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Substance use among youth and young adults continues to pose a variety of public health challenges. Young people who use opiates (heroin) and methamphetamine are more likely to have high risk sexual and injection practices, as well as more likely to be HIV+. Drug use among youth may be associated with a variety of problems including family trauma, academic difficulties, mental and physical health problems, sexual abuse, incarceration, poor peer relationships and violence. Youth in Northern California who are at risk for drug use, HIV and related health problems need to be better understood and targeted for prevention programs.

Rates of smoking among lesbian, gay, and bisexual adolescents and adults appear to be higher than rates for the general population (Gruskin, et al., 2001; Ryan, et al., 2001; Stall, et al., 1999). Smoking is also likely problematic among transgender people, many of whom face poverty, homelessness, stressful living and work environments, and depression in their daily lives. Despite the fact that smoking negatively impacts or complicates health issues of particular importance to LGBT persons (e.g., hormone therapy for transgender people, HIV/AIDS), tobacco companies target these communities. Yet, there is little research on smoking cessation by and for LGBT persons. Community activists in San Francisco started working more than a decade ago to address these problems. In the early 1990’s, Lyon-Martin Women’s Health Services initiated “The Last Drag,” the first stop-smoking group for LGBT and HIV positive smokers. The California Lavender Smokefree Project (CLSP), funded by the state in the mid-90’s, counteracted tobacco industry targeting of LGBT communities. In 1996, the Coalition of Lavender Americans on Smoking and Health (CLASH), with the help of Progressive Research and Training for Action (PRTA), (a community-based organization specializing in LGBT technical assistance), held Alive with Pleasure! the first federally funded conference on tobacco use among California’s LGBT population. In 1998, at the urging of CLASH members, the Center for AIDS Prevention Studies (CAPS) launched its first tobacco study with gay/bisexual men.

[S]ubstance use plays a major role in the transmission of HIV disease-indeed, a much larger role than has been generally recognized. Clearly, our nation's drug control policies must recognize this inextricable linkage between drugs and HIV disease and be designed to address the two aggressively and simultaneously. -National Commission on AIDS, The Twin Epidemics of Substance Use and HIV, 1991[1] Because neither a vaccine nor a cure for HIV infection appears likely in the near future, planning is needed for the long term to limit the spread of HIV among drug injectors, their sexual partners, and their potential offspring. -National Research Council, AIDS: The Second Decade, 1990[2]

Good Questions Better Answers: A Formative Research Handbook for California HIV Prevention Programs is for community agencies and service providers. The handbook shows how agencies and departments of health can formalize the research process and use it to guide and improve their services. It uses examples from programs throughout California to demonstrate how community agencies conduct formative research all the time, sometimes without realizing that what they are doing is “research.” Funded by the California State Office on AIDS and Northern California Grantmakers.Manual in PDF A Buenas Preguntas… ¡Mejores Respuestas! (manual in Spanish)

As the social ecological framework shows there are several levels -- including intrapersonal, interpersonal, organizational, community, and policy— and that determinants within these levels interact with one another to influence behavior and health outcomes. Studies have shown multilevel interventions which address determinants at a number of levels and mutually reinforce one another produce longer and more sustained effects than interventions that target only one level. Join us March 19th as we explore multilevel interventions, how to design them, and how to implement them in communities.