Using youth participatory action research to explore the impacts of structural violence on LGBTQIA + youth health.

Queerphobia is defined as society's negative attitude towards LGBTQIA + people, translating into structures that marginalise LGBTQIA + people and contribute to health inequities that cause real harm and can be understood as structural violence. The purpose of this article is to explore what historically marginalised youth in a youth participatory action research (YPAR) project characterise as the big picture issues affecting the lives of LGBTQIA + youth. We used participatory arts-based methods to conduct community and identity building, define research questions and photo prompts, conduct data collection, engage in group thematic analysis, and make recommendations at the state policy level. We also conducted individual semi-structured interviews with participants. Our findings can be grouped into three main themes: LGBTQIA + youth may feel it is safer to remain closeted; queerphobia perpetuates housing instability; and queerphobia functions as a structural barrier to social services. Youth also developed state level policy recommendations to address the structural issues causing harm to LGBTQIA + youth health. Recommendations included increasing access to affordable housing and LGBTQIA + inclusive foster and group homes, and advocating for government-funded LGBTQIA + specific healthcare practices for LGBTQIA + youth. More youth-driven data are needed that centre those directly impacted by structural violence and associated health outcomes.

Stacked Up Against Us: Using Photovoice and Participatory Methods to Explore Structural Racism's Impact on Adolescent Sexual and Reproductive Health Inequities.

While structural racism has profound impacts on adolescent health, little is known about how youth synthesize racialized experiences and work to dismantle systems of oppression. This article provides an overview of a Youth Participatory Action Research study that used Photovoice and community mapping to explore how structural violence, like racism, impacts the sexual and reproductive health of historically excluded youth as they navigate unjust socio-political landscapes. Youth participants used photography and community maps to identify how the experience of bias, profiling, and tokenism impacted their ability to navigate complex social systems. With youth voices prioritized, participants explored ways to address structural racism in their lives. The importance of co-creating opportunities with and for youth in critical reflection of their lived experience is emphasized. Through an Arts and Cultural in Public Health framework, we provide an analysis of the ways structural racism functions as a gendered racial project and fundamental cause of adolescent sexual and reproductive health inequities, while identifying pathways toward liberation in pursuit of health and well-being.

Social connectedness and surviving at the margins: Findings from interviews with low-income Latino men in the U.S. Northeast.

OBJECTIVES: Structural and interpersonal discrimination can lead to social exclusion and limited social integration, inhibiting the use of support networks to gain access to health-protective material and social resources. Social support theories suggest that connectedness may moderate the link between discrimination and health risk. This study examined how risk factors (i.e., structural and interpersonal discrimination) further marginalize Puerto Rican men by limiting access to social support. We also aimed to identify resiliency factors, such as cultural values related to social interactions and community support, which may be protective for these men's well-being. METHOD: We conducted 40 semistructured interviews with a stratified purposeful sample of Puerto Rican (92.5%) men aged 25-70 (Mage = 50.7) in the U.S. Northeast. A hybrid deductive and inductive thematic qualitative analysis was used to analyze data. RESULTS: Participants discussed how structural and interpersonal discrimination result in inequities and barriers to resources and services (e.g., lack of adequate shelter, insecurity, employment) which impacted their well-being through the inability to access fundamental support for survival. The men identified cultural values (e.g., familismo, simpatía) and emphasized the importance of community support as protective factors that may provide a respite from the difficulties of navigating discrimination experiences. CONCLUSION: Findings suggest discrimination limits Puerto Rican men's ability to access resources, which has a detrimental impact on their well-being. Identifying social support beyond the family, and considering cultural values related to support, can enhance community interventions by focusing on incorporating multiple forms of support that may improve Puerto Rican men's health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The use of digital stories as a health promotion intervention: a scoping review.

BACKGROUND: It is challenging to develop health promotion interventions created in collaboration with communities affected by inequities that focus beyond individual behavior change. One potential solution is interventions that use digital stories (DS). Digital storytelling (DST) is an opportunity for reflection, connection with others, and the elevation of voices often absent from daily discourse. Consequently, public health researchers and practitioners frequently employ the DST workshop process to develop messaging that promotes health and highlights concerns in partnership with historically marginalized communities. With participants' permission, DS can reach beyond the storytellers through behavior or attitude change interventions for health promotion among communities who share the targeted health concern. Our goal was to synthesize the literature describing interventions that use DS for health promotion to identify gaps. METHODS: We conducted a scoping review. Our inclusion criteria were articles that: 1) described empirical research; 2) used DS that were developed using the StoryCenter DST method; 3) assessed an intervention that used DS to address the health promotion of viewers (individuals, families, community, and/or society) impacted by the targeted health issue 4) were written in English or Spanish. To synthesize the results of the included studies, we mapped them to the health determinants in the National Institute of Minority Health and Health Disparities (NIMHD) research framework. We assessed the number of occurrences of each determinant described in the results of each article. RESULTS: Ten articles met the eligibility criteria. All the included articles highlighted health equity issues. Our mapping of the articles with definitive results to the NIMHD research framework indicates that interventions that use DS addressed 17 out of 20 health determinants. All mapped interventions influenced intentions to change health behaviors (NIMHD level/domain: Individual/Behavioral), increased health literacy (Individual/Health Care System), and/or stimulated conversations that addressed community norms (Community/Sociocultural Environment). CONCLUSIONS: Interventions that use DS appear to positively affect the health promotion of participants across a range of health issues and determinants. Future research is needed in the Interpersonal, Community, and Societal levels and within the Biological, Physical/Built Environment, and Sociocultural Environment domains.

Critical Narrative Intervention for Health Equity Research and Practice: Editorial Commentary Introducing the Health Promotion Practice Critical Narrative Intervention Special Collection.

This special collection of Health Promotion Practice introduces critical narrative intervention (CNI) as a key theoretical framing for an asset-based, narrative, and participatory approach to promoting health and addressing social inequality. Innovative digital and visual methodologies highlighted in this special collection-comics and graphic novels, cellphilms and other participatory film, story booths, digital storytelling, and photovoice-are changing the way critical public health researchers and practitioners forge new knowledge, creating new possibilities for interdisciplinary and activist-based inquiry. Public health research and engagement efforts that critically contend with historically repressive structures and intervene through narrative and participatory processes to enact change with and for disenfranchised communities are long overdue. This special collection showcases six CNI projects that promote equity and justice in the context of LGBTQ, nonbinary, and other gender-diverse young people; people who inject drugs living with hepatitis C virus; young women who trade sex; undocumented and formerly undocumented immigrants; and people living with HIV/AIDS. It is our intent that this collection of exemplars can serve as a guidepost for practitioners and researchers interested in expanding the scope of critical public health praxis. Individually and collectively, the special collection illustrates how CNI can create space for the increased representation of historically silenced populations, redress stigma, and provoke important questions to guide a new era of health equity research.

Participant Engagement and Ethical Digital Storytelling: The MOCHA Moving Forward Study.

African-American men continue to bear a disproportionate share of the burden of health disparities, in general, and chronic diseases, in particular. The Men of Color Health Awareness (MOCHA) Moving Forward study seeks to determine the effectiveness of an innovative, community-driven program to improve the health and quality of life of low-income African-American men between the ages of 35 to 70 years by reducing identified social risk factors for chronic disease for these men. The project uses digital storytelling (DST) to encourage African-American men to tell their stories, especially related to stress, gender role stereotypes, and mental and physical health and well-being. Thirty-six men were recruited to participate in one of four DST workshops, which resulted in each participant creating a 2- to 3-minute digital story. In this article, we describe and analyze three salient ethical dilemmas that arose in conducting the Men of Color Health Awareness Moving Forward study DST workshops with African-American men. The dilemmas can be traced to the distinct purposes for which DST can be used, data collection or intervention development, and the trade-offs between protecting and patronizing participants. We discuss potential ways to resolve or circumvent the identified issues.

Perspectives of health educators and interviewers in a randomized controlled trial of a postpartum diabetes prevention program for Latinas: a qualitative assessment.

BACKGROUND: Lifestyle interventions regularly rely on study staff to implement the intervention and collect outcomes data directly from study participants. This study describes the experiences of project staff in two randomized controlled trials of a postpartum lifestyle intervention to reduce risk factors for type 2 diabetes in Latinas. Latinas are the fastest growing minority group in the U.S. and have the highest rates of type 2 diabetes after a diagnosis of gestational diabetes mellitus. The challenges of implementing lifestyle interventions for postpartum women have been poorly documented. METHODS: A qualitative focus group was conducted with eight staff members (five health educators and three health interviewers) involved in Proyecto Mamá and Estudio Parto. The discussion was audio recorded, transcribed, and coded in NVivo. Focus group topics included: 1) participant recruitment, 2) participant retention, 3) implementation of the lifestyle intervention, 4) assessment of behavior change, 5) overall challenges and rewarding aspects of the trial, and 6) recommended changes for future trials. RESULTS: Key themes emerged regarding enabling factors and barriers to implementing a lifestyle intervention in postpartum Latinas. Enabling factors included: a) the staff's belief in the importance of the intervention, b) opportunities associated with the longitudinal nature of the trial, c) belief that the staff could empower participants to make behavior change, d) benefits of flexible intervention sessions, and e) connection with participants due to shared cultural backgrounds. Barriers included: a) participant stressors: home, food, and financial insecurity, b) low health literacy, c) issues related to recent immigration to the continental U.S., d) handling participant resistance to behavior change, e) involvement of family members in assessment visits, f) limitations of the assessment tools, and g) time limitations. CONCLUSIONS: Findings highlight the challenging contexts that many study participants face, and shed light on the potentially influential role of health educators and interviewers in intervention implementation and data collection. Specific recommendations are made for strategies to improve adherence to diabetes prevention programs in postpartum underserved and minority populations in this challenging, transitional period of life. TRIAL REGISTRATION: NCT01679210 . Registered 5 September 2012; NCT01868230 . Registered 4 June 2013.

Meth Mouth, White Trash, and the Pseudo-Racialization of Methamphetamine Use in the U.S.

Drug scares have historically been created for a range of purposes and with a variety of effects in the United States. Moral panics evoked by these drug scares either support or challenge dominant American ideas about race, economics, and society. In the present study, we examined newspaper accounts of methamphetamine use in the Inland Pacific Northwest of the United States in an effort to understand how the "reality" of the "meth epidemic" is socially constructed in a "meth hotspot," and reflect upon the ways that the discourse of Whiteness intersects with this construction. For our analysis, we are cognizant of the "slipperiness" of the logic of Whiteness as a concept, and the ways that an alternative logic is articulated - one that strategically embraces or distances White drug users to support notions of White dominance. We focus on the possibility that individual meth users could then be portrayed pseudo-racially as "White trash," and thus rendered outside the logic of White racial order. Our findings center on two main themes: (1) the use of fear in the construction of the meth drug scare through the sensationalization of meth, its anthropomorphization, and the depiction of the threat of the White drug user; and (2) how the logic of Whiteness is discursively reconciled within this construction. Given current mediated discourses about drug use and health in the United States that center on the emergence of the White drug user as the face of the opioid crisis, we are well served to carefully consider the recent historical precedence of the "meth epidemic" in which the public was faced with reconciling their views about drug use and the intersection of race, class, and mainstream American identity.

Mothers and Mentors: Exploring Perinatal Addiction and Recovery Through Digital Storytelling.

Substance use disorders (SUDs) are a growing problem for pregnant and parenting women. Woman-to-woman peer support may positively influence perinatal outcomes but little is known about the impact of such support on the women who are providing support. The purpose of this study was to describe experiences of addiction in pregnancy, recovery, and subsequently serving as a peer mentor to other pregnant women with active SUD among women in recovery in a rural setting. We conducted one digital storytelling workshop with five women serving as peer mentors with lived experience of perinatal SUD. The mentors faced significant stigma in pregnancy. They had each done the "inside work" to achieve recovery, and maintained recovery by staying balanced. Peer mentoring supported their own recovery, and story sharing was integral to this process. Peer-led support models may be an effective, self-sustaining method of providing pregnancy-specific peer support for SUD.

"Scribble Scrabble": Migration, Young Parenting Latinas, and Digital Storytelling as Narrative Shock.

The nexus of migration and family offers a conjuncture to enrich understanding of teen pregnancy and parenting. This article draws findings from a project centered on participant-produced new media to reveal how young mothers negotiate reproductive health disparities. We focus on young mothers' experiences of migration and movement, captured in local vernacular through participants' digital story depictions and follow-up interviews. We argue that disparities link up with the single story of teen mothering, involve public shaming, continue hand-in-hand with institutional humiliation, and are exacerbated through migration and movement. To disrupt the normative notions that shadow young mothers, we take seriously the young women's narratives. We theorize how the richness of stories and storytelling may serve as a potent intervention-a narrative shock-for articulating meanings and cultivating dignity for young mothers and their families, especially those who do not fit the sedentary and age biases of parenting ideals.

Restor(y)ing Health: A Conceptual Model of the Effects of Digital Storytelling.

We currently see an interdisciplinary shift toward a "participatory turn" in health research and promotion under which community engagement, shared decision making and planning, and the use of visual and digital methods have become paramount. Digital storytelling (DST) is one such innovative and engaging method increasingly used in applied health interventions, with a growing body of research identifying its value. Despite its increasing use, a standard approach to empirically assess the impacts on individuals participating in DST interventions does not currently exist. In this article, we define DST as a distinct narrative intervention, illustrate key elements that inform the methodology, and present a conceptual model to examine how DST may contribute to increased socioemotional well-being and bolster positive health outcomes. Our proposed model is informed by elements of narrative theory, Freirian conscientization, multimodality, and social cognitive theory and can serve as a guide for public health practitioners and researchers interested in assessing the potential benefits of DST as an applied health intervention. Recommendations for practice call for a rigorous methodological approach to apply and test this model across a range of health contexts and populations.

Moms Supporting Moms: Digital Storytelling With Peer Mentors in Recovery From Substance Use.

Substance use disorder (SUD) is a growing issue nationally, and SUD in pregnancy has significant consequences for mothers and their children. This article describes findings from a pilot project that used digital storytelling as a mechanism for understanding substance use and recovery from the perspective of women in recovery from SUD in pregnancy who worked as peer mentors with pregnant women currently experiencing SUD. Research on peer mentorship has primarily focused on outcomes for mentees but not the experience of the peer mentors themselves. In this qualitative study, a 3-day digital storytelling workshop was conducted with five women in recovery serving as peer mentors in their community. Each mentor also participated in an individual, in-depth interview. The digital storytelling workshop process helped peer mentors make linkages between their past substance use experiences to their present work of recovery, and fostered deep social connections between mentors through the shared experience. The workshop process also elicited a sense of hope among participants, which served as groundwork for developing advocacy-based efforts. Digital storytelling may be therapeutic for women in recovery and has the potential to be integrated into recovery programs to bolster hope and social support among participants.

Narrative Influences on "Desire to Act in My Community" in Digital Storytelling Workshops for Latina Teens.

Digital storytelling workshops are increasingly being used to capture lived experiences and develop/disseminate health promotion messages for vulnerable and marginalized populations. Thirty female Latina teens of varied sexual/parity status produced digital stories of significant life experiences in a group context and then viewed and evaluated them using the Narrative Quality Assessment Tool. This tool was used to examine participants' experience of emotional engagement and identification with each story as well as a single-item indicator of desire to "do something in my community" related to the story. Emotional engagement was moderately strong; identification scores were neutral relative to the stories. Emotional engagement was strongly, significantly related to "desire to act in my community," while identification was not related. Emotional engagement should be considered an important factor to incorporate in the production of digital stories for purposes of developing interest in social action beyond the digital storytelling workshop.

Puerto Rican Latina Youth Coming Out to Talk About Sexuality and Identity.

Public health efforts focused on Latina youth sexuality are most commonly framed by the syndemic of teen pregnancy and sexually transmitted infections, a narrow and often heteronormative focus that perpetuates silences that contribute to health inequities and overlooks the growing need for increased education, awareness, and support for lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth. This article presents findings from the project Let's Talk About Sex: Digital Storytelling for Puerto Rican Latina Youth, which used a culturally centered, narrative-based approach for analyzing participants' own specifications of sexual values and practices. The strength of digital storytelling lies in its utility as an innovative tool for community-based and culturally situated research, as well as in its capacity to open up new spaces for health communication. Here we present two "coming out" case studies to illustrate the value of digital storytelling in supporting the development of meaningful and culturally relevant health promotion efforts for LGBTQ-identified Puerto Rican Latina youth across the life span.

Measuring Down: Evaluating Digital Storytelling as a Process for Narrative Health Promotion.

Digital storytelling (DST) engages participants in a group-based process to create and share narrative accounts of life events. We present key evaluation findings of a 2-year, mixed-methods study that focused on effects of participating in the DST process on young Puerto Rican Latina's self-esteem, social support, empowerment, and sexual attitudes and behaviors. Quantitative results did not show significant changes in the expected outcomes. However, in our qualitative findings we identified several ways in which the DST made positive, health-bearing effects. We argue for the importance of "measuring down" to reflect the locally grounded, felt experiences of participants who engage in the process, as current quantitative scales do not "measure up" to accurately capture these effects. We end by suggesting the need to develop mixed-methods, culturally relevant, and sensitive evaluation tools that prioritize process effects as they inform intervention and health promotion.

Digital Storytelling as a Narrative Health Promotion Process: Evaluation of a Pilot Study.

Digital storytelling (DST) engages participants in a group-based process to create and share narrative accounts of life events. The process of individuals telling their own stories has not been well assessed as a mechanism of health behavior change. This study looks at outcomes associated with engaging in the DST process for vulnerable youth. The project focused on the experiences of Puerto Rican Latinas between the ages of 15 to 21. A total of 30 participants enrolled in a 4-day DST workshops, with 29 completing a 1 to 3-minute digital story. Self-reported data on several scales (self-esteem, social support, empowerment, and sexual attitudes and behaviors) were collected and analyzed. Participants showed an increase in positive social interactions from baseline to 3-month post workshop. Participants also demonstrated increases in optimism and control over the future immediately after the workshop, but this change was not sustained at 3 months. Analysis of qualitative results and implications are discussed.

Bridging graduate education in public health and the liberal arts.

The University of Massachusetts Amherst is part of Five-Colleges Inc, a consortium that includes the university and four liberal arts colleges. Consortium faculty from the School of Public Health and Health Sciences at the university and from the colleges are working to bridge liberal arts with public health graduate education. We outline four key themes guiding this effort and exemplary curricular tools for innovative community-based and multidisciplinary academic and research programs. The structure of the consortium has created a novel trajectory for student learning and engagement, with important ramifications for pedagogy and professional practice in public health. We show how graduate public health education and liberal arts can, and must, work in tandem to transform public health practice in the 21st century.

A situated practice of ethics for participatory visual and digital methods in public health research and practice: a focus on digital storytelling.

This article explores ethical considerations related to participatory visual and digital methods for public health research and practice, through the lens of an approach known as "digital storytelling." We begin by briefly describing the digital storytelling process and its applications to public health research and practice. Next, we explore 6 common challenges: fuzzy boundaries, recruitment and consent to participate, power of shaping, representation and harm, confidentiality, and release of materials. We discuss their complexities and offer some considerations for ethical practice. We hope this article serves as a catalyst for expanded dialogue about the need for high standards of integrity and a situated practice of ethics wherein researchers and practitioners reflexively consider ethical decision-making as part of the ongoing work of public health.