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Edison J Trickett,
Sarah Beehler,
Charles Deutsch,
Lawrence W Green,
Penelope Hawe,
Kenneth McLeroy,
Robin Lin Miller,
Bruce D Rapkin, Jean J Schensul,
Amy J Schulz,
Joseph E Trimble
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ABSTRACT: Community interventions are complex social processes that need to move beyond single interventions and outcomes at individual levels of short-term change. A scientific paradigm is emerging that supports collaborative, multilevel, culturally situated community interventions aimed at creating sustainable community-level impact. This paradigm is rooted in a deep history of ecological and collaborative thinking across public health, psychology, anthropology, and other fields of social science. The new paradigm makes a number of primary assertions that affect conceptualization of health issues, intervention design, and intervention evaluation. To elaborate the paradigm and advance the science of community intervention, we offer suggestions for promoting a scientific agenda, developing collaborations among professionals and communities, and examining the culture of science.
American Journal of Public Health 06/2011; 101(8):1410-9. · 3.93 Impact Factor
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ABSTRACT: This paper is based on qualitative in-depth interviews conducted from 2008 to 2009 with 118 ethnically diverse Ecstasy users from the greater Hartford area, CT, USA. Participants were urban, primarily Black and Hispanic, aged 18 to 36, and had limited higher education compared with samples in previous Ecstasy research. Interviews focused on personal background, history of Ecstasy and other drug use, and recent sexual events. In this paper, we examine: participants' negotiation of perceived risks and benefits of Ecstasy use, behavioral strategies employed to minimize risks, and the relationship of risk-benefit analysis, motivation for use, frequency of use, and polydrug use to participants' sense of control over their Ecstasy use. We conclude with recommendations for intervention approaches and suggestions for future research.
Substance Use & Misuse 01/2011; 46(13):1675-89. · 1.10 Impact Factor
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AIDS and Behavior 08/2010; 14 Suppl 1:S1-7. · 3.49 Impact Factor
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ABSTRACT: This paper summarizes the main results of the survey component of a mixed methods study of alcohol and sexual risk in a general population of young men 18-29 residing in low income communities in the Greater Mumbai area. The survey included demographic variables, and scales and indices measuring work related stress, social influence, exposure to alcohol in childhood, and currently, hyper masculinity, exposure to media and pornography, risk related leisure time activities and alcohol and alcohol/sex expectancies. Measures of alcohol use included frequency/amount/contextual use of six different types of alcohol, a general estimate of frequency and amount (AUDIT), and an estimate of total ml. alcohol consumed in the past 30 days, based on estimates of alcohol content in all types of alcohol consumed, by unit of consumption (glass, peg, bottle) etc. Sexual outcome measures included types and number of partners ever and in past year with and without alcohol, and a critical event with most recent partner (with or without alcohol) and culturally specific indicators of sexual health related to sexual risk taking. A cluster sampling protocol and the use of a screener produced a sample of 1239 men, 1071 thirty day drinkers and 161 nondrinkers. Logistic regression analysis (binary and multinomial) showed relationships between predictor variables and alcohol consumption and alcohol and sexual risk indicators as well as two of the sexual health indicators associated with extramarital sex. Risk behaviors are associated with higher levels of alcohol consumption in this low risk general population of married and unmarried men. Implications for intervention include: (a) reducing or eliminating home drinking, to reduce early childhood exposure; (b) including alcohol in sexual risk and HIV prevention programs; (c) improving couples (married or unmarried) communication to reduce men's search for sexual alternatives, and (d) treating garmi as an indicator of sexual risk taking rather than STIs.
AIDS and Behavior 08/2010; 14 Suppl 1:S48-60. · 3.49 Impact Factor
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ABSTRACT: Gender-based violence rooted in norms, socialization practices, structural factors, and policies that underlie men's abusive practices against married women in India is exacerbated by alcohol. The intersection of domestic violence, childhood exposure to alcohol and frustration, which contribute to drinking and its consequences including forced sex is explored through analysis of data obtained from 486 married men living with their wives in a low-income area of Greater Mumbai. SEM shows pathways linking work-related stress, greater exposure to alcohol as a child, being a heavy drinker, and having more sexual partners (a proxy for HIV risk). In-depth ethnographic interviews with 44 married women in the study communities reveal the consequences of alcohol on women's lives showing how married women associate alcohol use and violence with different patterns of drinking. The study suggests ways alcohol use leads from physical and verbal abuse to emotional and sexual violence in marriage. Implications for gendered multi-level interventions addressing violence and HIV risk are explored.
AIDS and Behavior 08/2010; 14 Suppl 1:S126-35. · 3.49 Impact Factor
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ABSTRACT: In this paper we use Qualitative Comparative Analysis (QCA) in critical event analysis to identify under what conditions alcohol is necessary in contributing to unprotected sex. The paper is based on a set of in-depth interviews with 84 men aged 18 = 29 from three typical low income communities in Mumbai who reported using alcohol and having sex with at least one nonspousal partner once or more in the 30 days prior to the interview. The interviews included narratives of critical events defined as recent (past 30-60 day) events involving sexual behavior with or without alcohol. The paper identifies themes related to alcohol, sexuality and condom use, uses QCA to identify and explain configurations leading to protected and unprotected sex, and explains the differences. The analysis shows that alcohol alone is not sufficient to explain any cases involving unprotected sex but alcohol in combination with partner type and contextual factors does explain unprotected sex for subsets of married and unmarried men.
AIDS and Behavior 08/2010; 14 Suppl 1:S113-25. · 3.49 Impact Factor
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ABSTRACT: Alcohol's role in unprotected sex is an important issue in the spread of HIV. Research on alcohol use in many countries has found complex relationships between individual characteristics, places where people drink, and consumption patterns. Data on drinking and leisure time activities and locations from in-person surveys with 1,239 young men aged 18-29 living in low-income communities in Mumbai, India, were analyzed. For every pair of men, an index of association measured the degree of similarity in their reported activities in specific communities. Multidimensional scaling of the similarity matrix revealed men who engaged in similar activities in the same communities. Hierarchical grouping classified men based on their activity dimensions. The ten groups of men, distinguished by their activities in particular communities, also differed in alcohol consumption, number of non-spousal sex partners, and level of unprotected sex. Understanding where activities take place is important in designing venue-based interventions to reduce health risk behaviors leading to the spread of HIV/AIDS.
AIDS and Behavior 08/2010; 14 Suppl 1:S104-12. · 3.49 Impact Factor
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ABSTRACT: Mental health problems are associated with disability, overuse of medical care, higher rates of mortality and suicide as well as personal suffering for older adults. Residents of urban, low-income senior housing may face increased risk of a variety of mental health problems, including depression. This study identified the prevalence of multiple mental health problems in older residents of low-income senior housing and explored correlates of major depressive disorder for the two largest ethnic groups: black and Latino.
In-person diagnostic interviews identified rates of mental illness in a sample of 635 residents of 13 low-income senior housing buildings in a medium-sized northeastern city. Applying George's Social Antecedent Model of Depression, logistic regression analyses identified shared and unique correlates of depression for Latino and black participants.
This population had high rates of major depressive disorder (26%), generalized anxiety disorder (12%) and other mental health problems that varied significantly by ethnic and racial group. Separate multivariate models for Latino and black people showed that younger age, more chronic conditions and social distress were related to major depressive disorder for both ethnic groups. Perceived environmental stress, shorter tenure in the building, poorer perceived health, higher life stress and fewer leisure activities were associated with depression for Latinos only.
Mental health screening and treatment services are needed in senior housing to address these high rates of mental illness. Unique constellations of correlates of depression for different ethnic groups underscore a need for culturally competent approaches to identification and treatment.
Aging and Mental Health 09/2009; 13(5):659-73. · 1.37 Impact Factor
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ABSTRACT: In this chapter we explore the predictors of perceived environmental stress (PES) and depression as indicators of quality 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. 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 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. that are closely linked to their mental health status and their perception of the stressors in their immediate environment.
12/2006: pages 151-165;
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ABSTRACT: Community-based research often brings investigators from different disciplinary backgrounds together with community representatives to conduct research on topics of mutual concern. This paper describes a case example that illustrates an interdisciplinary/intersectoral study of depression and barriers to mental health care among older adults and illustrate the factors central to implementing a successful research partnership. It will address the following conditions that facilitate and challenge interdisciplinary/intersectoral research: (1) achieving commonality of purpose in study design and research and referral approaches; (2) ensuring the ability to develop, field-test and implement psychometrically rigorous and culturally and qualitatively appropriate instruments; (3) building effective management structures for interdisciplinary/intersectoral research partnerships; and (4) identifying, training and supporting qualified researchers to carry out a mental health study with older ethnically diverse adults. The paper concludes with strengths and limitations of the approach.
American Journal of Community Psychology 10/2006; 38(1-2):79-93. · 1.74 Impact Factor
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ABSTRACT: Polydrug use is of particular interest to researchers concerned with the drug use of youth and young adults because it is associated with progression to regular and addictive drug use. New research shows that polydrug use appears to be taking new forms as youth use multiple drugs concurrently in the same setting, sometimes to achieve specific desired effects. Existing approaches to measuring polydrug use are confusing and inconsistent. This paper calls for new ways of measuring polydrug use that capture concurrency in context to obtain more accurate assessments of drug mixing and its potential physical and social effects.
Addictive Behaviors 04/2005; 30(3):571-4. · 2.09 Impact Factor
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ABSTRACT: Ecstasy is a drug commonly associated with all-night, or all-weekend electronic dance events known as raves. Upper- and middle-class clubs, gay bars and clubs, and party venues are other common public settings where ecstasy use occurs. During the mid to late 1990s its use was reported in locations as distant as Australia and New Zealand, England and Scotland, and North America. In the United States, use increased dramatically at the end of the millennium, and drug monitoring systems began to report its presence among urban youth. Using social influence, social marketing and diffusion theory, this paper outlines the micro-level processes through which ecstasy traveled from downtown clubs catering to suburban young adults through urban youth networks through distributors and users. The paper is based on participant observation, and in-depth interviews with dealers and users collected during the period of peak diffusion 1999-2001, and survey data collected from 401 poly-drug users between the ages of 16 and 24 and collected at two time points from 1999-2002.
Journal of Ethnicity in Substance Abuse 02/2005; 4(2):39-71.
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ABSTRACT: Ecstasy use has spread beyond the rave and club scenes into other arenas of party culture, and from middle-class America to working-class and low-income neighborhoods of large cities. In order to explore ecstasy use among inner city adolescents and young adults, we conducted in-depth interviews with 23 poly-drug users who had used ecstasy, in Hartford, CT. Most users reported positive experiences while on the drug. Negative experiences were most often related to poly-drug mixing. However, heavy users (40+ times ever used) experienced negative aftereffects, which led them to decide to decrease or halt their use. Some participants discussed using ecstasy during sex, and irregular use of condoms. These findings point to the need for more in-depth research on MDMA use within inner city settings, with a particular focus on ethnic and cultural context, self-controlled drug use, poly-drug mixing, and sex risk behaviors.
Journal of Ethnicity in Substance Abuse 02/2005; 4(2):9-38.
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ABSTRACT: Despite the rising number of cases of HIV in adults over age 50, older persons rarely are considered to be at risk for HIV/AIDS, and even though they may be involved in risky behavior, such as unprotected penetrative sex, they may not consider themselves vulnerable to becoming infected. Informed awareness of risk is essential to making positive decisions about adopting preventive measures. We examined demographic, sociobehavioral, and contextual factors that predict urban, low-income older adults' perception of HIV/AIDS risk. Logistic regression results from 398 residents aged 50-93 living in six buildings in two American cities found that males, younger participants (aged 50-61), those living in higher risk buildings, and those who worried more about contracting HIV/AIDS were more likely to perceive themselves to be at HIV/AIDS risk. Findings accounted for 32% of the variance and the prediction success rate was 72%. Results point to the importance of considering sociodemographic characteristics and environmental (contextual) factors as they influence heuristic decision making in understanding HIV/AIDS risk perception among low-income urban older adults and when designing HIV/AIDS education and intervention strategies targeting this population.
AIDS Education and Prevention 01/2005; 16(6):571-88. · 1.59 Impact Factor
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ABSTRACT: This study examines the influence of individual, contextual (building location and characteristics), and social network characteristics on HIV prevalence and risk behavior among people older than 50 years of age living in low-income senior housing in two cities, Hartford, Connecticut and Chicago, Illinois. The authors' study focuses on older residents of six buildings located in impoverished neighborhoods with high rates of HIV transmission through injection drug use and unprotected sexual activity, including the exchange of sex for drugs and money. The article is organized into three sections. First, the authors explore the HIV prevalence, distribution, and risk behaviors that may contribute to new infections among the buildings' older residents in general. These practices include unprotected sexual intercourse, sex with commercial sex workers, casual or multiple partners, regular use of alcohol and/or illicit drugs, and other high-risk activities that expose older residents to HIV, sexually transmitted diseases, and other negative health consequences. Next, the authors examine the relationship between building and neighborhood characteristics, the internal social organization of buildings, and the risk behaviors of individual residents by building residency. Finally, the authors use a social network analysis to identify possible entry points and transmission routes for HIV infection through drug and sexual exchanges between and among building residents and visitors. This approach also reveals variations in building structures that may facilitate the diffusion of HIV prevention efforts.
JAIDS Journal of Acquired Immune Deficiency Syndromes 07/2003; 33 Suppl 2:S138-52. · 4.43 Impact Factor
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ABSTRACT: Social network research increasingly expands our understanding of the social environment of drug users' health risks, particularly those associated with the transmission of HIV, hepatitis, and other sexually transmitted and bloodborne infectious diseases. Our study of the networks of drug users who use high-risk sites, where people gather to inject drugs and smoke crack cocaine, is designed to explore the relationships and interactions of drug users in settings in which potential risk occurs, and to assess the opportunity to create prevention linkages. This paper describes the ego-network characteristics and macro-network linkages among a sample of 293 drug users recruited through street outreach and personal drug-use network referral in Hartford, Connecticut. Characteristics of the largest connected component of the network are also described and analyzed. We discuss uses of network analyses as well as implications of network connections for peer-led AIDS prevention intervention conducted in high-risk drug-use sites.
AIDS and Behavior 05/2002; 6(2):193-206. · 3.49 Impact Factor
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ABSTRACT: Community-based research brings together researchers and community members as partners to conduct research of mutual concern. This article describes the components necessary to implement a successful research partnership, taking as an example a study of human immunodeficiency virus (HIV) risk among residents of senior housing sites in two North American cities. The article describes important aspects of building and sustaining partnerships, the methods implemented to conduct research on sensitive topics, share resources, disseminate results and collaborate on programs and interventions to benefit the health and well-being of older adults.
Family & community health 26(3):203-13. · 0.99 Impact Factor
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ABSTRACT: The number of people ages 50 or older living with HIV in the United States is increasing. Yet, few older adults see themselves at risk of infection. This study examines the heuristic reasoning that low income, minority adults, ages 50 or older use in calculating the likelihood of infection. The data are drawn from face-to-face interviews with a sample of 134 African American and Latino residents, ages 50 to 86, living in low-income housing in Chicago, Illinois, and Hartford, Connecticut. Results show that nearly half of the study's participants thought themselves to be at some level of risk for HIV. In self-assessing their risk, they relied on seven heuristic categories: self-imperilment, social imperilment, fate, incidental contact, situational safety, medical iatrogenesis, and self-protection. These findings extend our understanding of how individuals make sense of their likelihood of experiencing a major health threat and provide insight into more effective HIV prevention programming for older adults.
The Journal of the Association of Nurses in AIDS Care: JANAC 22(1):26-37. · 0.96 Impact Factor
