERSITY SCHOLARS: TRAINING IN THE TRANSFORMATION OF RESEARCH FOR COMMUNITY DEVELOPMENT

Community-based Participatory Research (CBPR) provides a methodology that creates mutually beneficial and equitable partnerships between researchers and community people involved in positive change. Participatory Action Research (PAR) is rooted in trust, connectivity, and reciprocity to address issues and actions that remedy inequitable social, economic, and environmental problems arising from racism rooted in structural/political imbalances. In this paper, we discuss the Health Equity Alliance of Tallahassee (HEAT) and its affiliated six week Ethnographic Field School that trains graduate students in CBPR methodology by bringing faculty, local community activists and stakeholders, and students together for mutual learning in dynamic classroom, community, and social settings. The paper offers reflections on the experience by a student, HEAT activist, local and visiting faculty, and demonstrate how a model field school based on PAR offers an empirical approach to building capacity to address power inequiti...

Evaluating Alternative Designs of a Multilevel HIV Intervention in Maharashtra, India: The Impact of Stakeholder Constraints

Background. Multilevel interventions combine individual component interventions, and their design can be informed by decision analysis. Our objective was to identify the optimal combination of interventions for alcohol-using HIV+ individuals on antiretroviral drug therapy in Maharashtra, India, explicitly considering stakeholder constraints. Methods. Using an HIV simulation, we evaluated the expected net monetary benefit (ENMB), the probability of lying on the efficiency frontier (PEF), and annual program costs of 5,836 unique combinations of 15 single-focused HIV risk-reduction interventions. We evaluated scenarios of 1) no constraints (i.e., maximize expected value), 2) short-term budget constraints (limits on annual programmatic costs of US

Kidney progression project (KiPP): Protocol for a longitudinal cohort study of progression in chronic kidney disease of unknown etiology in Sri Lanka

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