Journal of urban health : bulletin of the New York Academy of Medicine
-
Respondent driven sampling (RDS) has been used in several counties to sample injecting drug users, sex workers (SWs) and men who have sex with men and as a means of collecting behavioural and biological health data. We report on the use of RDS in three separate studies conducted among SWs between 2004 and 2005 in the Russian Federation, Serbia, and Montenegro. ⋯ The highly controlled and hidden nature of SW organizations and weak SW social networks in the region can combine to undermine assumptions underpinning the feasibility of RDS approaches and potentially severely limit recruitment. We discuss the implications of these findings for recruitment and the use of monetary and non-monetary incentives in future RDS studies of SW populations in Eastern Europe.
-
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. ⋯ 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.
-
Research on behavioral HIV risk reduction interventions for injection drug users (IDUs) has focused on primary outcomes (e.g., reduced injection drug use, increased condom use) but has not fully examined the respective roles played by intervention components on these primary outcomes. In this paper, we present a structural equation modeling (SEM) approach in which we specify the causal pathways leading from theory-based intervention components to risk reduction outcomes among a sample of primarily IDUs (n = 226) participating in an inner-city community-based methadone maintenance program. Similar pathways were found leading to both drug- and sexual-related risk reduction outcomes. ⋯ Findings also indicate that our intervention may be optimized by focusing more on participants' risk reduction motivation within the sexual-related content and placing equivalent emphasis on participants' risk reduction knowledge, motivation, and behavioral skills within the drug-related content. By quantifying the specific linkage between intervention components and risk reduction outcomes, our SEM findings offer empirical guidance for optimizing this intervention. This strategy may also serve as a useful theory- and data-driven means to inform the refinement of other behavioral interventions.
-
Census data are widely used for assessing neighborhood socioeconomic context. Research using census data has been inconsistent in variable choice and usually limited to single geographic areas. This paper seeks to a) outline a process for developing a neighborhood deprivation index using principal components analysis and b) demonstrate an example of its utility for identifying contextual variables that are associated with perinatal health outcomes across diverse geographic areas. ⋯ Component loadings were consistent both within and across study areas (0.2-0.4), suggesting that each variable contributes approximately equally to "deprivation" across diverse geographies. The deprivation index was associated with the unadjusted prevalence of preterm birth and low birth weight for white non-Hispanic and to a lesser extent for black non-Hispanic women across the eight sites. The high correlations between census variables, the inherent multidimensionality of constructs like neighborhood deprivation, and the observed associations with birth outcomes suggest the utility of using a deprivation, index for research into neighborhood effects on adverse birth outcomes.