Can community monitoring save the commons? Evidence on forest use and displacement.

Rapid deforestation is a major driver of greenhouse-gas emissions (1). One proposed policy tool to halt deforestation is community forest management. Even though communities manage an increasing proportion of the world's forests, we lack good evidence of successful approaches to community forest management. Prior studies suggest that successful approaches require a number of "design conditions" to be met. However, causal evidence on the effectiveness of individual design conditions is scarce. This study isolates one design condition, community-led monitoring of the forest, and provides causal evidence on its potential to reduce forest use. The study employs a randomized controlled trial to investigate the impact of community monitoring on forest use in 110 villages in Uganda. We explore the impact of community monitoring in both monitored and unmonitored areas of the forest, using exceptionally detailed data from on-the-ground measurements and satellite imagery. Estimates indicate that community monitoring does not affect our main outcome of interest, a forest-use index. However, treatment villages see a relative increase in forest loss outside of monitored forest areas compared to control villages. This increase is seen both in nonmonitored areas adjacent to treatment villages and in nonmonitored areas adjacent to neighboring villages not included in the study. We tentatively conclude that at least part of the increase in forest loss in nonmonitored areas is due to displacement of forest use by members of treatment villages due to fear of sanctions. Interventions to reduce deforestation should take this potentially substantial effect into consideration.

Adoption of community monitoring improves common pool resource management across contexts.

Pervasive overuse and degradation of common pool resources (CPRs) is a global concern. To sustainably manage CPRs, effective governance institutions are essential. A large literature has developed to describe the institutional design features employed by communities that successfully manage their CPRs. Yet, these designs remain far from universally adopted. We focus on one prominent institutional design feature, community monitoring, and ask whether nongovernmental organizations or governments can facilitate its adoption and whether adoption of monitoring affects CPR use. To answer these questions, we implemented randomized controlled trials in six countries. The harmonized trials randomly assigned the introduction of community monitoring to 400 communities, with data collection in an additional 347 control communities. Most of the 400 communities adopted regular monitoring practices over the course of a year. In a meta-analysis of the experimental results from the six sites, we find that the community monitoring reduced CPR use and increased user satisfaction and knowledge by modest amounts. Our findings demonstrate that community monitoring can improve CPR management in disparate contexts, even when monitoring is externally initiated rather than homegrown. These findings provide guidance for the design of future programs and policies intended to develop monitoring capabilities in communities. Furthermore, our harmonized, multisite trial provides sustainability science with a new way to study the complexity of socioecological systems and builds generalizable insights about how to improve CPR management.

Access to Health Care Services among Young People Exchanging Sex in Detroit.

Within the related epidemics of sex exchange, drug use, and poverty, access to health care is shaped by intersecting identities, policy, and infrastructure. This study uses a unique survey sample of young adults in Detroit, who are exchanging sex on the street, in strip clubs, and at after-hours parties and other social clubs. Factors predicting access to free or affordable health care services, such as venue, patterns of sexual exchange influence, drug use and access to transportation, were examined using multivariable logistic regression and qualitative comparative analysis. The most significant predictors of low access to health care services were unstable housing and lack of access to reliable transportation. In addition, working on the street was associated with decreased access to services. Coordinated policy and programming changes are needed to increase health care access to this group, including improved access to transportation, housing, and employment, and integration of health care services.

Outreach Strategies to Recruit Low-Income African American Men to Participate in Health Promotion Programs and Research: Lessons From the Men of Color Health Awareness (MOCHA) Project.

African American men continue to bear a disproportionate share of the burden of disease. Engaging these men in health research and health promotion programs-especially lower-income, African American men who are vulnerable to chronic disease conditions such as obesity and heart disease-has historically proven quite difficult for researchers and public health practitioners. The few effective outreach strategies identified in the literature to date are largely limited to recruiting through hospital clinics, churches, and barbershops. The Men of Color Health Awareness (MOCHA) project is a grassroots, community-driven initiative that has developed a number of innovative outreach strategies. After describing these strategies, we present data on the demographic and health characteristics of the population reached using these methods, which indicate that MOCHA has been highly effective in reaching this population of men.

Criminal Justice Involvement among Young People Exchanging Sex in Detroit.

For young adult sex workers, the risk of arrest and incarceration are dramatically influenced by the venue of sex exchange and individual and neighborhood characteristics. Using a unique venue-based survey sample of young adults in Detroit who are exchanging sex, multivariable logistic regression models were used to identify associations with arrest and incarceration. Criminal justice involvement was normative, and risk was increased by working on the street venue, using drugs, lacking stable housing, juvenile arrest or incarceration, dropping out of school before age 18, and neighborhood characteristics. Several promising points of intervention could reduce criminal justice involvement for young adults exchanging sex.

Transgender Demographics: A Household Probability Sample of US Adults, 2014.

OBJECTIVES: To estimate the proportion of US adults who identify as transgender and to compare the demographics of the transgender and nontransgender populations. METHODS: We conducted a secondary analysis of data from states and territories in the 2014 Behavioral Risk Factor Surveillance System that asked about transgender status. The proportion of adults identified as transgender was calculated from affirmative and negative responses (n = 151 456). We analyzed data with a design-adjusted χ2 test. We also explored differences between male-to-female and nontransgender females and female-to-male and nontransgender males. RESULTS: Transgender individuals made up 0.53% (95% confidence interval = 0.46, 0.61) of the population and were more likely to be non-White (40.0% vs 27.3%) and below the poverty line (26.0% vs 15.5%); as likely to be married (50.5% vs 47.7%), living in a rural area (28.7% vs 22.6%), and employed (54.3% vs 57.7%); and less likely to attend college (35.6% vs 56.6%) compared with nontransgender individuals. CONCLUSIONS: Our findings suggest that the transgender population is a racially diverse population present across US communities. Inequalities in the education and socioeconomic status have negative implications for the health of the transgender population.

Drugs, Sex, and Condoms: Identification and Interpretation of Race-Specific Cultural Messages Influencing Black Gay and Bisexual Young Men Living with HIV.

Black gay and bisexual young men carry a disproportionate burden of HIV in the United States. This study explored Black gay and bisexual young men living with HIV's identification and interpretation of race-specific cultural messages regarding substance use, sexual activity, and condom use. A total of 36 Black gay and bisexual young men living with HIV (ages 16-24, mean = 20.6 years) from four geographically diverse regions of the United States participated in qualitative in-depth interviews. Results from this study elucidate the ways in which these young men interpret various forms of race-specific cultural messages and experiences regarding substance use, sexual activity, and condom use. Participants discussed cultural messages and experiences promoting and discouraging condoms and substance use. Regarding sexual activity, only messages and experiences promoting sex were reported. Across all three categories, messages and experiences promoting risk were predominant. Data further revealed that socially transmitted cultural messages received by young men emanated from multiple sources, such as family, peers, sexual partners, community/neighborhood, and the broader society. Race-specific cultural messages and experiences should be addressed in interventions for this population, and programs should assist young men in developing a critical consciousness regarding these messages and experiences in order to promote health and well-being.

Jedi Public Health: Co-creating an Identity-Safe Culture to Promote Health Equity.

The extent to which socially-assigned and culturally mediated social identity affects health depends on contingencies of social identity that vary across and within populations in day-to-day life. These contingencies are structurally rooted and health damaging inasmuch as they activate physiological stress responses. They also have adverse effects on cognition and emotion, undermining self-confidence and diminishing academic performance. This impact reduces opportunities for social mobility, while ensuring those who "beat the odds" pay a physical price for their positive efforts. Recent applications of social identity theory toward closing racial, ethnic, and gender academic achievement gaps through changing features of educational settings, rather than individual students, have proved fruitful. We sought to integrate this evidence with growing social epidemiological evidence that structurally-rooted biopsychosocial processes have population health effects. We explicate an emergent framework, Jedi Public Health (JPH). JPH focuses on changing features of settings in everyday life, rather than individuals, to promote population health equity, a high priority, yet, elusive national public health objective. We call for an expansion and, in some ways, a re-orienting of efforts to eliminate population health inequity. Policies and interventions to remove and replace discrediting cues in everyday settings hold promise for disrupting the repeated physiological stress process activation that fuels population health inequities with potentially wide application.

Creating a Community of Practice to Prevent Suicide Through Multiple Channels: Describing the Theoretical Foundations and Structured Learning of PC CARES.

It is critical to develop practical, effective, ecological, and decolonizing approaches to indigenous suicide prevention and health promotion for the North American communities. The youth suicide rates in predominantly indigenous small, rural, and remote Northern communities are unacceptably high. This health disparity, however, is fairly recent, occurring over the last 50 to 100 years as communities experienced forced social, economic, and political change and intergenerational trauma. These conditions increase suicide risk and can reduce people's access to shared protective factors and processes. In this context, it is imperative that suicide prevention includes--at its heart--decolonization, while also utilizing the "best practices" from research to effectively address the issue from multiple levels. This article describes such an approach: Promoting Community Conversations About Research to End Suicide (PC CARES). PC CARES uses popular education strategies to build a "community of practice" among local and regional service providers, friends, and families that fosters personal and collective learning about suicide prevention in order to spur practical action on multiple levels to prevent suicide and promote health. This article will discuss the theoretical underpinnings of the community intervention and describe the form that PC CARES takes to structure ongoing dialogue, learning, solidarity, and multilevel mobilization for suicide prevention.

Discrimination and Depressive Symptoms Among Latina/o Adolescents of Immigrant Parents.

Discrimination is associated with negative mental health outcomes for Latina/o adolescents. While Latino/a adolescents experience discrimination from a number of sources and across contexts, little research considers how the source of discrimination and the context in which it occurs affect mental health outcomes among Latina/o children of immigrants. We examined the association between source-specific discrimination, racial or ethnic background of the source, and school ethnic context with depressive symptoms for Latina/o adolescents of immigrant parents. Using multilevel linear regression with time-varying covariates, we regressed depressive symptoms on source-specific discrimination, racial or ethnic background of the source of discrimination, and school percent Latina/o. Discrimination from teachers (ß = 0.06, p < .05), students (ß = 0.05, p < .05), Cubans (ß = 0.19, p < .001), and Latinas/os (ß = 0.19, p < .001) were positively associated with depressive symptoms. These associations were not moderated by school percent Latina/o. The findings indicate a need to reduce discrimination to improve Latina/o adolescents' mental health.

Spatial Stigma and Health in Postindustrial Detroit.

An emerging body of research suggests that those who reside in socially and economically marginalized places may be marked by a stigma of place, referred to as spatial stigma, which influences their sense of self, their daily experiences, and their relations with outsiders. Researchers conducted 60 semistructured interviews at partnering community-based organizations during summer 2011 with African American and Latina/o, structurally disadvantaged youth of diverse gender and sexual identities who were between 18 and 26 years of age residing in Detroit, Michigan. The disadvantaged structural conditions and dilapidated built environment were common themes in participants' narratives. Beyond these descriptions, participants' framings and expressions of their experiences in and perceptions of these spaces alluded to reputational qualities of their city and particular areas of their city that appear related to spatial stigma. Young Detroit residents articulated the ways that they experience and navigate the symbolic degradation of their city.

Brothers Leading Healthy Lives: Outcomes from the pilot testing of a culturally and contextually congruent HIV prevention intervention for black male college students.

We used a treatment group-only design to pilot test a newly developed intervention to increase condom use among higher risk heterosexually active African American/black male college students. A community-based participatory research partnership developed the intervention called Brothers Leading Healthy Lives. Following an initial screening of 245 men, 81 eligible men were contacted for participation. Of the 64 men who agreed to participate, 57 completed the intervention and 54 of those completed the 3-month follow-up assessment, for a 93% completion rate. Results show significant changes between the baseline and 3-month follow-up assessments in behavioral outcomes, including reductions in unprotected sex, increase in protection during last intercourse, and fewer condom use errors. Most potential mediators (knowledge, attitudes, intentions, and condom use self-efficacy) also changed significantly in the expected direction. These demonstrated changes provide good evidence that men exposed to this intervention will see changes that reduce their risk for HIV.

Preliminary findings exploring the social determinants of Black males' lay health perspectives.

The unequal discussion of Black males' health is a pressing social problem. This study addressed Black males' lay perspectives regarding their health, illness, and mortality, with attention to the determinants of men's health, prevention, lifestyle, and opportunities for health promotion using an exploratory/qualitative research methodology. Participants were 68 Black males aged 15 to 68 years, with an average age of 44 years (SD = 14.5). The narratives represented a complex interplay of biopsychosocial factors, ranging from intrapersonal attitudes, interpersonal experiences to discussions about community and public policy injustices. Five prominent themes emerged: (a) lack of chronic disease awareness, (b) fatalism, (c) fear and anxiety of academic-medical settings, (d) hyperactive masculinity fatigue, and (e) the gay-straight divide. The term Tired Black Male Health syndrome was coined in the forum. Implications of these findings are discussed in the context of culturally relevant strategies for improving Black male community health engagement.

Factors Influencing Depression and Anxiety among Black Sexual Minority Men.

The primary aim of this study was to examine the relationships between depression and anxiety, and ethnic and sexual identity development, and discrimination and harassment (DH) among Black sexual minority men. Additional aims were to determine whether an interaction effect existed between ethnic and sexual identity and whether coping skills level moderated these relationships. Using an observational cross-sectional design, 54 participants recruited through snowball sampling completed self-administered online surveys. Stepwise multiple regression analysis was used. Sixty-four percent of the variance in depression scores and 53% of the variance in anxiety scores were explained by DH and internalized homonegativity together. Thirty percent of the sample had scale scores indicating likelihood of depression and anxiety. Experience of DH and internalized homonegativity explained a large portion of the variability in depression and anxiety among Black sexual minority men. The study showed high prevalence of mental distress among this sample.

Exploring the mental health of black men who have sex with men.

Current research indicates that black men who have sex with men (MSM) are disproportionately burdened by depressive distress and anxiety disorders as compared to their white gay and heterosexual counterparts. This study utilizes focus groups to qualitatively explore issues surrounding the mental health status of this population in an attempt to shed light on potential influencing and determinant factors. Twenty-two self-identified black, or multi-racial including black, MSM residing in Atlanta, Georgia participated in two focus groups--11 subjects each, respectively. Categories that emerged from data analysis include: knowledge/experiences, attitudes/beliefs, societal action/behavior, identity development, relationship functionality, and mental health status. Overarching themes for each category were delineated.