An Exploration of Rural Housing Insecurity as a Public Health Problem in California's Rural Northern Counties.

Although widely acknowledged as an important social determinant of health, until recently researchers and policymakers have primarily approached housing insecurity as an urban issue, obscuring the visibility of its impacts in rural contexts, including the ways in which housing insecurity intersects with other health and structural inequities facing rural populations. Working to address this gap in the existing literature, this paper explores the experiences of housing insecurity in a rural context by reporting on an analysis of 210 in-depth interviews with 153 adults between the ages of 18-35, living in California's rural North State, a relatively overlooked far northern region of the state comprised of 12 north central and north eastern counties. Using in-depth qualitative interview data, we conducted an exploratory pattern-level analysis of participants' narratives structured by four dimensions of housing insecurity defined in the literature (housing affordability, housing stability, housing conditions, and neighborhood context). Drawing attention to the pervasiveness of rural housing insecurity within our sample, this analysis highlights the unique ways in which rurality creates distinct experiences not currently captured in the existing literature. Further research is needed across different types of rural communities to better understand the various ways that housing insecurity affects the everyday lives and health of rural residents. By grounding research within the experiences of rural residents, we are better able to respond to the crisis of rural housing insecurity and develop solutions that are tailored to rural residents' unique needs.

RETHINKING INTOXICATED SEXUAL ENCOUNTERS.

Social research on alcohol and sexual encounters has tended to be siloed into several different research endeavors, each addressing separate aspects of wanted and unwanted sexual encounters. While sociologists have focused on the patterns of social interaction, status competition, and emotional hierarchies of sexual encounters, they have left the role of alcohol intoxication largely unexamined. Conversely, the two dominant approaches to sexual encounters within alcohol research, the theories of alcohol myopia and alcohol expectancy, while focusing on alcohol have tended to take little account of the socio-relational dynamics and gendered meanings involved in those encounters. Our aim in this theoretical paper is to begin to bring together some of the concepts from these different research strands in examining how the social processes of intoxication potentially impact heteronormative sexual scripts and hence notions of femininity and masculinity among cisgender, heterosexual women and men. Our discussion is focused on the concepts of ritual and scripts; power, status, and hierarchies; and socio-spatial contexts, which are central to an understanding of the gendered and embodied social practices that take place within intoxicated sexual events; the emotional nature of the socio-spatial contexts within which they occur; and the socio-structural conditions that frame these events.

Pathways of Nicotine Product Use: A Qualitative Study of Youth and Young Adults in California.

INTRODUCTION: Existing research on youth's adoption of alternative nicotine delivery systems (ANDS) has focused on identifying pathways of nicotine product use, specifically examining whether vaping encourages progression to smoking. Few studies have considered other pathways of initiation. Qualitative studies suggest that meanings of vaping vary significantly, suggestive of the need for a more nuanced understanding of the role of vaping for youth with different pathways into vaping and smoking. METHODS: We conducted in-depth qualitative interviews with 49 Californian youth between 15 and 25 years old who reported ever vaping nicotine to gain a deeper understanding of their initiation pathways of vaping and smoking, paying special attention to youth's experiences and reasons for ANDS initiation and use. Categorizing participants into initiation pathways by self-reported use and age of initiation of ANDS and cigarettes, we then compared the meaning and role of vaping across three distinct pathways of use: (1) smoking to vaping, (2) vaping to smoking, and (3) vaping only. RESULTS: The most common pathway reported was smoking to vaping (74%), eight participants began vaping before smoking, and five participants reported only vaping but never smoking. Analysis of participants' narratives emphasized that youth in our study, regardless of initiation pathway, were generally aware of the health consequences of smoking and negotiated their use of nicotine products considering relative risks. CONCLUSION: Findings from this study suggest that ANDS serve as a transitional tool for youth who are keenly aware of the health consequences of smoking, thus challenging conventional discourses about ANDS as a threat to youth's health. IMPLICATIONS: This qualitative study queries concerns about the potential of alternative nicotine delivery systems (ANDS) to serve as a gateway into cigarette smoking for youth and young adults. Findings suggest that most of the youth participants discussed and considered relative risks in their pathways of initiation, highlighting the need to acknowledge harm reduction in constructing public health messaging and policies for smoking cessation.

The Role of Multiple Social Identities in Discrimination and Perceived Smoking-Related Stigma among Sexual and Gender Minority Current or Former Smokers.

AIMS: We investigated how intersections of being a racial minority (i.e. being African American) and economically-disadvantaged (i.e. housing insecurity) may influence experiences with discrimination and perceptions of smoking-related stigma among sexual and gender minority (SGM) current and former smokers. Methods: Survey data were collected from 227 SGM current and former smokers in California (19-65 years old), oversampling African American participants. Participants reported their race, ethnicity, past month housing insecurity, number of lifetime experiences with SGM discrimination, and perceptions of smoking-related stigma. FINDINGS: Using univariate General Linear Models and controlling for age, ethnicity, and SGM visibility, we found a significant interaction between being African American and facing housing insecurity on experiences with SGM discrimination [F(1,220)=7.21, p=0.01], perceived smoker stigma [F(1,220)=5.48, p=0.02], perceived differential treatment due to smoking [F(1,220)=10.03, p=0.00], and social withdrawal from non-smokers [F(1,220)=6.18, p=0.01]. These interactions suggest that economically-disadvantaged African American SGM current or former smokers experience increased levels of discrimination and perceive more smoking-related stigma compared to other SGM current and former smokers. Conclusions: Results suggest that people's multiple identities intersect to intensify oppression and inequities for some people and raise questions about the unintended consequences of stigmatizing smokers for reducing smoking among SGM adults.

The "here and now" of youth: the meanings of smoking for sexual and gender minority youth.

BACKGROUND: The mainstream tobacco field in the USA tends to situate youth as passive, particularly in terms of their susceptibility to industry manipulation and peer pressure. However, failing to acknowledge youths' agency overlooks important meanings youth ascribe to their tobacco use and how those meanings are shaped by the circumstances and structures of their everyday lives. METHODS: This article is based on analysis of 58 in-depth qualitative interviews conducted with sexual and gender minority youth living in the San Francisco Bay area in California. Topics covered in interviews focused on meanings of tobacco in the lives of youth. Interviews lasted approximately 2.5 h and were transcribed verbatim and linked with ATLAS.ti, a qualitative data analysis software. Following qualitative coding, narrative segments were sorted into piles of similarity identified according to principles of pattern-level analysis to interpret to what extent meanings of smoking for young people may operate as forms of resistance, survival, and defense. RESULTS: Analysis of our participants' narratives highlights how smoking is connected to what Bucholtz calls the "'here-and-now' of young people's experience, the social and cultural practices through which they shape their worlds" as active agents (Bucholtz, Annu Rev Anthropol31:525-52, 2003.). Specifically, narratives illustrate how smoking signifies "control" in a multitude of ways, including taking control over an oppressor, controlling the effects of exposure to traumatic or day-to-day stress, and exerting control over the physical body in terms of protecting oneself from violence or defending one's mental health. CONCLUSIONS: These findings call into question the universal appropriateness of foundational elements that underlie tobacco control and prevention efforts directed at youth in the USA, specifically the focus on abstinence and future orientation. Implications of these findings for research, prevention, and policy are discussed, emphasizing the risk of furthering health inequities should we fail to acknowledge the "here and now" of youth.

A tool for the consensual analysis of decision-making scenarios.

The authors believe there is a need for novel ways of enhancing professional judgment and discretion in the contemporary healthcare environment. The objective is to provide a framework to guide a discursive analysis of an ongoing clinical scenario by a small group of healthcare professionals (4-12) to achieve consensual understanding in the decision-making necessary to resolve specific healthcare inadequacies and promote organisational learning. REPVAD is an acronym for the framework's five decision-making dimensions of reasoning, evidence, procedures, values, attitudes and defences. The design is set out in terms of well-defined definitions of the dimensions, a rationale for using REPVAD, and explications of dimensions one at a time. Furthermore, the REPVAD process of application to a scenario is set out, and a didactic scenario is given to show how REPVAD works together with a sample case. A discussion is fleshed out in four real life student cases, and a conclusion indicates strengths and weaknesses and the possibility of further development and transferability. In terms of findings, the model has been tried, tested and refined over a number of years in the development of advanced practitioners at university healthcare faculties in two European countries. Consent was obtained from the four participating students.

Conceptualizing ethnicity in alcohol and drug research: Epidemiology meets social theory.

Since the 1990s, social scientists have rejected notions of ethnicity as something static and discrete, instead highlighting the context-dependent and fluid nature of multiple identities. In spite of these developments, researchers within the substance use fields continue to assess ethnic group categories in ways that suggest little critical reflection in terms of the validity of the measurements themselves, nor the social, bureaucratic, and political decisions shaping standard measures of ethnicity. This paper highlights these considerations, while also acknowledging the role of socially-delineated ethnic categorizations in documenting health inequities and social injustices. We call on researchers in alcohol and drugs research to critically appraise their use of ethnic categorizations, querying how to best measure ethnicity within their own studies in ways that are justified beyond simplified explanations of social convention and that "do no harm" in terms of perpetuating racism and obscuring the roots causes of social and health problems related to alcohol and drugs.

"Get Off Me": Perceptions of Disrespectful Police Behavior among Ethnic Minority Youth Gang Members.

Recent media accounts have highlighted issues of use and abuse of police force and policing practices targeted at ethnic minorities within inner city areas. To date, little research has focused specifically on the experiences and perceptions of youth gang members in dealing with police. Using data from 253 in-depth interviews with ethnic minority San Francisco-based youth gang members, we examine perceptions of respectful and disrespectful police behavior. Premised on a procedural justice model (Tyler, 2006), we explore how frequently disrespectful police behavior is reported and how these negative experiences shape gang members' attitudes towards the police more generally. We refine our investigation by comparing adverse encounters to examples in which gang members are treated respectfully. Using a data-driven inductive and qualitative theory testing deductive approach, our data revealed that male and female gang members regularly experience disrespectful police behavior in terms of physical and verbal abuse. Our findings indicate that these exchanges contribute to negative attitudes, fear, and distrust of police, while respectful interactions are meaningful and can contribute to positive attitudes towards officers.

Tobacco Denormalization as a Public Health Strategy: Implications for Sexual and Gender Minorities.

Although the population-level success of tobacco denormalization is widely accepted, it remains unclear whether these strategies alleviate health inequities for sexual and gender minorities. The high risk of smoking among sexual and gender minorities together with research that documents a relationship between stigma-related processes and smoking prevalence for these groups raises questions about whether tobacco-related stigma intensifies the disadvantages associated with the stigmas of other social identities. We have not adequately considered how tobacco-related stigma overlaps with other social identity stigmas. Given concerns about the intensification of inequality, this type of inquiry has important implications for understanding both the effectiveness and limitations of tobacco denormalization strategies for sexual and gender minorities and identifying those tobacco prevention, treatment, and public health policies that work to ameliorate health inequities.

Drug Sales, Gender, and Risk: Notions of Risk From the Perspective of Gang-Involved Young Adults.

We examine gender and meanings of risk in interviews (2007-2010) with gang-involved young men and women (n = 253) engaged in illicit drug sales in San Francisco, California. The in-depth interviews from this NIDA-funded study were coded using the software NVivo to identify patterns and themes. We examine their interpretations of the risks of drug-selling and their narratives about gender differences in these risks. We find distinct discourses regarding the role of femininities and masculinities and male and female bodies in shaping risk as well as the nexus between gender, family, and risk for female drug sellers.

"A cool little buzz": alcohol intoxication in the dance club scene.

In recent years, there has been increasing concern about youthful "binge" drinking and intoxication. Yet the meaning of intoxication remains under-theorized. This paper examines intoxication in a young adult nightlife scene, using data from a 2005-2008 National Institute on Drug Abuse-funded project on Asian American youth and nightlife. Analyzing in-depth qualitative interview data with 250 Asian American young adults in the San Francisco area, we examine their narratives about alcohol intoxication with respect to sociability, stress, and fun, and their navigation of the fine line between being "buzzed" and being "wasted." Finally, limitations of the study and directions for future research are noted.

Endogenous production of fibronectin is required for self-renewal of cultured mouse embryonic stem cells.

Pluripotent cells are attached to the extracellular matrix (ECM) as they make cell fate decisions within the stem cell niche. Here we show that the ubiquitous ECM protein fibronectin is required for self-renewal decisions by cultured mouse embryonic stem (mES) cells. Undifferentiated mES cells produce fibronectin and assemble a fibrillar matrix. Increasing the level of substrate fibronectin increased cell spreading and integrin receptor signaling through focal adhesion kinase, while concomitantly inducing the loss of Nanog and Oct4 self-renewal markers. Conversely, reducing fibronectin production by mES cells growing on a feeder-free gelatin substrate caused loss of cell adhesion, decreased integrin signaling, and decreased expression of self-renewal markers. These effects were reversed by providing the cells with exogenous fibronectin, thereby restoring adhesion to the gelatin substrate. Interestingly, mES cells do not adhere directly to the gelatin substrate, but rather adhere indirectly through gelatin-bound fibronectin, which facilitates self-renewal via its effects on cell adhesion. These results provide new insights into the mechanism of regulation of self-renewal by growth on a gelatin-coated surface. The effects of increasing or decreasing fibronectin levels show that self-renewal depends on an intermediate level of cell-fibronectin interactions. By providing cell adhesive signals that can act with other self-renewal factors to maintain mES cell pluripotency, fibronectin is therefore a necessary component of the self-renewal signaling pathway in culture.

Unlocking the spiritual with club drugs: a case study of two youth cultures.

Researchers have become increasingly interested in the link between spirituality and the use and misuse of drugs as well as intervention. First, studies have pointed to spirituality and religious involvement as a protective factor against substance use. Second, the quest for spirituality can play a role in drug use. This article has two aims. First, it seeks to examine the features of spirituality connected with both recovery from drug misuse and psychoactive drug use. Second, it seeks to understand the latter in the context of contemporary youth culture. We draw from our comparative study on club drug use among young people in two cultural locales-San Francisco and Hong Kong, where two different drugs, ecstasy and ketamine, have become associated in different dance party settings with a spiritual awakening of self-awareness and liberation.

Food choice as a multidimensional experience. A qualitative study with young African American women.

As obesity persists in the United States, many public health interventions have been conceived to encourage people to change their diets. These interventions are based on encouraging people to prioritize healthier alternatives in food choice. However a consideration of the existing but limited literature on food choice for diverse populations renders such an assumption problematic. This qualitative study examined the food choices of a population most at risk for obesity - low-income African American women - by considering psychological factors, social and cultural meanings of foods, and structural conditions that shape how women decide what to eat. Interviews revealed the complexity of their food choices, illustrating the extent to which multiple influences operate simultaneously on food choice decisions. Implications for obesity prevention are discussed, in particular highlighting the problem that some types of public health interventions do not correspond to the lived experiences of the populations they intend to target.

Consumption, drugs and style: Constructing intra-ethnic boundaries in Asian American youth cultures.

Based on 250 qualitative interviews with Asian American young men and women in the dance/club scenes in the San Francisco area, we examine the interplay between consumption, style and taste cultures with issues of ethnic identity, gender and acculturation. We explore the ways that consumption and taste markers (e.g. fashion, cars, music and drugs) are used to establish or negotiate symbolic boundaries between groups in this youth culture. The picture they paint of the dance scene is one less about cohesiveness and unity and more about divisions and boundaries, not only between but also significantly within ethnic groupings. The choice of drugs and ways of exhibiting intoxication are among the types of consumption that the young people drew upon to mark symbolic boundaries and establish identities. The young men and women in this study discuss a number of key boundaries in the scene, e.g. between FOBs and twinkies, between pretty boys and thugs, as they attempt to establish the cultural legitimacy of their own styles of Asian American identities.

Moving beyond the gang-drug-violence connection.

The aim of this article is to reflect on the conceptual and methodological developments of our gang research over the past 20 years. We have conducted a large number of consecutive qualitative studies on youth gangs, drugs and alcohol in one urban locale for over two decades and have amassed a data set of over 2000 qualitative interviews. We have kept pace with the social changes in San Francisco as they have impacted and shaped youth gangs and their members' lives. However, these changes have not only occurred in the social context of gang members' lives, but have also occurred in our own thinking about how to conceptualize research on gangs. We have broadened our analysis of gang members' lives and incorporated new theoretical developments from research outside of the gang field. In addition to this shift in emphasis, our overall aim has been to redirect the research focus on youth gangs from a social problem and criminological perspective to a more sociological approach in which these youth are situated within an everyday perspective. With these overall issues in mind, we see this discussion as taking stock of the nature of gang research in the past, present and future.

"BLURRING THE LINE:" INTOXICATION, GENDER, CONSENT AND SEXUAL ENCOUNTERS AMONG YOUNG ADULTS.

Social concern about sexual practices and sexual consent among young adults has increased significantly in recent years, and intoxication has often played a key role in such debates. While many studies have long suggested that alcohol plays a role in facilitating (casual) sexual encounters, intoxication has largely either been conceptualized as a risk factor, or researchers have focused on the pharmacological effects of alcohol on behaviors associated with sexual interaction and consent. To date little work has explored how young adults define and negotiate acceptable and unacceptable levels of intoxication during sexual encounters, nor the ways in which different levels of intoxication influence gendered sexual scripts and meanings of consent. This paper explores the latter two research questions using data from 145 in-depth, qualitative interviews with cisgender, heterosexual young adults ages 18-25 in the San Francisco Bay Area. In examining these interview data, by exploring the relationship between intoxication and sexual consent, and the ways in which gender plays out in notions of acceptable and unacceptable intoxicated sexual encounters, we highlight how different levels of intoxication signal different sexual scripts. Narratives about sexual encounters at low levels of intoxication highlighted the role of intoxication in achieving sexual sociability, but they also relied on the notion that intoxicated consent was dependent on the social relationship between the partners outside drinking contexts. Narratives about sexual encounters in heavy drinking situations were more explicitly gendered, often in keeping with traditionally gendered sexual scripts. In general we found that when men discussed their own levels of intoxication, their narratives were more focused on sexual performance and low status sex partners, while women's and some men's narratives about women's levels of intoxication were focused on women's consent, safety, and respectability. Finally, some participants rely on 'consent as a contract' and 'intoxication parity'- the idea that potential sexual partners should be equally intoxicated - to handle relations of power in interpersonal sexual scripts. Since these notions are sometimes deployed strategically, we suggest that they may serve to "black-box" gendered inequalities in power between the parties involved.

Food in the family. Bringing young people back in.

This article analyzes eating and beliefs about family meals in the qualitative interview narratives of 30 "at-risk" gang-involved young women in the San Francisco Bay Area. We begin our examination of consumption practices with a study of households and identify three major types-extended, single-parent and blended. Within these households, food purchasing and consumption activities are varied, and in many cases, our respondents rely upon extended family members and non-kin relations for support. In examining eating within the family, we identify two sets of practices and meanings: eating alone, and eating with others. Eating alone is symbolic of independence from one's family of origin, or is the result of familial conflict at the dinner table; however, it does not necessarily change our respondents' eating patterns. Eating with others in the family remains important, and many of the young women value family meals, although there are significant obstacles to eating regularly with the entire nuclear family. Many of these young women play an important role in the purchasing and preparation of food for family members as well. This paper highlights the importance of understanding family eating practices from the perspective of young people in the family, whose contribution to family ingestive practices has tended to be underestimated in much of available research literature.