Mark Edberg

A Trajectory Model for Understanding and Assessing Health Disparities in Immigrant/Refugee Communities

While numerous factors contributing to racial/ethnic health disparities have been identified, the clustering and interaction of these factors as a syndemic or trajectory has not been well-studied (Starfield in Soc Sci Med 64:1355–1362, 2007; Singer in Soc Sci Med 39(7):931–948, 1994). More importantly, for immigrant/refugee populations, the interaction of contributing factors is not documented adequately enough to provide a solid framework for planning, implementation and evaluation of interventions aimed at reducing disparities. In this paper, the authors draw from the literatures on health disparities and immigrant/refugee health, as well as direct program and research experience, to propose an approach for assessment of the diachronic interaction of ecological factors (a trajectory, or “diachronic ecology”) contributing to health disparities among immigrant/refugee populations. It is our hope that this approach will contribute to the important effort to collect data supporting the development of interventions and policies that effectively address the dynamic processes through which health disparities are created, maintained, and changed.

The SAFER Latinos Project: Addressing a Community Ecology Underlying Latino Youth Violence

This paper describes the intervention model, early implementation experience, and challenges for the Seguridad, Apoyo, Familia, Educacion, y Recursos (SAFER) Latinos project. The SAFER Latinos project is an attempt to build the evidence for a multilevel participatory youth violence prevention model tailored to the specific circumstances of Central American immigrants. Specific circumstances targeted in this intervention are decreased family cohesion as a result of sequential immigration (i.e., parents arriving first and bringing their children years later or youth arriving without parents); multiple school barriers; community disorganization and low community efficacy; limited access to services; and a social context (including gang presence) that is linked to youth norms supporting violence. In its implementation, the initial intervention model was adapted to address barriers and challenges. These are described, along with lessons learned and the ongoing evaluation.

Drug Traffickers as Social Bandits Culture and Drug Trafficking in Northern Mexico and the Border Region

This article discusses ethnographic/qualitative research concerning the ways in which drug trafficking and drug traffickers are portrayed and interpreted in northern Mexico and the border region via a recently popularized form of the traditional narrative music genre called the corrido. The research links the drug trafficker persona to historical issues/values associated with the Sierra and border areas, including long-standing patterns of smuggling, a tradition of independence, and conflicting relationships with both Mexican and U.S. authorities. The construction of traffickers as social bandits or heroes varies by social group and between rural and urban areas. In any case, the “celebretization” of drug traffickers described in this article highlights the ambivalent relationship between drug trafficking, historical conflicts between the United States and Mexico, and socioeconomic and cultural factors. Cross-cultural comparisons are also made regarding drug trafficker portrayals in the United States.

SAFER Latinos: a community partnership to address contributing factors for Latino youth violence.

Background: This paper describes a multilevel youth violence prevention effort called SAFER Latinos (Seguridad, Apoyo, Familia, Educacion, y Recursos), a collaboration between The George Washington University School of Public Health and Health Services (GWU) and two key Latino community organizations.Objectives: To implement and evaluate an intervention addressing factors within the social ecology of an immigrant Latino community.Methods: The intervention includes (1) Social promotores for family outreach and problem resolution; (2) Youth peer advocates at the high school level; (3) a drop-in center with support services for families and youth; and (4) community events, capacity building, and messages. Evaluation includes a baseline and follow-up surveys (N = 1,400) and focus groups.Lessons Learned: (1) Community circumstances change, requiring regular program adaptation. (2) Community interventions with research face potential contradictions in purpose impacting management of the collaboration and model fidelity. (3) Etiological models tied to interventions may have to be revisited owing to changes in the character and dynamics of the immigrant community.

Turning the corner: development of the Adelante program brand for Latino youth

This article reports on formative research to develop the Adelante brand, an innovative program for Latino immigrant adolescents and their families. The brand applies social marketing principles used in previous health brands in areas such as tobacco control, substance use, and HIV prevention. Specific objectives were to apply branding principles as an approach to increasing adolescent engagement with, and participation in, a community-based youth development program called Adelante, which is based on positive youth development theory. We collected data in a primarily low-income Latino immigrant community, Langley Park, MD, located near Washington, DC. A total of 39 adolescents, ages 13–19, participated in six focus groups. We designed and tested a brand positioning statement, associations, a logo and graphics, and youth archetypes. We used thematic content analysis to code focus group data into broad topic areas and then analyzed the data using substantive coding to identify themes. The concepts of strength, resilience, and “turning the corner” by overcoming life obstacles and succeeding were the main themes. Latino youth face a challenging environment in which they grow up, finish school, and succeed. Adelante represents a source of support and help to turn the corner. A graphic depicting a city street corner with a darker side (past) and a brighter side (future) was identified as the Adelante logo. Youth characters named Victor and Erika, and an educational entertainment strategy, were conceived as a way to create a brand persona. Adelante is now actively building its brand to increase youth engagement in the program.

Elimination of health disparities in racial/ethnic minority communities: developing data indicators to assess the progress of community-based efforts

Abstract This paper describes the development of a pilot uniform data set (UDS) intended to serve as the primary data collection mechanism for all grants and standard cooperative agreements funded by the US Office of Minority Health (OMH), within the US Department of Health and Human Services. OMH is mandated by Congress to coordinate Federal agency efforts to improve racial/ethnic minority health status and eliminate disparities in health, health care, and access to care for these populations. The majority of OMH programs are directed to racial/ethnic minority community-based organizations (CBOs), and involve a mixture of health promotion, screening, access to services and treatment, training and education, materials development, case management, capacity-building, development of community linkages, and other such activities in support of Healthy People 2010 goals concerning the elimination of health disparities. A range of OMH-awarded grants and cooperative agreements fund these projects. A key issue has been the need for uniform data across these programs, and the UDS was developed in response to this need. The modular format and content of the UDS was the product of a formative research process involving an advisory panel, focus groups, interviews, site visits and a pilot test aimed at identifying and defining appropriate data elements as well as an overall structure that made sense in terms of providing some form of standardized data across widely disparate projects. The UDS as developed is not only an important accountability and performance monitoring effort for OMH, but also a significant attempt to develop a data collection system that is meaningful for CBOs and the racial/ethnic minority populations they serve. Knowledge gained from the implementation of this system can be applied to general issues of evaluating community-based health programs, and to identifying/assessing the nature of progress with respect to racial/ethnic minority health, beyond its direct application to OMH projects.

Using a Qualitative Approach to Develop an Evaluation Data Set for Community-Based Health Promotion Programs Addressing Racial and Ethnic Health Disparities

Racial and ethnic disparities in health have increasingly become a central focus of health promotion efforts. At the community level, however, collecting data and evaluating these programs has been a challenge because of the diversity of populations, community contexts, and health issues as well as a range of capacities for conducting evaluation. This article outlines a qualitative research process used to develop a Web-based standard program performance data reporting system for programs funded by the U.S. Office of Minority Health (OMH), but generally applicable to community-based health promotion programs addressing health disparities. The “core-and-module” data set, known as the Uniform Data Set (UDS), is a Web-based system and is used as the programwide reporting system for OMH. The process for developing the UDS can be used by any agency, locality, or organization to develop a tailored data collection system allowing comparison across projects via an activity-based typology around which data reporting is structured. The UDS model enables the collection of grounded data reflecting community-level steps necessary to address disparities as well as a reporting structure that can guide data collection based on broader frameworks now emerging that specify criteria for measuring progress toward the elimination of health disparities.

Picturing Adelante: Latino Youth Participate in CBPR Using Place-Based Photovoice

We applied Photovoice, an innovative methodology, in order to enhance participation by Latino youth living in Langley Park, MD in community-based participatory research (CBPR) and in the ongoing Adelante Positive Youth Development intervention. This study sought to: 1) expand our understanding of current needs and experiences of Latino youth and update our information on the evolving Marketplace; 2) involve youth in the process of developing CBPR intervention and social marketing components; and 3) build skills in photography, critical thinking, and community activism among Latino youth. Using Photovoice, we engaged twelve Latino youth, including six recently arrived to the U.S. and six second generation immigrants, in a dialogue about peer, family, community, and health issues affecting Latinos. Through six sessions, participants developed photography skills, used photographs to stimulate critical thinking and discussion, and suggested solutions for emergent issues. Sixty pictures selected for group discussion all corresponded to one of the three main domains of inquiry: 1) Strengths and needs of Langley Park, 2) Latino youth experiences, and 3) Community health assets and risks. Participants organized a photography exhibition and community forum to raise awareness about important findings. Both recently arrived and second generation Latino youth have important perspectives to share that guide and refine ongoing targeted CBPR interventions. Findings from this study shed light on the most relevant topics for community-based interventions, advocacy, and social marketing campaigns needed in this community. Photovoice is a useful tool for social marketing formative research targeting immigrant youth sub-groups.

Applying Ecological Positive Youth Development Theory to Address Co-Occurring Health Disparities Among Immigrant Latino Youth

This article outlines the theory and resulting approach employed in a multilevel, integrated, collaborative community intervention called Adelante, implemented by a university–community partnership in a Latino immigrant community to address co-occurring health disparities of substance abuse, sex risk, and interpersonal violence among youth. The basis for the intervention is a social–ecological interpretation of positive youth development theory, which focuses on changes in the person environment context and community assets as a preventive mechanism. This approach is viewed as appropriate for a community facing multiple barriers to health equity. The article describes the translation of this positive youth development model to practice, including the design of the intervention, intervention components, and the protocol for evaluation. The Adelante intervention is intended to reduce health disparities and, in addition, to add a broader community model to the evidence base.

Patterns of HIV/AIDS, STI, substance abuse and hepatitis risk among selected samples of Latino and African-American youth in Washington, DC

In order to address evolving risk factors among youth in Washington, DC (District of Columbia), with respect to HIV/AIDS, sexually transmitted infections (STIs), substance abuse, and hepatitis, a targeted, community-needs assessment was conducted through a partnership between the Department of Prevention and Community Health at George Washington University School of Public Health and Health Services (GWU SPHHS), and the Latin American Youth Center (LAYC). Multiple methods were used in the assessment, including key informant interviews, the collection of risk factor data through a survey and focus groups, community mapping, and case file review of returning juvenile offenders. Results supported an understanding of multiple risk among these youth that was embedded within a broader social and community context. In addition, the data suggested that some sexual risk behaviour may be an unintended consequence of HIV/AIDS education.