Evans-Agnew Robin Andrew
1 University of Washington Tacoma, Tacoma, WA, USA.
Health Promot Pract. 2018 Mar;19(2):213-221. doi: 10.1177/1524839917691039. Epub 2017 Feb 1.
Policies in U.S. public schools that address asthma management for Black adolescents may not sufficiently transform sociocultural determinants of disparities. A critical analysis of public health policy maker and adolescent discourses on asthma management using an ecological framework could inform policy development. This study describes the discourses of asthma management disparities of school and other public health policymakers and Black adolescents with asthma during a statewide asthma planning activity.
I conducted a qualitative critical discourse analysis on transcripts and phototexts from a photovoice project with Black adolescents with asthma (n = 19), an asthma-planning meeting with school and public health policymakers (n = 12), and an observation of a photovoice dissemination event that included the same adolescents and policymakers.
Policymakers did not discuss sociocultural discourses concerning asthma management disparities such as racism and discrimination, but the adolescents did. The only shared discourses between adolescents and policymakers were on the management of indoor environments, health care quality, inadequate housing, and outdoor air pollution.
Including Black adolescents in policymaking activities concerning asthma management disparities furthers the identification of differing and shared discourses. School policies should include multilevel strategies that address structural inequities. Photovoice presents an opportunity for including the voice of marginalized youth in policy-planning processes.
美国公立学校针对黑人青少年哮喘管理的政策可能无法充分改变造成差异的社会文化决定因素。运用生态框架对公共卫生政策制定者和青少年关于哮喘管理的论述进行批判性分析，可为政策制定提供参考。本研究描述了在全州范围的哮喘规划活动中，学校及其他公共卫生政策制定者与患有哮喘的黑人青少年关于哮喘管理差异的论述。
我对一个针对患有哮喘的黑人青少年（n = 19）的摄影发声项目的文字记录和照片文本、一次与学校及公共卫生政策制定者（n = 12）的哮喘规划会议，以及一次包括相同青少年和政策制定者的摄影发声传播活动的观察进行了定性批判性话语分析。
政策制定者未讨论诸如种族主义和歧视等与哮喘管理差异相关的社会文化论述，但青少年讨论了。青少年和政策制定者之间唯一共同的论述是关于室内环境管理、医疗质量、住房不足和室外空气污染。
让黑人青少年参与有关哮喘管理差异的政策制定活动，有助于进一步识别不同的和共同的论述。学校政策应包括解决结构性不平等问题的多层次策略。摄影发声为将边缘化青年的声音纳入政策规划过程提供了一个机会。
