Applying Community-Based Participatory Approaches to Addressing Health Disparities and Promoting Health Equity.

This special issue highlights work that contributes to our understanding of health disparities and community-based participatory research (CBPR) approaches to promoting health equity across diverse populations and issues that matter to communities. We take on a global perspective, and thus, various efforts across international contexts are illustrated. Articles elucidate a variety of CBPR approaches designed to empower and build capacity among individuals and communities in order to seek changes at the level of community practices, programs, and systems. These articles span across diverse populations-children, youth, and families; adults and older adults; immigrants; refugees; Black people; Latinx people; Native Americans/Indigenous people, the Roma community; Muslim women, and women with disabilities-experiencing inequities of interest to community psychologists and other researchers and practitioners.

Muslims and mental health concerns: A social ecological model perspective.

Muslims in the United States experience many psychosocial issues and underutilize mental health services. This study sought to systematically identify the common issues and strengths of the Muslims affiliated with a college in the Southeast region of the United States and address them accordingly. A survey comprising 33 items and 2 open-ended questions regarding common issues and strengths was constructed. A total of 116 participants completed the survey. The overall rating for items was quite high, whereas the satisfaction rating was very low. The most important item was, "You have prayer places/rugs, ablution stations, and water in restrooms," with an importance rating of 94.52% and a satisfaction rating of 20.50%. Four items regarding mental health were rated as the least important, and participants reported lack of knowledge regarding mental health services. This is the first study that includes a list of common concerns and strengths of the Muslim communities affiliated with colleges in the United States.

Disposal of prescription drugs by parents of middle and high school students.

To determine how parents dispose of unused prescription medications and correlates of disposal, we recruited 3,043 parents of adolescents to complete a survey. Multivariate and multinomial logistic regression was conducted to examine correlates of disposal of prescription medication. Only 17.8% of parents in a household prescribed a controlled medication in the past year disposed of unused medications. Of those, 36.7% used organized disposal (e.g., take-back event or drop box) and 63.3% disposed of medications at home. Organized disposal was associated with awareness of disposal opportunities. Increasing awareness of organized disposal opportunities is a promising mechanism to increase their use by parents.

Social host policies and underage drinking parties.

Social host policies focused on underage drinking parties are implemented to reduce social availability of alcohol and high-risk drinking by adolescents in private locations. We examined the policies' relationship with drinking location, peer-group drinking size, heavy episodic drinking, and nonviolent consequences. Cross-sectional data from 11,205, 14-20-year olds, were analyzed using multilevel modeling. Policies were not associated with drinking location, decreased heavy episodic drinking, or nonviolent consequences. However, adolescents from communities with a preexisting policy had lower odds of drinking in large peer groups compared to those from communities without a policy at baseline. Additional research is needed to examine their effectiveness. The study's limitations are noted.

Accomplishing structural change: identifying intermediate indicators of success.

Coalitions are routinely employed across the United States as a method of mobilizing communities to improve local conditions that impact on citizens' well-being. Success in achieving specific objectives for environmental or structural community change may not quickly translate into improved population outcomes in the community, posing a dilemma for coalitions that pursue changes that focus on altering community conditions. Considerable effort by communities to plan for and pursue structural change objectives, without evidence of logical and appropriate intermediate markers of success could lead to wasted effort. Yet, the current literature provides little guidance on how coalitions might select intermediate indicators of achievement to judge their progress and the utility of their effort. The current paper explores the strengths and weaknesses of various indicators of intermediate success in creating structural changes among a sample of 13 coalitions organized to prevent exposure to HIV among high-risk adolescents in their local communities.

Conflict transformation, stigma, and HIV-preventive structural change.

Over the prior decade, structural change efforts have become an important component of community-based HIV prevention initiatives. However, these efforts may not succeed when structural change initiatives encounter political resistance or invoke conflicting values, which may be likely when changes are intended to benefit a stigmatized population. The current study sought to examine the impact of target population stigma on the ability of 13 community coalitions to achieve structural change objectives. Results indicated that coalitions working on behalf of highly stigmatized populations had to abandon objectives more often than did coalitions working for less stigmatized populations because of external opposition to coalition objectives and resultant internal conflict over goals. Those coalitions that were most successful in meeting external challenges used opposition and conflict as transformative occasions by targeting conflicts directly and attempting to neutralize oppositional groups or turn them into strategic allies; less successful coalitions working on behalf of stigmatized groups struggled to determine an appropriate response to opposition. The role of conflict transformation as a success strategy for working on behalf of stigmatized groups is discussed.

The effects of pedestrian gestures on driver yielding at crosswalks: A systematic replication.

Applied research on decreasing pedestrian injuries often focuses on how to increase driver yielding behavior but rarely studies what pedestrians can do to increase their safety. There is a lack of empirical research focusing on how pedestrians can effectively signal their need to cross the street when there is no traffic light directing the pedestrian and oncoming traffic. As a replication and extension of Crowley-Koch et al. (2011), this study examined the effects of two pedestrian gestures, an extended arm and raised hand, on driver yielding behavior at 3 crosswalks in Oklahoma City. Research assistants implemented gestures prior to crossing the street as cars approached the crosswalk. Data were collected on the percentage of drivers yielding to the pedestrian. Both pedestrian gestures increased driver yielding across all 3 sites when compared to no gesture. Results were discussed in terms of future research and practical solutions towards increasing pedestrian safety.

Examining implementation and effects of a comprehensive community intervention addressing type 2 diabetes among high-risk minority patients in Durham County, NC.

Type-2 diabetes affects millions of people. Racial minorities are at higher risk for developing diabetes and suffering complications. Duke University and its partners built a team to improve population-level health outcomes and reduce health disparities in Durham County, NC. An empirical case study design was used to examine the Durham Diabetes Program (DDP) and its effects on emergency department (ED) visits and hospital admissions (HAs). High-risk program participants (N = 200) were enrolled into the DDP using a risk algorithm. Culturally competent teams delivered various intervention components that were anchored in behavior change strategies (e.g. diabetes self-management education and support, enhancing clinical care, community mobilization, and health system/community transformation). More than a hundred community/system changes were implemented as part of the DDP. Further, the DDP was associated with decreased ED visits (by 34%) and HAs (by 40.5%). This research can inform the way diabetes is assessed and interventions are delivered.

Strengthening Our Collaborative Approaches for Advancing Equity and Justice.

The Principles for Collaborating for Equity and Justice are explicit about addressing social and economic injustice, structural racism, and community organizing to facilitate resident power and ownership. They also focus on structural change, an acknowledgment of complexity, and the need to thoughtfully build on decades of practice and scholarship on collaborating for community change. This special theme issue of Health Education & Behavior includes 10 articles that highlight these principles and provide insight into the complexities, challenges, and rewards of collaborating in ways that are intentional about advancing health equity through inclusive processes and shared goals to address social determinants of health. We provide a brief overview of the articles and identify community organizing and building resident power as possible strategies that should be combined with, complement, or in some cases replace, our more commonplace multisectoral coalitions if we hope to reduce health inequities through community collaboration.

Learning From Coalitions' Efforts to Promote Equity and Justice.

Coalitions and collaboratives are working to address many of the most pressing contemporary health and social issues. The articles in this special issue provide numerous insights into these complex collaborative processes across different contexts and focal issues. All emphasize and scrutinize the strategies that groups are using in their work. These strategies seek to navigate not only conventional notions of effectiveness but also the challenges of pursuing greater equity and justice. In this concluding article, we distill some of the key insights from these articles as a collective. This special issue on collaborating for equity and justice can serve as a launching point for new efforts by coalitions and researchers pursuing policy, systems, and structural changes, particularly those intent on addressing root causes of health and social disparities.

Grassroots advocacy campaign for HIV/AIDS prevention: lessons from the field.

There are many guides written for developing strategies and tactics related to advocacy, and many pages of text are devoted to developing advocacy plans. Less well described is the context within which grassroots advocacy campaigns can be successful. This article describes a successful campaign to establish a needle-exchange program (NEP) in Guilford County, North Carolina. The authors briefly describe NEPs in general, the history of NEPs in North Carolina, the mission of the North Carolina Harm Reduction Coalition (NCHRC), and why this approach was considered particularly important for Guilford County. Then the context of the successful adoption of an NEP in Guilford County and the progress to make it legal will be examined, including describing the specific advocacy activities facilitated by members of NCHRC. The article concludes with a discussion of lessons learned that may be applicable to other grassroots advocacy initiatives.

Transdisciplinary research and evaluation for community health initiatives.

Transdisciplinary research and evaluation projects provide valuable opportunities to collaborate on interventions to improve the health and well-being of individuals and communities. Given team members' diverse backgrounds and roles or responsibilities in such projects, members' perspectives are significant in strengthening a project's infrastructure and improving its organizational functioning. This article presents an evaluation mechanism that allows team members to express the successes and challenges incurred throughout their involvement in a multisite transdisciplinary research project. Furthermore, their feedback is used to promote future sustainability and growth. Guided by a framework known as organizational development, the evaluative process was conducted by a neutral entity, the Quality Assurance Team. A mixed-methods approach was utilized to garner feedback and clarify how the research project goals could be achieved more effectively and efficiently. The multiple benefits gained by those involved in this evaluation and implications for utilizing transdisciplinary research and evaluation teams for health initiatives are detailed.

Diffusion of medication drop-boxes in North Carolina from 2007 to 2016.

INTRODUCTION: A permanent drug donation box ("drop-box") is one strategy implemented in communities across the United States to reduce the availability of excess controlled medications, including prescription opioids, for diversion. The objective of this study was to examine correlates of the diffusion and implementation of drop-boxes in North Carolina. METHODS: We assessed the number and location of drop-boxes implemented in North Carolina. Cox proportional hazards models were used to examine covariates associated with drop-box implementation in NC counties (n = 100) between 2007 and 2016. RESULTS: There were 311 drop-boxes implemented in 91 (out of 100) counties. Most drop-boxes were in law enforcement agencies (78.8%) and a growing number were in pharmacies (14.5%). Counties with a higher percentage of whites, more educated residents, a substance abuse prevention coalition, higher rates of controlled medications dispensed and prescription opioid overdose, and that were Appalachian were more likely to be early adopters. Rural counties were less likely to have a drop-box. In the multivariate model, only higher rate of controlled medicines dispensed was significant. CONCLUSIONS: A growing number of drop-boxes are being implemented in law enforcement offices and pharmacies. Given that communities with higher rates of controlled medication dispensing likely have the highest need for disposal opportunities, it is promising that they are early adopters of drop-boxes. Future research should assess the effectiveness of drop-boxes as they become more widespread in a variety of locations.

Social validation of goals, procedures, and effects in public health.

By relying solely on tests of statistical significance as the measure of success for interventions in public health, and in community-based participatory research, we can miss important social dimensions of the project. These dimensions include how our interventions might affect the lives of participants (social validity) and the lives of people more broadly (clinical or public health significance). Social validation procedures were originally developed to assess the acceptability of procedures and effects of behavioral interventions among clients and consumers. This article describes the methods used to obtain social validity data for goals, procedures, and effects of interventions in health settings. The challenges in using these procedures are also discussed, and suggestions are offered for future research and practice in this area.

How do we know if we are making a difference with our program or community initiative?

In this article, the authors discuss issues related to knowing if health workers are making a difference with their community initiatives or programs being delivered in a community setting. Issues relating to the choice of evaluation questions, relevance of data sets used to answer those questions, and the rigor by which the answer can be evaluated--and the ability to generalize to other communities or populations--are explored. Finally, relevant resources to help you pursue these issues are provided.

Evaluating community partnerships and coalitions with practitioners in mind.

Evaluation plays a key role in developing and sustaining community partnerships and coalitions. We recommend focusing on three levels of coalition evaluation that measure (a) processes that sustain and renew coalition infrastructure and function; (b) programs intended to meet target activities, or those that work directly toward the partnership's goals; and (c) changes in health status or the community. A tendency to focus on quick wins and short-term effects of programs may explain why some coalitions are not able to achieve systems and/or health outcomes change. Although measuring community-level or system changes (e.g., improving environmental quality or changing insurance coverage policies) is much more difficult than evaluating program outcomes, it is essential. This article presents challenges that coalition practitioners and evaluators face and concludes with practical resources for evaluation.

The influence of community context on how coalitions achieve HIV-preventive structural change.

Community coalition action theory (CCAT) depicts the processes and factors that affect coalition formation, maintenance, institutionalization, actions, and outcomes. CCAT proposes that community context affects coalitions at every phase of development and operation. We analyzed data from 12 Connect to Protect coalitions using inductive content analysis to examine how contextual factors (e.g., economics, collaboration, history, norms, and politics) enhance or impede coalitions' success in achieving outcomes. Consistent with CCAT, context affected the objectives that coalitions developed and those they completed. Results suggest that local prevention history and political support have particular impact on coalitions' success in creating structural changes. These data underscore the heuristic value of CCAT, yet also imply that the contextual constructs that affect outcomes are issue specific.

Participatory research and capacity building for community health and development. Introduction.

It is my pleasure to introduce this themed issue on "Participatory Research and Capacity Building for Community Health and Development." While most of the literature is still dominated by targeted interventions, run by researchers, that have a limited reach (usually affecting change among much less than 100 persons), these community interventions affect the broader social ecology. Even further, there is a growing literature on community-engaged scholarship that calls for this kind of active partnership but often falls far short of its goals (Calleson, Jordan, & Seifer, 2005 ). The articles in this themed issue represent the possibility of collaborations between university researchers, state-level policy makers, and community-based groups to affect widespread changes in the social and physical environment.

Disseminating online tools for building capacity among community practitioners.

To prepare the workforce for building healthier communities, we need to assure capabilities of a diverse and geographically distributed community of practitioners. Although the Internet is used extensively to disseminate practice information, less is known about the relative impact of various strategies for promoting its use. This empirical case study examines implementation of dissemination strategies and their association with increased user sessions in the online Community Tool Box (CTB), a widely used resource for community building. Dissemination activities included social media efforts, eNewsletters, search engine optimization efforts, partnering with other Web sites, and implementing a global Out of the Box Prize. Results suggest that increased user sessions were associated with search optimization and "mashups" delivering CTB content through partners' Web sites. The report concludes with a discussion of challenges and opportunities in promoting widespread use of capacity-building tools among those working to improve their communities.

Programmatic capacity and HIV structural change interventions: influences on coalitions' success and efficiency in accomplishing intermediate outcomes.

This article assesses how programmatic capacity affects coalitions' ability to achieve structural HIV prevention interventions. The focus of the analysis was on the structural changes developed (n = 304) at all coalitions involved in Connect to Protect® between early 2006 through the end of 2008. Data included records of coalitions' structural change objectives and the progress made toward their accomplishment. For the current study, we divided objectives into two periods: those created before 2008 (n = 201) and those created from January 2008 through December 2008 (n = 103). In addition to becoming more structurally focused, C2P coalitions are becoming more efficient and most individual coalitions are becoming more successful. Findings highlight the benefit of creating high quality, strategic structural change objectives. Future research should investigate other influences that impede or facilitate the implementation of structural change HIV prevention interventions.