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Community Connectedness and Cleavages

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Community Connectedness and Cleavages

  1. 1. COMMUNITY CONNECTEDNESS AND CLEAVAGES INTERSECTIONS WITH HEALTH & HEALTH PROMOTION KIFFER G. CARD
  2. 2. OBJECTIVESParticipants will be able to + describe the importance of “community connectedness” for individual and population health; + understand how observational data can be used to identify communities and heterogeneity within them; and + generate strategies for studying communities and implementing health interventions among them. +
  3. 3. WHAT IS COMMUNITY? +
  4. 4. Tonnies Durkheim Gemeinschaft Based on feelings of togetherness and bonding between members. Gesellschaft Based on reliance on one another and ability to leverage relationships for personal gain. Mechanical Solidarity Cohesion comes from connection and homogeneity Organic Solidarity Cohesion comes from interdependence on one another Collectivism Individualism Community Society What is community?
  5. 5. Group Isolates Recognizes Authority Values Personal Freedom Accepts Risk Collectivists Recognizes Authority Values Solidarity Avoids Risk Individualists Disregards Authority Values Personal Freedom Manages Risk Dissenters Disregards Authority Values Solidarity Embraces Risk Grid What is community? Low Cohesion High Cohesion HierarchicalEgalitarian
  6. 6. Speech Codes “Speech and thought have been elaborated as specialized tools for decision- making, but the social structure still retains a strong grip on its members, even to the extent that its underlying assumptions are not challenged.” “Speech forms are firmly embedded in a stable social structure. The primary use of language is to affirm and embellish the social structure which rests upon unchallengeable metaphysical assumptions.” “Here are the people who live using elaborated speech to review and revise existing categories of thought. To challenge received ideas.” “The social structure has lost its grip...is unstable, a transitional phase…the individual is valued above the social structure.” Family Control Elaborated Restricted PositionalPersonal Where do these sort of cultural categories come from?
  7. 7. Union Membership Associations Membership Social Trust 1960-2000 What happened starting in the 1950’s and 1960’s?
  8. 8. WHAT IS DRIVING THESE TRENDS? +
  9. 9. Individualism Index Urbanization Income Inequality Rising Urbanization Rising Income Inequality Rising Individualism
  10. 10. “ This new world of networked individualism is oriented around looser, more fragmented networks that provide on-demand succor. Such networks had already formed before the coming of the internet. Still, the revolutionary social change from small groups to broader personal networks has been powerfully advanced by the widespread use of the internet and mobile phones. Barry Wellman Sociologist, University of Toronto
  11. 11. Rosser et al. (2008) “Are communities dying or in transition?” Heterosexuals are integrating into gay neighborhoods, gay venues are disappearing, gay event attendance is decreasing, volunteerism at gay organizations is in decline, visibility of gay communities is increasing. Rowe & Dowsett (2008) “Role for gay community in prevention?” The ethos of safe sex which once bound the community is gone. Subcultures, intertwined in risk, and ambivalence about the gay community has emerged as a new normal for gay communities. Holt (2011) “Gay men and ambivalence about ‘gay community.’ The concept of 'personal communities' may better reflect the ways in which gay men engage with each other and their social networks. Zablotska et al. (2012) “Gay men’s participation in community life” The proportion of men who socialized mainly with gay men declined and the Internet use to connect with sex partners increased over time. Gay social engagement was associated with HIV positive serostatus, unprotected anal intercourse with regular partners and a high frequency of HIV/STI testing. Kelly et al. (2013) “Exploring the gay community question.” Experiences of gay community are shaped principally by network relations rather than residential proximity to gay institutions, Community Decline Researchers are increasingly concerned about gay men’s community involvement
  12. 12. PLACE|SPACE + Analysis • Multivariable Linear Regression Analysis with logged outcome variable and robust standard errors to account for heteroscedasticity Variables • App-User Density • 2014 Census & National Household Survey Data Sampling • Grid of Sampling Points across the area • Count number of Grindr profiles within 1 mile.
  13. 13. What’s happening to gay spaces?
  14. 14. Population density only partially explains trends in app-user density.
  15. 15. West End Strathcona & Mt. Pleasant 0 5000 10000 15000 20000 25000 30000 0 50 100 150 200 AverageDisseminationAreaPopulation Density 1-mile Sampling Area App User Density App User Density by Population Density
  16. 16. Number of Momentum Health Study Participants
  17. 17. 5km Clinic Coverage by App User Density
  18. 18. Factors associated with app-user density.
  19. 19. VIRTUAL SPACES + Analysis • Multivariable Linear Regression Analysis with logged outcome variable and robust standard errors to account for heteroscedasticity Variables • App-User Density • 2014 Census & National Household Survey Data Sampling • Grid of Sampling Points across the area • Count number of Grindr profiles within 1 mile.
  20. 20. Community Based Organizations ID Description of Organization Months of Observation Number of “Facebook Fans” Number of Posts Shared by Organization Number of Engagements 1 AIDS Service Organization 78 1,168 1,458 1,281 2a Gay Men’s Research Organization 47 422 578 262 2b Anti-Stigma Social Media Campaign* 10 1,126 242 524 3 AIDS Fundraising Organization 79 1,578 699 1,385 4 Gay Men’s Health Organization 80 2,290 2,166 3,184 5 LGBT2SQ Pride Organization 74 8,813 1,791 7,405 6 AIDS Service Organization 65 1,015 1,921 675 7 Queer Community Organization 80 5,571 3,607 9,351 8a Youth-led Health Organization 74 1,097 758 824 8b Peer-led Program for Young GBT2SQ* 54 716 851 598 Median (Q1, Q3) 74 (57, 79) 1,147 (1,036, 2,112) 1,155 (714, 1,889) 1,053 (617, 2,734) Total 639.55 23,796 14,071 25,489
  21. 21. Engagements with CBO content
  22. 22. B SE IRR p Health Message PreP 1.29 0.12 3.64 <.0001 Stigma 0.47 0.08 1.60 <.0001 Mental Health 0.42 0.11 1.52 <.0001 Treatment 0.16 0.1 1.17 0.10 Testing 0.14 0.07 1.15 0.06 Research 0.01 0.08 1.01 0.90 Condoms -0.06 0.1 0.94 0.55 Dating -0.33 0.09 0.72 <.001 Predictors of Post Engagement
  23. 23. INVOLVEMENT + Analysis • Trends • Latent Class Analysis Variables • Residence • Collectivism • Participation Sampling • Respondent Driven Sampling • Sexually Active GBM, >16 Years
  24. 24. Respondent Driven Sampling In EquilibriumOut of Equilibrium
  25. 25. 719 participants recruited; 119 (16.6%) were seeds COLOUR: white = HIV-negative; black = HIV-positive; grey = unknown SHAPE: circle = 16-24 years; square = 25-39 years, triangle = 40+ years RDS Chains in Momentum Health Study
  26. 26. Progress in Recruitment 0 50 100 150 200 250 300 350 400 Participants Recruited Seeds Feb 2012 Feb 2013 119
  27. 27. Recruitment of Cohort Gay-identified: 79.9% (n=655) Ever had an HIV test: 92.2% (n=730) HIV-negative: 78.6% (n=551) Social Time with GBM: >25%: 67.7% (n=592) <$30k/yr: 72.9% (n=485) P6M sduCAS: 36.3% (n=291) || CAS: 62.3% (n=504) White: 68.8% (n=585) || Indigenous: 9.5% (n=50) “Always” Uses condoms: 57.6% (n=426) Age <24: 21.9% (n=147) || Age ≥40: 34.9% (n=296)Online Sex Seeking: 67.3% (n=586)
  28. 28. 49% 51% 78% 70% 80% 66% 39% 29% 83% 54% 25% 30% 76% 62% 22% 27% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1 2 3 4 5 6 7 8 Proportion(%) Visit Number Lives in the West End/ Downtown (in P6M) Believes Community involvement is Important/Somewhat Important Went to Gay Bars and Clubs More than Monthly (in P6M) Attended Gay Group Meetings (in P6M) Read Gay News Media (in P6M) Spent More than 50% of Social Time with Other GBM (in P6M) Sought Sex Online Using Apps or Websites (in P6M) Went to the Most Recent Pride Parade (in P12M) Community Involvement Across Visits
  29. 29. Wellman (2001, 2003) “Networked Individualism?” Online and offline participation in voluntary organizations and politics are positively correlated. Penard (2010) “Virtual Ties” Volunteerism and trust are associated with online socializing. But online socializing may reduce face-to-face contact with friends. Neves (2013) “Social Capital and Internet” Review highlights a mixture of studies in the literature, but a positive relationship between internet use and social capital is uncovered. Bauernschuster (2014) “Surfing Alone?” No evidence of negative effects of the Internet on several aspects of social capital. Internet Use and Social Capital Internet doesn’t seem to be the driving force behind the decline.
  30. 30. Any vs. None >Monthly vs. monthly/none More than monthly vs. < monthly Play on gay sports team 1.24 (0.73-2.09) 1.14 (0.60-2.15) 1.31 (0.61-2.81) Attend gay specific groups 1.32 (0.84-2.07) 1.29 (0.89-1.87) 1.32 (0.84-2.07) Attend gay bars/clubs 1.33 (0.95-1.87) 1.22 (0.91-1.65) 1.41 (1.01-1.97) Read gay bars/clubs 0.85 (0.63-1.14) 0.85 (0.63-1.14) 1.72 (1.18-2.49) Pride parade participation 0.99 (0.73-1.34) - - Number of groups attended 1.11 (0.96-1.29) - - Bivariate sensitivity analysis of factors associated with online sex seeking vs. none Bivariable Multivariable Social Time Spent with Gay Men 26-75% vs. <25% 2.20 (1.58-3.08) 1.99 (1.33-2.97) >76% vs. <25% 1.54 (0.96-2.48) 1.17 (0.66-2.08) Collectivism 1.07 (1.01-1.14) 1.08 (1.01-1.16) No. of Facebook Friends 1.09 (1.05-1.13) 1.08 (1.03-1.13) Selected covariates of online sex seeking vs. none Online dating doesn’t seem to be associated with lower community involvement
  31. 31. HOW DO YOU GO ABOUT WORKING WITH A COMMUNITY? +
  32. 32. HETEROGENEITY + Using Latent Class Analysis to Identify Sub- Groups and Sub-Cultures
  33. 33. Barrett & Pollack (2005) “Whose Gay Community?” Non-white, working-class men are less likely to connect to the gay community and identify as gay. Fraser (2008) “Young men, queer and theories of gay community” Despite the widely held perception that queer is supplanting gay among young same-sex attracted men in Australia, participants do not support this assumption. Further, conventional models of community (vs. individualism) continue to prioritize sameness and cooperation for common goals. Yet, participants feel excluded from community by their own differences. Goltz (2014) “Shifting Generational Perspectives and tensions.” Emergent generational divide in the conceptualization and articulation of "gay identity" as well as how this identity is understood in relation to "the gay community." Lewis (2015) “Community Cleavages” Perceived hierarchies of acceptance for the various subgroups as well as an age effect wherein middle-aged men perceive the least acceptance for all groups. These differences are linked with the uneven impact of social, political, and institutional changes relevant to gay and bisexual men in Canada. Community Cleavages
  34. 34. Latent Class Analysis SD D A SA γ1 γ2 γ3 γ4 γ5
  35. 35. Latent Class Analysis SD D A SA γ1 γ2 γ3 γ4 γ5
  36. 36. Latent Class Analysis SurveyDesignAnalysisInterpretation C γ1 γ2 γ3 γ4 γ5 K1 K2 K3 γ6 γ7 γ8 γ9 Indicators Latent Variable Classes
  37. 37. Patterns of Community Connectedness Among Gay and Bisexual Men Example #1
  38. 38. • Read gay news/ media, P6M • Attended gay group meetings, P6M • Attended gay pride parade, P12M • Spent >50% social time with GBM • Attended gay bars, P6M • Played on gay sports team, P6M • Used apps to seek sex, P6M • Used websites to seek sex, P6M • Had Facebook, Currently LCA Indicators
  39. 39. 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1 Attend Gay Bars/Clubs Read Gay News/Media Attended Pride Parade >50% Social Time with GBM Attend Gay Groups Used Apps to Seek Sex Used Websites to Seek Sex Has Facebook ItemResponseProbabilities Socialites Traditionalists Techies
  40. 40. 0 50 100 150 200 250 300 Feb. 2012 - Jul. 2012 Aug. 2012 - Jan. 2013 Feb. 2013 - Jul. 2013 Aug. 2013 - Jan. 2014 Feb. 2014 - Jul. 2014 Aug. 2014 - Jan. 2014 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% TotalNumberRecruited (Line) ProportionofRecruitsinEachGroup (Bar) Techies Traditionalists Socialites Total
  41. 41. Traditionalists vs. Socialites Techies vs. Socialites Techies vs. Traditionalists aOR (95%CI) aOR (95%CI) aOR (95%CI) Age (per year older) 1.06 (1.04-1.07) 1.01 (1.00-1.03) 0.96 (0.94-0.98) Annual Income (≥30,000 vs. <$30,000) 0.43 (0.28-0.66) 0.59 (0.41-0.86) 1.38 (0.89-2.15) Current Relationship Monogamous/Married Ref Ref Ref (Partially) Open 0.67 (0.37-1.22) 1.12 (0.60-2.07) 1.67 (0.88-3.19) No Regular Partner 0.54 (0.32-0.91) 1.45 (0.85-2.47) 2.70 (1.54-4.74) Collectivism 0.82 (0.75-0.89) 0.75 (0.69-0.81) 0.92 (0.84-0.99) Stigma Scale 0.93 (0.87-0.99) 1.00 (0.94-1.06) 1.07 (1.00-1.15) HIV Tested, Ever 0.37 (0.17-0.84) 1.23 (0.52-2.91) 3.30 (1.43-7.63) Ask Partners their HIV Status 0.57 (0.38-0.85) 1.03 (0.71-1.48) 1.80 (1.20-2.70) CAS with serodiscordant/unknown partner, P6M 0.74 (0.48-1.14) 1.32 (0.91-1.92) 1.79 (1.16-2.70) # Male Sex Partners, P6M 0.99 (0.98-1.00) 1.00 (1.00-1.00) 1.01 (1.00-1.02) Recruitment Time (odds per month) 0.98 (0.96, 1.01) 1.03 (1.00, 1.05) 1.05 (1.02, 1.08)
  42. 42. Any substance reported by more than 30 participants. Example #2
  43. 43. What groups are likely to emerge? +
  44. 44. Class Names Limited Conventional Sex Club Street Assorted Distribution 296 (36.7) 203 (25.9) 90 (11.4) 69 (9.5) 82 (12.1) 34 (4.5) Alcohol 75.6 100.0 84.3 98.6 75.8 92.9 Marijuana 29.6 79.7 74.0 90.2 70.1 93.2 Tobacco 23.2 43.1 47.0 69.1 69.9 84.9 Erectile Drugs 10.9 22.2 78.0 8.5 14.7 66.8 Poppers 20.1 36.9 74.8 51.9 32.7 73.7 Crystal 1.3 5.0 77.2 2.3 38.7 100.0 Cocaine 0.9 15.2 44.6 72.5 44.1 96.3 GHB 0.6 2.0 86.5 33.4 13.3 81.7 Ecstasy 0.0 20.2 65.7 89.1 4.8 83.3 Ketamine 0.0 2.7 41.3 43.2 0.0 91.2 Mushrooms 0.0 14.9 5.1 51.7 1.4 36.5 LSD 0.0 0.0 0.0 26.5 4.2 30.7 Heroin 0.0 0.0 0.0 0.0 19.9 35.8 Oxycodone 0.0 1.5 7.5 5.9 13.9 34.8 Crack 0.7 0.0 14.5 3.2 39.1 58.6
  45. 45. Conventional Use Age 1.00 (0.99, 1.02) Sexual Sensation Seeking Scale 1.03 (0.99, 1.09) Escape Movie Scale 1.01 (0.98, 1.05) Non-Gay Identified 1.48 (0.82, 2.68) HIV-Positive 1.03 (0.61, 1.74) Annual Income > $30,000 0.94 (0.62, 1.42) Stably Housed 0.77 (0.38, 1.57) Occupation (vs. unemployed) Professionals/Upper Class 0.97 (0.57, 1.67) Working Class/Lower Class 1.21 (0.71, 2.06) Income from Drug Sales. P6M 2.17 (0.39, 12.04) Attended Group Sex Events. P6M 1.22 (0.77, 1.94) Attend Gay-Bars/Clubs. P6M 2.32 (1.37, 3.92)
  46. 46. Club Drug Use Age 0.93 (0.89, 0.96) Sexual Sensation Seeking Scale 1.14 (1.06, 1.23) Escape Movie Scale 1.03 (0.98, 1.08) Non-Gay Identified 1.86 (0.85, 4.08) HIV-Positive 0.73 (0.24, 2.22) Annual Income > $30,000 1.15 (0.62, 2.12) Stably Housed 1.46 (0.42, 5.04) Occupation (vs. unemployed) Professionals/Upper Class 0.59 (0.28, 1.26) Working Class/Lower Class 0.62 (0.29, 1.32) Income from Drug Sales. P6M 6.51 (1.11, 38.29) Attended Group Sex Events. P6M 0.77 (0.38, 1.58) Attend Gay-Bars/Clubs. P6M 4.37 (1.56, 12.26)
  47. 47. Sex Drug Use Age 1.01 (0.98, 1.03) Sexual Sensation Seeking Scale 1.12 (1.04, 1.20) Escape Movie Scale 1.08 (1.03, 1.13) Non-Gay Identified 1.22 (0.51, 2.90) HIV-Positive 3.98 (2.07, 7.65) Annual Income > $30,000 2.92 (1.59, 5.35) Stably Housed 0.66 (0.27, 1.62) Occupation (vs. unemployed) Professionals/Upper Class 0.41 (0.20, 0.83) Working Class/Lower Class 0.57 (0.28, 1.15) Income from Drug Sales. P6M 9.24 (1.72, 49.8) Attended Group Sex Events. P6M 2.41 (1.34, 4.31) Attend Gay-Bars/Clubs. P6M 0.89 (0.47, 1.69)
  48. 48. Street Drug Use Age 1.01 (0.98, 1.03) Sexual Sensation Seeking Scale 1.04 (0.97, 1.11) Escape Movie Scale 1.09 (1.05, 1.15) Non-Gay Identified 3.16 (1.63, 6.10) HIV-Positive 1.75 (0.92, 3.32) Annual Income > $30,000 0.77 (0.39, 1.50) Stably Housed 0.29 (0.14, 0.59) Occupation (vs. unemployed) Professionals/Upper Class 0.30 (0.15, 0.61) Working Class/Lower Class 0.42 (0.22, 0.81) Income from Drug Sales. P6M 2.12 (0.32, 14.2) Attended Group Sex Events. P6M 0.77 (0.4, 1.49) Attend Gay-Bars/Clubs. P6M 1.02 (0.56, 1.86)
  49. 49. Assorted Drug Use Age 0.95 (0.91, 0.99) Sexual Sensation Seeking Scale 1.13 (1.02, 1.26) Escape Movie Scale 1.07 (1.00, 1.14) Non-Gay Identified 2.97 (1.14, 7.72) HIV-Positive 5.97 (2.18, 16.34) Annual Income > $30,000 1.06 (0.41, 2.79) Stably Housed 0.23 (0.08, 0.63) Occupation (vs. unemployed) Professionals/Upper Class 0.58 (0.20, 1.75) Working Class/Lower Class 1.04 (0.39, 2.76) Income from Drug Sales. P6M 19.77 (3.65, 106.89) Attended Group Sex Events. P6M 3.26 (1.39, 7.63) Attend Gay-Bars/Clubs. P6M 0.79 (0.33, 1.88)
  50. 50. 12.2% 10.9% 24.5% 28.3% 11.8% 12.0% 10.7% 10.7% 27.4% 28.5% 13.4% 9.6% 0% 5% 10% 15% 20% 25% 30% 35% Visit 1 Visit 2 Visit 3 Visit 4 Visit 5 Proportion(%)ofparticipantsineachclass Street Drug Use Limited Drug Use Club Drug Use Sex Drug Use Conventional Drug Use Assorted Drug Use
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