AIDS and Behavior

, Volume 14, Supplement 2, pp 222–238

A Dynamic Social Systems Model for Considering Structural Factors in HIV Prevention and Detection

  • Carl Latkin
  • Margaret R. Weeks
  • Laura Glasman
  • Carol Galletly
  • Dolores Albarracin
Original Paper


We present a model for HIV-related behaviors that emphasizes the dynamic and social nature of the structural factors that influence HIV prevention and detection. Key structural dimensions of the model include resources, science and technology, formal social control, informal social influences and control, social interconnectedness, and settings. These six dimensions can be conceptualized on macro, meso, and micro levels. Given the inherent complexity of structural factors and their interrelatedness, HIV prevention interventions may focus on different levels and dimensions. We employ a systems perspective to describe the interconnected and dynamic processes of change among social systems and their components. The topics of HIV testing and safer injection facilities (SIFs) are analyzed using this structural framework. Finally, we discuss methodological issues in the development and evaluation of structural interventions for HIV prevention and detection.


HIV AIDS Structural factors Diagnosis Prevention Social networks Systems theory 


  1. 1.
    Brown A, Moodie C, Hastings G. A longitudinal study of policy effect (smoke-free legislation) on smoking norms: ITC Scotland/United Kingdom. Nicotine Tob Res. 2009;11(8):924–32.PubMedGoogle Scholar
  2. 2.
    Glass TA, McAtee MJ. Behavioral science at the crossroads in public health: extending horizons, envisioning the future. Soc Sci Med. 2006;62(7):1650–71.PubMedGoogle Scholar
  3. 3.
    McMichael AJ. Prisoners of the proximate: loosening the constraints on epidemiology in an age of change. Am J Epidemiol. 1999;149(10):887–97.PubMedGoogle Scholar
  4. 4.
    Udoh IA, Mantell JE, Sandfort T, Eighmy MA. Potential pathways to HIV/AIDS transmission in the Niger Delta of Nigeria: poverty, migration and commercial sex. AIDS Care. 2009;21(5):567–74.PubMedGoogle Scholar
  5. 5.
    Mahajan AP, Sayles JN, Patel VA, Remien RH, Sawires SR, Ortiz DJ, et al. Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward. AIDS. 2008;22(Suppl 2):S67–79.PubMedGoogle Scholar
  6. 6.
    Hunter M. The changing political economy of sex in South Africa: the significance of unemployment and inequalities to the scale of the AIDS pandemic. Soc Sci Med. 2007;64(3):689–700.PubMedGoogle Scholar
  7. 7.
    Munoz-Laboy M, Hirsch JS, Quispe-Lazaro A. Loneliness as a sexual risk factor for male Mexican migrant workers. Am J Public Health. 2009;99(5):802–10.PubMedGoogle Scholar
  8. 8.
    Blankenship KM, Friedman SR, Working S, Mantell JE. Structural interventions: concepts, challenges and opportunities for research. J Urban Health. 2006;83(1):59–72.PubMedGoogle Scholar
  9. 9.
    Sweat MD, Denison JA. Reducing HIV incidence in developing countries with structural and environmental interventions. AIDS. 1995;9(Suppl A):S251–7.PubMedGoogle Scholar
  10. 10.
    Sumartojo E. Structural factors in HIV prevention: concepts, examples, and implications for research. AIDS. 2000;14(Suppl 1):S3–10.PubMedGoogle Scholar
  11. 11.
    Tawil O, Verster A, O’Reilly KR. Enabling approaches for HIV/AIDS prevention: can we modify the environment and minimize the risk? AIDS. 1995;9(12):1299–306.PubMedGoogle Scholar
  12. 12.
    Parker RG, Easton D, Klein CH. Structural barriers and facilitators in HIV prevention: a review of international research. AIDS. 2000;14(Suppl 1):S22–32.PubMedGoogle Scholar
  13. 13.
    Blankenship KM, Bray SJ, Merson MH. Structural interventions in public health. AIDS. 2000;14(Suppl 1):S11–21.PubMedGoogle Scholar
  14. 14.
    Neaigus A, Zhao M, Gyarmathy VA, Cisek L, Friedman SR, Baxter RC. Greater drug injecting risk for HIV, HBV, and HCV infection in a city where syringe exchange and pharmacy syringe distribution are illegal. J Urban Health. 2008;85(3):309–22.PubMedGoogle Scholar
  15. 15.
    Connell RW. Gender and power: society, the person and sexual politics. Stanford, CA: Stanford University Press; 1987.Google Scholar
  16. 16.
    Cohen DA, Scribner RA, Farley TA. A structural model of health behavior: a pragmatic approach to explain and influence health behaviors at the population level. Prev Med. 2000;30(2):146–54.PubMedGoogle Scholar
  17. 17.
    Barnett T, Whiteside A. AIDS in the twenty-first century: disease and globalization. Basingstoke: Palgrave Macmillan; 2002.Google Scholar
  18. 18.
    Fuller CM, Latkin CA, Borrell LA, Galea S, Ompad DC, Strathdee SA. The effect of race, neighborhood, and social network on age of initiation of injection drug use. Am J Public Health. 2005;95(4):689–95.PubMedGoogle Scholar
  19. 19.
    Latkin CA, Williams CT, Wang J, Curry AD. Neighborhood social disorder as a determinant of drug injection behaviors: a structural equation modeling approach. Health Psychol. 2005;24(1):96–100.PubMedGoogle Scholar
  20. 20.
    Williams CT, Latkin CA. Neighborhood socioeconomic status, personal network attributes, and use of heroin and cocaine. Am J Prev Med. 2007;32(6):203–210.Google Scholar
  21. 21.
    Rose DN. The epidemiology of HIV infection and AIDS in east and central Harlem, NY. Mt Sinai J Med. 1992;59(6):493–7.PubMedGoogle Scholar
  22. 22.
    Gupta GR, Parkhurst JO, Ogden JA, Aggleton P, Mahal A. Structural approaches to HIV prevention. Lancet. 2008;372(9640):764–75.PubMedGoogle Scholar
  23. 23.
    Kim J, Pronyk P, Barnett T, Watts C. Exploring the role of economic empowerment in HIV prevention. AIDS. 2008;22(Suppl 4):S57–71.PubMedGoogle Scholar
  24. 24.
    UNAIDS. Report on the global AIDS epidemic. Geneva, Switzerland: UNAIDS; 2008.Google Scholar
  25. 25.
    USAID’s HIV/AIDS Program in Senegal, December 2004. Geneva, Switzerland.
  26. 26.
    Avert. History of HIV & AIDS in South Africa. Retrieved from; 2009.
  27. 27.
    Ashby WR. Principles of the self-organizing dynamic system. J Gen Psychol. 1947;37:125–8.PubMedGoogle Scholar
  28. 28.
    Ashby W. An introduction to cybernetics. London: Chapman & Hall; 1956.Google Scholar
  29. 29.
    von Bertalanffy, L. General system theory: foundations, development, applications. New York: George Braziller; 1968 (revised ed.; 1976).Google Scholar
  30. 30.
    Le Moigne J-L. Le constructivisme, t. 1: Les fondements. Paris: Éd. ESF; 1994.Google Scholar
  31. 31.
    Le Moigne J-L. Le constructivisme, t. 2: Des épistémologies. Paris: Éd. ESF; 1995.Google Scholar
  32. 32.
    Wiener N. Cybernetics: or the control and communication in the animal and the machine. Cambridge: MIT Press; 1961.Google Scholar
  33. 33.
    Weik K. Management of organizational change among loosely coupled elements. In: Goodman P, editor. Change in organizations. San Francisco: Jossey-Bass; 1982. p. 375–408.Google Scholar
  34. 34.
    Goldstein J. Emergence as a construct: history and issues. Emergence: Complexity and Organization. 1999;1(1):49–72.Google Scholar
  35. 35.
    Bronfenbrenner U. Contexts of child rearing: problems and prospects. Am Psychol. 1979;34(10):844–50.Google Scholar
  36. 36.
    McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q. 1988;15(4):351–77.PubMedGoogle Scholar
  37. 37.
    Agha S, Van Rossem R. Impact of a school-based peer sexual health intervention on normative beliefs, risk perceptions, and sexual behavior of Zambian adolescents. J Adolesc Health. 2004;34(5):441–52.PubMedGoogle Scholar
  38. 38.
    Cohen DA, Farley TA, Bedimo-Etame JR, Scribner R, Ward W, Kendall C, et al. Implementation of condom social marketing in Louisiana, 1993 to 1996. Am J Public Health. 1999;89(2):204–8.PubMedGoogle Scholar
  39. 39.
    Mantell JE, Scheepers E, Karim QA. Introducing the female condom through the public health sector: experiences from South Africa. AIDS Care. 2000;12(5):589–601.PubMedGoogle Scholar
  40. 40.
    Warren M, Philpott A. Expanding safer sex options: introducing the female condom into national programmes. Reprod Health Matters. 2003;11(21):130–9.PubMedGoogle Scholar
  41. 41.
    Broadhead RS, Heckathorn DD, Weakliem DL, Anthony DL, Madray H, Mills RJ. et al. Harnessing peer networks as an instrument for AIDS prevention: results from a peer-driven intervention. Public Health Rep. 1998;113(Suppl 1):42–57.PubMedGoogle Scholar
  42. 42.
    Kelly JA, St. Lawrence JS, Stevenson LY, Hauth AC, Kalichman SC, Diaz YE, et al. Community AIDS/HIV risk reduction: the effects of endorsements by popular people in three cities. Am J Public Health. 1992;82(11):1483–9.PubMedGoogle Scholar
  43. 43.
    Latkin CA, Sherman S, Knowlton AR. HIV prevention among drug users: outcome of a network-oriented peer outreach intervention. Health Psychol. 2003;22(4):332–9.PubMedGoogle Scholar
  44. 44.
    Weeks MR, Convey M, Dickson-Gomez J, Li J, Radda K, Martinez M, et al. Changing drug users’ risk environments: peer health advocates as multi-level community change agents. Am J Community Psychol. 2009;43(3–4):330–44.PubMedGoogle Scholar
  45. 45.
    Jana S, Basu I, Rotheram-Borus MJ, Newman PA. The Sonagachi Project: a sustainable community intervention program. AIDS Educ Prev. 2004;16(5):405–14.PubMedGoogle Scholar
  46. 46.
    Kegeles SM, Hays RB, Pollack LM, Coates TJ. Mobilizing young gay and bisexual men for HIV prevention: a two-community study. AIDS. 1999;13(13):1753–62.PubMedGoogle Scholar
  47. 47.
    Ramirez-Valles J. The protective effects of community involvement for HIV risk behavior: a conceptual framework. Health Educ Res. 2002;17(4):389–403.PubMedGoogle Scholar
  48. 48.
    Dickson-Gomez J, Convey M, Hilario H, Corbett AM, Weeks M. Unofficial policy: access to housing, housing information and social services among homeless drug users in Hartford, Connecticut. Subst Abuse Treat Prev Policy. 2007;2:8.PubMedGoogle Scholar
  49. 49.
    Simmel G. The web of group affiliations. In: Kurt W, editor. Conflict and the web of group affiliations. Glencoe, IL: Free Press; 1955. p. 125–95.Google Scholar
  50. 50.
    Bandura A. Social learning theory. Englewood Cliffs, NJ: Prentice Hall; 1977.Google Scholar
  51. 51.
    Rogers EM. Diffusion of innovations. 5th ed. New York: Free Press; 2003.Google Scholar
  52. 52.
    Lewis M, DeVellis B, Sleath B. Social influence and interpersonal communication in health behavior. In: Glanz K, Rimer BK, Lewis FM, editors. Health behavior and health education: theory, research, and practice. San Francisco: Jossey-Bass; 2002. p. 240–64.Google Scholar
  53. 53.
    Terry D, Hogg M. Attitudes, behavior, and social context: the role of norms and group membership. Mahwah, NJ: Lawrence Erlbaum Associates Publishers; 2000.Google Scholar
  54. 54.
    Turner JC. Social comparison and social identity: some perspectives for intergroup behavior. Eur J Soc Psychol. 1978;5:5–34.Google Scholar
  55. 55.
    Giddens A. Central problems in social theory: action, structure, and contradiction in social analysis. Berkeley, CA.: University of California Press; 1979.Google Scholar
  56. 56.
    Yang CH, Yang SY, Shen MH, Kuo HS. The changing epidemiology of prevalent diagnosed HIV infections in Taiwan, 1984–2005. Int J Drug Policy. 2008;19(4):317–23.PubMedGoogle Scholar
  57. 57.
    Kroll T, Jones GC, Kehn M, Neri MT. Barriers and strategies affecting the utilisation of primary preventive services for people with physical disabilities: a qualitative inquiry. Health Soc Care Community. 2006;14(4):284–93.PubMedGoogle Scholar
  58. 58.
    Wang LY, Davis M, Robin L, Collins J, Coyle K, Baumler E. Economic evaluation of safer choices: a school-based human immunodeficiency virus, other sexually transmitted diseases, and pregnancy prevention program. Arch Pediatr Adolesc Med. 2000;154(10):1017–24.PubMedGoogle Scholar
  59. 59.
    Kirby D, Obasi A, Laris BA. The effectiveness of sex education and HIV education interventions in schools in developing countries. World Health Organ Tech Rep Ser. 2006;938:103–50.PubMedGoogle Scholar
  60. 60.
    Siegel DM, Aten MJ, Enaharo M. Long-term effects of a middle school- and high school-based human immunodeficiency virus sexual risk prevention intervention. Arch Pediatr Adolesc Med. 2001;155(10):1117–26.PubMedGoogle Scholar
  61. 61.
    Lin N, Ye X, Ensel WM. Social support and depressed mood: a structural analysis. J Health Soc Behav. 1999;40(4):344–59.PubMedGoogle Scholar
  62. 62.
    Pollini RA, Brouwer KC, Lozada RM, Ramos R, Cruz MF, Magis-Rodriguez C, et al. Syringe possession arrests are associated with receptive syringe sharing in two Mexico-US border cities. Addiction. 2008;103(1):101–8.PubMedGoogle Scholar
  63. 63.
    King R, Katuntu D, Lifshay J, Packel L, Batamwita R, Nakayiwa S, et al. Processes and outcomes of HIV serostatus disclosure to sexual partners among people living with HIV in Uganda. AIDS Behav. 2008;12(2):232–43.PubMedGoogle Scholar
  64. 64.
    Powell JE, Taylor D. Anger, depression, and anxiety following heroin withdrawal. Int J Addict. 1992;27(1):25–35.PubMedGoogle Scholar
  65. 65.
    Ksobiech K. Assessing and improving needle exchange programs: gaps and problems in the literature. Harm Reduct J. 2004;1(1):4.PubMedGoogle Scholar
  66. 66.
    Hedrich D. European report on drug consumption rooms. Lisbon: European Monitoring Centre for Drugs and Drug Addiction; 2004.Google Scholar
  67. 67.
    Kimber J, Dolan K. Shooting gallery operation in the context of establishing a medically supervised injecting center: Sydney, Australia. J Urban Health. 2007;84(2):255–66.PubMedGoogle Scholar
  68. 68.
    Kerr T, Small W, Moore D, Wood E. A micro-environmental intervention to reduce the harms associated with drug-related overdose: evidence from the evaluation of Vancouver’s safer injection facility. Int J Drug Policy. 2007;18(1):37–45.PubMedGoogle Scholar
  69. 69.
    Wood E, Tyndall MW, Montaner JS, Kerr T. Summary of findings from the evaluation of a pilot medically supervised safer injecting facility. CMAJ. 2006;175(11):1399–404.PubMedGoogle Scholar
  70. 70.
    Kerr T, Stoltz JA, Tyndall M, Li K, Zhang R, Montaner J, et al. Impact of a medically supervised safer injection facility on community drug use patterns: a before and after study. BMJ. 2006;332(7535):220–2.PubMedGoogle Scholar
  71. 71.
    Wood E, Tyndall MW, Qui Z, Zhang R, Montaner JS, Kerr T. Service uptake and characteristics of injection drug users utilizing North America’s first medically supervised safer injecting facility. Am J Public Health. 2006;96(5):770–3.PubMedGoogle Scholar
  72. 72.
    Kerr T, Tyndall M, Li K, Montaner J, Wood E. Safer injection facility use and syringe sharing in injection drug users. Lancet. 2005;366(9482):316–8.PubMedGoogle Scholar
  73. 73.
    Wood E, Kerr T, Small W, Li K, Marsh DC, Montaner JS, et al. Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users. CMAJ. 2004;171(7):731–4.PubMedGoogle Scholar
  74. 74.
    DeBeck K, Wood E, Zhang R, Tyndall M, Montaner J, Kerr T. Police and public health partnerships: evidence from the evaluation of Vancouver’s supervised injection facility. Subst Abuse Treat Prev Policy. 2008;3:11.PubMedGoogle Scholar
  75. 75.
    Campsmith M, Rhodes P, Hall H, Green T. HIV Prevalence estimates—United States, 2006. Morb Mortal Wkly Rep. 2008;57:1073–6.Google Scholar
  76. 76.
    Weinhardt LS. Changing HIV and AIDS-related behavior: promising approaches at the individual, group, and community levels. Behav Modif. 2005;29(2):219–26.PubMedGoogle Scholar
  77. 77.
    Castilla J, Del Romero J, Hernando V, Marincovich B, Garcia S, Rodriguez C. Effectiveness of highly active antiretroviral therapy in reducing heterosexual transmission of HIV. J Acquir Immune Defic Syndr. 2005;40(1):96–101.PubMedGoogle Scholar
  78. 78.
    Granich RM, Gilks CF, Dye C, De Cock KM, Williams BG. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet. 2009;373(9657):48–57.PubMedGoogle Scholar
  79. 79.
    Burke RC, Sepkowitz KA, Bernstein KT, Karpati AM, Myers JE, Tsoi BW, et al. Why don’t physicians test for HIV? A review of the US literature. AIDS. 2007;21(12):1617–24.PubMedGoogle Scholar
  80. 80.
    Greenwald JL, Hall J, Skolnik PR. Approaching the CDC’s guidelines on the HIV testing of inpatients: physician-referral versus nonreferral-based testing. AIDS Patient Care STDS. 2006;20(5):311–7.PubMedGoogle Scholar
  81. 81.
    Prost A, Chopin M, McOwan A, Elam G, Dodds J, Macdonald N, et al. “There is such a thing as asking for trouble”: taking rapid HIV testing to gay venues is fraught with challenges. Sex Transm Infect. 2007;83(3):185–8.PubMedGoogle Scholar
  82. 82.
    White DA, Scribner AN, Schulden JD, Branson BM, Heffelfinger JD. Results of a rapid HIV screening and diagnostic testing program in an urban emergency department. Ann Emerg Med. 2009;54(1):56–64.PubMedGoogle Scholar
  83. 83.
    Leibowitz AA, Taylor SL. Distance to public test sites and HIV testing. Med Care Res Rev. 2007;64(5):568–84.PubMedGoogle Scholar
  84. 84.
    Newhouse J. Rand Corporation Insurance Experiment Group. Free for all?: lessons from the RAND health insurance experiment. Cambridge, MA: Harvard University Press; 1993.Google Scholar
  85. 85.
    Rosenstock IM. The health belief model and HIV risk behavior change. In: DiClemente R, Peterson J, editors. Preventing AIDS: theories and methods of behavioral interventions. AIDS prevention and mental health. New York, NY: Plenum Press; 1994. p. 5–24.Google Scholar
  86. 86.
    Taylor SL, Leibowitz A, Simon PA, Grusky O. ZIP code correlates of HIV-testing: a multi-level analysis in Los Angeles. AIDS Behav. 2006;10(5):579–86.PubMedGoogle Scholar
  87. 87.
    Maman S, Abler L, Parker L, Lane T, Chirowodza A, Ntogwisangu J, et al. A comparison of HIV stigma and discrimination in five international sites: the influence of care and treatment resources in high prevalence settings. Soc Sci Med. 2009;68(12):2271–8.PubMedGoogle Scholar
  88. 88.
    Petroll AE, DiFranceisco W, McAuliffe TL, Seal DW, Kelly JA, Pinkerton SD. HIV testing rates, testing locations, and healthcare utilization among urban African-American men. J Urban Health. 2009;86(1):119–31.PubMedGoogle Scholar
  89. 89.
    Latkin CA, Kuramoto SJ, Davey-Rothwell MA, Tobin KE. Social norms, social networks, and HIV risk behavior among injection drug users. AIDS Behav. 2009. doi:10.1007/s10461-009-9576-4.
  90. 90.
    Heffelfinger JD, Sullivan PS, Branson BM, Mastro TD, Purcell DW, Griffiths SD, et al. Advancing HIV prevention demonstration projects: new strategies for a changing epidemic. Public Health Rep. 2008;123(Suppl 3):5–15.PubMedGoogle Scholar
  91. 91.
    Kimbrough LW, Fisher HE, Jones KT, Johnson W, Thadiparthi S, Dooley S. Accessing social networks with high rates of undiagnosed HIV infection: the social networks demonstration project. Am J Public Health. 2009;99(6):1093–9.PubMedGoogle Scholar
  92. 92.
    Vargo S, Agronick G, O’Donnell L, Stueve A. Using peer recruitment and OraSure to increase HIV testing. Am J Public Health. 2004;94(1):29–31.PubMedGoogle Scholar
  93. 93.
    Kerr T, Kimber J, Rhodes T. Drug use settings: an emerging focus for research and intervention. Int J Drug Policy. 2007;18(1):1–4.PubMedGoogle Scholar
  94. 94.
    Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006;55(RR-14):1–17.PubMedGoogle Scholar
  95. 95.
    Fincher-Mergi M, Cartone KJ, Mischler J, Pasieka P, Lerner EB, Billittier AJ. Assessment of emergency department health care professionals’ behaviors regarding HIV testing and referral for patients with STDs. AIDS Patient Care STDS. 2002;16(11):549–53.PubMedGoogle Scholar
  96. 96.
    Galletly CL, Pinkerton SD. Preventing HIV transmission via HIV exposure laws: applying logic and mathematical modeling to compare statutory approaches to penalizing undisclosed exposure to HIV. J Law Med Ethics. 2008;36(3):577–84.PubMedGoogle Scholar
  97. 97.
    Banerjee AV, Duflo E. Mandated empowerment: handing antipoverty policy back to the poor? Ann N Y Acad Sci. 2008;1136:333–41.PubMedGoogle Scholar
  98. 98.
    Karnani A. Microfinance misses its mark. Stanford: Stanford Social Innovation Review Stanford Graduate School of Business; 2007.Google Scholar
  99. 99.
    Friedman SR, Lieb S, Tempalski B, Cooper H, Keem M, Friedman R, et al. HIV among injection drug users in large US metropolitan areas, 1998. J Urban Health. 2005;82(3):434–45.PubMedGoogle Scholar
  100. 100.
    Bonell C, Hargreaves J, Strange V, Pronyk P, Porter J. Should structural interventions be evaluated using RCTs? The case of HIV prevention. Soc Sci Med. 2006;63(5):1135–42.PubMedGoogle Scholar
  101. 101.
    Susser M. The tribulations of trials—intervention in communities. Am J Public Health. 1995;85(2):156–8.PubMedGoogle Scholar
  102. 102.
    Manhart LE, Holmes KK. Randomized controlled trials of individual-level, population-level, and multilevel interventions for preventing sexually transmitted infections: what has worked? J Infect Dis. 2005;191(Suppl 1):S7–24.PubMedGoogle Scholar
  103. 103.
    Sanson-Fisher RW, Bonevski B, Green LW, D’Este C. Limitations of the randomized controlled trial in evaluating population-based health interventions. Am J Prev Med. 2007;33(2):155–61.PubMedGoogle Scholar
  104. 104.
    Diclemente RJ, Salazar LF, Crosby RA. A review of STD/HIV preventive interventions for adolescents: sustaining effects using an ecological approach. J Pediatr Psychol. 2007;32(8):888–906.PubMedGoogle Scholar
  105. 105.
    Sorensen G, Emmons K, Hunt MK, Johnston D. Implications of the results of community intervention trials. Annu Rev Public Health. 1998;19:379–416.PubMedGoogle Scholar
  106. 106.
    Fortmann SP, Flora JA, Winkleby MA, Schooler C, Taylor CB, Farquhar JW. Community intervention trials: reflections on the Stanford Five-City Project Experience. Am J Epidemiol. 1995;142(6):576–86.PubMedGoogle Scholar
  107. 107.
    Victora CG, Habicht JP, Bryce J. Evidence-based public health: moving beyond randomized trials. Am J Public Health. 2004;94(3):400–5.PubMedGoogle Scholar
  108. 108.
    West SG, Duan N, Pequegnat W, Gaist P, Des J, Holtgrave D, et al. Alternatives to the randomized controlled trial. Am J Public Health. 2008;98(8):1359–66.PubMedGoogle Scholar
  109. 109.
    Hawkins NG, Sanson-Fisher RW, Shakeshaft A, D’Este C, Green LW. The multiple baseline design for evaluating population-based research. Am J Prev Med. 2007;33(2):162–8.PubMedGoogle Scholar
  110. 110.
    Rapkin BD, Trickett EJ. Comprehensive dynamic trial designs for behavioral prevention research with communities: overcoming inadequacies of the randomized controlled trial paradigm. In: Trickett EJ, Pequegnat W, editors. Community interventions and AIDS. New York, NY: Oxford University Press; 2005.Google Scholar
  111. 111.
    Bernard HR. Social research methods: qualitative and quantitative approaches. Thousand Oaks, CA: Sage Publications; 2000.Google Scholar
  112. 112.
    LeCompte MD, Schensul JJ. Analyzing & interpreting ethnographic data: ethnographer’s toolkit, vol. 5. Walnut Creek, CA: AltaMira Press; 1999.Google Scholar
  113. 113.
    Miles MB, Huberman AM. Qualitative data analysis: an expanded sourcebook. 2nd ed. Thousands Oaks, CA: Sage Publications; 1994.Google Scholar
  114. 114.
    Ragin CC. The comparative method: moving beyond qualitative and quantitative strategies. Berkeley, CA: University of California Press; 1987.Google Scholar
  115. 115.
    Green LW. From research to “best practices” in other settings and populations. Am J Health Behav. 2001;25(3):165–77.PubMedGoogle Scholar
  116. 116.
    Flay BR. Efficacy and effectiveness trials (and other phases of research) in the development of health promotion programs. Prev Med. 1986;15:451–4.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Carl Latkin
    • 1
  • Margaret R. Weeks
    • 2
  • Laura Glasman
    • 3
  • Carol Galletly
    • 3
  • Dolores Albarracin
    • 4
  1. 1.Department of Health, Behavior and SocietyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.Institute for Community ResearchHartfordUSA
  3. 3.Center for AIDS Intervention ResearchMedical College of WisconsinMilwaukeeUSA
  4. 4.Department of PsychologyUniversity of Illinois at Urbana-ChampaignChampaignUSA

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