The District of Columbia is home to both many of the most affluent and most vulnerable communities in the nation. Public housing communities in the city represent the extremes of concentrated disadvantage: racial segregation, poverty, violent crime, high rates of incarceration and dismal health statistics. For more than a decade, the Urban Institute (Ul) has worked closely with the District of Columbia Housing Authority (DCHA), residents of DCHA public housing communities, and similar high-poverty urban communities across the nation to develop and improve outcomes and reduce disparities via improvements to health and social services and structures. As a result of concerns voiced by DCHA residents across multiple housing communities, DCHA approached Ul two years ago to assist them in addressing what they described as "the problems with our girls." Based on DCHA and resident recommendations, Ul reached out to resident leaders from Benning Terrace, a high-poverty, African American public housing community which has the highest crime rate and is the most underserved, located in the Districts'Ward 7. A preliminary needs assessment jointly conducted by Ul, DCHA and public housing residents identified a group of related adolescent sexual health concerns - sexual violence and coercion, teen pregnancy and HIV/STI. The current application includes the strengthening of this ongoing collaboration of the DCHA, African American residents (adults and adolescents) of Benning Terrace, community-based health, social service and faith-based organizations, Ul and university-based health disparities researchers to reduce adolescent sexual health disparities. Sexual assault and coercion, pregnancy, and HIV/STI are all significantly over-represented among African Americans in DC;HIV rates are the highest in the nation, with up to 12% of women infected. The proposed three-year CBPR process includes 1) a community-driven needs assessment;2) an asset mapping process regarding resources and expertise available for inclusion in a sustainable intervention;3) development of program and evaluation models;and 4) piloting to assess program feasibility, acceptability, perceived efficacy and outcomes.
Adverse sexual health outcomes (i.e., sexual coercion, pregnancy, and HIV/STIs) are significantly over-represented by African American adolescents, and reach their highest levels in high-poverty neighborhoods. In public housing communities, the use of CBPR to develop interventions targeting adolescents and their parents is a unique approach toward reducing adolescent sexual health disparities.