Robert E. Aronson

Challenges to Masculine Transformation Among Urban Low-Income African American Males

In this article we describe and analyze the challenges faced by an intervention program that addresses the fatherhood needs of low-income urban African American males. We used life history as the primary research strategy for a qualitative evaluation of a program we refer to as the Healthy Men in Healthy Families Program to better understand the circumstances and trajectory of mens lives, including how involvement in the program might have benefited them in the pursuit of their fatherhood goals. A model of masculine transformation, developed by Whitehead, was used to interpret changes in manhood/fatherhood attitudes and behaviors that might be associated with the intervention. We combined Whiteheads model with a social ecology framework to further interpret challenges at intrapersonal, interpersonal, community, and broader societal levels.

Critical race theory as theoretical framework and analysis tool for population health research

In population health research, it is important to consider socioecological perspectives that include cultural attitudes and beliefs which permeate all levels (intrapersonal, interpersonal, institutional/community, and structural/policy). Given the specificity of target populations centered on identity – ethnic and others – it is appropriate and warranted to centralize cultural studies theories into health determinant investigations. Cultural studies, which focus explicitly on identity exploration and impacts, have much to contribute to health research. In accordance with the transdisciplinary nature of population health and bearing in mind the significant role of ethnic identity in health outcomes, it is beneficial to utilize critical race theory (CRT) as a theoretical framework and analysis tool for population health research. This article will: (1) briefly overview a recent mental health study employing CRT, and a commentary that emphasizes how CRT can contribute to the sociology of mental health; and (2) propose ways CRT can be used in psychosocial health research.

Latino men who have sex with men and HIV in the rural south-eastern USA: findings from ethnographic in-depth interviews.

A community-based participatory research partnership explored HIV risk and potentially effective intervention characteristics to reduce exposure and transmission among immigrant Latino men who have sex with men living in the rural south-eastern USA. Twenty-one participants enrolled and completed a total of 62 ethnographic in-depth interviews. Mean age was 31 (range 18–48) years and English-language proficiency was limited; 18 participants were from Mexico. Four participants reported having sex with men and women during the past three months; two participants self-identified as male-to-female transgender. Qualitative themes that emerged included a lack of accurate information about HIV and prevention; the influence of social-political contexts to sexual risk; and barriers to healthcare services. We also identified eight characteristics of potentially effective interventions for HIV prevention. Our findings suggest that socio-political contexts must be additional targets of change to reduce and eliminate HIV health disparities experienced by immigrant Latino men who have sex with men.

What do men who serve as lay health advisers really do?: Immigrant Latino men share their experiences as Navegantes to prevent HIV.

HoMBReS was a lay health adviser (LHA) intervention designed to reduce sexual risk among recently arrived, nonEnglish-speaking Latino men who were members of a multicounty soccer league in central NC. Our community-based participatory research (CBPR) partnership collected, analyzed, and interpreted qualitative life-story narratives to characterize the roles of male LHAs known as Navegantes. Nine Navegantes were interviewed. Their mean age was 39 years (range: 26-62 years); six were from Mexico and three from El Salvador. Navegantes described the function and facilitators of serving as LHAs and identified leverage points for future HIV and STD prevention strategies. They highlighted psychosocial and sociocultural influences on HIV risk, settings for risky behavior, and personal changes from serving as Navegantes. This study provides preliminary evidence that an LHA approach is feasible and appropriate for Latino men, and can be effective in reaching men who might otherwise be difficult to reach.

Neighborhood Mapping and Evaluation: A Methodology for Participatory Community Health Initiatives

Objectives: This paper describes the use of neighborhood mapping as a key element in an ecological study of a community-based urban infant mortality prevention program. We propose the use of neighborhood mapping in evaluation research to more fully examine the local context of community health programs. Mapping can be used to study community change and to describe community assets and structural, epidemiological, and social features of neighborhoods that may influence program implementation and outcomes. Methods: Data on physical features were collected by community residents during street-by-street neighborhood walkthroughs. Other data sources included program records, Census, birth certificate, and state and city data. Analytic methods included geo-coding, exploratory factor analysis to create spatial density indicators of neighborhood features at the Census block group level, and analysis of associations between neighborhood features and outcomes. Results: Point and chloropleth maps provide a powerful illustration of neighborhood features (e.g., vacant buildings), client distribution and participation, health outcomes, and change over time. Factor analysis indicated two salient clusters of non-residential land use: (1) legitimate daily usage (liquor stores and other businesses) and (2) non-legitimate daily use (houses of worship and vacant buildings). A composite scale was created to indicate overall risk related to physical neighborhood features. Conclusions: Neighborhood mapping is a powerful tool that brings participants and residents into the research process. Moreover, it can improve understanding of the role of neighborhood ecology in program implementation and outcomes.

Perceptions of Vaccine Efficacy, Illness, And Health Among Inner-City Parents

A resurgence of measles in the past decade has focused attention on the limitations of current immunization programs, particularly for inner-city, low-income populations. As part of a larger study of immunization rates, we discussed perceptions of disease severity and vaccine efficacy, as well as the prioritization of the tasks of parenthood, with 40 parents of infants living in inner-city Baltimore to discover their beliefs about immunization. Vaccines were considered only partly successful; susceptibility to chickenpox after vaccination was repeatedly cited as evidence of vaccine failure. Fever was seen as a primary indicator of illness; thus, vaccines were believed to cause, rather than prevent, illness. Immunization was not considered a high-priority parental responsibility. These findings suggest future interventions be aimed at changing parental perceptions of vaccines as ineffective and of fever after immunization as an indicator of illness. Finally, immunizations should be made easily available, even during clinic visits for a childs illness.

The art and science of integrating Undoing Racism with CBPR: challenges of pursuing NIH funding to investigate cancer care and racial equity.

In this nation, the unequal burden of disease among People of Color has been well documented. One starting point to eliminating health disparities is recognizing the existence of inequities in health care delivery and identifying the complexities of how institutional racism may operate within the health care system. In this paper, we explore the integration of community-based participatory research (CBPR) principles with an Undoing Racism process to conceptualize, design, apply for, and secure National Institutes of Health (NIH) funding to investigate the complexities of racial equity in the system of breast cancer care. Additionally, we describe the sequence of activities and “necessary conflicts” managed by our Health Disparities Collaborative to design and submit an application for NIH funding. This process of integrating CBPR principles with anti-racist community organizing presented unique challenges that were negotiated only by creating a strong foundation of trusting relationships that viewed conflict as being necessary. The process of developing a successful NIH grant proposal illustrated a variety of important lessons associated with the concepts of cultural humility and cultural safety. For successfully conducting CBPR, major challenges have included: assembling and mobilizing a partnership; the difficulty of establishing a shared vision and purpose for the group; the problem of maintaining trust; and the willingness to address differences in institutional cultures. Expectation, acceptance and negotiation of conflict were essential in the process of developing, preparing and submitting our NIH application. Central to negotiating these and other challenges has been the utilization of a CBPR approach.

Evaluation findings on community participation in the California Healthy Cities and Communities program

As part of an evaluation of the California Healthy Cities and Communities (CHCC) program, we evaluated resident involvement, broad representation and civic engagement beyond the local CHCC initiative. The evaluation design was a case study of 20 participating communities with cross-case analysis. Data collection methods included: coalition member surveys at two points in time, semi-structured interviews with key informants, focus groups with coalition members and document review. Participating communities were diverse in terms of population density, geography and socio-demographic characteristics. Over a 3-year period, grantees developed a broad-based coalition of residents and community sectors, produced a shared vision, conducted an asset-based community assessment, identified a priority community improvement focus, developed an action plan, implemented the plan and evaluated their efforts. Local residents were engaged through coalition membership, assessment activities and implementation activities. Ten of the 20 coalitions had memberships comprised of mainly local residents in the planning phase, with 5 maintaining a high level of resident involvement in governance during the implementation phase. Ninety percent of the coalitions had six or more community sectors represented (e.g. education, faith). The majority of coalitions described at least one example of increased input into local government decision-making and at least one instance in which a resident became more actively involved in the life of their community. Findings suggest that the Healthy Cities and Communities model can be successful in facilitating community participation.

Using community-based participatory research to prevent HIV disparities: assumptions and opportunities identified by the Latino partnership.

Background:HIV disproportionately affects vulnerable populations in the United States, including recently arrived immigrant Latinos. However, the current arsenal of effective approaches to increase adherence to risk-reduction strategies and treatment within Latino populations remains insufficient. Methods:Our community-based participatory research (CBPR) partnership blends multiple perspectives of community members, organizational representatives, local business leaders, and academic researchers to explore and intervene on HIV risk within Latino populations. We used CBPR to develop, implement, and evaluate 2 interventions that were found to be efficacious. Results:We identified 7 assumptions of CBPR as an approach to research, including more authentic study designs, stronger measurement, and improved quality of knowledge gained; increased community capacity to tackle other health disparities; the need to focus on community priorities; increased participation and retention rates; more successful interventions; reduced generalizability; and increased sustainability. Conclusions:Despite the advancement of CBPR as an approach to research, key assumptions remain. Further research is needed to compare CBPR with other more-traditional approaches to research. Such research would move us from assuming the value of CBPR to identifying its actual value in health disparity reduction. After all, communities carrying a disproportionate burden of HIV, including immigrant Latino communities, deserve the best science possible.

Achieving organizational change: findings from case studies of 20 California healthy cities and communities coalitions

As part of an evaluation of the California Healthy Cities and Communities (CHCC) Program, we assessed the extent to which coalitions implementing the healthy cities and communities model demonstrated capacity to leverage financial resources, expand programs and influence organizational policies. The evaluation design was a multiple case study of 20 participating communities with cross-case analysis. Participating communities spanned the states diverse geographic regions and ranged from remote areas within rural counties to neighborhoods within large cities. Data included: semi-structured interviews with coordinators and community leaders, focus groups with coalition members and document review. Many CHCC coalitions were able to leverage significant financial resources across a diverse array of funding sources, including federal, state, county and city governments. In addition, all CHCC coalitions developed at least one new program, most commonly focused on youth development, civic capacity-building or lifelong learning. Changes in policies, reported by 19 of the 20 coalitions, were consistent with healthy cities and communities principles and were implemented in community-based organizations, county and city governments, and school districts. Typical changes included an increased willingness to collaborate, increased emphasis on engaging diverse parts of the community, greater responsiveness to community needs and more opportunities for resident input into decision-making. Our findings suggest the healthy cities and communities model has the potential to strengthen the organizational infrastructure of communities to promote health.