Haitian picuristes/injectionists as alternatives to conventional health care providers in South Florida.

Barriers in seeking access to conventional health care services continue to be a problem in the United States, especially among recent racial and ethnic immigrants who tend to be least able to afford adequate health insurance coverage. Ethnic immigrants sometimes seek out traditional healers as unconventional providers of health care services to overcome barriers in accessing the conventional health care delivery system. The purpose of this work is to provide insight into the practices of Picuristes or Haitian "lay injectionists" in their role as alternative, unconventional providers of health care services among Haitian immigrants in South Florida. Based on in-depth interviews with 10 picuristes who were identified through venue and snowball sampling and who volunteered to participate in a larger exploratory study that examined various aspects of picuriste practices, findings revealed benefits and risks of seeking health care services from these traditional practitioners. Among the benefits reported to their services were greater accessibility, affordability, convenience, and cultural compatibility. Risks observed from analysis of picuriste interviews included the lack of formal medical training for picuristes, their nonadherence to established standards for safe injections and their potential to expose clients and the community to contaminated needles, syringes, and other biohazardous waste materials. Insight was also gained into how picuristes learned to practice their trade and to incorporate Haitian cultural beliefs regarding the relationship between clients and healers. Given the continuation of barriers to health care among ethnic immigrants, implications for conventional heath care practice and social policy are also discussed.

Adolescents at risk for violence: an initial validation of the life challenges questionnaire and risk assessment index.

Initial validation was sought for the Life-Challenges Questionnaire-Teen Form, a 120-item youth-risk assessment tool. The questionnaire was administered to 99 students enrolled in an adolescent detention facility and a comparison group of 305 students attending high school. The survey items included correlates of youth violence and categorized risk level in a Risk Assessment Index (RAI) based on 53 critical items most strongly correlated with youth violence. Higher RAI scores were expected for the detention sample, males, minorities, and 15- to 18-year-olds. Differences between adolescents in detention and high school in terms of risk for violence were assessed by means of analysis of variance, and multiple regression analysis was used to examine the relative effect of detention status, race/ethnicity, gender, and other factors on risk behavior as measured by the RAI. Findings revealed that the detention group endorsed correlates of youth violence more often than the non-detention group and received significantly higher RAI scores. In addition, being in detention, male, and a racial/ethnic minority were significant predictors of risk behavior. The authors conclude that The Life-Challenges Questionnaire (and Risk Assessment Index) effectively differentiated between the detention and student samples, thus, providing initial support for its validity as a risk-assessment measure.