City Youth Research Articles

A Robust Square: Planning, Youth Work, and the Making of Public Space in Post‐Unification Berlin

AbstractDrawing on ethnographic fieldwork in post‐unification Berlin, this article examines the re‐articulation of the problematic of “the social” in city planning. It juxtaposes the contrasting visions of city planners and youth workers for Alexanderplatz, a controversial square in Berlin's eastern centre. I argue that the notion of “robustness” is helpful in understanding an important contemporary shift in thinking about planning and the social. In a sense, both planners and youth workers accused each other of taking insufficient notice of “the social.” While planners spoke of robustness as a technical, economic and aesthetic quality to which public space needs to aspire, the youth workers' vision for Alexanderplatz was a proposal for a kind of “social” robustness where the social is, quite literally, built into the urban design. These ethnographic observations need to be understood in a context where city planning has been one of the most critical domains in which the tensions provoked by German unification are played out. Taking such socio‐cultural specificities into account will lead to a more nuanced understanding of forms of neoliberal city planning.

Injury Prevention and Safety

<P>Injury is the leading cause of morbidity and mortality in childhood in the United States. Worldwide, childhood injuries are ubiquitous and deadly, especially the injuries that result from armed conflict and violence. The impact of injuries on children ought not be news to today’s pediatricians, experts in child development and health. Prevention of injuries is a major topic for anticipatory guidance.</P><h4>ABOUT THE GUEST EDITOR</h4><P>Robert R. Tanz, MD is Professor of Pediatrics at Northwestern University Feinberg School of Medicine and an attending physician in the Division of General Academic Pediatrics at Children’s Memorial Hospital in Chicago. He received his undergraduate degree in biology from Lafayette College in Easton, Pennsylvania, in 1972 and his MD from the Chicago Medical School in 1976. He was a resident in pediatrics at Children’s Memorial Hospital from 1976 to 1979 and joined the faculty of the Department of Pediatrics at Northwestern University Medical School in 1980. From 1982 to 2000 he was Director of Continuity Clinic. He was Associate Chair for Education from 1997 to 1999 and the Director of Medical Education in the Department of Pediatrics from 1999 to 2004. He is a five-time recipient of the Faculty Excellence in Education Award, voted by the pediatric house staff.</P><P>Dr. Tanz was a member of the Executive Committee of the American Academy of Pediatrics (AAP) Section on Injury and Poison Prevention from 1996 to 2007, serving as Chair of the Section from 1999 to 2003. He was a co-organizer of the Handgun Epidemic Lower Plan (HELP) Network in 1993 and subsequently served on several HELP committees and the Board of Directors. Since 1999 he has been a member of the Board of Directors of Kids in Danger, Inc., an advocacy organization focused on improving the safety of childhood products. He received the 2007 Kids in Danger Best Friend Award.</P><P>Dr. Tanz has conducted research and published in the areas of child and adolescent injuries, including firearm injuries, motor vehicle pedestrian and passenger injuries, cycling-related injuries, and product-related injuries. He has testified in regulatory and legislative hearings on child passenger safety, motorcycle helmet laws, firearm regulation and legislation, and child product safety. He is also engaged in research related to streptococcal infections.</P><P>Dr. Tanz visited all 30 major league baseball parks in 2006, in the process raising more than $30,000 for Chicago Youth Programs Inc., a comprehensive inner city youth support organization. He was a youth baseball, softball, and basketball coach for many years, and he is currently the assistant varsity girls’ softball coach at the Latin School of Chicago.</P>

The Challenges of Conducting Research to Improve the Health of American Indians and Alaska Natives

Research to improve the health of American Indians and Alaska Natives (AI/AN) is subject to many special challenges. To that end, the merits and barriers of health disparities research was a central discussion topic by the editorial advisory board members for this special issue when they met in the fall of 2006. This discussion reflected that the comparison of AI/AN and non-Hispanic white health issues has limited value when limited ability exists to control contextual differences. These differences include the AI/AN history, level of poverty, culture, living environment, and the ability to access quality health services. Therefore, the board agreed to give priority to research papers that focused on measures for improving AI/AN health. AI/AN are dispersed in large cities such as New York City and Los Angeles and in small cities like Anchorage and Tulsa. In addition, they live in relatively isolated tribal reservations and villages disproportionately located in the 30% of U.S. counties that are sparsely populated and located at a great distance or travel time from the closest significant service center or market (Fig. 1). Most AI/AN live west of the Mississippi River. The National Center for Frontier Communities has described the challenges of economic development in these areas. We included papers that demonstrate the diversity of AI/AN with respect to their place of residence, as well as critical health issues. We cannot adequately represent the geographic and other diversity of the federally recognized 562 tribes who live on reservations or in urban areas. Assisting AI/AN in developing their own public health interventions will require knowledge and sensitivity to a multitude of variations. Maternal and child health practice research among AI/ AN is plagued by low response rates that limit generalization of specific findings. Response rates are often available for the overall survey, but not for AI/AN. In this issue, low reported response rates included 51% for inner city youth in two Oklahoma cities, 54% overall in the National Survey of Child Health [1] and 63% among AI in the Pregnancy Risk Assessment Systems (PRAMS) [2]. The median AI/AN response rates for Behavioral Risk Factor Surveys declined from 63% in 1997 to 50% in 2000 [3]. Kim noted that the 2000 US Census had an overall response rate from AI of 67%, with only 8.5% of tribes having a response rate of 70% or higher [4]. On the positive side, Kim documented that non-response in PRAMS was chiefly due to inability to contact the desired respondent. Once contacted, AI/AN responded as often as non-Hispanic whites. Conducting valid research to improve the health of AI/ AN may require more resources than research on the general population. Methods to increase research validity may include oversampling, face-to-face (rather than telephone) interviews; large record-linkage studies; identifying county code of residence of birth mothers for local area analysis; and the engagement of communities and their leaders in developing health assessment and practice methods. Moreover, educational resources should be devoted to developing more AI/AN researchers who can lead in achieving relevant research to improve the health of AI/AN mothers and children. R. Rochat (&) Hubert Department of Global Health, Rollins School of Public Health, STE 768, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA e-mail: rrochat@sph.emory.edu 1 http://www.frontierus.org/geography.htm

Attempted suicide and associated risk factors among youth in urban Japan

Suicide is a major social and health issue in Japan. We assessed prevalence of attempted suicide and explored individual, interpersonal, behavioral, and psychological risk factors associated with attempted suicide in a general community sample of youth in a metropolitan Japanese city. Survey of 2,095 participants age between 15 and 24 who were recruited using street-intercept techniques. Overall, 6% of males and 11% of females reported a prior suicide attempt. For males, attempted suicide was independently associated with experience of school bullying, being homosexual or bisexual, history of drug use, experience of unwanted sex, history of a diagnosed sexually transmitted infection, and low self-esteem. For females, attempted suicide was independently associated with being younger (ages 15-19 compared to 20-24), experience of school bullying, history of drug use, and history of smoking. Prevention intervention programs for youth in Japan are necessary to achieve national aims to reduce attempted suicides and suicide mortality.

Conclusions and Directions for Future Research Concerning Racial Socialization

The overall findings incorporated in these exploratory studies suggest that parental racial socialization processes are an important factor in: determining favorable outcomes related to youth and parental mental health, and influencing important decisions; such as youth avoiding violent confrontations. A strong sense of ethnicity appears to be a strong protective factor for the mental health and behavioral outcomes of these inner city youth and their families. These multiple effects of parental racial socialization processes suggest that this variable is an important feature in the day to day lives of African American families residing in low income inner-city environments; therefore, the examination of parental racial socialization processes could be included in future studies on resilience in minority populations. Data also revealed that several parental racial socialization processes constructs explained family use of child mental health services. Those providing services to urban adolescents need to be knowledgeable about the effects that culturally and contextually specific variables have on youth residing in urban environments. Therefore, it is important that future research studies on child mental health service use for urban families of color includes culturally specific factors such as parental racial socialization processes. Furthermore, although this study focused specifically on low-income urban youth and families, future studies must investigate the influence of parental racial socialization processes on youth and family mental health outcomes across urban, suburban, and rural, as well as economic strata. This type of research could provide invaluable information on the process of how parental racial socialization processes influence youth and family outcomes across a broad spectrum.

Gang Membership, Gun Carrying, and Employment: Applying Routine Activities Theory to Explain Violent Victimization Among Inner City, Minority Youth Living in Extreme Poverty*

Conceptual inconsistencies in routine activities theory are illustrated by demonstrating how gang membership, gun carrying, and employment can be categorized as both risk and protective factors in a high‐poverty context. Two waves of longitudinal data from a high‐poverty sample of African American youth were used to examine the determinants of victimization risk. Bivariate analyses indicated that gang membership, gun carrying, and employment status are significant risk factors for violent victimization, but these effects were mediated by measures of lifestyles (e.g., demographic and family factors, deviant lifestyles) included as controls in the full multivariate model. In other words, the strong positive relationship between gang membership and gun carrying found in previous studies may be due to model misspecification and/or the lack of research on high‐poverty samples of inner city youth from the Deep South. Additional logistic regression analyses also indicate that the number of hours employed per week (but not employment status) is a risk factor for violent victimization. Finally, the theoretical implications of these findings for routine activities theory are discussed.

Black 'N Mild and Carcinogenic

Considerable concern has been expressed about the use of illicit drugs like heroin and cocaine among disadvantaged, minority youth and young adults in America's inner cities. Often overlooked in this research and associated public response are the far greater health consequences that stem from the use of legally sold drugs like alcohol and tobacco (Baer, Singer, and Susser, 2003, Singer, 2004). Recently, based on research in Miami/Dade and Alachua, Florida, Page and Evans (2003) have drawn attention to the significant rise in small cigars use among urban youth, especially African Americans between 11 and 15 years of age. They note that “a cigarillo called ‘Black ‘N Mild’ that contains between five and twelve times the nicotine of cigarettes has become the product of choice among African American and other youth” in the counties under study (Page and Evans, 2003:64). To date, there has been only limited research on the existence of this practice among inner city youth and young adults in other locales (Malone, Yerger, & Pearson, 2001). This paper reports on findings on Black 'N Mild use from a study of changing licit and illicit drug use among inner city populations in Hartford, CT; these findings include similarities to and differences from the findings reported by Page and Evans. The study highlights the importance of examining regional differences in drug use patterns (Singer et al., 1992).

Contesting Race and Power: Second‐Generation Dominican Youth in the New Gotham

One of the effects of the new era of globalization has been an intensification of racialized inequalities, both globally and locally. Youth in cities like New York have been working arduously to establish projects and coalitions that challenge globalization and its consequences. This article examines social and racial justice projects in which New York based Dominican youth are involved. In their attempts to confront and challenge globalization and racism, they have begun to construct a new political identity; their work involves other people of color throughout the diaspora. What does the work of these activists tell us about the prospects of the “new contestatory politics” emerging among youth? What does their work tell us about the ways in which people reconfigure their sense of self, of political community, and social justice ideology in today's world?

Evidence-Based Practice: A Reliable Source to Access Interventions for Youth Risk Behaviors

As I did with the column for the special issue on dementia care, I went to one of my colleagues, Keville Frederickson, who is doing research related to this issue's theme-vulnerable populations. Her specific focus is interventions for at-risk youth in inner cities, specifically the Bronx, New York, and Monterrey, Mexico (Alonso, Esparza, & Frederickson, in press; Frederickson, Alonso, & Esparza, in press). My question to her was: Where can nurses working with this population go to find evidence-based interventions without having to review a plethora of individual studies to guide their interventions with this population? Here is her answer. Risk behaviors among youth, specifically violence and drug-related deaths among youth, result in what is reported to be the primary cause of death among 10-24-yearolds. And the rates are highest among blacks and Hispanics (CDC, 2006). These risk behaviors include unprotected sex, violence, drug and alcohol use, and smoking. Given the seriousness of these behaviors, educators and health care providers as well as communities seek guidance about successful intervention programs that have been able to change these behaviors. As part of a previous intervention study (Alonso et al., in press; Frederickson et al., in press), I sought information about intervention programs for third and fourth graders. At that time, little evidence was published in the format of current evidence-based practice reports. One intervention, however, the Life Skills Program, was listed by the Centers for Disease Control (CDC) as a Program that Works (www.lifeskillstraining.com). literature published by the creators of the intervention included multisite studies under randomized controlled conditions. research support for this program was a precursor of current evidence-based practice (EBP) reviews. CDC no longer lists such interventions, but the program was very useful for my research and turned out to be very effective in an after-school program in an area of the Bronx (Frederickson et al., in press). Recently, I conducted another review of interventions for the prevention/reduction of youth violence as well as other risk behaviors. purpose of this article is to examine one Web site that recommends interventions. Web site selected is entitled The Blueprints for Violence. Most of the interventions they identified have been classified as promoting social and interpersonal skills as well as reducing or preventing violence and drug and alcohol abuse. Web site, http://www. colorado.edu/cspv/blueprints/index.html, is managed by the Center for the Study and Prevention of Violence (CSPV), at the University of Colorado at Boulder, with funding from the Colorado Division of Criminal Justice, Centers for Disease Control and Prevention, and the Pennsylvania Commission on Crime and Delinquency. In 1996, they designed and launched a national violence prevention initiative to identify violence prevention. material on the Web site is the result of their work. Web site does not refer to evidence citations directly, but does identify interventions that meet the standards for solid evidence on the effectiveness of interventions that have been used to reduce or prevent risk behaviors among youth. CSPV states: Overall, the Blueprints Initiative sets a gold standard for implementing exemplary, research-based violence and drug programs and for implementing these programs with fidelity to the models. work that is being conducted will help to bridge the gap between knowledge (research) and practice and inform the users of programs of the barriers that must be overcome in order to achieve maximum success. (CSPV, 2002-2004a, p. 1) programs that they evaluated have primarily targeted violence. Many of them, however, have also been effective in reducing or preventing other risk behaviors such as tobacco use and alcohol and substance abuse. In addition, many of the interventions also have been effective in promoting social and interpersonal skills (CSPV, 2002-2004a). …

Growing Up Urban: The City, the Cinema, and American Youth

Growing Up Urban: The City, the Cinema, and American Youth

Young people's mental health in context: Comparing life in the city and small communities in Siberia

The study compares young people's mental health in the major Siberian city of Novosibirsk with small communities of the surrounding region, at the end of the statutory period of secondary education. Data are drawn from a school-based questionnaire survey of ninth graders and semi-structured interviews. In line with the findings of international comparative studies, general health profiles are not good by Western standards, but extending such findings, general health appears even poorer in small communities and is differentiated further by the rural household's impoverished socio-economic circumstances. However, despite poorer general health among rural youth, the study finds the opposite for more specific profiles of mental health, which are worse among city youth. In this, distinctive social factors are associated with mental health differently in the large city and small communities of the region. In the relatively affluent city of Novosibirsk, self-worth and depression are differentiated by family background and engagement with the education system. By contrast, in small communities social capital associated with family support and kin-based networks become important resources instead. Positive mental health is bound up with the local cultural context, centred on the family household and ‘traditions’ of rural society.

Child Victims of Katrina Need More MH Access

The state launched a workforce initiative to recruit medical professionals nationwide to the area for a minimum of three years, but many professionals who are coming to the area are filling lucrative positions with private contractors, Cerise said. Further complicating the recruitment effort is the "piecemeal" rebuilding in the city, which has insufficient housing for even its smaller post-Katrina population.

Replicating a Teen HIV/STD Preventive Intervention in a Multicultural City

Although there are now several adolescent HIV and STD preventive interventions of demonstrated efficacy in the literature, little is understood about the portability of these interventions. This study replicated Stanton's Focus on Kids intervention, developed for inner city African American adolescents, in a different population, transferring it to a multicultural city. Despite careful replication of the original study's procedures, youth in the preventive intervention condition of the replication study did not improve in attitudes, perceived norms, self-efficacy, or intentions toward sexual initiation, condom use, or abstinence compared with a carefully matched control condition. We discuss several possible reasons for this failure to replicate, concluding that the most likely reason is the lower rates of sexual activity among youth in the replication city.

Dating violence, sexual assault, and suicide attempts among urban teenagers.

To evaluate the relationship between dating violence, sexual assault, and suicide attempts among urban adolescents. Secondary analysis of the 2005 New York City Youth Risk Behavior Survey. Eighty-seven New York City public high schools. Representative population-based sample of 8080 students, 14 years and older. Dating violence in the past year and lifetime history of sexual assault. One or more suicide attempts in the past year. Respondents were 50.0% female and primarily black (36.0%) or Hispanic (40.1%). In the past year, 11.7% of females and 7.2% of males reported 1 or more suicide attempts. Lifetime history of sexual assault was reported by 9.6% of females and 5.4% of males. Dating violence in the past year was reported by 10.6% of females and 9.5% of males. In multivariate models, controlling for persistent sadness, sexual orientation, and significant risk behaviors, recent dating violence (odds ratio, 1.61; 95% confidence interval, 1.05-2.47) was associated with suicide attempts in adolescent girls, while lifetime history of sexual assault (odds ratio, 3.86; 95% confidence interval, 2.11-7.06) was associated with suicide attempts in adolescent boys. In this population of urban youth, recent dating violence among females and lifetime history of sexual assault among males were significantly associated with suicide attempts. Clinicians and educators should be trained to routinely screen adolescents for violence victimization and should have a low threshold for referring these at-risk teenagers for mental health services.

Youth Leadership, Racism, and Intergroup Dialogue

The National Conference for Community and Justice- Greater Kansas City's Youth Leadership Institute (Anytown) for high school-aged youth-is designed to expose young people to multicultural issues and topics and facilitate purposeful intergroup dialogue on addressing systemic oppression and privilege. An evaluation was conducted over a three-year period to determine whether the Anytown programming had an effect on changing the knowledge and attitudes of participants concerning a variety of racial/ethnic groups. At the beginning of the first day of the 7-day residential institute and again at the end of the last day, the students completed a self-report survey rating a series of statements concerning their knowledge and attitudes. At the end of each day, the students also answered open-ended questions concerning what they had learned during the day. Frequencies, t-tests, ANOVA comparisons, and content analyses were conducted. In every area measured by the pre- and post-Institute surveys, there was a statistically significant positive change, at the 95% or higher confidence level, in respondents' ratings of their knowledge and attitudes.

Response to the letter by Norman Constantine and Carmen Nevarez asking retraction of Mike Males’ article, “Youth Health Services, Development Programs, and Teenage Birth Rates in 55 California Cities”

Drs. Constantine’s and Nevarez’s letter has nothing to do with my article evaluating Get Real About Teen Pregnancy’s and the California Adolescent Health Collaborative’s Reality Check rankings of city services. They simply pulled a sentence out of the middle of the study, misrepresented it as the study’s conclusion even though it clearly was not, misattributed it to a method I clearly did not rely on, and completely ignored the multiple regression analysis I did rely on. Contrary to their claim, their letter did not in any way “replicate” my study’s method or finding that “the availability of these services is not associated with lower rates of or greater reductions over time in teenage birth rates.” First, Drs. Constantine and Nevarez complain that my conclusions are “flawed in several fundamental ways” because the Reality Check rankings, developed for “the explicit purposes of description and goal setting” cannot be used to assess teen birth rate outcomes. They should direct their complaint of misuse of the rankings not to me, but to Get Real and CAHC. Far from treating the Reality Check as merely for description and goal setting, Get Real and the CAHC (2004) released its rankings to the press and publicly credited Berkeley’s top ranking in services for the city’s supposedly having the state’s lowest rate of teen births (a double error, since Berkeley does not have the state’s lowest urban teen birth rate) (see Bender, 2004). My paper simply analyzed the public statements by these two groups (and others) linking their Reality Check rankings to teen birth rates according to the data they provided — data which I, like Drs. Constantine and Nevarez, found lacking for the use to which these groups applied it. Second, Drs. Constantine and Nevarez grossly misrepresent my study as having based its conclusions on raw Reality Check rankings unadjusted for city population size. They fabricate that charge by pulling a sentence from my description of Table 2, which reports that the simple, unadjusted correlation finds higher levels of services weakly associated with high rates of teen births. However, they fail to note my subsequent qualification: “This correlation is probably backwards; it more likely reflects the targeting of services toward low-income teens rather than a negative effect of services themselves” since “youth in cities with higher youth poverty rates have considerably more teen health services and youth development programs available than youth in more affluent cities.” I continue: “To isolate the effect of youth services, a stepwise multiple regression analysis examines their effect on teen birth rates (both level and change) when adult birth rates, economic variables such as poverty rates, and city population size are controlled” (page 50). The multiple regression explicitly controlled for city population size, a far more precise variable than the Reality Check’s broad quartile rankings (which place Los Angeles and Stockton in the same quartile).

Factors affecting attitude toward safe sex and reproductive health among Shiraz City youth

Youth are the most vulnerable to reproductive and sex issues than the others. Many young people face the risk of Sexually Transmitted Infections (STIs), HIV, physical abuse and sexual violence, female genital mutilation, unintended pregnancy, and emotional, cultural and social problems related to their sexual and reproductive health. Iranian youth like many other counterparts throughout the world encounter social, cultural and economic barriers to the information and health services they need to protect themselves against sexual and reproductive diseases. The purpose of this study was to examine the relationship between some demographic, socio-economic, and cultural factors affecting the attitude toward safe sex and reproductive health among Shiraz city youth. A cross-sectional quantitative survey was conducted in Shiraz city with a final sample of 384 youth in fall 2004. The data collection was done by use of a self-administered questionnaire. The data was coded and analyzed by the use of SPSS 11.5. Results are presented in both descriptive and inferential statistic tables. The multivariate analysis showed that six of fourteen studied independent variables have effect on youth attitude toward safe sex and reproductive health in Shiraz city; interpersonal communications, father's education, access to modern applicants and facilities, awareness about safe sex and reproductive health, non-printed mass media habits, and printed mass media habits.

Environmental equity is child's play: mapping public provision of recreation opportunities in urban neighbourhoods

This paper examines the spatial distribution of recreational opportunities for children and youth in a mid-sized Canadian city (London, Ontario), in relation to the socioeconomic status of neighbourhoods and estimated local need for publicly provided recreation spaces. Public recreation facilities (N = 537) throughout the city were identified, mapped and analysed in a geographic information system. To explore potential socio-environmental inequities, neighbourhoods (N = 22) were characterized by socioeconomic and environmental variables, an index of neighbourhood social distress, a neighbourhood play space needs index, and measures of the prevalence and density of recreational opportunities. The results of the spatial analysis indicate there is no systematic socioenvironmental inequity with respect to the prevalence and density of publicly provided neighbourhood recreation spaces; however, there are several areas in the city where youth do not have access to formal play spaces. We argue that to promote physical activity among urban children and youth, city planners and health policy analysts should consider carefully the geographical distribution of existing recreational opportunities and ensure that new publicly funded recreation spaces are provided to neighbourhoods with the greatest need. Further research should seek to identify what kinds of recreation spaces are most effective for promoting healthy behaviours among vulnerable children and youth.

Displaced Masculinities: Chavs, Youth and Class in the Post-industrial City

In an insecure post-industrial society working-class young men must forge new youth transitions. This entails rethinking what it is to be a ‘man’ beyond the world of industrial paid employment. It also involves a reshaping of a whole ‘way of life’ with the erosion of traditional labour and leisure lifestyles. This ethnographic study contrasts the cultural habitations of young men from traditional skilled working-class backgrounds with those from families experiencing long-term inter-generational unemployment. It explores their differently textured ‘going out’ experiences, their values, attitudes and practices. By focusing upon the subtle and explicit demarcations that distinguish the ‘rough’ from the ‘respectable’ working-class, the article argues that social class is of marked and continuing salience in youth culture. Furthermore, the work suggests that by exhibiting ‘spectacular masculinities’ of white male excess, young men accrue a body capital that has a currency and a local exchange value within the circuits they inhabit.

Reinterpreting ethnic patterns among white and African American men who inject heroin: a social science of medicine approach.

BackgroundStreet-based heroin injectors represent an especially vulnerable population group subject to negative health outcomes and social stigma. Effective clinical treatment and public health intervention for this population requires an understanding of their cultural environment and experiences. Social science theory and methods offer tools to understand the reasons for economic and ethnic disparities that cause individual suffering and stress at the institutional level.Methods and FindingsWe used a cross-methodological approach that incorporated quantitative, clinical, and ethnographic data collected by two contemporaneous long-term San Francisco studies, one epidemiological and one ethnographic, to explore the impact of ethnicity on street-based heroin-injecting men 45 years of age or older who were self-identified as either African American or white. We triangulated our ethnographic findings by statistically examining 14 relevant epidemiological variables stratified by median age and ethnicity. We observed significant differences in social practices between self-identified African Americans and whites in our ethnographic social network sample with respect to patterns of (1) drug consumption; (2) income generation; (3) social and institutional relationships; and (4) personal health and hygiene. African Americans and whites tended to experience different structural relationships to their shared condition of addiction and poverty. Specifically, this generation of San Francisco injectors grew up as the children of poor rural to urban immigrants in an era (the late 1960s through 1970s) when industrial jobs disappeared and heroin became fashionable. This was also when violent segregated inner city youth gangs proliferated and the federal government initiated its “War on Drugs.” African Americans had earlier and more negative contact with law enforcement but maintained long-term ties with their extended families. Most of the whites were expelled from their families when they began engaging in drug-related crime. These historical-structural conditions generated distinct presentations of self. Whites styled themselves as outcasts, defeated by addiction. They professed to be injecting heroin to stave off “dopesickness” rather than to seek pleasure. African Americans, in contrast, cast their physical addiction as an oppositional pursuit of autonomy and pleasure. They considered themselves to be professional outlaws and rejected any appearance of abjection. Many, but not all, of these ethnographic findings were corroborated by our epidemiological data, highlighting the variability of behaviors within ethnic categories.ConclusionsBringing quantitative and qualitative methodologies and perspectives into a collaborative dialog among cross-disciplinary researchers highlights the fact that clinical practice must go beyond simple racial or cultural categories. A clinical social science approach provides insights into how sociocultural processes are mediated by historically rooted and institutionally enforced power relations. Recognizing the logical underpinnings of ethnically specific behavioral patterns of street-based injectors is the foundation for cultural competence and for successful clinical relationships. It reduces the risk of suboptimal medical care for an exceptionally vulnerable and challenging patient population. Social science approaches can also help explain larger-scale patterns of health disparities; inform new approaches to structural and institutional-level public health initiatives; and enable clinicians to take more leadership in changing public policies that have negative health consequences.