The Effects of Two Community-Based Participatory Action Research Programs on Violence Outside of and in School Among Adolescents and Young Adults in a Latino Community.

PURPOSE: Violence is the leading cause of death among adolescents and young adults in the Americas. Community-Based Participatory Action Research engaged youth and parents to develop and implement two interventions. A Violence Prevention Program (VPP) focused on risk factors for violence, and a Positive Youth Development Program (PYDP) focused on protective factors. Program effects on violence outside of and in school were assessed at 6 and 12 months. METHODS: Both interventions included an 8-week internet-based program and an in-person youth summit. Participants were prospectively randomized twice, first to the VPP and a no-VPP control group and again to the PYDP and a no-PYDP control group. Participants self-reported violence outside of and in school through self-administered baseline surveys with repeat assessments at 6 and 12 months. Analysis of covariance models examined VPP and PYDP effects on violence. RESULTS: The analysis sample was 86% Latino, 56% female, 36% aged 10-13 years, 45% aged 14-18, and 19% aged 19-23 years. Analysis of covariance models of violence outside of school demonstrated small program interaction effects at 6 months (partial eta2 = .030; p = .007) and small VPP effects at 12 months (partial eta2 = .023; p = .025). Models of violence in school demonstrated small PYDP effects at 6 months (partial eta2 = .023; p = .018). CONCLUSIONS: Community-Based Participatory Action Research engaging adolescents, young adults, and parents to address locally relevant health issues can have multiple benefits. In this study, a VPP had positive effects on violence outside of school at 12 months, and a PYDP had positive effects on violence in school at 6 months.

A prospective randomized controlled trial of an interpersonal violence prevention program with a Mexican American community.

Using methods of community-based participatory research, a prospective randomized controlled trial of a violence prevention program based on Latino cultural values was implemented with elementary school children in a Mexican American community. Community members participated in intervention program selection, implementation, and data collection. High-risk students who participated in the program had greater nonviolent self-efficacy and demonstrated greater endorsement of program values than did high-risk students in the control group. This collaborative partnership was able to combine community-based participatory research with a rigorous study design and provide sustained benefit to community partners.

Latino adolescent mothers and fathers in south Texas managing violence.

During the course of this study young Latino parents living in San Antonio, TX shared their stories. Their stories draw attention to the multiple forms of violence they experienced in the past, continue to experience, and are forced to manage. Their lives occur within the context of enduring social disparities and exposure to violence. At a young age they develop strategies to manage violence, but new challenges with violence manifest themselves as they enter into intimate partner relationships. For some of these youth, parenthood is perceived as a transforming experience that offers an opportunity for a positive change in their life trajectory. They recognize the need to find non-violent ways to manage their relationships with their intimate partner and their children. Culturally-appropriate intervention strategies that focus on developing relationships of equality and balance are needed.

Mexican-American neighborhood's social capital and attitudes about violence.

Measurement of the effectiveness of violence prevention interventions is in a developmental phase. Social capital provides a framework within which to examine this topic from a community perspective. The purpose of this study was to examine the relationships among three measures of social capital and attitudes about violence among Mexican-Americans. A cross-sectional survey was conducted of households randomly selected by block in two adjacent Mexican-American communities. Demographics, attitudes about and experiences with violence, and three measures of social capital (collective efficacy, neighborhood block conditions, community integration) were assessed. Descriptive, bivariate, and logistic regression analyses were used to examine indicators of violence attitudes and experiences. Of the 473 respondents who completed the survey, 323 (68%) were female, 393 (83%) were Mexican-American, 395 (84%) were born in the US, and 346 (72%) owned their own homes. Participants with high measures of collective efficacy were 1.68 times more likely to have negative attitudes about violence (CI 1.06-2.65) and 15.25 times more likely to have negative attitudes about couple violence (CI 9.05-25.74). Participants with high scores on neighborhood block conditions were 2.33 times more likely to have negative attitudes about couple violence (CI 1.40-3.87). Scores on community integration were not significant indicators of participants' tolerance and experiences with violence. Two measures of social capital were positively associated with and predictive of negative attitudes toward violence. The results suggest that primary violence prevention programs in Mexican-American communities should focus on strengthening a sense of collective efficacy and improving neighborhood conditions.

SAFE TEENS: facilitators of and barriers to adolescent preventive care discussions.

BACKGROUND AND OBJECTIVES: This study's goal was to describe the topics discussed during adolescent preventive care visits and to identify facilitators and barriers of these discussions among physicians in family medicine residency programs. METHODS: Forty-six family physicians in five residency programs used SAFE TEENS study cards to record data during 321 visits with adolescents ages 11--21 years. The study cards included a checklist of 31 potential topics organized under 10 categories. Closed- and open-ended questions were used to explore facilitators and barriers. RESULTS: The topics most frequently discussed were under the categories of toxins (tobacco, alcohol, and drugs), environment (school, home, and friends), sexuality, and exercise. Physicians were more likely to conduct preventive care discussions in the clinical context of a physical examination and with a new patient. Parents being present for part of the visit, a reminder system, and the recognition of developmental stage were also significant facilitators. The presence of competing demands was the strongest barrier. CONCLUSIONS: To increase the number of adolescent preventive care discussions, family medicine educators should stress that visits with established patients and visits for reasons other than a physical examination are also opportunities to provide preventive care. The development of electronic reminder systems would also be useful.

Healing wounded relationships to reduce Latino youth violence.

Latino male youth in the United States are disproportionately affected by violence. This study explores the experiences that young Latino males in a long-term correctional treatment center have had with violence. An iterative qualitative research design was used to guide sequential periods of data collection and analysis. Data was gathered through the use of open-ended, semi-structured group and individual interviews. The information that these young men shared about their lives both in and out of the facility highlight the importance of healing wounded relationships. Long-term interventions that focus on healing, strengthening, and building the relationships that high-risk Latino youth have with caring adults will help to decrease their risk of suffering further violence-related morbidity and mortality.

Community-academic research partnerships with vulnerable populations.

Community-academic research partnerships have evolved as a multidisciplinary approach to involve those communities experiencing health disparities in the development, implementation, and evaluation of health interventions. Community-academic partnerships are intended to bring together academic researchers and communities to share power, establish trust, foster colearning, enhance strengths and resources, build community capacity, and address community-identified needs and health problems. The purpose of this chapter is to review the current state of community-academic research partnerships in the United States and Canada. We discuss contextual issues; present a review of the current literature; identify the major strengths, challenges, and lessons learned that have emerged during the course of these research collaborations; and explore implications for future research and policy.

Approaches to community nursing research partnerships: a case example.

Every community is unique and has special strengths and health-related needs, such that a community-based participatory research partnership cannot be formed and implemented in a predetermined, step-by-step manner. In this article, we describe how the Community Partnership Model (CPM), designed to allow flexible movement back and forth through all action phases, can be adapted to a variety of communities. Originally developed for nursing practice, the CPM has evolved into approaches for the collaborative initiation and maintenance of community partnerships. The model is informed by the recognition that cultural, social, economic, and knowledge backgrounds may vary greatly between nurse researchers and their community partners. The Familias En Acción violence prevention project exemplifies the use of the CPM in a transcultural partnership formation and implementation process. The collaborative approaches of the model guide community and research partners to interconnect and move flexibly through all partnership phases, thereby facilitating sustainability and community self-advocacy.

High school students in a health career promotion program report fewer acts of aggression and violence.

PURPOSE: This study examined the effects of two school-based programs on the perpetration of nonphysical aggression, physical violence, and intimate partner violence among high-risk secondary school students in an economically disadvantaged and predominantly Latino school district. The intervention program was El Joven Noble, and the control program was the Teen Medical Academy. METHODS: The study used a repeated-measures quasi-experimental intervention/control design. The participants self-reported the previous 30 days' acts of nonphysical aggression, physical violence, and intimate partner violence at baseline and at 3 and 9 months after enrollment. Program- and grade-level effects at 3 and 9 months were examined using three-factor analyses of covariance models with one factor for repeated measures. The covariate in each of the models was the baseline measure of the dependent outcomes. RESULTS: No significant baseline differences were found between the participants in the intervention (n = 96) and control (n = 127) programs. At 9 months after enrollment in the study, high school students who participated in the Teen Medical Academy reported fewer acts of nonphysical aggression (p < .001) and physical violence (p = .002) than high school students who participated in El Joven Noble. Students who participated in the Teen Medical Academy also reported fewer acts of intimate partner violence (p = .02) than students who participated in El Joven Noble. CONCLUSIONS: High school students who participated in a health career promotion program reported fewer acts of aggression and violence as compared with high school students who participated in a culturally tailored character development program.

The Teen Medical Academy: using academic enhancement and instructional enrichment to address ethnic disparities in the American healthcare workforce.

PURPOSE: A worsening adolescent health disparity issue in the United States is the significant underrepresentation of ethnic minority youth in higher medical education. The Teen Medical Academy (TMA) was developed to increase the number and quality of underrepresented ethnic minority applicants from economically disadvantaged backgrounds. In this study we examine whether participation in the TMA is associated with greater interest, confidence, belongingness, and achievement motivation as related to health careers. METHODS: Self-administered surveys were mailed to all of the 361 youth who had applied to the first 3 years of the TMA. One-way analysis of variance and multivariate backward stepwise linear regression models were used to examine program effects on attitudes. RESULTS: Among our sample of economically disadvantaged ethnic minority students (N = 232), greater participation in the TMA independently and significantly predicted the following: greater interest in medical and allied health careers; confidence in the ability to achieve a health career, to learn surgical skills, and to learn other health career-related technical skills; sense of belongingness in a health career and among doctors; and commitment to achieve a health career and meaningful work. Higher grade point average and greater involvement in extracurricular health career programs was also positively associated, whereas increasing age was negatively associated with the outcome variables. CONCLUSIONS: The TMA offers a successful model of collaboration between economically disadvantaged ethnic minority communities and academic institutions of higher medical education. The TMA can be easily replicated by family medicine, pediatric, and internal medicine residency programs throughout the U.S.