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Adelante Ambassadors: Using digital media to facilitate community engagement and risk-prevention for Latino youth

Barrett, N., Villalba, R., Andrade, E.L., Beltran, A., Evans, W.D.


Digital and social media are now widely used to promote engagement in health programs and improve health behaviors across a variety of age groups and domains. However, limited research exists on applying culturally relevant, new media interventions specific to Latino immigrant youth. This paper describes the pilot Adelante Youth Ambassador program for Latino immigrant youth, which used digital media and community-based participatory research to build positive youth development (PYD) assets as a prevention mechanism to reduce co-occurring health risks of substance use, sexual risk, and interpersonal violence. We worked collaboratively with adolescents to create video content as a conduit for Adelante-branded messages to be disseminated on the program’s social media platforms. Using an active audience engagement methodology, youth participants informed the development of prevention messages, scripts for the videos, and acted in videos. Participants disseminated content to their social media networks and engaged peers in dialogue about topics addressed in the videos. Using pre and post tests, we evaluated changes in PYD assets (Civic Action Competence, Confidence, Connection to Community, and Connection to Peers) and skills related to digital media use, communication, and advocacy. The program used innovative branding and social media strategies to engage Latino youth in health risk prevention.


Development of the place-based Adelante social marketing campaign for prevention of substance use, sexual risk and violence among Latino immigrant youth

Andrade, E.L., Evans, W.D., Barrett, N.D., Cleary, S.D., Edberg, M.C., Alvayero, R.D., Kierstead, E.C., Beltran, A.


Immigrant Latino youth represent a high-risk subgroup that should be targeted with health promotion efforts. However, there are considerable barriers to engagement in health-related programming. Little is known about the engagement possibilities of social marketing campaigns and digital strategies for traditionally ‘hard-to-reach’ immigrants, underscoring the importance of testing these techniques with immigrant Latino adolescents. We developed and piloted a place-based social marketing campaign in coordination with the branded, Positive Youth Development-based (PYD) Adelante intervention targeting risk factors for co-occurring youth substance abuse, sexual risk and violence. Building on prior research, we conducted a four-phase formative research process, and planned the Adelante social marketing campaign based on findings from one group interview and ongoing consultation with Adelante staff (n=8) and four focus groups with youth (n=35). Participants identified four overarching campaign themes, and suggested portrayal of resilient, proud youth who achieved goals despite adversity. Youth guided selection of campaign features and engagement strategies, including message/visual content, stylistic elements, and a mixed language approach. We developed a 12-month campaign to be delivered via print ads, multi-platform social media promotion, contests, youth-generated videos, blog posts, and text messaging. We describe the process and outcome of campaign development and make recommendations for future campaigns.


Formative Research to Design a Promotional Campaign to Increase Drinking Water among Central American Latino Youth in an Urban Area

Barrett, N., Colón-Ramos, U., Elkins, A., Rivera, I., Evans, W.D., Edberg, M.


Latinos consume more sugary drinks and less water than other demographic groups. Our objective was to understand beverage choice motivations and test promotional concepts that can encourage Central American Latino urban youth to drink more water. Two rounds of focus group discussions were conducted (n = 10 focus groups, 61 participants, 6-18 years old). Data were transcribed verbatim and analyzed using inductive and deductive coding approaches. Youth motivations for drinking water were shaped by level of thirst, weather, energy, and perceptions of health benefits. Youth were discouraged from drinking water due to its taste and perceptions of the safety and cleanliness of tap water. Youth beverage preference depended on what their friends were drinking. Availability of water versus other beverages at home and other settings influenced their choice. Promotional materials that included mixed language, informative messages about the benefits of drinking water, and celebrities or athletes who were active, energized, and drinking water were preferred. A promotional campaign to increase water consumption among these Latino youth should include bicultural messages to underscore the power of water to quench true thirst, highlight the health benefits of drinking water, and address the safety of tap water.


How Latina Mothers Navigate a ‘Food Swamp’ to Feed their Children: A PhotoVoice Approach

Colón-Ramos, U., Monge-Rojas, R., Cremm, E., Rivera, I.M., Andrade, E.L., Edberg, M.C.


OBJECTIVE: To understand how mothers who recently migrated from Central America to the USA feed their children in a neighbourhood saturated with unhealthful food choices (‘food swamp’) and to formulate a mother-driven plan of action to facilitate their acquisition of foods. Design/Setting/Subjects We purposively sampled mothers with children (<10 years old) who were recent immigrants/refugees from Central America and lived in a ‘food swamp’ neighbourhood. We used the photovoice approach to elicit textual data from thirty in-depth interviews, a participatory workshop, and visual data from photographs. Analyses were guided by the Social Ecological Framework and Social Cognitive Theory to identify barriers, facilitators and strategies that support parents in feeding their children.
RESULTS: Mothers valued foods that they considered to be ‘traditional’ and ‘healthful’. They navigated their food retail environment looking for these foods (of good quality and well-priced). Food values were reinforced by pre-migration food customs and culture, health professionals’ advice and, in some cases, by the desire to avoid conflict with their children. The neighbourhood food environment could directly influence children’s food preferences and often created conflict between what the child wanted to eat and the foods that mothers valued. Mothers in this ‘food swamp’ wanted to be engaged in addressing the selection of foods offered in schools and in neighbourhood food venues to reflect their own food values.
CONCLUSIONS: These mothers’ feeding choices were influenced directly by their food values, and indirectly by the neighbourhood and school food environments via their children’s preferences.


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

Cubilla-Batista, I., Andrade, E.L., Cleary, S.D., Edberg, M.C., Evans, W.D., Simmons, L.K., 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.

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

Edberg, M., Clearly, S.D., Andrade, E.L., Evans, W.D., 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.

Turning the Corner: Development of the Adelante Program Brand for Latino Youth

Evans, W.D., 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.

Where PYD Meets CBPR: A Photovoice Program for Latino Immigrant Youth 

Andrade, E., Cubilla, I., Sojo-Lara, G., Simons, L.B., Cleary, S.D., Edberg, M.C.


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.

Defining the ‘Community’: An Application of Ethnographic Methods for a Latino Immigrant Health Disparities Intervention

Edberg, M., Cleary, S.D., Andrade, E.L., 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.

Victor and Erika Webnovela: An Innovative Generation @ Audience Engagement Strategy for Prevention 

Andrade, E., Evans, W.D., 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.

Community Sampling: Sampling in an Immigrant Community

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.

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

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.

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

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.