The photo was very straightforward, a simple shot of an elderly African-American woman riding a Connecticut city bus. But to the young photographer, the elderly stranger was symbolic of one of the most important things in his life—a grandmother, a figure deserving of respect, a source of security and the protective embrace of family. That photo, and many others included in the exhibit: Understanding Youth Violence in New Haven: A Photovoice Project, was also a revealing piece of research for scholars attempting to solve one of the toughest public health dilemmas of our time: gun violence among urban teens.
Photovoice—a joint project of the Robert Wood Johnson Clinical Scholars at Yale and the New Haven Family Alliance—was created to help the Alliance evaluate its anti-street violence outreach program. The Violence Interrupters Project is one of many programs around the country that aim to prevent violent acts by sending respected adults into communities to defuse violent situations. The project was successful to some degree, “but we wanted to learn more about what was actually causing the violence,” said Barbara Tinney, executive director of the Alliance. “There was a lot of work out there on gun violence, but very little reflecting the feelings and thoughts of young people.”
“Our goal was to shed new light on the problem of youth violence,” said Luke Hansen, M.D., (Scholar 2009). “We asked what had we been missing by using a [statistical] risk-factor model. What else was really going on for these kids?” The research team, which included Scholars Chisara Asomugha, M.D., MSPH; Jill Barron, M.D. and Mitesh Rao, M.D., designed the project to engage a population seldom heard in the world of public health research—at-risk youth. “They were not subjects in this project,” Hansen said, “they were participants; they were involved in every step of the process.”
A Fresh Perspective
The Photovoice team selected 20 African-American and Latino New Haven teens, ages 14 to 19. The 10 girls and 10 boys were first taught how to compose photographs and given digital cameras. The second component of the project was a series of 13 focus groups in which the teens talked about how violence affected their lives.
“We thought the focus groups would just be about the photos,” Hansen said, “but that was just a starting point. We learned so much more just hearing them talk.” When asked to identify the roots of violence in their lives, for instance, the teens suggested seven issues: People; the system; family; drugs, guns and money; peer pressure; survival; pride and disrespect. “In addition, it became clear that like all adolescents, these kids needed to have a sense of self-efficacy, a sense of belonging, security and structure,” Hansen explained. “But because healthy opportunities to obtain these things were not often available to them, they were tempted by unhealthy choices, such as gangs, that might provide security or belonging.”
“We realized that the decision that youth violence should be stopped when it’s about to happen was being made at the expense of the reality that the decisions that lead to acts of violence actually start years before a violent incident,” Hansen said. “We were able to suggest community interventions that were based on offering surrogate family structures, alternatives to physical danger and healthier opportunities. Young men and women also expressed different relationships to violence, so we recommended female outreach workers be trained to work with the women.”
A Model for More Effective Research
The other great lesson of the Photovoice project was the power of participatory, community-based research. “We’ve had a long relationship with Yale,” Tinney said, “but in the past, community members felt that they were research ‘subjects’ who did not benefit from the work. This time, the researchers were determined to produce data that would help the city and that’s what we have,” she said. “The youngsters that we talked to say they are better informed about the causes of gun violence and will think differently about the decisions they make—two have even gone on to work on other art projects at the gallery.”
“For us, learning from these young people’s words was so compelling,” Hansen said. “It speaks volumes and it must stand with quantitative data to be used to create positive change in communities that effectively addresses the social determinants of health.”