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Health in the Tenderloin: A Resident-Guided Study of Substance Use, Treatment, and Housing.


Understanding the relationship between health and places is critical for the successful delivery of community-based health services. This is particularly true in places that are considered "risky", where the social or physical environments can increase harm, such as the Tenderloin neighborhood of San Francisco, California. In this study, I examine the relationship between places and health in the Tenderloin from a sociological perspective. I conceptualize places and health not as self-contained concepts suspended in time; rather, they are constructed and contested. They have active histories, and the two concepts shape one another.

The purpose this dissertation is to describe how historic and modern struggles among groups and individuals for resources, power, identity, and control, are directly linked to the built physical and social constructs that affect everyday health in today's Tenderloin neighborhood. Because of my dual role as sociologist and program evaluator in a community-based program located in the Tenderloin, my goal was to provide sociological and substantive contributions that can be used by both researchers and people providing health services in communities. These goals motivated all aspects of the study design, data collection, and analysis. For example, as I describe in Chapter I, I developed the docent tour method, a place-based qualitative method. I designed the docent tour to examine places in a way that is broad and participant-guided, but also systematic and targeted to key sites and concepts relevant to health.

The dissertation begins with a brief social history of the race-, class-, and gender-based development of Uptown Tenderloin as a stigmatized neighborhood. In Chapter II, I show how today's Tenderloin (Uptown Tenderloin) is closely linked to San Francisco's former so-called "zone of deviance" - Barbary Coast (Downtown Tenderloin). Then in Chapter III, I situate modern-day Uptown Tenderloin, which is known as a "containment zone", within this historical context. Using the data collected I from docent tour interviews (N=20), I describe four defining features of the Tenderloin as a modern containment zone: the concentration of the drug market; the concentration of risks; heightened policing and surveillance; and social and physical stratification. These factors have glaring similarities to the historical "zone of deviance" I describe in Chapter II. In Chapter IV, I explore how the containment zone's social and physical contexts shape relationships between residents living in Tenderloin hotels. I argue that this context results in "calculated associations" - women routinely described having to manage or balance the opportunities versus the risks relationships presented. Using social, physical and emotional boundaries were one way relationships were managed. Finally, I conclude with several contributions of the dissertation to sociology theory and methods, as well as substantive implications for community-based health services delivery. For example, I present the clock gear model, a theoretical model I developed to conceptualize health and places as the contested, historic concepts they are. I also argue that the findings of the dissertation bolster and nuance the theories of social conditions as a fundamental cause of disease and illness.

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