Attachment 5

A Community-Based Participatory Research Study of

Behavioral Mapping Detailing Essential Components

of Primary Prevention of HIV/AIDS and Drug Addiction

Jay C. Chunn, Ph.D; Harold L. Aubrey, Ed.D;

Ricardo D. LaGrange, Ph.D; Ava Joubert-Curtis, MD, Dr.PH(c)

Research Monograph

August, 2008

Published by the National Center

for Health Behavioral Change e-Press©

Location: Urban Medical Institute /Morgan State University

2600 Liberty Heights Avenue

Baltimore, MD 21215

www.nchbc.org

Research funding by the Kellogg Foundation: Grant #P0093145 ©

Acknowledgement

We wish to acknowledge the support of the Kellogg Foundation in financing this study and for their strong belief in our work. Ms. Barbara Sabol, Program Director for Kellogg, has given her support and insight generously to our work at the National Center for Health Behavioral Change. We also acknowledge the support of Chairperson, Dr. Anna McPhatter, Department of Social Work. We greatly appreciate the involvement of the Public Health Program for interns and faculty input.

We further gratefully recognize the contributions of the following persons for their assistance in making the research possible by participating in the study and helping to interpret the results. Special thanks are extended to the 375 participants from the community for sharing their life experiences and challenges with this community participatory research. Research contributors include: Lucy Perez, MD; Rena Boss-Victoria, RN, DrPH; Olu Ekundayo, MD, DrPH; Leroy Issac, MPH; Dale Berry, BA; Angela Anderson; Leon Jackson; Joyce Dorsey, B.Ed; Janice Jefferson, M.Ed; Bro. Al Moye; Brana Grant; and DrPh Interns Ava Joubert-Curtis, MD, Dr.PH (c) (fourth co-author); Edna B. Green, M.Ed, Dr.PH (c); Solomon E. Agbor, Dr.PH; Curtis Obike, MPH, Dr.PH( c)

We extend my thanks to the co-authors on the title page and all of the above for their valuable contributions.

Jay C. Chunn, Ph.D

Director/Principal Investigator

Primary Funding: Kellogg Foundation Grant # P0123895

ABSTRACT

HIV/AIDS continues to infect and affect minority communities at disparate proportions. While prevention efforts have had some success over the last 20 years, proliferation of the disease within minority communities continues to grow. The objective of this study was to use Behavioral Mapping (BM), an innovative participatory research technique, to determine the most effective forms of intervention that can be implemented for primary prevention at critical periods of an individual’s life. With active community involvement in the form of focus group interviews, intervention strategies were statistically generated based upon the frequency in which they were discussed. Several intervention strategies emerged has having significant perceived impact on the prevention of HIV/AIDS. The focus groups identified age 12 or under as the time that a sentinel event was likely to occur. This event was a type of negative experience that led the individual into aberrant lifestyle behavioral patterns hence, that led in many instances to HIV and/or drug related behaviors. Therefore, for an educational or health literacy intervention to be effective it would have to be implemented before the age of 12 in most instances.

In addition, the community’s overriding concern with the need to improve health literacy and educate young people on drug abuse prevention emerged as a consistent possibly enabling theme.

Key Words: Community-based participatory research; Behavioral mapping; Primary prevention

Single function variable; composite function variables; exploratory analysis; climate of consensus

Despite the development and implementation of numerous prevention programs, racial disparities in the prevalence and incidence of HIV and AIDS in the United States continue to be a cause for alarm. The CDC (2008) reports that in 2006, blacks made up almost half (49%) of the estimated number of new HIV diagnoses while only representing 13% of the population. That year, blacks were nearly 9 times more likely to have AIDS than whites. Due to multifaceted and complex underlying causes, these differences have been persistent for nearly 20 years and are largely resistant to intervention (Kraut-Becher, Eisenberg, Voytek et al., 2008; Miranda, Duan, Sherbourne et al., 2003).

While race and ethnicity are not specific risk factors for HIV/AIDS, epidemiological research consistently highlight the disproportionate challenges African-Americans and Hispanics face due to high rates of sexually transmitted diseases (CDC, 2007; Flemming & Wasserheit, 1999), substance abuse (Leigh & Stall, 1993), incarceration (Braithwaite & Arriola, 2003; Maruschak, 2001), and limited access to high quality health care (Diaz, 1994). Although HIV incidence rates have dropped nationally from a high of 150,000 per year in the mid-1980’s and stabilized at about 40,000 new cases per year since the late 1990s (Noar, 2007), the disproportionate number of blacks contracting HIV continues to grow and creates a public health dilemma that will effect large segments of the country.

A paradigm shift is needed to help mobilize the broader African-American community and reduce the disproportionate impact of HIV/AIDS on disadvantaged populations. The reality of the morbidity and mortality that blacks face precipitates a greater search for a solution that emphasizes primary prevention (Chunn, 2002). Behavioral science theory promises to shift the focus of HIV-interventions to disease prevention by identifying those variables that most strongly predict future behavior. Changes in predictor variables should translate into health behavior change (Yzer, Fishbein, & Hennessy, 2008).

Adapting behavioral theory for HIV prevention efforts within the black community requires cultural competence and relevance. To address these needs, the investigators utilized Behavioral Mapping (BM), community participatory research that systematically observes and tracks behavior over the life cycle. BM was developed and validated by the National Center for Health Behavioral Change of Morgan State University in Baltimore, Maryland to be the first predictive process and instrumentation designed and developed for high risk urban populations living with HIV/AIDS and drug addiction.

Tracing human behavior through mapping is a technique that has been used extensively for health promotion programs including nutritional interventions, violence prevention, and asthma education (Tortolero, 2005; Bartholomew, Parcel, Kok, & Gottlieb, 2001). It produces a framework that identifies health behavior determinants with specific methods and strategies. BM avoids the criticism of many theories and models of behavior change by incorporating the physical, environmental, and sociocultural influences on behavior.