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This community-based participatory research study explores the influence of structural racism on sexual and reproductive health (SRH) inequities among immigrant, including refugee, youth. We conducted interviews with emerging youth and youth service providers living in two communities in Massachusetts. Our results detail three major themes illustrating how structural racism influences SRH inequities among immigrant youth: (1) lack of culture-centered SRH supports for recently immigrated youth; (2) immigration enforcement and fear impacting access to adolescent SRH (ASRH) education and services; and (3) perceived ineligibility related to tenuous legal status as a barrier to accessing ASRH services. Conclusions: Findings illustrate the importance of rooting sexuality education curricula in a culture centered framework that recognizes local cultural understandings, acknowledges structural constraints faced by young people, and prioritizes youth agency and voice when engaging in this work. Raising awareness of SRH resources available to immigrant youth may expand access for this underserved population.

This special collection of Health Promotion Practice introduces critical narrative intervention (CNI) as a key theoretical framing for an asset-based, narrative, and participatory approach to promoting health and addressing social inequality. Innovative digital and visual methodologies highlighted in this special collection—comics and graphic novels, cellphilms and other participatory film, story booths, digital storytelling, and photovoice—are changing the way critical public health researchers and practitioners forge new knowledge, creating new possibilities for interdisciplinary and activist-based inquiry. Public health research and engagement efforts that critically contend with historically repressive structures and intervene through narrative and participatory processes to enact change with and for disenfranchised communities are long overdue. This special collection showcases six CNI projects that promote equity and justice in the context of LGBTQ, nonbinary, and other gender-diverse young people; people who inject drugs living with hepatitis C virus; young women who trade sex; undocumented and formerly undocumented immigrants; and people living with HIV/AIDS. It is our intent that this collection of exemplars can serve as a guidepost for practitioners and researchers interested in expanding the scope of critical public health praxis. Individually and collectively, the special collection illustrates how CNI can create space for the increased representation of historically silenced populations, redress stigma, and provoke important questions to guide a new era of health equity research.

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.

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.

Substance use disorder (SUD) is a growing issue nationally, and SUD in pregnancy has significant consequences for mothers and their children. This article describes findings from a pilot project that used digital storytelling as a mechanism for understanding substance use and recovery from the perspective of women in recovery from SUD in pregnancy who worked as peer mentors with pregnant women currently experiencing SUD. Research on peer mentorship has primarily focused on outcomes for mentees but not the experience of the peer mentors themselves. In this qualitative study, a 3-day digital storytelling workshop was conducted with five women in recovery serving as peer mentors in their community. Each mentor also participated in an individual, in-depth interview. The digital storytelling workshop process helped peer mentors make linkages between their past substance use experiences to their present work of recovery, and fostered deep social connections between mentors through the shared experience. The workshop process also elicited a sense of hope among participants, which served as groundwork for developing advocacy-based efforts. Digital storytelling may be therapeutic for women in recovery and has the potential to be integrated into recovery programs to bolster hope and social support among participants.

We currently see an interdisciplinary shift toward a "participatory turn" in health research and promotion under which community engagement, shared decision making and planning, and the use of visual and digital methods have become paramount. Digital storytelling (DST) is one such innovative and engaging method increasingly used in applied health interventions, with a growing body of research identifying its value. Despite its increasing use, a standard approach to empirically assess the impacts on individuals participating in DST interventions does not currently exist. In this article, we define DST as a distinct narrative intervention, illustrate key elements that inform the methodology, and present a conceptual model to examine how DST may contribute to increased socioemotional well-being and bolster positive health outcomes. Our proposed model is informed by elements of narrative theory, Freirian conscientization, multimodality, and social cognitive theory and can serve as a guide for public health practitioners and researchers interested in assessing the potential benefits of DST as an applied health intervention. Recommendations for practice call for a rigorous methodological approach to apply and test this model across a range of health contexts and populations.

Digital storytelling (DST) engages participants in a group-based process to create and share narrative accounts of life events. The process of individuals telling their own stories has not been well assessed as a mechanism of health behavior change. This study looks at outcomes associated with engaging in the DST process for vulnerable youth. The project focused on the experiences of Puerto Rican Latinas between the ages of 15 to 21. A total of 30 participants enrolled in a 4-day DST workshops, with 29 completing a 1 to 3-minute digital story. Self-reported data on several scales (self-esteem, social support, empowerment, and sexual attitudes and behaviors) were collected and analyzed. Participants showed an increase in positive social interactions from baseline to 3-month post workshop. Participants also demonstrated increases in optimism and control over the future immediately after the workshop, but this change was not sustained at 3 months. Analysis of qualitative results and implications are discussed.

Since the 2003 call by the Institute of Medicine to educate undergraduates in public health, various models have emerged for incorporating public health into the liberal arts and sciences. One model is a professionalized public health major that uses core public health competencies to prepare a workforce of health professionals. A second model offers a broad-based public health major rooted in liberal arts principles, resisting the utilitarian trend toward human capital formation. A third model resists even the label of “public health,” preferring instead to introduce undergraduates to many ways of analyzing human health and healing. The multidisciplinary Culture, Health, and Science Program, based on six key commitments for preparing liberal arts students to analyze health and respond to global health challenges, is offered as an alternative to the public health major.

Substance use disorders (SUDs) are a growing problem for pregnant and parenting women. Woman-to-woman peer support may positively influence perinatal outcomes but little is known about the impact of such support on the women who are providing support. The purpose of this study was to describe experiences of addiction in pregnancy, recovery, and subsequently serving as a peer mentor to other pregnant women with active SUD among women in recovery in a rural setting. We conducted one digital storytelling workshop with five women serving as peer mentors with lived experience of perinatal SUD. The mentors faced significant stigma in pregnancy. They had each done the “inside work” to achieve recovery, and maintained recovery by staying balanced. Peer mentoring supported their own recovery, and story sharing was integral to this process. Peer-led support models may be an effective, self-sustaining method of providing pregnancy-specific peer support for SUD.

Digital storytelling workshops are increasingly being used to capture lived experiences and develop/disseminate health promotion messages for vulnerable and marginalized populations. Thirty female Latina teens of varied sexual/parity status produced digital stories of significant life experiences in a group context and then viewed and evaluated them using the Narrative Quality Assessment Tool. This tool was used to examine participants' experience of emotional engagement and identification with each story as well as a single-item indicator of desire to "do something in my community" related to the story. Emotional engagement was moderately strong; identification scores were neutral relative to the stories. Emotional engagement was strongly, significantly related to "desire to act in my community," while identification was not related. Emotional engagement should be considered an important factor to incorporate in the production of digital stories for purposes of developing interest in social action beyond the digital storytelling workshop.

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.

The field of public health frequently issues calls for social justice, but it is not clear that everyone agrees on what this means or how to achieve it. To assess lay citizens' views on the relationship between justice and health, we conducted individual interviews with 19 young parenting women to hear and discuss their thoughts about the causes of health disparities, ways to reduce them, and the nature of the just society. A salient theme to emerge in these interviews was the topic of “caring.” This article reports on four categories identified under the theme of caring: 1) observations of apathy and indifference; 2) the effects of not caring; 3) models of caring; and 4) the pull of caring. Based on these results, the article outlines a grounded theory on the role of caring in conceptualizing health motivation.

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.

Background Young Latinas living in the United States experience inordinate sexual and reproductive health outcome disparities. However, though prioritized as subjects for prevention, they are also often denied sexual agency. Purpose This article reports the results of a study conducted to examine young Latino/a participants' perspectives on communicating and learning about sexuality in school and family settings. Methods A Photovoice project was conducted with 20 Latino/a high school students. Each participant received a digital camera to take photos for 2 discussion sessions. Participants discussed select photos in relation to self-generated topics. Results One overarching theme, double standards in expectations about sexual communication, and 2 related subthemes, contrasting gender expectations in sexual desire and pleasure and confirming ideologies in sexual taboos and disconnections, emerged during discussions. Discussion The persistence of a double standard placing responsibility for sexual protectio...

Digital storytelling (DST) engages participants in a group-based process to create and share narrative accounts of life events. We present key evaluation findings of a 2-year, mixed-methods study that focused on effects of participating in the DST process on young Puerto Rican Latina’s self-esteem, social support, empowerment, and sexual attitudes and behaviors. Quantitative results did not show significant changes in the expected outcomes. However, in our qualitative findings we identified several ways in which the DST made positive, health-bearing effects. We argue for the importance of “measuring down” to reflect the locally grounded, felt experiences of participants who engage in the process, as current quantitative scales do not “measure up” to accurately capture these effects. We end by suggesting the need to develop mixed-methods, culturally relevant, and sensitive evaluation tools that prioritize process effects as they inform intervention and health promotion.

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).

Using a positive youth development framework, this article describes how a 3-year digital storytelling project and the 566 digital stories produced from it in Northwest Alaska promote protective factors in the lives of Alaska Native youth and serve as digital “hope kits,” a suicide prevention approach that emphasizes young people’s reasons for living. Digital stories are short, participant-produced videos that combine photos, music, and voice. We present process data that indicate the ways that digital stories serve as a platform for youth to reflect on and represent their lives, important relationships and achievements. In so doing, youth use the digital storytelling process to identify and highlight encouraging aspects of their lives, and develop more certain and positive identity formations. These processes are correlated with positive youth health outcomes. In addition, the digital stories themselves serve as reminders of the young people’s personal assets—their reasons for living—after the workshop ends. Young people in this project often showed their digital stories to those who were featured positively within as a way to strengthen these interpersonal relationships. Evaluation data from the project show that digital storytelling workshops and outputs are a promising positive youth development approach. The project and the qualitative data demonstrate the need for further studies focusing on outcomes related to suicide prevention.