Search

Background: Tobacco-related disparities are a leading contributor to health inequities among marginalized communities. Lack of support from health professionals is one of the most cited barriers to tobacco cessation reported by these communities. Improving the proficiencies with which health professionals incorporate social and cultural influences into therapeutic interactions has the potential to address this critical barrier. In general, training to improve these proficiencies has shown promise, but the specific proficiencies required for treating tobacco use among marginalized communities are unknown. This project aimed to develop a competency-based curriculum to improve these proficiencies among health professionals with experience and training in the evidence-based treatment of tobacco use, and then pilot test the content delivered via an expert review of a virtual, self-paced workshop., Methods: We used the Delphi Technique to systematically identify the specific competencies and corresponding knowledge and skill sets required to achieve these proficiencies. Educational content was developed to teach these competencies in a virtual workshop. The workshop was evaluated by 11 experts in the field by examining pre- and post-training changes in perceived knowledge, skill, and confidence levels and other quantitative and qualitative feedback. Repeated measures analysis of variance and paired sample t-tests were used to examine pre-post training differences., Results: Six competencies and corresponding skill sets were identified. After exposure to the virtual workshop, the experts reported significant increases in the overall proficiency for each competency as well as increases in nearly all levels of knowledge, skill, and confidence within the competency skill sets. Qualitative and quantitative findings indicate that content was relevant to practice., Conclusions: These findings provide preliminary support for 6 competencies and skills sets needed to improve therapeutic interpersonal interactions that recognize the importance of social and cultural influences in the treatment of tobacco use., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Intimate partner violence (IPV) is as prevalent or more so as reported by lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals compared with non-LGBTQ individuals. Yet largely due to prior harmful and nonaffirming experiences with service providers, they are reluctant to seek services from domestic violence service providers (DVSP). These factors, combined with the reality that those who do seek services may not be provided with safe, affirming, and effective responses, exacerbate the impact of IPV on LGBTQ health and recovery. The North Carolina (NC) LGBTQ Domestic Violence Response Initiative (NC Initiative) was developed to increase DVSP capacity to serve LGBTQ survivors. This article describes the first four phases of the Initiative's development: (1) formative focus group research with DVSPs statewide, identifying agencies' interest in improving their responses to LGBTQ survivors; (2) Initiative launch, including funding and identification of partners; (3) development of capacity assessment tools; and (4) review of baseline capacity assessment findings. The development of tools, specifically designed to assess capacity of DVSPs to serve LGBTQ survivors, is a unique contribution as no tools existed to do so. The common capacity-building needs and data-informed recommendations identified provide a starting point for agencies expanding into LGBTQ-focused work, who may not have the benefit of grant funding, tools, or evaluators to assist. Our findings, lessons learned, and tools may be used by agencies to evaluate and inform their own practices, thereby creating safer, more affirming agencies that are capable provide effective care to meet unique needs of LGBTQ survivors.

This article delves into the views of 72 leaders in domestic violence and sexual assault advocacy, policy, service, and research to determine their vision for the future direction of the field. Through discussions with experts, we identified numerous strategies necessary to best meet the needs of domestic violence and sexual assault victims. Common themes focused on the need to (a) examine the context of victims' and offenders' experiences; (b) increase cultural competence to adequately provide appropriate victim services and criminal justice responses for underserved, marginalized, and culturally specific populations; (c) increase reliance on victims' voices; (d) continue to develop partnerships at both the community and the state levels and ensure the role of local communities; (e) expand the concept of successful outcomes that can be reliably and validly assessed; (f) emphasize mixed-methods approaches to address these questions, in recognition that various methods complement each other; and (g) be open to novel or emerging approaches to intervention.

Despite widespread awareness of the health benefits for both mothers and babies we are far from achieving universal breastfeeding. Breastfeeding rates globally are lower than recommended levels and there are concerns that some global breastfeeding efforts have stalled (1, 2). In addition, we see persistent disparities in breastfeeding rates by race, ethnicity, class and status (3). A growing literature documents how a range of injustices, including gender inequality (7), racism (8), poverty (9), and violence (10, 11) shape whether, how exclusive, and for how long mothers and others will be able to breastfeed or feed their infants human milk. These social injustices and inequities work to privilege breastfeeding even as the health message becomes more mainstreamed and human milk more desirable. A social justice approach could help us address the gender, race, and sexuality-based inequities and injustices in opportunities, resources, status, and power that are influencing the patterns of breastfeeding we see today. The 12th Breastfeeding and Feminism International Conference held in 2017 took as its theme Breastfeeding as Social Justice: From Crucial Conversation to Inspired Action. The planning team for that conference identified seven core domains that could help us conceptualize a framework for placing social justice at the core of our work. This paper presents this framework and suggestions for policy and practice that follow.

Background: Stress contributes to the development and maintenance of substance use disorders (SUD), with some research suggesting that the impact of stress on SUD is greater in women. However, this has yet to be evaluated in a national dataset, across major substances of abuse., Methods: Using data from the newly available U.S. National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; Wave 3; n =36,309) we evaluated relationships among past year stressful life events (0 or 1 vs. 2+ events, range 0-16) and gender, and their association with transitions (new vs. absent cases; ongoing vs. remitted cases) in Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) alcohol use disorder (AUD), tobacco use disorder (TUD), cannabis use disorder (CUD), and nonmedical prescription opioid use disorder (OUD) diagnoses., Results: Having 2 or more stressful life events in the past year increased the odds of having a new AUD, TUD, CUD, and OUD (OR=3.14, 2.15, 5.52, and 3.06, respectively) or ongoing AUD, TUD, and CUD (OR=2.39, 2.62, and 2.95, respectively) compared to 0 or 1 stressful life event. A stress by gender interaction for new vs. absent AUD demonstrated that having 2 or more stressful life events was associated with increased odds of new AUD in men (OR=2.51) and even greater odds of new AUD in women (OR=3.94)., Conclusions: Results highlight that stress is a robust factor in both men and women with new or ongoing substance use disorders, and that effective treatments for substance use should consider the role of stress in addiction etiology and maintenance. There was little evidence for gender differences in the role of stress on transitions in substance use disorders, except for the onset of alcohol use disorders. Given that rates of alcohol use disorders are increasing in women; the impact of stress needs to be considered., Competing Interests: Declaration of conflicting interests Sherry A. McKee has consulted to Cerecor and Embera, has received research support for investigator-initiated studies from Pfizer, Inc. and Cerecor, and has ownership in Lumme, Inc. All other authors declare that there is no conflict of interest.

Research has documented important sex differences in associations between early stress, stress-sensitization, and psychiatric outcomes. The current study investigated whether sex differences in stress-sensitization extended to cigarette smoking cessation. Data were analyzed from the National Epidemiologic Survey on Alcohol and Related Conditions (waves 1 and 2), selecting for current daily and non-daily smokers at wave 1 (daily smokers: n =3,499 women, 3055 men; non-daily smokers: n =451 women, 501 men). Three-way interactions between sex, childhood adversity, and past year stressful life events were modeled in the prediction of smoking cessation. Among women, stressful life events were more strongly related to lower likelihood of smoking cessation for those with a history of childhood adversity than those without. This relationship was not found among men. The stress-sensitization model may be applicable to women with regards to smoking cessation, supporting further exploration of stress-sensitization as a prevention and clinical target for smoking cessation.

This quasi-experimental study investigated the efficacy of clinic-based advocacy for intimate partner violence (IPV) to increase help seeking, reduce violence, and improve women's well-being. Eligible and consenting women attending one of six selected clinics in the rural Southern United States were assessed for IPV. Consenting women disclosing IPV were offered either an in-clinic advocate intervention or usual care, depending on the clinic they attended and were followed for up to 24 months. Over follow-up time both IPV scores and depressive symptoms trended toward greater decline among women in the advocate intervention clinics relative to the usual care (business card referral only).

A longitudinal examination of male perpetration of physical aggression toward a romantic partner and its covariation with sexual aggression reveals a decline from adolescence through 4 years of college. Witnessing domestic violence and experiencing parental physical punishment increased the likelihood of physical aggression in adolescence, but not thereafter. Prior perpetration best predicted subsequent perpetration. Although adolescence was the time of greatest risk, the 2nd year in college was an additional time of increased risk. Furthermore, physical and sexual aggression covaried with each other in the sample at rates significantly greater than chance, indicating that covariation may be a unique form of perpetration. Witnessing domestic violence and experiencing parental physical punishment were associated with an increased likelihood of men committing both forms of intimate partner aggression in adolescence.

Objectives: Little research has addressed differences in health care expenditures among women who are currently experiencing intimate partner violence (IPV) compared with those who are not. The purpose of this work is to provide estimates of direct medical expenditure for physician, drug, and hospital utilization among Medicaid-eligible women who screened as currently experiencing IPV compared with those who are not currently experiencing IPV., Methods: In this family practice-based cross-sectional study, women were screened for current IPV using a 15-item Index of Spouse Abuse-Physical (ISA-P) between 1997 and 1998. Consents were obtained from study subjects to review Medicaid expenditure and utilization data for the same time period., Results: Mean physician, hospital, and total expenditures were higher for those women with higher IPV scores compared with those who scored as not currently experiencing IPV, after adjusting for confounders. Higher IPV scores were associated with a three-fold increased risk of having a total expenditure over $5,000 (95% confidence interval [CI] 1.3, 8.4). The mean total expenditure difference between the high IPV and no IPV groups was $1,064 (95% CI $623, $1506). The adjusted risk ratio for high IPV score and the log of total Medicaid expenditures was 2.3 (95% CI 1.2, 4.4)., Conclusions: Women screened as experiencing higher IPV scores had higher Medicaid expenditures compared with women not currently experiencing IPV. Early IPV assessment partnered with effective clinic or community-based interventions may help to identify IPV earlier and reduce the health impact and cost of IPV.

An avidin-biotin immunocytochemical technique was used to localize cells containing an insulin- or glucagon-like peptide in the major salivary glands of Sprague-Dawley rats. Cells with insulin-like staining were observed in the intercalated ducts of both the parotid and submandibular glands, but none were found in the sublingual gland. A discrete population of cells with intense glucagon-like immunostaining was associated with the acini of all three major salivary glands. This immunostaining only followed use of a glucagon antiserum with N-terminal specificity and not after incubation of tissues with an anti-glucagon serum having C-terminal specificity. These results suggest that rat salivary glands may contain peptides potentially capable of influencing substrate metabolism. In addition, the present findings indicate that the glucagon-like peptide found in salivary glands has a greater immunocytochemical similarity to glicentin (gut-type glucagon) and/or glucagon precursors than to the 3500 molecular weight pancreatic glucagon.