Drs. Garcia (PI) and Heckert (co-PI) are working on a NIH-funded R15 project, "Juramentos and Recovery: The Use of a Religious-Based Alcohol Intervention among Mexican Immigrant Farmworkers" (1R15MD0114767). The study investigates the use of the juramento among Mexican immigrant farmworkers in southeastern Pennsylvania. The juramento is a ritualized pledge that Catholics make to a saint for divine intervention in abstaining from alcohol. It is a religious-based alcohol intervention with origins in Mexico and a strong and growing presence in Mexican immigrant communities. Mexican farmworkers have been identified as a high-risk group for developing substance use disorders (SUDs), and too often experience extraordinary barriers that keep them from formal alcohol treatments, when available in their communities. Unable to access treatments, they turn to alternative interventions in their communities, such as immigrant-specific and Spanish-language Alcoholics Anonymous meetings and anexos, including juramentos.

The Latino Immigrant SUDs Help-Seeking Model, currently under development in another study, drives our R15 project. It will help us to explain why Mexican immigrant farmworkers do not use conventional treatments, as a consequence of individual-level, treatment and intervention-level, and structural factors in and beyond their communities that produce inequitable access to treatment services. The model will also help to explain how the farmworkers learn about the juramento, as well as how they use it to initiate sobriety, to stay sober, and to work on their recovery. We modify the model to include the religiosity of the farmworkers, opening the model's aperture and increasing our understanding of a religious-based indigenous alcohol intervention. That is, an alcohol intervention with origins in the homeland of the immigrants and adopted in the United States is created. With the data gathered, our model will be developed into an empirically-informed indigenous recovery systems paradigm that includes the juramento and other indigenous alcohol interventions and treatments in farmworker communities. It will also allow us to generate scientific knowledge of an indigenous and religious-based alcohol intervention not addressed in the ethnic-specific alcohol treatment literature. The extant literature highlights farmworker and other migrant laborers' alcohol prevalence and the many barriers to alcohol and other SUDs treatment, but tends to ignore their help-seeking pathways and the indigenous interventions and treatments available in their communities.

The project is designed around the qualitative methodan appropriate approach for exploratory studies such as oursand the preparation of students for qualitative health research through field praxis. We will use semi-structured interviews to collect qualitative data on juramento use among Mexican immigrant farmworkers in southeastern Pennsylvania who will be recruited using purposive sampling. First, we will use semi-structured interviews to query two priests, both of whom perform juramentos in the region, about the juramentos and the farmworkers who use them. Second, we will conduct exploratory semi-structured interviews with 30 farmworkers: 15 who made juramentos, irrespective of if they are in an alcohol treatment program or not, and 15 who did not but are in alcohol treatment. We will use these interviews to gather information on their use of juramentos, their religious background, their personal histories of alcohol use, and their experience with other interventions and treatments, if any. Third, we will conduct two focus groups with farmworkers. One focus group will be comprised of men who have made juramentos and the other with men who have not made juramentos but are in alcohol treatment. The focus groups will help us to gain a more nuanced understanding of how and why they use juramentos, and what they believe in regards to how the juramento contributes to their sobriety and recovery. The exploratory interviews and focus groups will also include the DUREL and the AUDIT instruments. Dr. Heckert will assist in administering the instruments and will analyze the responses. All interview transcripts will be analyzed using standard qualitative data analysis and the instruments. Together with basic demographic characteristics from exploratory and focus group samples, they will be analyzed using basic statistical analyses.

The research activities of the project will assist IUP, in particular the Mid-Atlantic Research and Training Institute for Community and Behavioral Health (MARTI), to expose students to research and to strengthen a nascent public health research infrastructure on campus. MARTI is also working on establishing a qualitative health research program designed to prepare graduate and undergraduate students for this kind of research. Basically, qualitative health research is social science research that uses qualitative field methods to study health, illness, health care, and disparities in health care, among many other areas of inquiry. This kind of research differs from more dominant modes of enquiry in public health research, such as clinical and quantitative research. Qualitative health research is ideal for explorative research, such as the research proposed in this R15 research project. It allows for gaining new insights, discovering new ideas, and increasing new knowledge of a health problem or practice. Qualitative health research is characterized by field studies, case studies, ethnography, and the analysis of textual data, especially from interviews and observations. The major research methods used to gather data are participant observation, genealogies, and in-depth interviews, as well as informal interviews, focus groups, and content analysis. Qualitative health research is interdisciplinary, and is popular in anthropology, sociology, nursing, and a number of other disciplines.

The NIH AREA grant, the proposed R15 research project, and the qualitative health research program are the first at IUP and in the Pennsylvania State System of Higher Education. The project will contribute significantly to IUP's budding public health research infrastructure and environment in four major ways. First, Drs. Garcia and Heckert will prepare students from different disciplines for public health research and the use of qualitative research methods in this kind of research. The students will learn valuable skills, and will also learn to apply them in a real research setting, making the students more competitive for graduate studies or careers in public health. Second, the plan is to dovetail these student training workshops in the near future and develop NIH grant development workshops to teach faculty to develop public health research using qualitative methods in their projects. Third, through the R15 project, Drs. Garcia and Heckert, along with colleagues at IUP, will develop additional public health research on substance abuse disorders and treatments in Latino immigrant communities and on other health problems in these communities. Fourth, together, an AREA Award, the R15 research project, and the student training program will contribute significantly to the public health bachelor's program being created at IUP, and the global health minor currently under formal review.