SEMw

8/11/2019 SEMw

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8/11/2019 SEMw


Introduction:• Social Ecological Approach

▫ Explores the connections between:Individuals’ health, Co-participants in their lives and,The everyday settings in which their health behaviors are expressed

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Introduction Cont.:• Four core principles of Ecological Models:

▫ 1. There are multiple influences on specific health

behaviors, including factors at the intrapersonal,interpersonal, organizational, community and publicpolicy levels

▫ 2. Influences on behaviors interact across thesedifferent levels

▫ 3. Ecological models should be behavior-specific,identifying the most relevant potential influences ateach level

▫ 4. Multi-level interventions should be most effective inchanging behavior

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Introduction Cont.:• Systems Theory (1979)

▫ Urie BronfenbrennerThree levels of environmental influences:

1) Microsystem2) Mesosystem3) Exosystem*

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Introduction Cont.:• Ecodevelopmental Model (1999)

▫ Szapocznik and Coatsworth A recent theoretical development that sensitively builds upon Bronfenbrenners (1979) work byproviding framework for organizing the influenceson substance useThe model examines an individual within and acrossthe protective processes that influence substance use

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Introduction Cont.:• Geographic Information Systems (GIS)

A set of tools that capture, manage, analyze and visualize spatial data

▫ What is where?▫ Why it is there?

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Aim 1:• To describe and analyze substance using and

non- using urban adolescents’ social networks;risky and protective settings where theysocialize; and the relationship to healthoutcomes such as substance use, depression and

stress.

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Study Population:• Georgetown University Medical Center Adolescent

Medicine Clinic• Interviews were administered to teens lasting 45 to 60 min.

▫ 37 adolescents▫ 14-18 years of age▫ 51% female

• Ethnicity▫ 49% African American▫ 37% Caucasian▫ 12% other international origin

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Methodology Cont.:• Adolescent Drug Involvement Scale (ADIS)

▫ A research scale that has acceptable internalconsistency and correlates with:

self-reported levels of drug usesubjects perceptions of severity of their own druguse problem and, with clinical assessments

▫ Categorizes level of substance usei.e. score of below 30 falls into either ‘little or no use’

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Methodology Cont.:• Children’s Depression Inventory (CDI)

▫ 27-item self-reportQuantifies a range of depressive symptoms includingdisturbed mood, hedonic capacity, vegetativefunctions, self-evaluation, and interpersonal behaviorsCDI generates normed-derived total score and fivescale scores:

(a) negative mood; (b) interpersonal problems; (c)ineffectiveness; (d) anhedonia; (e) negative self-esteem

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Methodology Cont.:• Adolescent-Family Inventory of Life Events and

Changes (A-FILE)▫ 50-item self-report▫ Designed to record normative and nonnormative

life events and changes an adolescent perceivestheir family has experience during the last 12months

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Methodology Cont.:• Ecological Interview

▫ Measured the geography of risk and protection▫ Produced a geographically specific listing of the

teen’s daily activity locations, as well as evaluativedescriptions of various environments

• Defined to the adolescent as:▫ Safe▫ Risky▫ Important

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Methodology Cont.:• Adolescent Social Network Assessment (ASNA)

▫ Structured interview

▫ Characterizes egocentric social network data in theform of :Network risk or protectionDensityMultiplexityProportion of adult membersSatisfaction with networkType and frequencyDistance between membersTypes of relationshipsPerceived closeness

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Full Sample Results:

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Case Study: The Case of Natasha• 18 year-old• Female• African American substance user• Demographics:

Resides in the District of Columbia

In her block 41% of all families live in poverty

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Case Study: The Case of Natasha• Natasha’s Social Network

▫ 100% dense▫ 80% highly multiplex▫ 40% substance users

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Case Study: The Case of Natasha• Geographical Analysis▫ Ecological Interview▫ DC Police Crime Reports▫ Locations of

Liquor StoresPublic LibrariesBoys and Girls Clubs

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Case Study: The Case of Natasha• Three-Dimensional Risk Profile

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Results:• Full Sample:

▫ 65% (n=24)• (ADIS: 30.5) Average subject fell into the serious drug involvement category

More than experimentalNot yet diagnosable for dependency

▫ Drug of choice: AlcoholMarijuanaCocainePrescription Medication Abuse

• (CDI: 52) Substance users reported that more of their social networkmembers used substances and that they were:▫ More depressed▫ More stressed▫ And participated in more negative actives with their social network members

when compared to nonusers (p<.05)• (A-FILE: 6.3) Teens with social network members who were substance users were

almost 16 times as likely to be substance users themselves• Teens with social network members who were daily substance users were:

▫ Twice as likely to be depressed▫ 3.5 times as likely to have significantly elevated stress symptoms

• Distance between homes and the safe places for substance users was three times thedistance between the homes and risky places

• Case Study:• ADIS: 28

▫ Drug use is on thecusp

• CDI: 73▫ Indicates very likely to

be depressed• A-FILE: 15

▫ Experiencingsignificant stress inher family life

• Access to positiveresources is limited

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Recommendations:• Transdisciplinary Implications

▫ Utilizing these tools to assess a risk/protection profile and access safe environments foradolescents

▫ Aid in providing more a thorough understanding of the environment and social networkthat the adolescent operates in

• Prevention Implications▫ Prevention efforts can use the descriptions of the teen’s social networks to begin to create

a risk/protection profile▫ This type of a profile could aid prevention and treatment providers as well as mobilize

community action toward developing more positive, safe and protective spaces for theseadolescents

• Personal, Social and Environmental Preventive Implications▫ Case Study of Natasha

Immediate attention to her severe depressive symptoms, substance use and stresslevelChanges in her social networkBecoming active in community

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Discussion:• What are some limitations to this study?• How accurate is the self-reported data?

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SEMw