I plan to pursue a patient-oriented research career studying contextual determinants of health. This proposal summarizes a 5-year program of mentored professional development linked to an innovative, multi-method research project intended to better define the social and physical spaces in which health-related behaviors occur, as well as understand young women's interpretation of these spaces. My educational objectives are (1) to gain a theoretical understanding of adolescent sexual behaviors;(2) to conceptualize, perform, and integrate spacetime, qualitative, and longitudinal analyses;and (3) to appropriately address complex ethical issues of measuring location and sensitive behaviors using self-reported, geographic, and photographic data. I will accomplish these with guidance of mentors from adolescent medicine, biostatistics, geography, and sociology;practical knowledge obtained through coursework and directed readings;and the proposed research plan. Our research focuses on how dynamic context, or changing physical and social conditions surrounding an individual, affects an adolescent woman's health-risk behavior. Specifically, we aim to (1) develop, using ethnographic interviews and visual sociology techniques, a set of contextual characteristics potentially pertinent to urban adolescent women's health-risk behavior;(2) test whether a dynamic model of context is associated with sexual behaviors by (a) comparing times and spaces where an individual engages in sexual behavior, and (b) assessing whether time of day, day or week, and season modify this association. In order to better understand subjective factors associated with physical and social environments, we will investigate where young women spend time using qualitative and photo-elicitation techniques. We will use GPS and ethnographic data to define a set of constructs to monitor how context and behaviors change among 20 young women over a 20-month period. A pilot study using GPS-enabled cell phones documented our capacity to utilize this technology to accurately and reliably track young women's locations and record their daily sexual behaviors. I will accomplish these aims with the guidance of my primary mentor. Dr. Fortenberry, and a team of mentors from the fields of biostatistics, geography, health behavior and health services research, and sociology.
A barrier to the success of health promotion and disease prevention efforts is limited understanding of how adolescents interact with the physical and social spaces of their communities. This study will combine novel methodologies, including ethnography, photography, and GPS technology, to better understand how places where adolescents spend time relate to their sexual behavior.