Adolescence is a time of considerable emotional and psychological growth. In order to provide an optimally healthy environment for youth development, it is essential to understand the contexts within which youth, and girls in particular, mature.

The specific health challenges facing Oklahoma’s adolescent girls are daunting. Oklahoma ranks fifth in the nation in births to teens (CDC, 2009), first in the incarceration of women (Sharp, 2008), and almost last in the percentage of women in the state legislature (Center for American Women and Politics, 2010). Furthermore, Oklahoma is expected to have the highest obesity rate in the nation by 2018 (United Health Foundation’s America’s Health Rankings, 2009).

In order to elucidate the ways in which adolescent girls’ health can be encouraged in the face of these disturbing statistics, this investigation explored low-income adolescent girls’ perceptions of their own physical, social, and emotional health as well as the health promoting and inhibiting elements of their communities. Findings will be used to inform programing at the Center for Children and Families, Inc. (CCFI) as well as for the development of a pilot intervention aimed at encouraging positive health behaviors in low-income teenage girls living in Oklahoma.

The Center for Children and Families, Inc. has been operating child abuse prevention and treatment services in Cleveland County, Oklahoma since 1969. A community-based agency, CCFI, enjoys tremendous community support and currently operates eight programs in partnership with over twenty community partners.

Representative Programs:• Teenage Parenting Program: Provides school-based peer-support groups, home visits, parent support, and education classes that focus on teaching parenting skills to pregnant/parenting teens in Norman, Moore, and surrounding cities

• Neighborhood Centers: Working in collaboration with the City of Norman, the Norman Public Schools, and other organizations to provide youth development and family support programs in two of the highest poverty neighborhoods in Norman

• Girl Power: In 2009, a youth-led group of girls emerged out of the NC program, requesting more time with NC staff in order to focus on the needs of girls – the group includes 4th to 9th grade girls from all NC sites, the meetings and activities are designed to bolster the girls’ self-esteem, the group helps girls build healthy relationships, and it addresses the social, emotional, and physical health needs as well as the interests of girls

The research team employed a qualitative methodology known as Photovoice. Photovoice has its roots in public health research and is a powerful community-based participatory method that may effectively capture the perspectives of groups traditionally underrepresented by research (Wang, Burris, & Xiang, 1996; Wang & Burris, 1994; 1997). This method allows individuals to use photography as a means to visually document the realities of their lives, promotes critical dialogue about community issues (sparked by the photographs), and, through the use of photographic exhibitions, is eventually intended to reach policy makers and the larger community (Wang, 1999). In addition to the development of critical consciousness and awareness of issues facing a particular community, participating in a Photovoice project can be especially empowering for participants (Foster-Fishman, et al, 2005).

Sample• Fourteen 7th-8th grade girls were recruited from the Girl Power group• Eleven girls participated consistently, six were Caucasian, three were African American, and two were Hispanic – this is representative of the neighborhoods served by CCFI

• Participants were recruited based on their school enrollment, grade-level, and willingness to participate

Research Questions• How do adolescent girls perceive their own personal physical, emotional, and social health status?

• What are the health promoting elements of girls’ communities (i.e. school, neighborhood, city)?• What are the health inhibiting elements of girls’ communities?

Building Community Partnerships1) Be flexible and prepared to frequently re-negotiate every aspect of the study

2) Be aware that the community partner may not understand the realities of conducting research

3) Build rapport with ALL members at ALL levels of the partner agency - take the time necessary to socialize without discussing the project

4) Be prepared to encounter relationship challenges, but do not be discouraged – view these as developmental opportunities

5) Value the expertise and experience of EVERYONE on the research team (i.e. students, community partners, and researchers) - this leads to effective power sharing and relationship development

6) Be reflexive and self-aware in order to minimize conflict and challenges

Working with Adolescents7) Early adolescents are not equipped for abstract thinking and need more specific and literal tasks and questions

8) Middle school girls represent a WIDE array of maturity levels - this can make focus group facilitation a challenge

9) Spend time training adolescents on the Photovoice method - have a structured curriculum

10) Spend time getting to know the participants before recruiting and training them for the study as well as during the initial stages of training and data collection

Ethical Issues11) Be thoughtful regarding IRB applications and anticipate unique questions and concerns

12) Be aware that community partners may have different ethical concerns than university groups and personnel

13) Be prepared to report child abuse and neglect

Benefits of Research14) Possible intervention development15) Micro benefits for girls (e.g., empowerment, skills, etc.)16) Mezzo benefit for CCFI (e.g., program development)17) Macro benefit for community (e.g., social policy and change) and greater academic understanding of the issues

• A Photovoice investigation with a different population• Possible programming and intervention development

“Images of Health” The Girl Power Photovoice Project

Christina R. Miller, LCSW, Ph.D.Anne and Henry Zarrow School of Social Work, University of Oklahoma

Zermarie Deacon, Ph.D.Department of Human Relations, University of Oklahoma

Katie Fitzgerald, MSWCenter for Children and Families, Inc.

Annie Smith, BA & Melissa Broaddus, BSWAnne and Henry Zarrow School of Social Work, University of Oklahoma

Introduction

Community Partner

Methods Lessons Learned

Next Steps

For more information contact:Christina R. MillerUniversity of OklahomaSchool of Social Work(405) 325-5718crmiller@ou.edu

Zermarie DeaconUniversity of OklahomaDepartment of Human Relations(405)325-2749zermarie@ou.edu

Participants documented strengths as well as areas for improvement in their communities•The girls’ photographs reveal positive recreational spaces, sources of social support, evidence of good health habits, and home gardens•The participants’ photographs also documented the presence of negative temptations, poor nutritional choices made by many teenagers, negative peer pressure, littering, and the negative lifestyle habits practiced by some community members

Preliminary Results