Community Needs Assessment among Latino Families in an Urb.docx

Community Needs Assessment among Latino Families in an
Urban Public Housing Development
Patricia Escobedo1, Karina Dominguez Gonzalez1, Jill
Kuhlberg2, Maria ‘Lou’ Calanche3,
Lourdes Baezconde-Garbanati1,
Robert Contreras4, and Ricky Bluthenthal1
Abstract
Studies examining the health of public housing residents are
limited. In response, community-based participatory research
principles were used to develop an intervention aimed at
improving health outcomes related to multifactorial risk
behaviors among Latino families living in a low-income
neighborhood. A two-part needs assessment was completed to
guide the intervention: interviews with parents (n = 10) and a
group model building (GMB) workshop with youth and parents
(n = 40) to explore the parent- youth dynamic. Interviews
indicated that poverty, youth disobedience, and inadequate
communication between parents and youth led to parental stress.
During the workshop, balancing and reinforcing feedback loops
involving Communication, Trust, and Respect between youth
and parents were identified. Based on these findings and
collaboration with a community
1University of Southern California, Los Angeles, CA, USA
2The University of North Carolina, Chapel Hill, USA 3Legacy
LA, Los Angeles, CA, USA
4Bienestar Human Services, Inc., Los Angeles, CA, USA

Corresponding Author:
Patricia Escobedo, Department of Preventive Medicine, Keck
School of Medicine, University of Southern California, 2001 N.
Soto Street, 3rd Floor Mail, Los Angeles, CA 90032, USA.
Email: [email protected]
Hispanic Journal of Behavioral Sciences 2019, Vol. 41(3) 344–
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Escobedo et al. 345
advisory board, a bilingual, mindfulness-based meditation
intervention was designed to address community needs: positive
parent-child interaction emphasizing trust and communication,
stress reduction, and family well- being.

Keywords
community-based participatory research (CBPR), Latino
families, mindfulness, pilot intervention, group model building,
needs assessment
In the United States, Latinos constitute 18% of the total
population, yet rep- resent nearly 20% of the nation’s poor
(Semega, Fontenot, & Kollar, 2017). Among children living in
poverty in the United States, more than a quarter are Latino
(Semega et al., 2017), signifying a critical health disparity as
child poverty is associated with lower educational attainment,
higher prevalence of emotional and behavioral problems,
chronic diseases, adulthood morbidity, and reduced life
expectancy (Blane, Bartley, & Smith, 1997; Kozyrskyj, Kendall,
Jacoby, Sly, & Zubrick, 2010; Singh & Ghandour, 2012; Singh,
Siahpush, & Kogan, 2010).
Living in poverty may also exacerbate existing disparities in
health outcomes among Latinos. Compared with Whites,
Latino adults suffer dispro- portionately higher rates of
mortality related to obesity, diabetes, and cirrhosis (Centers for
Disease Control and Prevention [CDC], 2015). Many Latinos
face linguistic and cultural barriers when accessing health care,
which can result in less satisfaction with quality of medical care
and reduced health seeking (Garcia & Duckett, 2009). Latino
adolescents may be especially vulnerable. Compared with their
White peers, Latino adolescents have a higher prevalence of
depression, which is concerning as depression is associated with
substance use, lower academic attainment, and eating disorders
(Chaiton, Cohen, O’Loughlin, & Rehm, 2009; Lee & Liechty,
2015; Liechty & Lee, 2013). Family structure and family
functioning may also influence health outcomes. Parent-child
conflict among Latino families was associated with higher
levels of depressive symptoms and conduct problems (Gonzales,

Deardorff, Formoso, Barr, & Barrera, 2006; Smokowski et al.,
2014). In addition, Latino adolescents in single parent families
reported high levels of economic adversity, depression, and
family stress (Zeiders, Roosa, & Tein, 2011). Overall, these
disparities indicate a need for culturally tailored interventions
that address multiple risk factors among Latino families.
Tailored interventions are especially needed in communities of
concentrated poverty such as low-income and public housing
developments.
346 Hispanic Journal of Behavioral Sciences 41(3)
Nearly 1.2 million U.S. households live in government-
subsidized public housing developments (U.S. Department of
Housing and Urban Development, 2017); however, studies
examining the health of public housing residents are limited.
Earlier research found that when compared with the general
population, public housing residents reported a higher
prevalence of chronic health conditions, tobacco use, physical
inactivity, and are more likely to rate their health as fair or poor
(Digenis-Bury, Brooks, Chen, Ostrem, & Horsburgh, 2008;
Manjarrez, Popkin, & Guernsey, 2007). Given that many Latino
public housing residents are foreign-born and Spanish-speaking
(Chambers & Rosenbaum, 2014; Harley et al., 2014; Quintiliani
et al., 2014), more research on Latino families in public housing
is needed.

To address this gap, a community-campus partnership, known as
the Partners for Strong Healthy Families (PSHF), was
established with the goal of improving the health and well-being
of Latino families living within and around the Ramona Gardens
public housing community in Los Angeles through the
development of a family-based health intervention. The PSHF is
founded on a partnership between the following three
organizations: (1) the University of Southern California (USC);
(2) Bienestar, a Latino AIDS service organization; and (3)
Legacy LA, a community-based nonprofit organization
focused on youth development in the Ramona Gardens
community. Engaging public housing residents in the
identification of community health needs is a fundamental step
toward the implementation of culturally tailored community-
based interventions (Bowen et al., 2013). Several studies have
successfully used community-based participatory research
(CBPR) approaches to identify health needs within underserved
Latino communities (Bopp et al., 2012; Corona, Gonzalez,
Cohen, Edwards, & Edmonds, 2009; Dulin, Tapp, Smith, De
Hernandez, & Furuseth, 2011; Valenzuela, McDowell, Cencula,
Hoyt, & Mitchell, 2013). Using collaborative partnerships and
shared decision-making between partners to develop research
questions of importance to all stakeholders allows researchers
to move beyond basic or applied research approaches in order to
design a tailored research strategy that is culturally competent
and accordant with the specific life experiences, cultural
traditions, and languages of the participants in the study (Baker,
White, & Lichtveld, 2001; McQuiston, Parrado, Martínez, &
Uribe, 2005). The specific health issues and outcomes assessed
by the PSHF pilot intervention were determined using the
results of a community needs assessment which integrated two
community participatory processes: the first, a group model
building (GMB) workshop using a community-based system
dynamics (CBSD) approach, and the other, key informant
interviews developed using CBPR principles. Both processes

involved the engagement of adolescents and parents living
within the Ramona Gardens public housing development and
surrounding communities.
Escobedo et al. 347
This article described the development of the PSHF intervention
by providing an overview of the GMB workshop designed to
understand and improve the relationships between parents and
youth living in the Ramona Gardens community and the
findings from the key informant interviews. We provide a
description of the planning process and structure of the GMB
workshop and report the results and insights generated from
the workshop and key informant interviews.
Method
Participants
Participants were recruited from the Ramona Gardens public
housing development and surrounding community. Ramona
Gardens houses an estimated 2,000 residents who are almost
exclusively Latino (City of Los Angeles, 2015). The
development is located 3 miles east of downtown Los Angeles
within the neighborhood of Boyle Heights, where nearly all
residents are Latino (90.9%), speak Spanish at home (85%),

and nearly half are foreign-born (47%) (U.S. Census Bureau,
2016). The needs assessment integrated two community-based
participatory processes: the first, key informant interviews,
which were followed by a GMB workshop using a CBSD
approach.
Key Informant Interviews
Sampling and recruitment. Parents were eligible to participate
in key informant interviews if they lived in the Ramona
Gardens community (inclusive of both the public housing
complex and the surrounding neighborhood) and had a child of
middle school or high school age. Parents receiving services
from Legacy LA who were eligible for the study were contacted
over the phone or in person by bilingual Legacy LA staff
members and promotoras. To recruit eligible parents in the
community not receiving Legacy LA services, Legacy LA staff
members and promotoras conducted door-to-door recruitment
visits in the housing project, where eligible parents were invited
to participate. All participants were offered transportation to the
Legacy LA office. Recruitment of eligible fathers proved to be
challenging, as the majority of families contacted were single-
mother households; however, four fathers were recruited using
community outreach and referral sampling. Each parent
received US$10 in cash after the completion of the interview.
348 Hispanic Journal of Behavioral Sciences 41(3) Procedures
A semi-structured interview guide was developed in
collaboration with USC faculty, and community partners

Bienestar Human Services and Legacy LA. Participants had the
option to complete the interview in English or Spanish. Prior to
each interview, interviewers obtained verbal consent, and a
written copy of the consent form was provided to parents in
their preferred language.
During the interview, parents were asked to share information
about (1) their personal history in the community, (2)
knowledge about helping agencies or individuals in the
community (e.g., recreational leagues, religious organizations,
city and county services, and other formal and informal groups
or individuals interested in the well-being of families in the
community), (3) family communication, (4) sources of stress,
and (5) community health issues and health resources. Lastly,
parents were asked about community perception of research and
health interventions and what kind of intervention topics,
design, and incentives would increase participation and
retention among Ramona Gardens families.
Six mothers and four fathers were recruited for a total of 10
parent interviews. Average duration of interviews was 40
minutes. All interviews were digitally recorded and transcribed.
Eight parents requested an interview in English, and audio-
recordings of English interviews were completed by a
professional transcription service. Two parents requested
interviews in Spanish, and audio-recordings were translated and
transcribed by a bilingual member of the university research
team.
Data Analysis
Thematic content analysis was conducted using software
package Atlas.ti7. A thematic data analysis approach was taken
to understand the following domains: community strengths,
risks to youth and families, sources of parent and youth
conflict, sources of stress, community health, and community

perception of research and health interventions.
Community-Based System Dynamics
CBSD is a participatory approach which involves communities
in the process of understanding the dynamics of an identified
problem from a feedback per- spective (Hovmand, 2014). CBSD
is appropriate when the goal of a project is to build a
community’s capacity to interpret problems with a holistic
perspec- tive and arrive at a shared understanding of a problem
(Munar, Hovmand,
Escobedo et al. 349
Fleming, & Darmstadt, 2015). Using the CBSD approach,
collaborators can gain insight into the issues surrounding
parent-youth (PY) relationships in Ramona Gardens to design
more effective interventions for its residents and to empower
parents and youth to address the problems in their relationships.
CBSD draws on GMB practices, including the use of structured
activities carried out by trained facilitators from the community
with system dynamics modelers in supportive roles. These
activities use models to initiate deeper insights and
conversations about problems and systems that are changing
over time, using the formal diagramming conventions of system
dynamics, including causal loop diagrams (CLDs) (Hovmand,

2014; Hovmand et al., 2012; Richardson & Andersen, 1995;
Vennix, 1996).
Procedures
The approximately 3-hour workshop with parents and youth
included several scripted activities designed and adapted to
involve and build capacity of the Ramona Gardens community
members in generating a deeper understanding of the dynamics
of PY relationships. Group facilitators consisted of Legacy LA
and Bienestar staff members, and bilingual research team
members trained in CBSD methodology. Parent activities were
conducted in Spanish, while youth activities were conducted in
English. Discussions with parents and youth were conducted in
English and Spanish.
Graphs over time. To begin, parents and youth divided into
separate groups, with parents working on one end of the room
and youth on the other. Partici- pants were asked to draw graphs
showing how variables that affect or are affected by the PY
relationship have changed over time. Variables could include
feelings (e.g., respect), behaviors (e.g., communication),
activities/ responsibilities (e.g., school), people (e.g., friends),
and items (e.g., Internet). Parents shared their graphs with other
parents, while youth shared their graphs with other youth
participants. All participants then reconvened for a large group
discussion to summarize key findings. Next, to understand
which variables parents and youth felt were key to
understanding the dynamics of the PY relationship, participants
were asked to mark the five to six graphs they felt were most
important. Facilitators tallied votes and listed the most popular
PY variables.
CLDs. Following a meal break, parents and youth again divided
into separate groups, where facilitators introduced the design
and function of CLDs. Using examples relevant to parents and

youth, facilitators described the concepts required to draw
CLDs, which included causal arrows, polarity, and
reinforcing and balancing feedback loops. In small groups,
participants were asked to draw CLDs showing how different
variables and experiences, identified during the graphs over
time activity, are interrelated. Groups could choose variables
from the list of most popular PY variables, as well as other
variables they felt influenced the PY relationship. Facilitators
actively coached participants, helping groups understand CLD
concepts as well as identify and characterize feedback loops.
After 30 minutes, participants presented CLDs to their
respective groups by explaining how the feedback loops they
found influence the PY relationship. Lastly, parents and youth
reconvened to discuss and evaluate their workshop experience
with facilitators. Trained notetakers transcribed all group
discussions during the workshop. All graphs and CLDs were
labeled and collected by research team members to assist with
data analysis.
Data Analysis
All parent and youth CLDs were reconstructed by J.K. using
Venism DSS modeling software. Using the transcribed notes,

individual diagrams were updated as needed (arrowhead
direction and/or polarity changed) to ensure they reflected the
story told by participants. Once all diagrams were updated, they
were examined to identify the most commonly occurring
variables across parent and youth CLDs. Transcribed notes were
also reviewed at this time to determine how terms used in the
diagrams could serve as links between the CLDs created by
different groups. Finally, one synthesized CLD combining both
parent and youth stories in English and Spanish was created
using this iterative process.
Results
Key Informant Interview Results
A total of six mothers and four fathers were interviewed. Nine
parents currently lived in the Ramona Gardens housing
development, with length of residency ranging from 1.5 to 30
years (M = 13.85 years). Three of the parents were married, two
were living with a partner, and five were single parents. The
number of children living in each household ranged from 2 to 7
(M = 4.2), with ages of children ranging from 2 to 22 years (M
= 11.2 years).
Community change. A common theme was the noticeable
decrease in violence, crime, drug deals, and gang activity
within the Ramona Gardens community over the past decade.
Parents felt this was due to increased police
Escobedo et al. 351

presence, a decrease in gang activity, and a proliferation of
programs for youth in the Ramona Gardens and Boyle Heights
community. Increased police presence in the community,
including police patrols, installation of security cameras, and
community outreach efforts, was also attributed to the increase
in neighborhood safety. Most parents appreciated the efforts
made by law enforcement to control and discourage gang
activity; however, two fathers who themselves were raised in
the Ramona Gardens community felt that police and law
enforcement stereotyped young men in the neighborhood as
gang members and arrested groups of young men without
provocation, causing tension between police and families. One
father described how his nephews are stopped by police “all the
time and for no reason, they’re just out there just, you know,
with friends and they [the police] go there . . . they already
think, these guys are doing something, even though you’re not.”
Longer term residents felt that previous generations of Ramona
Gardens residents became involved in gang activity due to a
lack of youth development programs in the Boyle Heights
area. Parents felt that youth now had access to numerous youth
programs, and “if they’re always busy they won’t have time to
be out in the streets, looking for something to do.” Although all
parents agreed that neighborhood safety had increased
significantly over the past years, a lingering fear of gang
violence and crime discouraged some families from enrolling
their children in sports and youth programs in Ramona Gardens
and the Boyle Heights community.
Risks to youth and parenting. In the Ramona Garden
community, dropping out of school, along with gang

involvement, violence, and substance use, was perceived as the
greatest risk to youth. Longer term residents felt it was difficult
to discourage their children’s interest in gang activity and
substance use as both are pervasive within the community:
There are many youth in our community who want to get
involved in the wrong things, go down the wrong path and we as
parents need to help them. We as parents should motivate them,
speak with them, we should be communicating with them. If
their self-esteem is low, we should raise it up. Tell them that if
they want something, they need to earn it. To keep moving
forward. (Grandmother)
Conflicts between parent and children and overall family stress
were perceived as risk factors for gang involvement.
Disrespectful behavior by children and ineffective
communication between parent and child were identified as
major sources of stress within families. Children often ignored
instructions or directives, refused to follow directives given by
parents, argued with
352 Hispanic Journal of Behavioral Sciences 41(3) parents, used
inappropriate language with parents, or did not return home by
a given curfew:
I think a lot of conflict is the disrespecting. You know, that’s
one of the biggest ones, disrespect, a lot of kids nowadays don’t
find it something that we need to continue to have. The
disrespecting happens at a young age, and I’m talking about 5-6

years old. You know, we got 5-year-olds and 6-year-olds
disrespecting their mom and, and saying no. As soon as they say
no, that’s a problem, because they shouldn’t be allowed to tell
you no. I think they need to learn that the respect you give, you
shall receive, and a lot of times it’s confusing, they think they
got to get the respect from the homies instead of the family, and
it’s like, no, it’s, you got it backwards. Family needs to be
involved more to stop all of that. (Mother)
Being a single parent was associated with greater parent-child
conflict and family stress, as single parents, especially working
mothers, found it difficult to cope with and respond to
disrespectful behavior from children. Several single mothers
felt that agencies providing counseling services, nutrition, and
health resources, and youth mentorship were at times difficult
to locate in the surrounding community but were used regularly
to help overwhelmed parents with their child’s academic
progress, health needs, and behavioral chal- lenges. Mothers felt
that free parenting classes were needed to help parents improve
positive interaction with children and to demonstrate effective
disciplinary strategies.
Stress and coping. Financial difficulties and poverty were the
greatest source of stress among families. Even among
households with two working parents, parents described
difficulties paying monthly rent, utilities, and providing the
basics for their family. One mother felt that she could not
provide her children the material possessions they wanted, she
could only afford what was needed, which caused conflict
between parents and children. Parents also felt stressed about
unemployment and job security. Other sources of stress were
related to household and community violence, child
misbehavior, and financial stress. Several mothers described
family therapy and counseling services as beneficial and
integral to stress reduction, increasing self-esteem, and overall
family functioning and well-being.

Community health needs. The most concerning health issues
within the community were related to diet, physical activity,
and mental health. Parents mentioned psychological stress,
diabetes, hypertension, obesity, and unhealthy diet. Many
negative health outcomes were attributed to a high-fat
Escobedo et al. 353
diet and lack of access to fresh produce. Vendors sold foods
like “churros, chips, nachos and tamales” in the housing
development, making it easy to eat inexpensive and high-fat
foods. The nearest market is a liquor store with limited produce
options and “inflated” prices. All parents agreed that in order to
access a larger and more affordable selection of fresh produce,
families were required to travel outside the community as there
were no grocery stores within walking distance. The estimated
distance to these larger grocery stores varied depending on
whether the parent used public transportation or their own
vehicle. The parents describing grocery stores as easily
accessible all owned a personal vehicle. Parents who used
public transportation described the journey to and from the
grocery store as tiresome and time-consuming and estimated the
nearest grocery store as being several miles away. How- ever,
parents who owned vehicles estimated the nearest grocery store
as being half a mile to a mile away from Ramona Gardens.

Parents who were unhappy with the produce price and selection
at the local liquor store wanted access to a farmer’s market, “a
healthy supermarket,” or more frequent trips from a local
produce truck. However, one parent expressed some hesitation
about the affordability of organic or natural markets in his
community: “How are you going to have that here, you’re going
to have a poor community, those are expensive stores, you
know, like it’s just hard when the community’s poor and you’re
trying to live rich, eat like the rich.”
Nearly all parents felt that the Ramona Gardens Recreation
Center was an important health resource because it offered
numerous sports programs for youth at reduced prices. The
surrounding parks were also mentioned as important areas for
recreation and exercise, especially for youth. Those who
mentioned the parks described them as a place for physical
activities like skateboarding, basketball, and running; however,
several mothers expressed concern about personal safety when
playing outdoors. Concern over personal safety was perceived
as a barrier to physical activity for both parents and youth, and
though most parents felt that residents were willing to venture
outside their home and walk freely around the housing
development, some parents did not feel comfortable leaving
their home later in the evening.
. . . two years ago we donated 27 bikes to the school, we’re
trying to get kids on bikes, to you know, to lose the weight and
kids get their bikes stolen all the time. Keeping them active is a
little bit harder. We try to give out skates, give out things that
they could use to physically help them, but people walk into the
projects and just intend to steal stuff, so. They can only do so
much with that. (Mother)
Several parents recommended that group exercise classes for
adults also be offered at the Ramona Gardens Recreation Center
to encourage adults and parents to exercise. Some parents felt

that the installation of outdoor exercise
equipment in the nearby parks would increase physical activity
among parents because parents could exercise while also
supervising their children. Parents also felt it was important to
involve the entire family ingroup or family-based class to
increase positive interaction among family members.
Increasing community participation. Most parents felt that
families would com- mit to 1 to 6 hours per week, while others
specified once or twice a week, with a duration of 3 months at
most. Overall participation and time invested in a program
would depend on the goals and outcomes, childcare availability,
and transportation. Parents expressed a preference for family-
based activities that focus on exercise, nutrition, and parenting
classes. Parents felt that incentives such as gift cards, free
groceries, and childcare would be attractive incentives and
increase participation. All parents felt that a university-spon-
sored program focusing on health and well-being would be
welcomed into the community. Parents also felt it was
imperative for researchers to communicate directly with the
community and meet with community members at Ramona
Gardens before the start of the intervention program to explain
how the intervention would benefit the participants and the

community. It was recommended that researchers partner with
community leaders such as the Ramona Garden Advisory
Council to discuss community needs and resources. While many
parents were aware of the university’s affiliation with the local
county hospital, some felt that the university could improve its
relationship with the community by offering health and
counseling services to Ramona Gardens residents and providing
referrals to local social and health services.
GMB Results
Graphs over time. Several themes surfaced during the graphs
over time exercise. Both parents and youth indicated that the
PY relationship is affected by an increase in the time youth
spend with friends, increased hours worked by parents,
increased use of technology (e.g., computers, cell phones,
video- games), increasing fear of deportation, and a decrease in
trust and communication over time. Several youth graphs
described increasing household responsibilities and police
presence in the community, while parents described declining
respect between parents and youth and the declining number of
parents and youth who communicate in the same language.
CLDs. CLDs allow participants to see how variables related to
the PY relationship are interrelated. Both parents and youth
identified several reinforcing processes (labeled R1, R2, and
R3 in Figure 1) linking Confianza/Trust, Respeto/Respect, and
Communicación/Communication with both virtuous
Escobedo et al. 355

Figure 1. Casual loop diagram combining both parent and youth
stories.
and vicious cycles. Other reinforcing loops that emerged
included involvement in sports (R4 in Figure 1). Youth felt
that when parents had less trust in them, this led to less
involvement in sports and other school activities, which reduced
overall school involvement, lowering grades, and further
weakening parental trust. Both parents and youth identified the
youth’s friends as influ- ential factors, especially friends who
parents felt were negative influences on their children.
Spending more time with friends also reduced time spent on at-
home responsibilities (R5 in Figure 1), which was undesirable
for the youth.
The use of technology and electronics was mentioned by all
small groups. The more parents and youth use technology and
electronics, the less they communicate, and the less they
communicate, the more likely they are to use technology (R6).
Parents and youth also identified several balancing

processes (B1-B5 in Figure 1). Parents and youth reported
several benefits associated with technology use (B1), which
included stress reduction, assistance with schoolwork, and
daily communication between parents and youth. Interestingly,
youth identified an interesting balancing process (B2) related to
sports, such that higher involvement in sports created time
management issues, which took a toll on youth health over time.
When health declined, youth were less likely to participate in
sports. Two other important balancing processes involved trust
between parents and youth. When parental trust is higher, youth
are allowed to use more electronic devices, but spending an
excessive amount on these devices negatively affects youth
academic outcomes, reducing parental trust (B3). Trust in
youth also allows parents to feel comfortable working outside
the home, but more time spent at work decreases communication
with the youth, which reduces trust (B4). Lastly, the dual
influence of police in the community is represented as a
reinforcing process, where police encourage students to do well
in school (R6), yet police arrests decrease school attendance,
and decreased attendance leads to more problems with the
police.
Intervention Development
Feedback from the community, in both forms, directly impacted
intervention development. The funded grant had originally
proposed to focus on substance use and sexual risk behaviors
(U.S. Department of Health and Human Services, National
Institute of Health, 2018). However, neither issue was identified
as an important concern for youth or parents during using either
method. Interpretation of these results in collaboration with our
community partners led the team to focus on an intervention
that would improve trust and communication between youth and
parents, while assisting both with skills that would improve

stress management in the home, school, and workplace.
Discussion and Implications for Practice
We presented findings from a community needs assessment
consisting of two community participatory processes: a GMB
workshop with parents and adolescents living in Ramona
Gardens community and key informant interviews with parents
of adolescents living in and around the Ramona Gardens com-
munity. Meaningful engagement of community members is an
essential step in the successful implementation of culturally
tailored community-based interventions (Bowen et al., 2013).
The insights gained from this needs assessment process are
important given that studies using CBPR principles to identify
health needs among Latino public housing residents are scarce.
Escobedo et al. 357
Findings from the GMB workshop and key informant interviews
suggest several potential next steps to address the issues
related to PY relationships and health needs in the Ramona
Gardens community.
By having Ramona Garden community members visualize the
PY relationship system and identify balancing and reinforcing
feedback loops that lead to conflict within their own families,

stakeholders can collaborate to design a family-based
intervention that balances or controls specific virtuous or
vicious cycles in the system. The proposed PSHF intervention
should focus on strengthening the reinforcing processes that
increase levels of Confianza/Trust, Respeto/Respect, and
Communicación/Communication among parents and youth.
These processes are particularly important given that
communication and respect emerged as common themes
throughout the interview process, serving as both risk and
protective factors.
Interviewed parents felt that positive encouragement increased
positive PY interaction and was protective against gang
involvement and substance use. In addition, disrespectful
behavior by youth and ineffective communication between
parents and youth were major sources of stress within families,
especially within single parent households. GMB workshop
findings also indicated that spending time with friends
decreased bonding with parents; therefore, the intervention
should develop a family-based intervention that includes
educational components for both parents and children, an
intervention format supported by interviewed parents.
During the GMB workshop, police interaction was characterized
with both reinforcing and balancing processes, as police would
encourage youth to achieve higher academic success, yet
increased police presence led to more arrests. Arrests decreased
school attendance, leading to more problems with the police.
Interaction with police was also a concern among the
interviewed parents. Interviews indicated that negative
interaction with the police was a greater concern among fathers
and men in the community; therefore, a separate parent
intervention program could be provided to fathers which
includes sessions addressing the impact of policing tactics on
the health and well- being of men in the Ramona Garden
community.

Although there was moderate overlap between themes and
experiences discussed during the GMB workshop and the parent
interviews, each approach offered unique findings to inform the
development of the intervention. The GMB workshop revealed
reinforcing and balancing feedback loops related to the use of
technology. Although technology use was associated with stress
reduction, it was also associated with less PY communication,
and lower academic achievement and involvement. Given this,
the proposed intervention should be implemented without the
use of electronic devices.
Parent interviews revealed that although all parents felt that
community safety had improved, a lingering fear of gang
activity and violence dis- courages some families from enrolling
children in local sports programs. Parents were also concerned
with safety and transportation; thus, the intervention and any
informational sessions and activities should be held in a nearby
location recognized by community members as a safe space for
youth and families. Parents were receptive to USC’s
involvement in a community-based health intervention program;
however, before the pilot intervention begins, it is imperative
for the academic research team to discuss intervention goals
and outcomes directly with community members. The academic

research team must also explain how the intervention will
benefit the participants and community involved, not just the
university partners.
Limitations
These preliminary findings are based on a small sample of
Ramona Gardens community members. Additional GMB
workshops and key informant interviews should be conducted
with a larger sample of mothers and fathers to determine
whether key differences in opinions and perspectives exist
between mothers and fathers in the Ramona Gardens
community.
Conclusion
Based on GMB workshops and interview findings and
collaboration with a community advisory board, a bilingual,
family-based meditation intervention will be designed to
specifically address community needs: positive parent-child
interaction that emphasized trust and communication, stress
reduction, and family well-being. It is worth noting should the
intervention be effective, we would expect to see improvements
in substance use and sex risk behaviors, which were the original
goals of the study. The use of CBPR, GMB, and key informant
interviews provided important insights on how to achieve public
health outcomes for low-income, racial/ethnic minority par-
ents and youth in a manner that builds on family and community
strengths and concerns.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.

Escobedo et al. 359 Funding
The author(s) disclosed receipt of the following financial
support for the research, authorship, and/or publication of this
article: This paper was supported by grant R24MD007978 from
the NIH National Institute on Minority Health and Health
Disparities (NIMHD). The NIH had no role in study design,
collection, analysis, and interpretation of data, or writing of
report. The content is solely the responsibility of the authors.
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91. Author Biographies
Patricia Escobedo received her BA from the University of
California, Berkeley, and her MA from California State
University, Northridge. She is currently a doctoral stu- dent in
the Health Behavior Research Program in the Department of
Preventive Medicine at the University of Southern California
(USC). Her research interests include health disparities among
ethnic minorities and vulnerable populations, community-
based participatory research, tobacco control, and multiple
substance use.
Karina Dominguez Gonzalez earned her BA from California
State University, Dominguez Hills, and her MPH from USC.
She is a research specialist in the Department of Preventive
Medicine at the Keck School of Medicine of USC. Her work and
research focuses on a wide range of health issues, including
utilization of preventive care, HIV and hepatitis C prevention,
education and testing, cancer care, at-risk youth education,
behavior modification, and substance abuse prevention and
treatment.
Jill Kuhlberg earned her BA from the University of California,
San Diego, and her MSW and PhD from Washington University.
She is a postdoctoral research associate in Health Policy and
Management at University of North Carolina (UNC) Gillings

School of Global Public Health. Research interests include
understanding and addressing social- and public health–related
issues at the local and international level using community-
based system dynamics. Areas of expertise include community-
based system dynamics, systems science, and community
participation.
Maria ‘Lou’ Calanche earned her BA from Loyola Marymount
University and Master of Public Administration from USC. She
is the founder and executive director of Legacy LA, a youth
development program serving at-risk Latino youth living in the
Ramona Gardens neighborhood and surrounding communities.
Legacy LA provides youth with academic support, leadership
development, mentoring, and arts programming.
Lourdes Baezconde-Garbanati is a tenured professor in
Preventive Medicine, associate dean for Community Initiatives
at the Keck School of Medicine, and associate director for
Community Outreach and Engagement at the Norris
Comprehensive Cancer Center at USC. She conducts research on
health disparities among vulnerable population groups and is a
widely recognized national and international community-
engaged scholar in the areas of culture and community health,
with an emphasis on Hispanic/Latino health.
Robert Contreras received his BS from California State
University, Los Angeles, and MBA from Loyola Marymount
University. He is deputy executive director at Bienestar Human
Services. Bienestar is a community-based social services
organization based in the Greater Los Angeles that identified
and addresses emerging health issues faced by Latino and
Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ)

populations. Bienestar’s education and support programs
include HIV/AIDS treatment and prevention, sexually
transmitted infections (STIs), mental health services, substance
use, and harm reduction.
Ricky Bluthenthal is a professor in the Department of
Preventive Medicine and is associate dean for Social Justice at
the Keck School of Medicine at USC. His research has
established the effectiveness of syringe exchange programs,
tested novel interventions and strategies to reduce HIV risk
and improve HIV testing among injection drug users and men
who have sex with men, and examined health policy
implementation and how community conditions contribute to
health disparities.

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