Harnessing the Power of Partnership and Community Collaboration: Addressing Youth Health Inequalities

Abstract

Harnessing the Power of Partnership and Community Collaboration:Addressing Youth Health Inequalities H. Mollie Greves Grow, MD MPH The three manuscripts in this issue related to addressing pediatric or youth health by Gamache Martin et al., Javier et al., and McCleary-Sills et al. point to the promise of community-based participatory research (CBPR) methods to identify and ameliorate health inequalities in youth populations. The authors have harnessed some of the best of CBPR methods1 to reach populations in need at different research stages—from formative research to training development to full intervention implementation. For those of us on the front lines of pediatric care, these methods represent important improvements to traditional medical research approaches. It is not that these approaches are completely new, but that now there are codified approaches for CBPR2 combined with increasing interest in addressing health inequalities3,4 helping to bring this approach more into the fore of health research methods.5 One of the main limitations of biomedical research has been translating bench or clinical research into community settings.6 Starting with the community may offer a more direct approach. Researchers bring the academic awareness of the state of the science, and community partners bring awareness of community need and feasibility. The power of this type of partnership and collaboration applied specifically to pediatric or youth populations are highlighted by the manuscripts in this issue. There are three overarching themes that underscore important examples of the potential role of CBPR in pediatric research. Theme 1: CBPR Helps to Document and Address Health Inequalities of Underserved Youth From Within the Community All three articles highlight important health inequalities in a particular youth population and the systematic steps taken from within the community to address the problem. This approach allows for development of authentic interventions relevant to the community and, hopefully, more complete community buy-in. Gamache Martin et al. make a compelling case to serve Puerto Rican children, who have the highest rates of asthma of any ethnic group in the United States, with an entirely Puerto Rican community partnership approach. Javier et al. describe the higher teenage pregnancy rates among Filipino youth and how Javier, as a Filipina trainee, partnered with a local community agency who saw an unmet need to support teens and traditional parents in communicating about sexual activity. McCleary-Sills et al. characterize the higher smoking rates for immigrant Hispanic youth and the important role of a local community agency and a provider group to carry out research to understand root influences on smoking behavior. Each manuscript documents specific, important cultural lessons included in the study/intervention as a result of the active community partners' roles. Starting from within the community allowed for the particular research to be possible in the first place, because each study documented some difficulty reaching the population to be served. Through problem solving together, the groups overcame obstacles to carrying out their respective studies, and learned important lessons along the way, such as how cultural barriers prevented publicly discussing smoking or teen sexual activity. The other important outcome working from within the community is the likelihood of sustainability of the research products leading to more meaningful and enduring change. Each of the manuscripts document ongoing effects of the studies described: Uptake of the CALMA asthma intervention by Puerto Rican government entities (Gamache Martin); a second conference on [End Page 253] Filipino youth sexual behavior and communication, and additional ongoing research with Filipino youth around mental health (Javier et al.); and a second phase of research on environmental influences on Hispanic youth smoking behavior that will lead to intervention and policy recommendations in Baltimore (McCleary-Sills et al.). Theme 2: Importance of CBPR to Provide Education, Especially Culturally Tailored Education, and Mutual Training Benefit Two of the eight principles of CBPR as outlined by Israel et al.8 are to "integrate knowledge and action for mutual benefit of all partners," and "promote a co-learning and empowering process that attends to social inequalities." The three articles highlight an important role of CBPR in providing education to impact health early in life, particularly for parents and for adolescents/young adults themselves. In the CALMA intervention (Gamache...