Structural Interventions: Concepts, Challenges and Opportunities for Research

Abstract

Structural interventions refer to public health interventions that promote health by altering the structural context within which health is produced and reproduced. They draw on concepts from multiple disciplines, including public health, psychiatry, and psychology, in which attention to interventions is common, and sociology and political economy, where structure is a familiar, if contested, concept. This has meant that even as discussions of structural interventions bring together researchers from various fields, they can get stalled in debates over definitions. In this paper, we seek to move these discussions forward by highlighting a number of critical issues raised by structural interventions, and the subsequent implications of these for research.

Neighborhood Disadvantage and Changes in Condom Use among African American Adolescents

“…While additional qualitative and quantitative research is warranted to examine these plausible explanations, our finding underscores the value of exploring the role of neighborhood disadvantages within specific locales as they may elucidate patterns differing from aggregated national data, and inform the development of community-specific interventions. 14,56 We found no evidence to suggest that neighborhood disadvantage had a timevarying direct (i.e., neighborhood factors are associated to the linear and non-linear estimates of inconsistent condom use) or indirect (i.e., neighborhood factors are associated to condom use correlates; such as sexual intercourse frequency and number of partners) association with the change in inconsistent condom use over time. In other words, contrary to our initial hypotheses, neighborhood disadvantage was not associated with changes in inconsistent condom use across the high school years, after accounting for baseline differences.…”

“…10,11 Increasingly, researchers have begun to assess how these structural factors are associated with HIV/AIDS risk behaviors in order to create multilevel HIV/STI prevention programs that go beyond traditional, individual-level behavior change efforts. [12][13][14][15][16] Given our interest in understanding how neighborhood disadvantage may influence youth HIV/AIDS risk, we focused on youth condom use across adolescence as it is the only reproductive health technology that serves as a barrier method against HIV/STI infection during youth's exploration of their sexuality. Specifically, we examined how neighborhood disadvantage was associated with condom use in a sample of African American youth followed over the high school years.…”

Physical violence among a prospective cohort of injection drug users: A gender-focused approach

“…Furthermore, since involvement in the drug trade and street economy appears to carry greater risks for women, gender-focused programming that addresses the economic and educational disadvantage of injection drug using women should be a priority. Given that improved economic status and decreased financial dependence on male partners have been associated with reduced HIV-related risks among women elsewhere (Blankenship et al, 2006), we suggest that income support and vocational programming would carry other benefits in terms of reducing women's exposure to violence. And finally, given the evidence indicating that escalated prohibition and police enforcement increases the level of violence between police and drug users and between individuals within the street-based drug market (Erickson, 2001;Kerr et al, 2005c), continued reliance on such measures to minimize drug-related violence is not recommended.…”

How Can Community Health Programmes Build Enabling Environments for Transformative Communication? Experiences from India and South Africa

“…These findings, along with the impressive achievements in empowering sex workers, have led to it serving as a model project for replication throughout India and beyond (Blankenship, Friedman, Dworkin, & Mantell, 2006;NACO, 2006).…”