Substance-using Youth in Northern California

Qualitative Research Team Youth Drug Study - Five-County Formative Research on Substance-using Youth at Risk for HIV and Related Health Problems

The main objective of this study are to describe and explain salient socio-cultural factors and forces that contextualize the everyday lives of 14-25 year old substance using youth in five Northern California counties (San Francisco, San Mateo, Alameda, Contra Costa, and San Joaquin), with an emphasis on how such factors and forces place this population at risk for HIV (Human Immunodeficiency Virus) and related health problems. This qualitative research-training project is designed to collaborate with epidemiologists, public health practitioners, and other social service providers with the goals of:

1. Undertake formative qualitative research on substance using youth at risk for HIV and related health problems towards:

  • describing the target population of substance using youth at risk for HIV and related health problems within and between the five Northern California counties; and

  • providing information and recommendations for a epidemiologic survey, including issues related to sampling, recruitment, and questionnaire items; and

  • providing qualitative data for comparison with findings from the epidemiological survey conducted across five Northern California counties

2. Train and forge a multi county qualitative research team of public health practitioners for the purposes of:

(a) collecting qualitative data towards meeting objective and

(b) providing team members with experiences that will be helpful to the success of the epidemiologic survey and overall capacity building. The project, consisting of both research and training objectives, is designed to meet both objectives concurrently, which are not mutually exclusive

The ethnographic study of the social dynamics that place youth at risk of acquiring HIV and related health risks comes from recognition that HIV prevention and treatment is most effective when it is highly specific to particular populations that takes into account identified risk behaviors, the contexts of risks, and additionally remains open to unanticipated or unforeseen social factors and forces that place youth at risk.

The target populations are youth (individual and groups) between the ages of 14 and 25 years who are identified as substance users at risk for HIV infection and related health problems. The purpose of including youth who use legal substances (i.e.; over-the counter pharmaceuticals, inhalants, alcohol, etc) and not solely youth who use illicit substances is too cast the widest net in including youth at risk who are being inducted into heavier drug use. Recent studies clearly indicate that early substance use patterns and drug exposure are associated with initiation injection (Sherman et al 2005) and drug abuse. Moreover, a qualitative approach to professionally considered at-risk substance using youth may be at variance with how youth themselves conceive of risks. Greater understanding of the contrasts of the very conceptions and practices of risk between substance using youth and professional public health practitioners will be vital and informative in forging effective health promotion interventions (Kelly 2005).

Generally, youth who repeatedly use substances have been identified as experiencing a variety of problems to include family abuse, sexual abuse, academic difficulties, mental and physical health problems, poor peer relationships, involvement with the juvenile justice system, etc. Moreover, greater use and abuse of substances by youth may lead to increasingly perilous conditions and practices such as sex in exchange for drugs, money, shelter or other needs, or drug injection practices involving unclean needles and sharing of paraphernalia that increases exposure to HIV. However, rather than view these problems, conditions, and practices “as endogenous to individuals’ cognitive decision-making and immediacy of interpersonal relations” (Rhodes et al 2006), a qualitative approach includes understanding how social situations, structures, and places are significant factors and forces that contribute to increased risk. This is in keeping with a qualitative medical anthropological approach that understands “risk environments” as socially produced and comprising of risk factors exogenous to the individual (ibid). The few attempts to synthesize evidence of how the environment influences the risk of HIV transmission (ibid) have not primarily focused on youth.

Youth at risk for HIV and related health problems need to be better understood particularly given the ubiquity and complexity of substance use in this population and a qualitative approach will focus on local conditions, social factors and forces that are not generalizable from one neighborhood, community, or environment to another. Hence a multi-sited qualitative approach that links research, training, and intervention responsive to local conditions is the primary objective and motive for establishing a multi-county cohort of public health practitioners trained in ethnographic research.

The training of public health practitioners in qualitative research methods will out of necessity be attained through actual research supervised and directed by experienced qualitative researchers. This approach is in keeping with the Socratic method of learning from actual engagement. Qualitative and ethnographic research methods are best learned through a combination of actual supervised fieldwork experience with academic instruction. The end products of such training will be descriptive and analytic data applicable to public health agencies and professionals responsible for serving substance using youth at risk for HIV and related health problems. Training and research will be actualized by partnering county public health practitioners with qualitative researchers.

 

Investigator: Dr. James Quesda