Academic journal article Human Organization

Defining the "Community": Applying Ethnographic Methods for a Latino Immigrant Health Intervention

Academic journal article Human Organization

Defining the "Community": Applying Ethnographic Methods for a Latino Immigrant Health Intervention

Article excerpt

Introduction

The Washington, D.C. metropolitan area has been a destination for an increasing number of immigrants and refugees from multiple countries of origin. Mirroring national trends and particularly the most recent Census data (http://www.census.gov), Latino immigrants and refugees are the largest of these populations. Newcomers from Central America began to arrive in the D.C. metro area in significant numbers during the late 1970s and 1980s, fleeing from civil strife in El Salvador, Guatemala, and other Central American countries, and their numbers have since grown substantially in all parts of the region.

Though Latino immigrants face significant health disparities, research and knowledge about effective program approaches have not kept up with population needs. In this paper, we briefly describe the background for a communitylevel health disparities intervention that aims to help close this gap, and the ethnographic methods used to define the community for purposes of sampling, to determine the location and focus of intervention activities and to gain preliminary insight with respect to community identity and social boundaries. As an additional key theme, we also describe the role of ethnographic and qualitative methods in helping to shape an intervention that treats the community as a whole phenomenon, juxtaposed against the more prevalent tendency within public health to decontextualize specific causal factors for purposes of intervention.

Addressing a Health Disparities Cluster

To better understand the need for the ethnographic community definition effort, it is useful to begin with a description of the intervention and its rationale. The Avance Center for the Advancement of Immigrant/Refugee Health, an exploratory health disparities research center in the Washington, D.C. metropolitan area, is funded by the National Institute of Minority Health and Health Disparities (NIMHD) as a university-community collaboration. The Avance Center's work is based on a context-driven conceptualization of health disparities as the outcome of multiple contributing factors interacting within what could be called a social ecology of disparities. The term "ecology" is intentionally employed here to frame the contributing factors as interconnected in a holistic sense and to do so using a term that has increasingly been adopted in public health planning models (Green and Kreuter 1999; WHO 2014), though we would argue, primarily in the acknowledgment that there are multiple levels of causation, for example, the individual, family, and community levels, and so on, rather than in the connectedness between levels or as an integrated phenomenon situated within a broader structural context.

From our perspective, health disparities and their contributing factors typically occur in related clusters, as a syndemic (see Singer 1994; Singer and Clair 2003), arguing for intervention approaches that target shared contributing factors as a whole complex. Recent commentaries and reviews of efforts to redress health disparities (Edberg et al. 2010; Starfield 2007) support the identification of shared contributing factors that, over time, create "pathways" or trajectories of health and vulnerability that may be unique to specific population groups.

Among Latino immigrant populations, one such health disparities cluster affecting youth is associated with substance abuse and includes family/partner violence, other interpersonal violence, and sexual risk. For purposes of the intervention discussed here, substance abuse is therefore viewed as a key element within a vulnerability cluster that, as a cooccurring syndrome, is disproportionately high among Latino youth (Martinez, Jr. 2006; Martinez, Jr., Eddy and DeGarmo 2003; Vega and Gil 1999). There is evidence that substance abuse and related health problems among Latino youth have increased, particularly for those who are more acculturated or bom in the US (Edberg et al. …

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