Problem Definition and Community Participation in Environmental Health Interventions: An Exploratory Study of Groundwater Arsenic Remediation.

Arsenic, a known carcinogen, naturally occurs in the groundwater in large parts of West Bengal, a state in eastern India. Communities that depend on groundwater face twice the lifetime mortality risk for cancers, cardiovascular diseases, and developmental disorders. This study, focused on arsenic-affected communities in the state of West Bengal, offers an initial exploration of how local stakeholders construct groundwater arsenic as a health problem. Arsenic remediation interventions involve a host of international, regional, and local stakeholders (public health departments, government engineers, community health workers, consultants, hydrologists, etc.). How an environmental health problem is constructed has implications for who is considered responsible, what causes it, and pertinently, how/whether affected communities participate in addressing the problem. Drawing from a culture-centered approach, this fieldwork-based study offers three distinct yet related problem construction discourses, viz. social/political, technical and personal, in how the problem of arsenic is construed locally, and how such discourses are related to a particular conceptualization of community participation in environmental health.

A Culture-Centered Community-Grounded Approach to Disseminating Health Information among African Americans.

This study highlights the role of local communities in creating culturally rooted health information resources based on comparative effectiveness research (CER), depicting the role of culture in creating entry points for building community-grounded communication structures for evidence-based health knowledge. We report the results from running a year-long culture-centered campaign that was carried out among African American communities in two counties, Lake and Marion County, in Indiana addressing basic evidence-based knowledge on four areas of cardiovascular disease (CVD). Campaign effectiveness was tested through an experimental design with post-test knowledge of CER among African Americans in these counties compared to CER knowledge among African Americans in a comparable control county (Allen). Our campaign, based on the principles of the culture-centered approach (CCA), increased community CER knowledge in the experimental communities relative to a community that did not receive the culturally centered health information campaign. The CCA-based campaign developed by community members and distributed through the mass media, community wide channels such as health fairs and church meetings, postcards, and face-to-face interventions explaining the postcards improved CER knowledge in specific areas (ACE-I/ARBs, atrial fibrillation, and renal artery stenosis) in the CCA communities as compared to the control community.

Health Communication in the Time of Ebola: A Culture-Centered Interrogation.

This brief essay is a commentary on how critical health communication theory can contribute to an understanding of the cultural dynamics of infectious disease pandemics. In particular, we focus on a specific trajectory of health communication theorizing-the culture-centered approach-and its heuristic and pragmatic utility in enhancing knowledge about public health crises like infectious disease outbreaks. In the backdrop of the mobilizations against the 2014 Ebola virus disease epidemic in the 3 West African nations of Guinea, Sierra Leone, and Liberia, indigenous cultural practices were construed as pathogenic and local agency of affected communities disregarded, even as the global risks of the epidemic were highlighted. In contrast to this interventionist notion of culture, the culture-centered approach offers a heuristic rubric through which to scrutinize the dialectical interrelationship between indigenous cultural practices, structural determinants of health, and the everyday agency of individuals of affected communities. We argue that such a listening-based paradigm of communication theorizing is instrumental in developing authentic, ethical, and effective health communication practice in public health crises.

Narratives of Stress in Health Meanings of African Americans in Lake County, Indiana.

Across the life course, African Americans bear an unequal burden of disease compared to other racial groups. In spite of the widespread acknowledgment of racial health disparities, the voices of African Americans, their articulations of health and their local etiologies of health disparities are limited. In this article, we highlight the important role of communication scholarship to understand the everyday enactment of health disparities. Drawing upon the culture-centered approach (CCA) to co-construct narratives of health with African Americans residents of Lake County, Indiana, we explore the presence of stress in the everyday narratives of health. These narratives voice the social and structural sources of stress, and articulate resistive coping strategies embedded in relationship to structures.

Communicating the Ontological Narrative of Ebola: An Emerging Disease in the Time of "Epidemic 2.0".

In this article, we critically analyze the implications of "Epidemic 2.0"-specifically the formative role of social media (as an exemplar of Web 2.0 technology) in disseminating information during epidemics. We use a narrative analysis framework to study the Ebola-related messaging on the official Facebook pages of the World Health Organization (WHO) and the Center for Disease Control (CDC) in the wake of the recent epidemic in Western Africa. Using as our corpus all the messages on these pages between the period of July 1 and October 15, 2014, our analysis traces the development of an ontological Ebola narrative: a specific, historically contingent, ideological plot that reaffirms contemporary Western anxieties around emerging infections. Our analysis focuses on the evolution of this ontological narrative from a) consulting and containment, to b) an international concern, and c) the possibility of an epidemic in the United States.

Long Distance Truck Drivers and the Structural Context of Health: A Culture-Centered Investigation of Indian Truckers' Health Narratives.

Long-distance truck drivers (truckers) in India have been identified as a "high-risk" group for the HIV/AIDS epidemic, and are consequently the targets of prevention and education-based interventions. While such interventions have addressed risk at the level of individual behavior, little attention has been paid to the structural barriers to health for truckers. Research among truckers in India has ignored the economic, social, and cultural context of health. In this article, I employ the culture-centered approach (CCA) to health communication in documenting truckers' narratives of health, which are innately connected to social and institutional structures around their lives. The data included 36 narrative interviews that I conducted as part of my fieldwork with Indian truckers, in addition to field notes and a reflexive journal. Through a reflexive analysis of these narratives, I present three themes: (a) the everyday violence of trucking, (b) health as sacrifice, and (c) migration and HIV/AIDS. I discuss how communication interventions can attend to the relationship between trucker health and the structural barriers they encounter.

Structure and agency in long-distance truck drivers' lived experiences of condom use for HIV prevention.

Condom promotion has emerged as a mainstay of targeted HIV prevention interventions in India, with its emphasis on individual behaviour change and personal responsibility. However, such approaches often do not account for marginalised populations' structural vulnerability to HIV, arising from social, economic and political factors in the lived environment. In this paper, I use a critical health communication framework to analyse how structure and agency interact in influencing condom use among long-distance truck drivers in India. Drawing on an abductive discourse analysis of condom-use discourses among truckers and peer educators in two Indian cities, findings reveal that while truckers understand the biomedical logic of condoms as barriers, they also express anxiety about condom breakage and experience structural barriers to condom use. The paper concludes by calling for greater attention to structural vulnerabilities in future HIV prevention efforts with truck drivers.

Public health, global surveillance, and the "emerging disease" worldview: a postcolonial appraisal of PEPFAR.

Drawing upon a postcolonial lens, this project looks at how meanings of HIV/AIDS are discursively constructed within the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), which was launched in 2003 under the presidency of George W. Bush and has been heralded as the largest global public health intervention program in history. Building on existing literature that theorizes the interrelationships of public health and national security, global surveillance, and transnational hegemony, the postcolonial theoretical standpoint interrogates how such meanings are constructed within PEPFAR. A postcolonial deconstruction of the 2009 PEPFAR report to the Congress revealed three meanings of HIV/AIDS that were discursively constructed in such policy documents: (a) the "Third World" as a site of intervention, (b) U.S. altruism as "lifting" the burden of the soul, and (c) AIDS, economics, and security. The themes put forth the linkages among the symbolic representations in neocolonial configurations and the politics of material disparities across the globe, thus issuing a call for the creation of participatory and dialogic spaces for engaging subaltern voices that are typically treated as targets of policy and intervention discourses.

Postcolonial constructions of HIV/AIDS: meaning, culture, and structure.

As a field of inquiry, postcolonial health communication seeks to apprehend processes implicated in the construction of "primitive" versus "modern" with respect to issues of health. In the case of HIV/AIDS, the sociocultural representations of the disease have a profound impact on how the disease is configured medically and symbolically in dominant cultural imagination. Postcolonial constructions of disease are mobilized around the political and economic interests of the dominant power structures in global spaces. In this article, a thematic analysis of the constructions of HIV/AIDS in India in the mainstream U.S. news media was conducted. A corpus of news articles from the Lexis-Nexis database was created with the keywords "HIV," "AIDS," and "India." Three themes emerged from the study: (a) India as a site of biomedical control; (b) the economic logics of HIV/AIDS; and (c) AIDS, development, and the "Third World."