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BackgroundLow/no-income Latino men are disproportionately burdened by chronic disease morbidity and mortality, which is often compounded by persistent exposure to stress. Chronic stress is a key mediating factor in pathways linking macro-level socio-structural forces to micro-level behavioral factors with negative health outcomes. Being that Latinxs continue to be one of the fastest growing populations in the U.S., it is imperative to better understand the roots of stress pathways and explore multi-level interventions.MethodsThis study presents qualitative findings from in-depth interviews with Puerto Rican men (95%) living in Springfield, Massachusetts. We utilized the Minority Stress Model (MSM) first posited by Ilan Meyers, as a framework to understand stress and stress processes amongst Puerto Rican men. We mapped our data onto Meyers' MSM, which allowed us to find diverging themes and identify areas for expansion.ResultsAs expected, participants reported stress rooted in experiences of racism and prejudice, expectations of rejection, English-language acquisition, family relationships, insecure housing, precarious employment, and lack of resources. Nevertheless, the MSM did not account for the historical contexts that, as our findings indicate, are used to filter and understand their experiences with everyday stressors. Participants described and linked histories of colonial violence and movement and migration to their stress and community wellbeing.DiscussionFindings suggest the need to expand the current MSM and our conceptualization of the stress process to include historical understandings when contextualizing present-day stress and future interventions. We propose an expanded heuristic model that delineates the impact of distinctive historical trajectories that aid in interpreting racial health disparities amongst minoritized populations. Future multi-level interventions should give weight to highlighting history and how this impacts the present, in this case including the culpability of U.S. policy regarding Puerto Rico and the adverse health effects for Puerto Rican men on the mainland.

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. A qualitative focus group was conducted with eight staff members (five health educators and three health interviewers) involved in Proyecto Mama 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. 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. 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. NCT01679210 . Registered 5 September 2012; NCT01868230 . Registered 4 June 2013.

Opioid-related fatalities increased exponentially during the COVID-19 pandemic and show little sign of abating. Despite decades of scientific evidence that sustained engagement with medications for opioid use disorders (MOUD) yields positive psychosocial outcomes, less than 30% of people with OUD engage in MOUD. Treatment rates are lowest for women. The aim of this project was to identify women-specific barriers and facilitators to treatment engagement, drawing from the lived experience of women in treatment. Data are provided from a parent study that used a community-partnered participatory research approach to adapt an evidence-based digital storytelling intervention for supporting continued MOUD treatment engagement. The parent study collected qualitative data between August and December 2018 from 20 women in Western Massachusetts who had received MOUD for at least 90 days. Using constructivist grounded theory, we identified major themes and selected illustrative quotations. Key barriers identified in this project include: (1) MOUD-specific discrimination encountered via social media, and in workplace and treatment/recovery settings; and (2) fear, perceptions, and experiences with MOUD, including mental health medication synergies, internalization of MOUD-related stigma, expectations of treatment duration, and opioid-specific mistrust of providers. Women identified two key facilitators to MOUD engagement: (1) feeling “safe” within treatment settings and (2) online communities as a source of positive reinforcement. We conclude with women-specific recommendations for research and interventions to improve MOUD engagement and provide human-centered care for this historically marginalized population.

Precarious work has steadily grown in the United States since the rise of neoliberal policies. The continued expansion of this type of work has led to precarious employment as a recognized category within social determinants of health work and to a growing literature within public health research. African-American men are disproportionately vulnerable to precarious work, which in turn contributes to adverse health effects. Nevertheless, African-American men’s experiences of employment and the perceived impact on their well-being remain underexplored. This study was part of the formative exploratory phase of a 5-year community-based participatory research project to examine the biopsychosocial determinants of stress among low/no-income, African-American men. Through thematic analysis of 42 semi-structured interviews, 3 themes emerged: ( a) occupational hazards and health, ( b) internalization of neoliberal ideology, and ( c) constraints of structural factors. Neoliberal economic policies cause material deprivation and exacerbate systemic injustices that disproportionately affect communities of color. The accompanying neoliberal ideology of personal responsibility shapes men’s perceptions of success and failure. Public health research must continue to push against health promotion practices that predominantly focus on individual behavior. Rather than exploring only the granularities of individual behaviors, health problems must be examined through prolonged historical, political, economic, and social disenfranchisement.

The familiar story about young pregnant and parenting Latinas relies on commonsense logic about the timing of reproductive lives. We explore young mothers' own sense making, captured in local vernacular through participants' digital story depictions, our fieldnotes of digital storytelling workshop talk, and participants' follow-up interview reflections about enduring judgment and doing their lives. In this article, we introduce the Hear Our Stories project and present key digital stories and related ethnographic material that serve as local exemplars of “doing your life.” Findings reveal ways participants negotiate value making about their reproductive lives. As a narrative intervention, digital storytelling helps to gain a firmer grasp on social worlds and to better understand inequality, while also engaging participants in a process that affords them the opportunity to shift from being a judged teen mom to co-creators of knowledge and change as strategic storytellers.

This article focuses on findings of a two-year pilot research study focused on addressing sexual and reproductive health inequities faced by adolescent women of Puerto Rican descent living on the mainland United States. Working with three groups of young women, in the pilot study we gathered ethnographic data in and around a group-based digital storytelling process to inform the development of a larger intervention. Digital stories are short (1–3 minute), participant produced videos that synthesize still and moving image, a voiceover recording of the participant telling her story, and background music and text to document personal experiences. Based on narrative analysis of digital stories and field notes written in and around the digital storytelling workshop process, as well as follow-up individual interviews with workshop participants, our findings center on the ways that trauma has specifically shaped participants’ sexual and reproductive health experiences. We argue that digital storytelling serves as a critical narrative intervention, whereby participants’ engagement in the storytelling process enables them to collaboratively interrogate and potentially address prior trauma, bolster a sense of social support and solidarity, and potentially recalibrate stigmatizing conversations about them. We introduce our project methodology, and then present key findings on trauma as it informs sexual and reproductive health practices, with digital storytelling showcased as a modality for critical narrative intervention. We conclude by discussing implications for critical public health research and practice.

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.

Purpose: There is a dearth of effective, evidence-based programs to reduce chronic disease in low-income African-American men. We report on the results of formative research in the National Institutes of Health (NIH)-funded MOCHA Moving Forward project on factors identified by the participants to drive health disparities. Methods: Based on individual interviews with 42 middle-aged (40–65 years), low-income African-American men, three themes emerged. Results: First, the results indicate a hierarchy in the perceived relative influence of different factors, with poverty and unemployment perceived to have the most powerful affects. Second, results show that factors in different domains do not operate as discrete independent influences, but rather, interact synergistically. Finally, the findings show how perceived social structural constraints have produced deep cynicism about the future, with notably divergent reactions, producing a sense that there is almost nothing an individual can do, or paradoxically, a greater the sense of personal responsibility. Conclusion: The implications of addressing the cascade of social determinants to reduce chronic disease in African-American men are discussed.

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.

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.

Comprehensive sexuality education curricula that incorporate sex positive and integrated approaches go beyond a presentation of facts and strategies for prevention to emphasize the promotion of sexual subjectivity and wellbeing. A pilot sensual sexuality education program was planned, implemented and informally evaluated with young parenting women at an alternative General Educational Development test preparation center. The program prioritized a sex positive framework, including topics such as pleasure, desire and sexual entitlement, and invited participants to explore sexuality through a multisensory orientation. Participants took part in small group discussions and activities that engaged their senses through arts-based methods. Grounded in holism, program topics were integrated with a focus on participants' everyday experiences. The pilot curriculum serves as a promising program for re-positioning young parenting women as sexual subjects, which is key to the promotion of health and wellbeing.

This collection of original articles, a companion to the authors' Participatory Visual and Digital Methods, illustrates how innovative visual and digital research techniques are being used in various field projects in health care, environmental policy, urban planning, education and youth development, and heritage management settings. These methodologies produce rich visual and narrative data guided by participant interests and priorities, key tools for collaborative work. The 16 chapters-include digital storytelling, PhotoVoice, community-based filmmaking, participatory mapping and GIS, and participatory digital archival research;-provide a portfolio of model research projects for researchers who wish to collaborate on community-based studies;-will appeal to an audience across social science, heritage, health, education, and social service fields.An open-access companion website will allow readers to view the research products presented in each contributor's chapter.

Predominant approaches to teen pregnancy focus on decreasing numbers of teen mothers, babies born to them, and state dollars spent to support their families. This overshadows the structural violence interwoven into daily existence for these young parents. This paper argues for the increased use of participatory visual methods to compliment traditional research methods in shifting notions of what counts as evidence in response to teen pregnancy and parenting. We present the methods and results from a body mapping workshop as part of 'Hear Our Stories: Diasporic Youth for Sexual Rights and Justice', a project that examines structural barriers faced by young parenting Latinas and seeks to develop relevant messaging and programming to support and engage youth. Body mapping, as an engaging, innovative participatory visual methodology, involves young parenting women and other marginalised populations in drawing out a deeper understanding of sexual health inequities. Our findings highlight the ways body mapping elicits bodies as evidence to understand young motherhood and wellbeing.

In a recent Editors Choice column in the American Journal of Public Health Northridge and Coupey1 advocate the increased use of long-acting reversible contraception (LARC) specifically the intrauterine device and the implant as a means to achieve reproductive health equity. They reference the American Academy of Pediatrics recommendation which states that these methods should be considered "first-line contraceptive choices" for adolescents and young adults.2 (Am J Public Health. Published online ahead of print November 12 2015: e1-e2. doi:10.2105/AJPH.2015.302900).

This paper presents the Ford Foundation-funded Hear Our Stories: Diasporic Youth for Sexual Rights and Justice project, which explores the subjective experience of structural violence and the ways young parenting Latinas embody and respond to these experiences. We prioritize uprooted young parenting Latinas, whose material conditions and cultural worlds have placed them in tenuous positions, both socially constructed and experientially embodied. Existing programs and policies focused on these women fail to use relevant local knowledge and rarely involve them in messaging efforts. This paper offers a practical road map for rendering relevant and modifying notions of voice as a form of knowledge with the potential to disrupt authoritative knowledge. We present the context and method behind the four digital storytelling workshops that served as a venue for transforming assumptions about young parenting women and producing novel understandings of teen pregnancy and parenting. We end by suggesting an intervention for what we call “strategic authenticity” as it plays out in storytelling, meaning making, and voice, and implications for policy concerned with social justice and equity.