Cubilla-Batista, I, Andrade, EL, Cleary, SD, Edberg, MC, Evans, WD, Simmons, LK, Sojo-Lara, G
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..
Edberg, M, Clearly, SD, Andrade, EL, Evans, WD, Simmons, L, Cubilla, I
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.
Evans WD, Andrade E, Villalba R, Cubilla I, Rivera I, Edberg M
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.
Andrade, E, Cubilla, I, Sojo-Lara, G, Simons, LB, Cleary, SD, Edberg, MC
Community engagement in identifying issues of collective concern to address health disparities is an approach that is central to conducting community-based participatory research. It is particularly important for youth to be engaged in dialogue around issues that affect their lives. Participation of this nature is understood, within a Positive Youth Development (PYD) approach, to be an element of primary prevention vis a vis health risks. Photovoice has been an increasingly used methodology to enable youth to identify and address issues relevant to their daily experiences. We implemented a six-week Photovoice project guided by a PYD approach with Latino immigrant youth (n=12) from Langley Park, MD. This article describes the experiences of facilitators in implementing the program, testing a new curriculum, and also presents results related to changes in PYD assets among participants. We also offer recommendations for future Photovoice programs with similar populations and aims.
Edberg M, Cleary SD, Andrade EL, Cubilla-Batista I, Simmons L, Gudger G
Although Latino and other immigrant populations are the driving force behind population increases in the United States, there are significant gaps in knowledge and practice on addressing health disparities in these populations. The Avance Center for the Advancement of Immigrant/Refugee Health, a health disparities research center in the Washington, D.C. area, includes as part of its mission a multi-level, participatory community intervention (called Adelante) to address the co-occurrence of substance abuse, violence, and sex risk among Latino immigrant youth and young adults. Research staff and community partners knew that the intervention community had grown beyond its Census-designated place (CDP) boundaries, and that connection and attachment to community were relevant to an intervention. Thus, in order to understand current geographic and social boundaries of the community for sampling, data collection, intervention design, and implementation, the research team conducted an ethnographic study to identify self-defined community boundaries, both geographic and social. Beginning with preliminary data from a pilot intervention and the original CDP map, the research included: geo-mapping de-identified addresses of service clients from a major community organization, key informant interviews, and observation and intercept interviews in the community. The results provided an expanded community boundary profile and important information about community identity.
Andrade E, Evans WD, Villalba R, Edberg M, Cleary S, Cubilla I
Entertainment-education (E-E) approaches for young audiences continue to evolve in order to keep stride with younger generations’ affinity for technology. E-E and novelas have been used with a wide variety of audiences in the US, particularly hard-to-reach, Latino populations, and have demonstrated effectiveness in disseminating culturally relevant prevention information for a wide variety of health-related risk factors and behaviors. This study discusses the formative research and active engagement of Latino youth living in Langley Park, MD for the development and filming of an innovative six-episode webnovela entitled, Victor and Erika (V&E). V&E is part of a larger branding strategy of the Adelante Positive Youth Development (PYD) intervention that seeks to prevent substance abuse, sexual risk and interpersonal violence among Latino youth; V&E is also an intervention component. The V&E webnovela is a dramatic portrayal of the lives of two immigrant Latino teenagers that also disseminates risk prevention messages. The storyline represents the “turning the corner” (to a better life) theme that underlies the Adelante intervention brand. Formative research was conducted for character development (n=20) and creative development of the episodes (n=14). Results of the formative research showed that youth recommended inclusion of the following topics in V&E episodes: sex, unintended pregnancy, fidelity, trust, family dynamics, immigration status, violence, school drop-out, respect, home life, and poverty. Detailed character and episode descriptions are provided, and the implications of using the V&E series as a tool for in-person and online engagement of youth and the dissemination of prevention messages are also discussed.
Cleary S, Simmons L, Cubilla I, Andrade E, Edberg M
This case study describes the process used to obtain a representative sample in an immigrant community. A mixed-methods approach was utilized, including a geographic boundary study, abstraction of census data, key informant and brief random interviews. This information was integrated to construct a sampling frame from which a two-stage, random cluster sampling procedure was implemented. This case study illustrates the challenges of selecting a representative sample in a dynamic community to elicit valid and reliable information about the impact of a multi-level intervention on residents. In addressing this challenge we utilized a variety of methods to inform the development of the sampling frame to ensure the broadest representation of community respondents and thus the systematic delivery of the intervention.
Edberg M, Cleary S, Andrade E, Klevens J, Leiva R, Bazurto M, Rivera I, Taylor del Cid A, Montero L, Calderon M
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.
Edberg M, Cleary S, Vyas A
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.
Assessing the Impact of Family Status, Family Cohesion, and Acculturation on Youth Violence among Immigrant Latinos (Using SAFER Latinos data)
Lin S, Cleary S, Edberg M
Poster presented at George Washington University Research Days 2014
Latino youth violence is an emerging public health concern. The objective is to assess the impact of family status, family cohesion, and acculturation on youth violence among Latino immigrants in Langley Park, MD compared with a control community in Culmore, VA. Constructs were generated from survey questions to represent family support and cohesion, acculturation, and youth violence. Bivariate and multivariate regression analyses were modeled to evaluate the relationships between family support and cohesion, acculturation, and violence, after adjusting for confounders.