| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
ANALYTIC ESSAY FORUM |
Stephanie A. Farquhar is with the School of Community Health, Portland State University. Yvonne L. Michael is with the Department of Public Health and Preventive Medicine, Oregon Health and Sciences University. Noelle Wiggins is with the Community Capacitation Center at the Multnomah County Health Department.
Correspondence: Requests for reprints should be sent to Stephanie A. Farquhar, PhD, School of Community Health, Portland State University, PO Box 751, Portland, OR 97207-0751 (e-mail: farquhar{at}pdx.edu).
ABSTRACT
There has been an appeal to reduce health inequities by increasing community involvement and social capital. Poder es Salud/Power for Health is a community-based participatory prevention research project that seeks to address health disparities in the African American and Latino communities by enhancing community-level social capital.
We provide specific examples of how this intervention uses community health workers and popular education to reduce language and cultural barriers and enhance community social capital. Although the communities share fundamental challenges related to health disparities, the ways in which the Latino and African American communities identify health concerns, create solutions, and think about social capital vary. Members of the project are working together to identify opportunities for cross-cultural collaboration.
COMMUNITIES OF COLOR continue to face a disproportionate burden of morbidity and mortality despite overall progress in improving the health of our nation.1 The Healthy People 2010 objectives identified "eliminating racial and ethnic health disparities" as a priority area of focus2 and recognized the need to identify approaches that address the social determinants of health, such as income inequality, social exclusion, job insecurity, poor working conditions, food insecurity, and inadequate housing.3,4 Many public health practitioners and researchers have identified greater community involvement and increased social capital as ways to reduce inequities related to income, race, gender, ethnicity, and geographic location.5,6
The principal goal of Poder es Salud/Power for Health, a community-based participatory prevention research project funded by the Centers for Disease Control and Prevention in 2002, is to begin to address social determinants of health and reduce health disparities in the African American and Latino communities in Multnomah County, Oregon. (In Spanish, the word poder means both "power" and "to be able." To convey the same active notion in English, the project team chose the title "Power for Health" rather than the more directly translated "Power is Health"). Informed in part by the health disparities literature, which suggests that a more empowered and competent community is a healthier community,7–11 the project builds on existing social capital to expand ties between the African American and Latino communities and increase access to social and economic resources. The specific aims of the project are presented to illustrate culture-specific elements of an effective community health worker (CHW) intervention in the African American and Latino communities; to identify supportive policies and environments that allow CHWs and community members to effectively recognize and address health issues; and to determine how social capital both influences and results from an effective participatory approach to focusing on health promotion and disease prevention (Box this page).
We describe the 3 core strategies used to address social determinants of health in the Poder es Salud/Power for Health project and provide illustrative examples of project activities. The Poder es Salud/Power for Health project is still in progress; thus, we are not yet able to offer conclusions as to whether the project has actually increased social capital in the African American and Latino communities in Multnomah County. However, we address 2 questions here, on the basis of our initial experience of "learning through doing": (1) how do CHWs create projects designed to enhance social capital? and (2) what aspects of social capital are targeted by cross-cultural applications of the CHW model in the project’s partner communities?
CORE STRATEGIES AND MODELS
Poder es Salud/Power for Health relies on 3 core strategies designed to work together to enhance community-level social capital in the participating communities: community-based participatory research, popular education, and CHWs. Each core strategy was selected because it explicitly addresses social determinants of health, including disparities in education, power, and access. We begin by briefly defining each of these core strategies and continue with a discussion of the theoretical model that describes the relationship of these strategies to social capital.
The Poder es Salud/Power for Health project selected community-driven research, or community-based participatory research (CBPR), as its model of investigation. When used effectively, CBPR helps to identify and build on strengths, resources, and relationships that exist within communities; involves all partners as equal members to share decisionmaking power and resources; and creates cross-cultural partnerships.12–19 One example of the application of CBPR in Poder es Salud/Power for Health is its steering committee, which includes representatives from all project partners, including the Community Capacitation Center of the Multnomah County Health Department, Latino Network, Oregon Health and Sciences University, Portland State University School of Community Health, and participating communities. The steering committee meets monthly to provide guidance and oversight to the project.
Popular education is the method used in this intervention to identify health issues and their social determinants; to explicate existing community skills, knowledge, and experience; and to develop the leadership necessary to take action.20 Most closely associated with the work of Brazilian educator Paulo Freire, popular education is based on the premise that all people know a great deal as a result of their life experience. To draw out and organize what people know, popular educators use techniques such as brainstorming, sociodramas, simulations, and problem posing. For example, the staff of Poder es Salud/Power for Health uses learning games called dinámicas at the beginning of meetings, capacity-building sessions, and presentations to help put people at ease and make learning more enjoyable. Sociodramas are short, typically unscripted plays that highlight a problem based on real life concerns.
Several studies have pointed to the effectiveness of popular education and other liberating educational methodologies for promoting health.11,21 One study identified popular education as an effective method that community members could use to identify social determinants of health (e.g., differences in education, language barriers, and access to information).22 Popular education is explicitly linked to participatory research. According to Minkler, "the dialogical method of . . . Freire, with its accent on co-learning and action based on critical reflection, provided some of the critical philosophical grounding for . . . participatory research."23(p191)
CHWs—carefully chosen community members who participate in training that enables them to promote health in their own communities—are gaining increasing recognition as health professionals and "integral members of the health care workforce."24(p1055) CHW interventions have produced positive health and community outcomes in both African American25 and Latino26 communities for such diverse concerns as breast and cervical cancer screening,27 smoking cessation,28 and mental health.29 Because the Poder es Salud/Power for Health project is focused on enhancing social capital to improve health generally, CHWs participated in an 80-hour initial training program that employed popular education methodology to augment their knowledge and leadership skills in local politics and governance structure, advocacy, community organizing, and popular education, in addition to health promotion and disease prevention.
Social capital is characterized by a sense of trust, shared norms and values, and intercon-nectedness.30,31 It is enhanced over time through positive interaction and assists communities in achieving mutual goals and responding to crises.32 National interest in social capital as a modifiable social determinant of health is growing.33 Communities of color have fewer ties to institutions and individuals that provide social and economic resources.34 Recent studies document that higher levels of social capital are associated with better health and health behaviors in various ethnic communities,35–37 although the evidence is not consistent.38 On the basis of a study that suggested that a CHW model that used popular education methodology would be "consistent with . . . increasing" community capacity,39(p274) the conceptual model developed to inform this CBPR project predicts that community members selected as CHWs and trained to use popular education will enhance social connections within their respective communities as well as connections between communities and that this increase in social capital will lead to improvements in community health. The discussion that follows describes the ongoing intervention and highlights specific activities undertaken by project partners to enhance social capital.
PODER ES SALUD/ POWER FOR HEALTH PARTICIPANTS
The concept of community as an aspect of collective and individual identity is central to CBPR.40 Community-based research works with existing units of identity that share an emotional connection, values and norms, common interests, and a commitment to meeting shared needs. Through a participatory process, Poder es Salud/Power for Health elected to work with 5 units of identity: 3 African American faith-based communities; the Comunidad Cristiana, a coalition of 5 evangelical congregations in the Latino community; and a geographically defined community consisting of 4 apartment complexes. This decision to work with relatively small units (each unit of identity consists of 40–107 members) helps the steering committee and CHWs to identify and focus on specific issues of concern in the participating communities rather than on broad, overarching issues for all Latino or African American residents of Multnomah County.
Steering committee members identified limited interaction between the communities as a potential challenge to the project, which aims to build bridges between the 2 communities. Nevertheless, when asked about the history of collaboration and interaction between the communities, one CHW said "Our dances may be different and our food may be different, but we’re a lot alike. We share a whole lot, and we’re going to help each other, because our communities are merging . . . it’s good for us because it’s going to be stronger (Poder es Salud/Power for Health In-Depth Interview Report, unpublished)."
CASE STUDIES: TWO CHW PROJECTS
As part of an iterative and ongoing process, CHWs used popular education to identify health issues in their communities and design projects to respond to those issues.21,41 Specific methods varied, as did the projects, which included a public safety committee, a community health fair, a diabetes support and information group, a homework club, and a Photovoice Project that provided community residents with cameras to document community challenges and strengths. The Photovoice Project (see Wang and Redwood-Jones42 for a description of the Photovoice methodology) led residents to develop a campaign to remove trash and illegally-dumped materials from the areas surrounding the housing complexes.
The projects we describe here are excellent examples of how Poder es Salud/Power for Health builds trust and expands social networks among members of the participating community groups.
Exploring Latino Health Issues
Beginning in September 2003, Gonzalo Gonzalez, the CHW for the Comunidad Cristiana, worked with pastors from participating churches to organize a series of meetings with congregants to talk about health needs. In each meeting, Gonzalo used popular education to help members define health and a healthy community. For example, he asked congregants to respond to the questions, "What do you know about health?" "What does health mean to you?" and "What are the causes of (poor or good) health?" He then asked participants to work in groups and to consider the following scenario: "Imagine you have 1 million dollars. How will you use this money to solve the problems we identified?" After the group exercise, participants were asked to think about solutions, taking into consideration that they do not really have any money with which to address the problems. Reflecting on his work, Gonzalo noted that his job was to "get [members] organized and then we can all work together" (G. Gonzalez, oral communication, July 2004).
During this initial process, one of the African American CHWs invited children from her congregation to participate in Gonzalo’s meetings to discuss social inequalities and health disparities. The CHWs noted that the participants representing the 2 communities identified some of the same health problems (e.g., diabetes, cardiovascular disease, lack of preventive screenings, high blood pressure) as well as some of the same social causes. Currently, all 3 African American CHWs are working with Gonzalo to plan and conduct an upcoming health fair and eye clinic. The clinic is intended to serve both Latinos and African Americans and to continue building bridges between the 2 communities.
To gather further information and foster group cohesiveness, Gonzalo met individually with the pastors from each church, with those who participated in the meetings, and with others who could not attend the meetings. The purpose of these meetings was to help individuals identify community strengths and needs and create a list of specific goals and solutions. Gonzalo recognizes that this process helps people already involved to feel more committed and also involves people who were not originally interested in attending the community meetings.
As a result of these group and individual meetings, community members prioritized 3 pressing social determinants of health: (1) lack of health insurance, (2) lack of self-employment and small business knowledge, and (3) lack of jobs and employment security. The group identified as its primary solution the creation of a cooperative that will provide members with insurance, small-business loans, and job opportunities. To date, the group has organized a board of directors and has become incorporated with the state of Oregon. Another group of congregants is organizing to develop a systematic way of connecting people seeking work with those who are seeking workers. This effort is intended to serve congregants of participating churches as well as Latino community members who are not congregants.
The Peace Campaign
Another example of a CHW project is the Peace Campaign, initiated and implemented by Linda Hornbuckle, the CHW for Grace and Truth Pentecostal Church in the African American community. Two pressing issues in the African American community are the increase in gang violence and the repeated police use of lethal force against unarmed citizens. The latter concern has mobilized both the African American and the Latino communities to demand a variety of changes in the police department and has provided an opportunity for collaboration between the 2 communities.
Linda feels strongly that church members should not "sit and listen, but should get out into the community" (L. Horn-buckle, oral communication, July 2004). Building on that precept, she worked with members of her church and other local churches and organizations to identify a variety of health concerns. Several groups identified the issue of violence in light of recent police shootings and youth-on-youth violence in Portland. This issue was particularly important for the youths themselves, who reported that they were afraid to leave their homes or to be out in the street. Guided by Linda and with assistance from the project’s community organizer, a planning coalition of youths, churches, and community organizations decided to develop and sponsor the Peace Campaign and invited community residents, church congregants, young police cadets-in-training, and a dozen local organizations to participate. The 3 primary goals of the Peace Campaign were (1) to explore violence as a public health issue within the African American community, (2) to build lasting relationships between young people and police officers and other adults, and (3) to help youths learn nonviolent communication techniques that they can use with peers and adults.
Linda has actively involved the coalition members in design, implementation, and evaluation of the campaign. Project participants include a youth advisory council, a youth gang task force, Weed and Seed (a community-based initiative created to prevent crime and revitalize the community), and several local churches. In addition, one of the Latino CHWs has participated in the planning and has invited residents from her community to participate in the Peace Campaign.
DISCUSSION
As described in the previous section, Poder es Salud/Power for Health is focusing its efforts on increasing social capital within and between the Latino and African American communities as a way to improve health. Despite the fact that African American and Latinos may have similar factors that influence health, such as being more likely to experience discrimination and less likely to have access to safe neighborhoods, there are few formal or informal cross-cultural coalitions nationally that exist to identify solutions to these factors.43 Rapid growth in the Latino population during the past decade has resulted in its displacement of African Americans as the nation’s largest minority group.44 Speculation in the popular press suggests that the demographic shift has led to distrust and increasing competition between African American and Latino communities for scarce resources.45 The cross-cultural group that developed the proposal for Poder es Salud/Power for Health identified bridge-building between the 2 communities as a major aim of the project. This aim was eagerly embraced by the CHWs, who have sought out opportunities to work together.
In our examples of cross-cultural applications of the CHW model, social capital was enhanced when community members formed groups to achieve shared goals. The philosophy of popular education used by CHWs provided opportunities for participation to members of the African American and Latino communities who may not have had access to more formal mechanisms of decisionmaking. Similarly, individuals who shared mutual values and culture resulting from a common race/ethnicity and religion were able to mobilize human and physical resources toward a common goal.
The CHW projects primarily target civic engagement, trust, and social networks. Civic engagement is an aspect of social capital that defines people’s role in their communities and whether they feel they can influence events within the community. For example, as a result of the cross-cultural collaboration on the Peace Campaign, the CHWs and members of the units of identity have established trust between community residents and community officials (e.g., police cadets) and have empowered local youths to participate in a dialogue with the police as a way to reduce violence in the community. Furthermore, Poder es Salud/Power for Health builds leadership skills among CHWs and community members, and these leadership skills should be transferable to other organized groups. Social networks develop as youths and adults come together around a shared concern.
Key Lessons
Key lessons have been learned during the short tenure of this project. The first is the recognition that although the Latino and African American communities share some fundamental challenges related to health disparities, the ways in which these 2 cultures identify health concerns, create solutions, and think about social capital may vary considerably. Culture is the knowledge, beliefs, and values shared by a particular group. Each stakeholder and steering committee member is influenced by a set of values and beliefs and a body of knowledge, and these are shaped by education, race/ ethnicity, religion/spirituality, and geographic community, among other affiliations. For example, an exercise conducted during a steering committee retreat helped emphasize the fact that the culture of academia is very different from the culture of a faith community. The members of Poder es Salud/Power for Health have embraced these differences and are working together to identify opportunities for cross-cultural collaboration. Popular education is 1 tool that, when used throughout the research and intervention components of the project, can begin to break down barriers between researchers and community partners, between CHWs and their communities, and between communities of different races and ethnicities. Specifically, one of the challenges of working across cultures of any sort—educational, racial/ethnic, social—is the barrier of language, identified in the literature and by this project as a social determinant of health.12,46 Popular education, which uses role playing and other creative learning methods that are not language dependent, can increase clarity of communication and reduce the potential divisiveness of language barriers.
In addition, results of the project to date can help inform and further refine social capital theory. Social capital has historically measured individual-level responses and aggregated data to represent community-level capital. Although we are also collecting individual-level social capital measures, we are supplementing this method of measurement by examining the CHW projects and their consequences to assess whether an increase in social capital results. The experience of this project supports theoretical work proposed by other researchers. For example, social capital definitions should include not only the presence of relationships but also the quality of resources brought to "horizontal" relationships formed between communities. By combining each community’s assets, an opportunity for increased solidarity, effectiveness, and collective social capital exists.47,48 Furthermore, it is not enough to increase social capital in vulnerable communities without also changing economic opportunities, work conditions, and access to education and health care.49 Public health projects that seek to increase social capital should not be considered a substitute for equitable economic, social, and political infrastructure and policies.
Limitations
It is important to acknowledge that the findings presented here are of limited generalizability. The study’s eligibility criteria required that the 5 participating units of identify be from the African American or Latino communities in Multnomah County, Oregon. Similarly, the study’s small number of CHWs cannot capture or represent all of the possible perspectives of African American or Latino CHWs. Therefore, the study’s processes and conclusions should be applied to other communities with caution. Furthermore, members of the steering committee worked with the CHWs to attempt to ensure that information gathering was implemented as inclusively as possible. However, it is a potential weakness of the project that no specific steps were taken to evaluate the degree of representation from the full community.
Conclusions
One of the primary goals of both CBPR and the CHW model is to provide long-term benefits to the participating communities that continue after project funding has ended. The principal way in which CHW projects, including Poder es Salud/Power for Health, achieve this goal is to build leadership among CHWs and community members such that the skills, knowledge, and capital will stay in the community. In addition, one of the project’s aims was to identify and create supportive policies and environments that allow CHWs and community members to effectively address health issues. More concretely, the project partners hope to facilitate changes in local and state policies—such as resolutions for better and more affordable housing and a more transparent review of police misconduct cases—that will persist after the end of the project. It is still not known how the project’s opportunities for building skills, increasing knowledge, and sharing in decisionmaking will translate into increased social capital, sustained improvement in health outcomes in the communities, or policy changes. We have provided preliminary findings based on specific examples of projects conducted by 2 CHWs and the impact of these projects on social capital in and among the participating units of identity. Future research will be undertaken by this group to evaluate the effectiveness of the project through use of multiple methods of data collection and analysis. In addition, the project partners hope to use the core strategies in other racial/ethnic communities in the future.
Specific Aims of Poder es Salud/Power for Health.
Acknowledgments
This research was supported by the Centers for Disease Control and Prevention (grant R06-CCR021527–02–02).
We thank Teresa Rios, Capacitation Coordinator, for contributing her extensive experience as a CHW leader and trainer and Lawrence Wallack, DrPH, former principal investigator of Poder es Salud/Power for Health, for leadership.
We also thank CHWs Alicia Lopez, Linda Hornbuckle, Gonzalo Gonzalez, Robert Seay, Maria Avila, and Jovita Walker and all members of the Poder es Salud/Power for Health steering committee and research advisory board, including Denise Johnson, Fred Miller, Joe Gallegos, Bishop A. A. Wells, Mandy Green, Maria Lisa Johnson, Pam Ballentine, Richard Loudd, Star Waters, and Ruth Kemp.
Human Participant Protection
This study was approved by the Portland State University human subjects research review committee.
Footnotes
Contributors
S. A. Farquhar and Y. L. Michael originated the overall research design, designed data collection instruments, and contributed to the study hypotheses and analyses. N. Wiggins initiated the project and identified the 3 key strategies described in the article. All authors assisted in the writing and editing of the article and approved the final version.
Accepted for publication November 13, 2004.
References
1. Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academy Press; 2002.
2. Healthy People 2010: Understanding and Improving Health. Washington, DC: US Dept of Health and Human Services; 2001. Available at: http://www.healthypeople.gov/Document/tableofcontents.htm#under. Accessed February 19, 2004.
3. Raphael D. Addressing the Social Determinants of Health in Canada: Bridging the Gap between Research Findings and Public Policy. Paper presented at: The Social Determinants of Health Across the Life-Span Conference, Toronto, Ontario, Canada, November 2002.
4. Wilkinson R, Marmot M. Social Determinants of Health: The Solid Facts. Co-penhagen, Denmark: World Health Organization; 1998.
5. Cheadle A, Wagner E, Walls M, et al. The effect of neighborhood-based community organizing: results from the Seattle Minority Youth Health Project. Health Serv Res. 2001;36:671–677.[ISI][Medline]
6. McCarthy M. Social determinants and inequalities in urban health. Rev Environ Health. 2000;15:97–108.[Medline]
7. Fawcett SB, Francisco VT, Hyra D, et al. Building healthy communities. In: Tarlov A, St. Peter RF, eds. The Society and Population Health Reading: A State and Community Perspective. New York, NY: The New Press; 2000:75–93.
8. Minkler M, Wallerstein N. Improving health through community organization and community building: a health education perspective. In: Minkler M, ed. Community Organizing and Community Building for Health. New Brunswick, NJ: Rutgers University Press; 1997: 30–52.
9. Freudenberg N, Eng E, Flay B, Parcel G, Rogers T, Wallerstein N. Strengthening individual and community capacity to prevent disease and promote health: in search of relevant theories and principles. Health Educ Q. 1995;22:290–306.[ISI][Medline]
10. Eng E, Parker E. Measuring community competence in the Mississippi delta: the interface between program evaluation and empowerment. Health Educ Q. 1994;21:199–220.[ISI][Medline]
11. Wallerstein N, Bernstein E. Introduction to community empowerment, participatory education, and health. Health Educ Q. 1992;21:141–148.
12. Metzler MM, Higgins DL, Beeker CG. Addressing urban health in Detroit, New York City, and Seattle through community-based participatory research partnerships. Am J Public Health. 2003; 93:803–810.
13. McAllister CL, Green BL, Terry MA, Herman V, Mulvey L. Parents, practitioners, and researchers: community-based participatory research with early head start. Am J Public Health. 2003;93: 1672–1680.
14. Findley SE, Sanchez M, Irogoyen M, et al. Community-provider partnerships to reduce immunization disparities: field report from Northern Manhattan. Am J Public Health. 2003;93: 1041–1044.
15. Provan KG, Nakama L, Veazie MA, Teufel-Shone NI, Huddleston C. Building community capacity around chronic disease services through a collaborative interorganizational network. Health Educ Behav. 2003;30:646–662.[Abstract]
16. Twiss J, Dickinson J, Duma S, Kleinman T, Paulsen H, Rilveria L. Community gardens: lessons learned from California Healthy Cities and Communities. Am J Public Health. 2003;93: 1435–1438.
17. Derose KP, Hawes-Dawson J, Fox SA, Maldonado N, Tatum A, Kington R. Dealing with diversity: recruiting churches and women for a randomized trial of mammography promotion. Health Educ Behav. 2000;27:632–648.
18. Kegler MC, Twiss JM, Look V. Assessing community change at multiple levels: the genesis of an evaluation framework for the California Healthy Cities Project. Health Educ Behav. 2000; 27:760–779.
19. Schulz AJ, Parker EA, Israel BA, Becker AB, Maciak BJ, Hollis R. Conducting a participatory community-based survey: collecting and interpreting data for a community intervention on Detroit’s east side. J Public Health Manag Pract. 1998;4:10–24.[Medline]
20. Wallerstein N, Duran B. The conceptual, historical, and practice roots of community based participatory research and related participatory traditions. In: Minkler M, Wallerstein N, eds. Community-Based Participatory Research for Health. San Francisco, Calif: Jossey-Bass; 2002:27–52.
21. Merideth E. Critical pedagogy and its application to health education: a critical appraisal of the Casa en Casa model. Health Educ Q. 1994;21: 355–367.[ISI][Medline]
22. Eng E, Young R. Lay health advisors as community change agents. Fam Community Health. 1992;15:24–40.
23. Minkler M. Using participatory action research to build health communities. Public Health Rep. 2000;115: 191–198.[CrossRef][ISI][Medline]
24. Witmer A, Seifer SD, Finocchio L, Leslie J, O’Neil EH. Community health workers: integral members of the health care work force. Am J Public Health. 1995;85:1055–1058.[ISI][Medline]
25. Fedder DO, Chang RJ, Curry S, Nichols G. The effectiveness of a community health worker outreach program on healthcare utilization of west Baltimore City Medicaid patients with diabetes, with or without hypertension. Ethn Dis. 2003;13:22–27.[ISI][Medline]
26. Ramos IN, May M, Ramos KS. Environmental health training of promotoras in colonias along the Texas-Mexico Border. Am J Public Health. 2001;91: 563–570.
27. Brownstein JN, Cheal N, Ackermann SP, Bassford TL, Campos-Outcalt D. Breast and cervical cancer screening in minority populations: a model for using lay health workers. J Cancer Educ. 1992;7:321–325.[Medline]
28. Stillman F, Bone LR, Becker D, Rand C, Levine DM. The heart, body and soul: a church-based smoking cessation program for urban African Americans. Prev Med. 1993;22:335–349.[CrossRef][ISI][Medline]
29. Musser-Granski J, Carillo DF. The use of bilingual, bicultural paraprofessionals in mental health services: issues for hiring, training, and supervision. Community Ment Health J. 1997;33: 51–60.[CrossRef][ISI][Medline]
30. Coleman JS. Foundations of Social Theory. Cambridge, Mass: Harvard University Press; 1990.
31. Bourdieu P. The forms of capital. In: Richardson JG, ed. The Handbook of Theory: Research for the Sociology of Education. New York, NY: Greenwood Press; 1986:241–258.
32. Lochner K, Kawachi I, Kennedy BP. Social capital: a guide to its measurement. Health Place. 1999;5: 259–270.[CrossRef][ISI][Medline]
33. Edmondson R. Social capital: a strategy for enhancing health? Soc Sci Med. 2003;57:1723–1733.[CrossRef][ISI][Medline]
34. Berkman L, Clark C. Neighborhoods and networks: the construction of safe places and bridges. In: Kawachi I, Berkman L, eds. Neighborhoods and Health. New York, NY: Oxford University Press; 2003:288–302.
35. Denner J, Kirby D, Coyle K, Brindis C. The protective role of social capital and cultural norms in Latino communities: a study of adolescent births. Hisp J Behav Sci. 2001;23:3–22.
36. Hyyppa MT, Maki J. Social participation and health in a community rich in stock of social capital. Health Educ Res. 2003;18:770–779.
37. Lochner KA, Kawachi I, Brennan RT, Buka SL. Social capital and neighborhood mortality rates in Chicago. Soc Sci Med. 2003;56:1797–1805.[CrossRef][ISI][Medline]
38. Caughy MO, O’Campo PJ, Muntaner C. When being alone might be better: neighborhood poverty, social capital, and child mental health. Soc Sci Med. 2003;57:227–237.[CrossRef][ISI][Medline]
39. Raczynski JM, Cornell CE, Stalker V, et al. Developing community capacity and improving health in African American communities. Am J Med Sci. 2001;322:269–275.[Medline]
40. Israel BA, Schulz AJ, Parker EA, Becker AB. Review of community-based research: assessing partnership approaches to improve public health. Annu Rev Public Health. 1998;19: 173–202.[CrossRef][ISI][Medline]
41. Wallerstein N. Powerlessness, empowerment, and health: implications for health promotion programs. Am J Health Promot. 1992;6:197–205.[Medline]
42. Wang CC, Redwood-Jones YA. Photovoice ethics: perspectives from Flint Photovoice. Health Educ Behav. 2001;28:560–572.
43. Vaca N. The Presumed Alliance: The Unspoken Conflict Between Latinos and Blacks and What It Means for America. New York, NY: Rayo; 2004.
44. Census of Population and Housing. Washington, DC: US Bureau of the Census; 2000.
45. Navarro M. Blacks and Latinos try to find balance in touchy new math. New York Times. January 17, 2004:A1.
46. Chavez V, Duran B, Baker QE, Avila MM, Wallerstein N. The dance of race and privilege in community based participatory research. In: Minkler M, Wallerstein N, eds. Community-Based Participatory Research for Health. San Francisco, Calif: Jossey-Bass; 2003: 81–97.
47. Putnam R. The prosperous community: social capital and public life. Am Prospect. 1993;4(13):47.
48. Putnam R. Bowling alone: America’s declining social capital. J Democracy. 1995;6:65–78.
49. Labonte R. Social capital and community development. Aust N Z J Public Health. 1999;23:430–433.[ISI][Medline]
This article has been cited by other articles:
|
|
 |
|
  A. T. Rogers and J. S. Gallegos Pathways to health and mental-health service utilization among older Mexicans International Social Work, September 1, 2007; 50(5): 654 - 670. [Abstract] [PDF]
|
|
|
|
 |
|
 K. L. Davis, M. L. O'Toole, C. A. Brownson, P. Llanos, and E. B. Fisher Teaching How, Not What: The Contributions of Community Health Workers to Diabetes Self-Management The Diabetes Educator, June 1, 2007; 33(Supplement_6): 208S - 215S. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
