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Objectives: This paper describes ethnographically informed community evaluation (EICE), a framework for evaluating complex community-based interventions, and illustrates its use in the evaluation of Baltimore City Healthy Start, a federally funded infant mortality prevention project. EICE, which is influenced by cultural anthropology and assets-based community assessment, supports continuous program improvement, resident involvement, and measurement of community-level change. This approach takes into account both individual and contextual levels of analysis. Methods: The evaluation coupled a participatory approach with qualitative and survey research methods to study community context and how it might contribute to infant mortality and influence program implementation, and to assess community change resulting from the program. Data collection included focus groups, key informant interviews, surveys, neighborhood mapping, journaling, and a study of community problem-solving. Results: The evaluation provided program-related feedback to staff, contributed to a collective understanding of the local context, validated and augmented outcome findings, and imparted skills and a sense of empowerment to the neighborhood. Results reveal a community burdened by crime and social problems, yet showing great diversity in physical and social conditions when examined at the census block group level. Nevertheless, these social and physical hazards in the community are more salient than any specific health issue such as infant mortality. Conclusions: EICE is a powerful evaluation approach able to respond to the complexities of community-based maternal and child health initiatives designed to institute changes across multiple domains. EICE may be used, in whole or in part, as a supplement to traditional designs. [ABSTRACT FROM AUTHOR]

Recent years have seen a steady increase in attention to communities as a source of both risk and protective factors for various individual outcomes. Psychological sense of community (PSOC) is one concept which can be important in describing the ways in which real and perceived aspects of community might mediate both individual and community outcomes. To understand the setting-specific interaction of individual and community, it is necessary to examine how individual and community level factors are simultaneously associated with psychological sense of community. As part of a larger study of community influence on health, we conducted a random household survey in three geographically defined low-income communities in Baltimore City. Nine hundred fourteen individuals were surveyed with a questionnaire that included a measure of psychological sense of community. This article describes the variability of PSOC in these communities and identifies individual- and community-level characteristics associated with varying levels of PSOC. Statistical methods of multi-level analysis were employed. Individuals in low-income communities showed heterogeneity for PSOC that is partially explained by variation in individual- and community-level characteristics. We suggest that this variability, as well as the promotion of positive PSOC within low-income communities, has implications for the development and implementation of community-based interventions. © 1999 John Wiley & Sons, Inc. [ABSTRACT FROM AUTHOR]

Abstract: This study builds upon existing research by examining whether risk indices for child psychological well-being behave in the same way in different types of neighborhoods. Specifically, we sought to determine if neighborhood characteristics acted to exacerbate or, alternatively, to buffer risk factors at the family and/or child level. Families with a child entering first grade in Fall 2002 were recruited from Baltimore City neighborhoods, defined as census block groups. This study included 405 children, and data came from an interview with the primary caregiver and an assessment of the first grader. The dependent variables were externalizing behavior and internalizing problems. A family risk index consisting of 13 measures, and a child risk index consisting of three measures were the main independent variables of interest. We examined the effects of these indices on child psychological well-being and behavior across two neighborhood characteristics: neighborhood potential for community involvement with children and neighborhood negative social climate. Results of multivariate analyses indicated that cumulative family risk was associated with an increase in both internalizing and externalizing behavior problems. Perceived negative social climate moderated the effect of family risks on behavior problems such that more risk was associated with a larger increment in both externalizing behavior problems and psychological problems for children living in high versus low risk neighborhoods. These findings further emphasize the importance of considering neighborhood context in the study of child psychological well-being. [ABSTRACT FROM AUTHOR]

To diagnose asymptomatic bacterial vaginosis (BV), self-sampled vaginal smears were collected during a study of risk factors for preterm birth in African American women. More than 90% of those women who were willing to participate in the interview portion of the study were also willing to provide a self-sampled vaginal smear. The smears are an acceptable and efficient way of detecting BV in an urban minority population.