title: Community as a source of health in three racial/ethnic communities in Oregon: a qualitative study.
abstract: BACKGROUND
  A 2011 report by the Oregon Health Authority and the Department of Human Services documented disparities in its Latino and American Indian populations on multiple individual-level health indicators. However, research is lacking on the social contexts in which Latinos and American Indians in Oregon live and how these environments influence the health of communities as a whole. To help fill this gap, this study sought to contextualize the social environments that influence the health of Latinos and American Indian residents in three Oregon communities.
  
  
  METHODS
  Guided by an ecological framework, we conducted one-time semi-structured qualitative interviews with 26 study participants to identify the prominent health-related issues in the communities and to examine the factors that study participants perceived as enabling or inhibiting healthy lifestyles of community residents. We used a grounded theory approach to perform content and thematic analyses of the data.
  
  
  RESULTS
  Study participants identified preventable chronic conditions, such as diabetes, obesity, and hypertension, as the most pressing health concerns in their communities. Results showed that traditional and cultural activities and strong family and community cohesion were viewed as facilitators of good community health. Poverty, safety concerns, insufficient community resources, and discrimination were perceived as barriers to community health. Three themes emerged from the thematic analyses: social connectedness is integral to health; trauma has an ongoing negative impact on health; and invisibility of residents in the community underlies poor health.
  
  
  CONCLUSIONS
  This study's findings provide insight to the social contexts which operate in the lives of some Latinos and American Indians in Oregon. While participants identified community-level factors as important to health, they focused more on the social connections of individuals to each other and the relationships that residents have with their communities at-large. Our findings may also help to explain how the intra- and inter-personal levels, the community/institutional level, and the macro level/public policy contexts can serve to influence health in these communities. For example, trauma and invisibility are not routinely examined in community health assessment and improvement planning activities; nonetheless, these factors appear to be at play affecting the health of residents.
authors.affiliation: College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, 97331, USA. Carolyn.mendez-luck@oregonstate.edu.
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Mendez-Luck
authors.affiliation: College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, 97331, USA. jeff.bethel@oregonstate.edu.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Bethel
authors.affiliation: Department of Social Work, Western Carolina University, Cullowhee, NC, 28723, USA. rtgoins@email.wcu.edu.
authors.forename: R Turner
authors.initials: RT
authors.lastname: Goins
authors.affiliation: Veterans Affairs-Health Services Research & Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, 98108, USA. schuremarc@gmail.com.
authors.forename: Marc B
authors.initials: MB
authors.lastname: Schure
authors.affiliation: College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, 97331, USA. gordane@onid.oregonstate.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McDermott
mesh_terms: D000328:Adult; D002908:Chronic Disease / Q000208:ethnology*; D005260:Female; D006304:Health Status; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009922:Oregon; D011203:Poverty; D011287:Prejudice; D036301:Qualitative Research; D012111:Residence Characteristics; D012449:Safety; D012931:Social Environment; D012944:Social Support; D012959:Socioeconomic Factors