TOWARDS A PEOPLE’S SOCIAL EPIDEMIOLOGY: An Intergenerational Study of Place, Embodiment, & Health via Participatory Action Research with Residents of Public Housing BY RYAN J. PETTEWAY A dissertation submitted in partial satisfaction of the requirements for the degree of Doctor of Public Health in the Graduate Division of the University of California, Berkeley Committee in charge: Rachel A. Morello-Frosch, Chair Mahasin S. Mujahid Amani M. Nuru-Jeter Tapan S. Parikh Fall 2015 Abstract TOWARDS A PEOPLE’S SOCIAL EPIDEMIOLOGY: An Intergenerational Study of Place, Embodiment, & Health via Participatory Action Research with Residents of Public Housing By Ryan J. Petteway Doctor of Public health University of California, Berkeley Professor Rachel Morello-Frosch, Chair Social Epidemiology has made critical contributions to understanding health inequities. However, translation of social epidemiology science into meaningful and timely action remains a challenge. With so much focus within the field on issues like social position, discrimination, racism, power, and privilege, there has been surprisingly little deliberation about the extent and value of social inclusion and equity within the field itself, and how the challenge of translation might be more readily met through re-envisioning the role of the people in the research enterprise—reimagining what “social” could, or even should, mean for the future of the field. Place-health research represents a particularly promising subfield within which to emphasize these principles, especially within the context of public housing. Thus, the overall aim for my dissertation work was to conduct research at the nexus of public health and public housing by integrating participatory research methods and information communication technologies (ICTs) to democratize the research process and facilitate local action. In this spirit, my work develops, introduces, and field-tests 3 interrelated and nested concepts that, in application, represent a model for inclusive and equitable social epidemiology: A People’s Social Epidemiology, the Placescape, and Geographies of Embodiment. First, Chapter 1 introduces a conceptual framework for A People’s Social Epidemiology— a multicomponent and tiered framework to guide social epidemiology research/practice to become more inclusive and equitable, improve knowledge translation, and facilitate timely, locally relevant action—essentially, to enhance the “social” in social epidemiology. The framework draws upon theory, concepts, and principles from social epidemiology, community- based participatory research (CBPR), and information and communication technologies for development (ICTD). This work specifically highlights place-health research as a subfield particularly suited for A People’s Social Epidemiology approach, and the framework was accordingly “field-tested” through my development and implementation of the People’s Social Epidemiology Project (PSEP)—an intergenerational CBPR study of place, embodiment, and health with residents of public housing. For the PSEP, parent-youth dyads were recruited from a predominantly Black public housing community and trained in core principles related to social epidemiology and health equity, and fundamental aspects of public health research and CBPR. They were then trained in 4 participatory research methods: Photovoice, Activity Space Mapping, X-Ray Mapping, and 1 Participatory GIS. All research methods were completed by the participants themselves. First, participants used Photovoice (via cellphones) to identify, photo-document, and describe their important daily places and specific exposures/opportunities within each place they perceive affects their health. Next, they used Activity Space Mapping to geolocate and map their Photovoice photos, identify any additional non-photographed places, and to rate and provide time estimates for each mapped place. Then, using a cognitive mapping method known as X- Ray Mapping, they created symbolic representations of place-embodiment reflecting how each of their mapped places affects their bodies/health. Finally, constituting Participatory GIS, they integrated and digitally mapped their work via a web-based multimedia-enabled ICT platform, Local Ground. This platform allows participants to create, print, and digitally share their place- health research maps with the broader community and city officials. Anchored in A People’s Social Epidemiology, Chapter 2 introduces the Placescape framework. The goal of the work presented here was to develop and field-test a place-health framework that: 1) accounts for the multi-nodal nature of “place” and its contingent spatial, temporal, and social inter-nodal connections/divisions; 2) elucidates potential intergenerational and life-stage differences in place experiences/perceptions; and 3) explicitly engages the sociopolitical mechanisms that make, unmake, and remake place over time. A framework for a placescape approach was developed drawing from place-health, social epidemiology, participatory research, geography, and sociology literatures. This framework was then applied to the PSEP study, with parents and youth using the above combination of participatory methods to map their “placescapes”. Findings revealed clear spatial and temporal differences in adult and youth placescapes, as well as a very distinct pattern of place “nodes” among youth— indicating a multinodal placescape. Lastly, rooted in the Placescape framework, Chapter 3 introduces the Geographies of Embodiment concept through detailing the process and findings of a novel cognitive mapping methodology to elucidate subjective notions of place-embodiment within place-health research—X-Ray Mapping. This work aims to enhance place-health research efforts by furthering our understanding of: 1) which places matter for health and when (i.e. spatially- and temporally-specific notions of “place”); 2) how these places matter—the processes/mechanisms of the physiological embodiment of place; and 3) intergenerational and life-stage differences in place-embodiment experiences/perceptions. Findings revealed clear spatial differences between adult and youth geographies of embodiment, as well clear perceptual differences in which body areas are affected by place and how. Overall, the work presented in these three chapters outlines a framework for conducting more inclusive and equitable—and more practicable and actionable—social epidemiology research, develops a new paradigm for understanding/researching place and health—especially within public housing communities—rooted in intergenerational and participatory approaches, and introduces a novel research methodology to elucidate subjective notions of place-embodiment within place-health research. These combined contributions improve efforts to appropriately conceptualize and measure “place”, and further understanding of place, place-embodiment, and health within public housing. Moreover, these contributions offer guidance on how to move towards a more inclusive and equitable social epidemiology research practice—one that is of, for, and by the people, and not simply about them/us. 2 To KaLijah, to Kruz; to Kellen, to DW3, ‘til the fire next time. To the fire next time. “Take no one’s word for anything, including mine—but trust your experience. Know whence you came. If you know whence you came, there is really no limit to where you can go.”1 *** 1 Baldwin, J (1993). The Fire Next Time. Vintage International: p.8. i TRACK LISTING THE INTRO i LIST OF TABLES iii LIST OF FIGURES iv PREFACE v ACKNOWLEDGEMENTS vi INTRODUCTION 1 CHAPTER 1 7 TOWARDS A PEOPLE’S SOCIAL EPIDEMIOLOGY: ENVISIONING A MORE INCLUSIVE AND EQUITABLE FUTURE FOR SOCIAL EPI RESEARCH AND PRACTICE IN THE 21ST CENTURY CHAPTER 2 38 PLACESCAPES AND PUBLIC HOUSING: ADVANCING UNDERSTANDING OF “PLACE” IN PLACE-HEALTH RESEARCH AND PLACE-BASED HEALTH AND HOUSING STRATEGIES CHAPTER 3 76 THE BODY LANGUAGE OF PLACE: MAPPING INTERGENERATIONAL GEOGRAPHIES OF EMBODIMENT IN PLACE-HEALTH RESEARCH CONCLUSION 108 THE OUTRO 112 BIBLIOGRAPHY 113 ii LIST OF TABLES CHAPTER 1 TABLE 1: 10 ICTs to Socialize Social Epidemiology 23 TABLE 2: 8 Ways to Move Towards a People’s Social Epi 26 CHAPTER 2 TABLE 1: Conceptual Foundations for the Placescape Framework in Public Health and Public Housing 46 TABLE 2: The Placescape: Core Operational Tenets for Place-Health Research 49 TABLE 3: Youth Photovoice Results Summary 56 TABLE 4: Adult Photovoice Results Summary 56 TABLE 5: Youth Activity Space Mapping Summary 58 TABLE 6: Adult Activity Space Mapping Summary 58 TABLE 7: Youth Appraisal of Photovoice and Activity Space Mapping Places 62 TABLE 8: Adult Appraisal of Photovoice and Activity Space Mapping Places 63 CHAPTER 3 TABLE 1: Adult vs. Youth Place-Embodiment Summary Comparison 91 TABLE 2: Youth Place-Embodiment: Positive/Negative Body Effect Perceptions 92 by Place-Domain TABLE 3: Adult Place-Embodiment: Positive/Negative Body Effect Perceptions 92 by Place-Domain iii LIST OF FIGURES CHAPTER 1 FIGURE 1: A People’s Social Epi Framework for Research Translation and Action 24 CHAPTER 2 FIGURE 1: A Placescape Framework for Place and Health in Public Housing 50 FIGURE 2: Photovoice Narrative Guide 53 FIGURE 3: “Rate Your Place” section of Activity Space Mapping worksheet 54 FIGURE 4: X-Ray Mapping Worksheet 55 FIGURE 5: Youth Geolocated Photovoice Place on Local Ground 57 FIGURE 6: Adult Geolocated Photovoice Place on Local Ground 57 FIGURE 7: Youth Placescape Summary Infographic 60 FIGURE 8: Adult Placescape Summary Infographic