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AIMS: To examine and describe women’s emergency department visits and care-seeking experiences, including recognition, evaluation, and communication of symptoms, injuries, and health risks after non-fatal intimate partner strangulation. DESIGN: Using a diagnostic process framework, this mixed-methods study explores concordance and discordance of interview and medical records data to highlight opportunities for clinical diagnostic improvement. METHODS: In-depth, semi-structured interviews with women after an emergency department visit for non-fatal intimate partner strangulation, concurrent with medical records reviews were conducted between March 2018 and January 2019. A constant comparative approach was used to analyze interview and medical record data using an a priori codebook designed based on the National Academies of Science, Engineering and Medicine’s conceptual model of the diagnostic process and prior intimate partner violence research. RESULTS: Interviews reflected participants did not have a sense of long-term health risks from their strangulation beyond addressing emotional trauma. Women noted that forensic and emergency nursing support was treatment in and of itself that allowed them to be heard and validated. Medical record clinical impressions and final diagnoses included domestic violence, domestic abuse or sexual assault, but not specifically strangulation. CONCLUSION: This study contributes to the growing literature regarding strangulation diagnosis and care. Our findings provide new details of women’s emergency department care-seeking experiences which, while overall aligned with medical records documentation, were not reflected in final diagnostic impressions nor in patient recollection of long-term health risks. IMPACT: Nurses are strongly positioned as clinical practice leaders and policy advocates to improve collective responses to this dangerous violence mechanism. Actions such as improving patient education, referral, and follow up options to better communication and address long-term strangulation risk are one example. Further research on non-fatal intimate partner strangulation and care-seeking is warranted to expand on this knowledge, particularly in longitudinal cohorts and varied geographical areas.

ObjectivesBlack women disproportionately experience STIs (including HIV/AIDS), gender-based violence, substance misuse and mental health conditions. Addressing a gap in syndemic research, we characterised comorbidity overlap within the context of sociostructural inequities and adverse childhood experiences (ACEs) among black women in Baltimore, Maryland.MethodsBetween 2015 and 2018, black women (n=305) were recruited from STI clinics in Baltimore, Maryland. Among those with complete survey data (n=230), we conducted a latent class analysis to differentiate women based on their profile of the following syndemic comorbidities: STIs, adult sexual victimisation, substance misuse and mental health disorders. We then examined the association between ACEs and syndemic latent class membership.ResultsThirty-three percent of women experienced three to nine ACEs before age 18 years, and 44% reported four to six comorbidities. The two-class latent class solution demonstrated the best fit model, and women were categorised in either class 1 (past-year STI; 59%) or class 2 (syndemic comorbidities; 41%). Women in class 2 were more likely to report unstable housing (10% vs 3%) and identify as bisexual/gay (22% vs 10%) than women in class 1. ACEs were significantly associated with an increased likelihood of class 2 membership.ConclusionsThis study reinforces the importance of screening for ACEs and offering trauma-informed, integrated care for black women with syndemic comorbidities. It also highlights the critical nature of tailoring interventions to improve sociostructural equity, preventing and reducing syndemic development.

The Danger Assessment (DA) is a widely-used risk assessment instrument designed to help women understand their risk of femicide. Currently, no validated tool exists in Brazilian Portuguese. The purpose of this study was to conduct a cross-cultural adaptation of the DA for use in the Brazilian context as a precursor to validation and broader testing among women in Brazil. This study describes a community participatory approach for translation and cultural adaptation of the DA from European to Brazilian Portuguese that engages the target population in the process. Using a three-step process, a final version of the DA-Brazil instrument was developed.

Intimate partner homicide (IPH) consists primarily of men killing women in the context of intimate partner violence. Researchers have described and identified risk factors associated with IPH; additional comprehensive data collection is needed to better understand IPH risk and to develop risk-informed prevention. Due to structural racism, available interventions within the criminal legal and social service systems may be eschewed by those—such as Black women—who are at the highest risk. Anti-racist research, practice, and policy are key to reducing IPH. Gender and racial equity, combined with fostering relational health leads, ultimately, down the long road to IPH prevention.

Background Safety protocols are an essential component of studies addressing violence and mental health but are rarely described in the published literature from Sub-Saharan Africa. We designed and implemented a safety protocol within Project YES! (Youth Engaging for Success), which enrolled 276 youth living with HIV (ages 15–24 years) in a randomized controlled trial of a peer-mentoring intervention across four HIV clinics in Ndola, Zambia. Methods Youth who reported severe violence and/or suicidal thoughts on research surveys or during meetings with youth peer mentors (YPM) were referred to designated healthcare providers (HCP). We explored experiences with the safety protocol using: a) monitoring data of referrals, and b) in-depth interviews with youth (n = 82), HCP (n = 10), YPM (n = 8), and staff (n = 6). Descriptive statistics were generated and thematic analysis of coded transcripts and written memos performed. Results Nearly half of youth enrolled (48% of females, 41% of males) were referred to a HCP at least once. The first referral was most often for sexual violence (35%) and/or suicidal ideation/depression (29%). All referred youth aged 15–17 years and over 80% of referred youth aged 18 + agreed to see a HCP. HCP referred 15% for additional services outside the clinic. Twenty-nine youth, all HCP, all YPM, and all staff interviewed discussed the safety protocol. Most youth felt “encouraged,” “helped,” “unburdened,” and “relieved” by their meetings with HCP; some expressed concerns about meeting with HCP. The safety protocol helped HCP recognize the need to integrate care for violence and mental health with medication adherence support. HCP, YPM, and study staff raised implementation challenges, including youth choosing not to open up to HCP, time and resource constraints, deficiencies in HCP training, and stigma and cultural norms inhibiting referrals outside the clinic for emotional trauma and mental health. Conclusions Implementing a safety protocol within an HIV clinic-based research study is possible and beneficial for youth and HCP alike. Implementation challenges underscore that HCP in Zambia work in over-stretched healthcare systems. Innovative strategies must address deficiencies in training and resources within HIV clinics and gaps in coordination across services to meet the overwhelming need for violence and mental health services among youth living with HIV.

There is increasing evidence that green space in communities reduces the risk of aggression and violence, and increases wellbeing. Positive associations between green space and resilience have been found among children, older adults and university students in the United States, China and Bulgaria. Little is known about these associations among predominately Black communities with structural disadvantage. This study explored the potential community resilience in predominately Black neighborhoods with elevated violent crime and different amounts of green space. This embedded mixed-methods study started with quantitative analysis of women who self-identified as “Black and/or African American.” We found inequality in environments, including the amount of green space, traffic density, vacant property, and violent crime. This led to 10 indepth interviews representing communities with elevated crime and different amounts of green space. Emergent coding of the first 3 interviews, a subset of the 98 in the quantitative analysis, led to a priori coding of barriers and facilitators to potential green space supported community resilience applied to the final 7 interview data. Barriers were a combination of the physical and social environment, including traffic patterns, vacant property, and crime. Facilitators included subjective qualities of green space. Green spaces drew people in through community building and promoting feelings of calmness. The transformation of vacant lots into green spaces by community members affords space for people to come together and build community. Green spaces, a modifiable factor, may serve to increase community resilience and decrease the risk of violence.

Black transgender women are disproportionately affected by violence and poor care-delivery, contributing to poor mental health. Little is known regarding the effect of transgender and gender diverse (TGD) community connection (TCC) on health. This analysis (a) explores relationships between TCC, polyvictimization, and mental health and (b) analyzes how TCC influenced help-seeking following violent experiences among Black transgender women. Mixed-methods data from 19 Black transgender women were analyzed using correlational and thematic content analyses. Findings suggest that TCC is associated with improved help-seeking and mental health among Black transgender women, highlighting a need for longitudinal research to identify approaches for leveraging TCC.

Introduction Nonfatal intimate partner strangulation poses significant acute and long-term morbidity risks and also heightens women’s risk for future femicide. The lifetime prevalence of nonfatal intimate partner strangulation has been estimated to be approximately 10%, or 11 million women, in the general United States population. Given the potential for significant health risks and serious consequences of strangulation, this study adds to the limited literature by estimating prevalence and describing the associated characteristics of strangulation-related visits among United States ED visits by adult women after intimate partner violence. Methods Prevalence estimation as well as simple and multivariable logistic regression analyses were completed using data from the Nationwide Emergency Department Sample spanning the years 2006 to 2014. Results The prevalence of strangulation codes was estimated at 1.2% of all intimate partner violence visits. Adjusting for visits, hospital characteristics, and visit year, higher odds of strangulation were noted in younger women, metropolitan hospitals, level I/II trauma centers, and non-Northeast regions. Increases in strangulation events among intimate partner violence–related visits in recent years were also observed. Discussion A relatively low prevalence may reflect an underestimate of true nonfatal intimate partner strangulation visits owing to coding or a very low rate of ED visits for this issue. Higher odds of strangulation among intimate partner violence visits by women in more recent years may be due to increased recognition and documentation by frontline clinicians and coding teams. Continued research is needed to further inform clinical, postcare, and social policy efforts.

The objective of this study was to examine differences in change over time in health and safety outcomes among female college students randomized to myPlan, a tailored safety planning app, or usual web-based safety planning resources. Three hundred forty-six women (175 intervention, 171 control) from 41 colleges/universities in Oregon and Maryland completed surveys at baseline, 6- and 12-months from July 2015 to October 2017. Generalized estimating equations were used to test group differences across time. Both groups improved on four measure of intimate partner violence (IPV; Composite Abuse Scale [CAS], TBI-related IPV, digital abuse, reproductive coercion [RC]) and depression. Reduction in RC and improvement in suicide risk were significantly greater in the myPlan group relative to controls ( p = .019 and p = .46, respectively). Increases in the percent of safety behaviors tried that were helpful significantly reduced CAS scores, indicating a reduction in IPV over time in the myPlan group compared to controls ( p = .006). Findings support the feasibility and importance of technology-based IPV safety planning for college women. myPlan achieved a number of its objectives related to safety planning and decision-making, the use of helpful safety behaviors, mental health, and reductions in some forms of IPV.

This study seeks to determine the concurrent and predictive validity of a dual risk assessment protocol. It combines the risk of persistence in intimate partner violence (IPV) measured via the Domestic Violence Screening Instrument–Revised (DVSI-R) with supplemental items from the Danger Risk Assessment (DRA) bearing on the risk of potential lethality. We further test whether this assessment protocol reproduces disparities by race and ethnicity found in the larger population. Using a sample of 4,665 IPV male defendants with a female victim, analyses support both types of criterion validity. The DRA risk score is associated with felony charges, incarceration at the initial arrest, and the frequency of subsequent dangerous behavior. Results also suggest minimal predictive bias or disparate impact by race and ethnicity. Incorporating supplemental items bearing on potential lethality risk adds important information concerning the risk management strategies of those involved in IPV.

Background: Maternal mortality decreased globally by about 38% between 2000 and 2017, yet, it continues to climb in the United States. Gaping disparities exist in U.S. maternal mortality between white (referent group) and minority women. Despite important and appropriate attention to disparities for black women, almost no attention has been given to American Indian/Alaska Native (AI/AN) women. The purpose of this scoping review is to synthesize available literature concerning AI/AN maternal mortality. Methods: Databases were searched using the terms maternal mortality and pregnancy-related death, each paired with American Indian, Native American, Alaska Native, Inuit, and Indigenous. Criteria (e.g., hemorrhage) were paired with initial search terms. Next, pregnancy-associated death was paired with American Indian, Native American, Alaska Native, Inuit, and Indigenous. Criteria in this category were homicide, suicide, and substance use. Results: The three leading causes of AI/AN pregnancy-related maternal mortality are hemorrhage, cardiomyopathies, and hypertensive disorders of pregnancy. AI/AN maternal mortality data for homicide and suicide consistently include small samples and often categorize AI/AN maternal deaths in an "Other" race/ethnicity, which precludes targeted AI/AN data analysis. No studies that reported AI/AN maternal mortality as a result of substance use were found. Health care characteristics such as quality, access, and location also may influence maternal outcomes and maternal mortality. Conclusions: Despite AI/AN maternal mortality being disproportionately high compared to other racial/ethnic groups, relatively little is known about root causes.

Reservation-based Native American youth are at disproportionate risk for high-risk substance use. The culture-as-treatment hypothesis suggests aspects of tribal culture can support prevention and healing in this context; however, the protective role of communal mastery and tribal identity have yet to be fully explored. The objectives of this study were to investigate (1) the relationship between cultural factors and high-risk substance use, which includes polysubstance use, early initiation of alcohol and illicit drugs, and binge drinking, and (2) substance use frequency and prevalence of various substances via cross-sectional design. Multiple logistic regression modeling was used to analyze data from 288 tribal members (15–24 years of age) residing on/near the Fort Peck Reservation in the Northern Plains. When controlling for childhood trauma and school attendance, having at least a high school education (OR = 0.434, p = 0.028), increased communal mastery (OR = 0.931, p = 0.007), and higher levels of tribal identity (OR = 0.579, p = 0.009) were significantly associated with lower odds of polysubstance use. Overall prevalence of polysubstance use was 50%, and binge drinking had the highest single substance prevalence (66%). Prevalence of early initiation of substances (≤ 14 years) was inhalants (70%), alcohol (61%), marijuana (74%), methamphetamine (23%), and prescription drug misuse (23%). Hydrocodone, an opioid, was the most frequently misused prescription drug. Findings indicate programs focused on promoting education engagement, communal mastery, and tribal identity may mitigate substance use for Native American adolescents living in high-risk, reservation-based settings.

Intimate partner violence (IPV) is a national and international public health and human rights concern. Immigrant women are disproportionately affected by IPV that includes homicides. This study explored the perspectives of survivors of IPV, who are immigrants to the United States, regarding their sources of strength that enhance their safety and promote coping in abusive relationships. Data for this qualitative study were collected from ethnically diverse immigrant women residing in Massachusetts, Arizona, Virginia, Washington, D.C., New York, Minnesota, and California, using purposive and snowball sampling techniques. Eighty-three in-depth interviews were conducted with adult immigrant survivors of IPV who self-identified as Asian ( n = 30), Latina ( n = 30), and African ( n = 23). Data were analyzed using thematic analysis. Women identified both external (e.g., community support, support from social service agencies) and internal (e.g., optimism, faith, beliefs) sources of strength. The study highlights how these sources can adequately address needs of survivors and offers areas for improvement in services for survivors. The findings are informative for practitioners serving immigrant survivors of IPV in legal, social service, and physical and mental health settings.

As ecosystems that support human health, societies, and civilization change in the era of the Anthropocene, individuals with disproportionate balance of salivary hormones may be at greatest risk of morbidity and mortality. Vulnerable communities, in particular, are overburdened by inequities in features of built environments linked to health disparities. This study examined the cross-sectional association of greenness in the built environment with the ratio of cortisol to dehydroepiandrosterone (DHEA) in an urban-dwelling high-risk community sample of African American women (n = 84, age 18-44 years). Saliva samples, collected across 2 consecutive days, were assayed for cortisol and DHEA. Controlling for sexual violence, perceived stress, education, and income, as well as crime, traffic density, and vacant properties, we observed a significant positive cross-sectional association between greenness and the cortisol to DHEA ratio, (β = 7·5, 95% CI: 0.89, 14.19). The findings highlight environmental influence on stress response at waking when there is the greatest individual variation. Implications for advancing our understanding of the waking ratio of cortisol to DHEA as a potential marker of physiological resilience are discussed.

Purpose: This study examines the relationship between polyvictimization, emotional transgender and gender diverse community connection (eTCC), and symptoms of depression and post-traumatic stress d...

Background: In the United States, rates of maternal morbidity and mortality (MMM) are high compared with other high-income countries and are characterized by significant racial/ethnic disparities. Typically, research on MMM focuses on obstetrical problems. Less research examines the role of intimate partner violence (IPV). Maternal health, IPV, and their intersection are linked with the impacts of social determinants of health. Objective: We sought to understand the intersection of MMM and IPV in the United States, particularly data issues that hinder research in this area and the resulting knowledge gaps. Methods: We identified major articles of interest regarding maternal morbidity and mortality and IPV in the United States and drafted a mini review based on relevant information. Results: Despite the prevalence of IPV during pregnancy, the intersection of maternal health and IPV has not been widely reviewed or discussed. Conclusion: There are a number of limitations in surveillance activities and data collection that underestimate the impact of IPV on MMM. Importantly, women who die by homicide or suicide— which in many cases is linked with IPV—are not counted as pregnancy-related deaths in the United States under the current definition. Establishing separate panels of local experts in maternal health or maternal mortality review committees (MMRCs) that are dedicated to examining violent deaths and use of the Maternal Mortality Review Information Application system would likely improve data accuracy of pregnancy-associated deaths. Based on the literature reviewed and limitations of current data, there are significant knowledge gaps on the effects of IPV and maternal health.

Background There is a dearth of literature describing factors supporting a successful transition from a career-development fellowship to resumption of the full complement of faculty roles. Purpose Because little is known about the transition back to the full faculty role, a subset of Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars (NFS) was interviewed to evaluate the self-identified challenges and opportunities that the scholars faced and factors contributing to their success when they reassumed the full faculty role. Methods A subset of scholars from cohorts beginning the RWJF NFS program between 2008 and 2012 (n = 10) was interviewed by members of the NFS National Advisory Committee. NFSs identified challenges and opportunities faced as they transitioned to their faculty roles following completion of the career development fellowship as well as the character of support received from individuals in their organizational influencing the experience of the faculty transition. Evaluation outcomes include recommendations for transition planning for home institutions, colleagues and fellows. Results NFSs identified transition challenges including managing multiple responsibilities and increased teaching demands coupled with loss of protected time and funding for scholarly work. Opportunities for career advancement were influenced by effective mentorship, institutional supports including advocacy and allocation of time and responsibilities consistent with continued research productivity. Issues contributing to a more difficult transition included non-supportive relationships among administrators and colleagues and newly assigned responsibilities that detracted from success in meeting expectations for tenure and promotion. Effective transition from fellow to faculty included plans for continued mentorship and stakeholder engagement of administration, mentors and faculty colleagues. Conclusions Effective transition from fellow to the full complement of the faculty role benefits both the home institution and scholar. Positive outcomes may be contingent on scholar support and organizational investment during the transition period.

We examined the relationship between past-year violence victimization and viral load (VL) failure among consecutively-sampled male and female adolescents and young adults, aged 15–24, in four HIV clinics in Ndola, Zambia. Measures of past-year physical violence, psychological abuse, and forced sex were adapted from the ICAST-C and WHO Multi-Country Study. Using logistic regression, we derived associations between VL failure (≥ 1000 copies/mL) and: any victimization; cumulative victimization; and types and perpetrators of violence. Among 272 youth (59.2% female, 72.8% perinatally infected), 73.5% (n = 200) experienced past-year violence and 36.8% (n = 100) had VL failure. Higher odds of VL failure were observed for participants who reported high frequency of any violence versus no violence victimization (adjusted OR, aOR: 3.58; 95% CI 1.14–11.27), high frequency of psychological abuse versus no psychological abuse (aOR: 3.32; 95% CI 1.26–8.70), any versus no violence from a family member other than a parent/caregiver for physical violence (aOR: 2.18, 95% CI 1.05–4.54) and psychological abuse (aOR: 2.50; 95% CI 1.37–4.54), and any versus no physical violence from a friend/peer (aOR: 2.14, 95% CI 1.05–4.36). Past-year violence victimization was associated with VL failure when considering the frequency, type, and perpetrator of violence. Programs addressing violence among youth living with HIV may be critical to improving viral suppression and preventing onward transmission. Electronic supplementary material The online version of this article (10.1007/s10461-020-02958-3) contains supplementary material, which is available to authorized users.

This paper describes the adaptation of a web-based safety planning intervention for Native American women exposed to intimate partner violence (IPV). We conducted interviews with Native American wo...

One-third of women are victimized by intimate partner violence (IPV) in their lifetime; when women are killed, they are often murdered by a previously abusive intimate partner. Risk-informed collaborative interventions, such as domestic violence high risk teams (DVHRTs), use IPV risk assessment to identify and intervene in high-risk IPV cases. This study reports on the development and testing of the Danger Assessment for Law Enforcement (DA-LE), an IPV risk assessment intended for use with DVHRTs. Data were collected through structured telephone interviews from service-seeking survivors of IPV at two time points approximately seven to eight months apart. One sample (n = 570) was used to develop the DA-LE and another (n = 389) was used to test the predictive validity of the instrument using the receiver operating characteristic area under the curve (AUC). The DA-LE predicted near fatal IPV on follow-up with similar or better accuracy than most validated IPV risk assessment instruments (AUC = 0.6864–0.7516). There were no significant differences in predictive validity based on survivor/offender race or ethnicity. The DA-LE has the potential to identify high-risk police-involved IPV cases. Risk-informed collaborative interventions may enhance outcomes for survivors of IPV by holding offenders accountable, increasing help seeking, and reducing future assaults.

INTRODUCTION: Latina women disproportionately report experiencing reproductive coercion (RC), a set of behaviors that interfere with autonomous reproductive decision-making. Given RC’s associations with intimate partner violence (IPV) and unintended pregnancy, it is critical to identify and address RC to assist women to achieve safety, autonomy, and reproductive life plans. The purpose of this study was to describe and understand the context of RC and the use of RC safety strategies among Latina women receiving services at an urban clinic, through listening to the experiences of the women in their own words. METHODS: Qualitative descriptive methodology was used. Semi-structured interviews were conducted with a purposive sample of 13 Latina women recruited from a Federally Qualified Health Center in the Washington, DC area. RESULTS: Data were organized into three a priori categories: (1) RC Behaviors, (2) Co-occurrence of RC and IPV, and (3) RC Harm Reduction Strategies. New RC behaviors emerged, and immigration status was used as a method of coercive control. From these a priori categories emerged four themes: Impact of Immigrant and Citizenship Status, Machismo, Strength and Bravery, and Importance of Family. Harm reduction strategies included less detectable contraception; some sought community services but others resorted to deception and stalling as the only tools available to them. DISCUSSION: Less detectable methods of contraception remained useful harm reduction strategies for women experiencing RC. Midwives should inquire about method fit and be mindful of honoring the request when patients ask to change methods. Women’s strength and resilience emerged as a vital source of power and endurance. This diverse sample and the powerful voices of the women who participated make a significant contribution to the understanding of RC experienced by Latina women in the United States.

Intimate partner violence (IPV) is an epidemic among transgender and gender diverse (TGD) people. However, intimate partner homicide (IPH) among TGD people is under researched. Thus, thematic content analysis was used to describe and examine antecedents of severe assault and IPH among TGD adults who have experienced IPV (N = 13), via community listening sessions. While some themes resembled known severe assault and IPH risks among cisgender women, several themes were unique to TGD people and should be considered when safety planning with TGD individuals or adapting IPV screening tools for this population.

OBJECTIVE: To describe characteristics of strangulation, and associated medical care, documentation, and injuries of women after non-fatal intimate partner strangulation (NF-IPS) who present for care to a community-based ED with an associated IPV advocacy program between 2008 and 2016. SETTING, DESIGN, AND PARTICIPANTS: A retrospective review of 345 female ED patients’ medical records who sought care at a community hospital ED following a physical assault including strangulation by an intimate partner was conducted. Demographics, characteristics related to reported signs and symptoms, injuries, and subsequent imaging, diagnoses and discharge information were abstracted. RESULTS: Commonly reported symptoms were neck pain (67.2%) and headache (45.8%), with fewer patients reporting more severe symptoms such as loss of consciousness (22.6%), dysphagia (25.0%), or dysphonia (26.7%). Rates of patients disclosing strangulation to the entire multidisciplinary team and dedicated neck imaging appeared to improve between 2008 and 2014. Among the 45 patients with noted head and neck findings, two patients were found to have an internal carotid artery dissection, two patients were found to have strokes, and one patient was found to have an intracranial hemorrhage. CONCLUSIONS: Survivors of NF-IPS may present to community-based hospitals, and existing imaging guidelines can support clinicians in identifying serious internal injury like carotid artery dissection and stroke. Further research is needed to better discern symptoms previously attributed to psychological trauma from post-strangulation brain injury. This study contributes to the growing literature on NF-IPS with data specific to community-based ED visits.

In the United States, Black women are disproportionately affected by HIV, accounting for most new HIV infections diagnosed among women. Socio-structural barriers to HIV testing include stigma and discrimination but may be mitigated by resilience.We aimed to examine the effect of discrimination and resilience on HIV testing behaviors among Black women.Between 2016 and 2018, we conducted The ESSENCE Project, a retrospective cohort study on the role of physiological and environmental factors on the association between sexual assault and HIV risk among Black women in Baltimore, Maryland, USA. Black women aged 18-44 were recruited from public health STD clinics and completed an audio-computer-assisted self-interview survey. Hierarchical multiple negative binomial regression models were used to examine the associations of everyday discrimination (subtle and overt) and resilience on HIV testing frequency; resilience and its subscales (relational maintenance, personal fortitude, positive coping, independence and insight) were also examined as moderators.Among 236 Black women reporting HIV testing history, the median number of lifetime HIV tests was 4 (IQR = 2, 6). Mean everyday discrimination was 2.3 (SD = 1.2). Mean resilience was 5.3 (SD = 0.8). Everyday discrimination and its subscales (overt and subtle) were negatively associated with lifetime HIV testing frequency, while overall resilience was not associated with lifetime HIV testing frequency. Accounting for demographics, overall resilience moderated the association of subtle discrimination and lifetime HIV testing frequency. For the resilience subscales, more specifically: (1) associations of subtle discrimination and HIV testing frequency were significant at the lowest relational maintenance and lowest positive coping resilience; and (2) the association of subtle discrimination and HIV testing frequency was significant at the highest resilience for all four subscales.These findings highlight the need for provider- and community-level interventions addressing the deleterious effects of everyday discrimination and more specifically subtle everyday discrimination to encourage HIV testing.

Across the world, suicidal behaviors are responsible for more than one million deaths each year. In Haiti, suicidal behaviors were found to be related to intimate partner violence (IPV) against women. This study was conducted after the 2010 earthquake in Haiti and women were asked about IPV before and after that event. A sample of women between 18 and 44 years of age responded to a questionnaire about physical, psychological, or sexual abuse by an intimate or non-intimate partner. The women were divided into two groups: (a) women who were abused by partners (n = 133) and (b) women who were not abused (n = 75). Those who were abused had 2.2 times higher odds for suicidal thoughts and 1.9 times higher odds for suicidal attempts and were significantly more likely to suffer from depression and PTSD. For each 1-unit increase in a measured PTSD score, the odds of being abused increased by 105.7%. For each 1-unit increase in the measured depression score, the odds of being abused increased by 14.9%.

Background Black women disproportionately suffer from violence and its subsequent mental health outcomes. Increasing levels of perceived stress are associated with greater symptoms of depression and post-traumatic stress disorder (PTSD). Social support and resilience can potentially mediate the negative consequences of perceived stress on women's mental health. This study assesses the association between perceived stress and mental health outcomes among Black women. In addition, this study examines social support and resilience as mediators of association between perceived stress and mental health. Methods Black women residing in Baltimore, MD (n = 310) were recruited from STD clinics into a retrospective cohort study (2013–2018) on sexual assault and HIV risk. Social support and resilience served as coping variables and were assessed as mediators in the associations between perceived stress and mental health. Analyses were stratified by exposure to sexual violence in adulthood. Results Almost half of our sample (46%) experienced severe depression and about one-third (27%) experienced severe PTSD. Resilience partially mediated the association between perceived stress and severe depressive symptoms among exposed women. Social support partially mediated the association between perceived stress and severe PTSD symptoms among exposed women. Limitations Since this is a cross-sectional analysis, we are unable to determine the temporal relationship between outcome and exposure variables. The CES-D-10 and NSESSS are scales that measure the severity of depressive and PTSD symptoms, respectively, and are not clinical diagnoses. Conclusion There is a critical need to develop interventions focused on reducing the burden of stress on mental health.

To promote safe and positive health outcomes by utilizing culturally relevant evidence-based interventions for immigrant and refugee women survivors of intimate partner violence, their active participation in research is critical. With 43.6 million immigrants and refugees living in the United States, there is a need for research studies to eliminate health disparities in these populations. However, barriers to recruiting and retaining these populations in research prevent the provision of quality and culturally informed services to meet their needs. The aim of this article is to discuss the recruitment and retention strategies employed and analyze the methodological and ethical challenges in the context of the weWomen Study. The use of a multifaceted approach informed by best practices maximized recruitment efforts and active participation that generated high numbers of immigrant and refugee women participants. The study also substantiated the need for more community-based participatory approaches to engage community members in the development of culturally appropriate approaches that instill a sense of ownership over the research process. Active research participation of immigrant and refugee survivors will help investigators understand their unique needs and facilitate the implementation of targeted evidence-based interventions.

Purpose: The purpose of this research is to deepen the understanding of DEI training and show how scholars across the nation incorporated DEI leadership into academic roles. Faculty and administrators' experiential experience in diversity, equity, and inclusion (DEI) plays a role in the success or failure of DEI training. DEI training at institutes of higher learning should include metrics that examine our bias for invisible and overt support for DEI. Methods: Robert Wood Johnson Foundation Nurse Faculty Scholars (RWJFNFS) were surveyed by The Gauda Group at Grayling. Data were collected from a diverse group of scholars across the nation. An online survey followed by an in-depth phone interview was used to assess participants' roles as leaders in academic nursing, challenges faced by scholars in addressing DEI, and perceived values of undertaking DEI activities. Results: Major themes emerged from the findings. The themes included championing for DEI comes with a personal and professional risk. Greater success was noted when DEI was supported by leadership and included in institutional strategic planning. Conclusion: DEI is important and necessitates commitment from all levels of leadership, faculty, and strategic planning initiatives. DEI training fills an important role and subsidizes leadership effectiveness as it relates to DEI.

Background How to be an effective mentor is typically not taught formally because good mentoring is thought to beget good mentoring, but there is little concrete data to support that connection. Purpose Scholars in the Robert Wood Johnson Foundation's Nurse Faculty Scholars (NFS) program were surveyed to find out if the mentoring they received influenced their subsequent mentoring. Method The qualities that form the Mentorship Effectiveness Scale were used to investigate if the experience changed scholars' views of mentoring; open-ended questions provided an opportunity for scholars to describe additional insights. Results Thirty-nine out of 93 scholars (42%) replied. Scholars were influenced by the mentoring they received: they were now more inclined to give guidance on professional issues, provide constructive critiques, suggest resources, acknowledge mentees' contributions, and challenge mentees to extend their abilities. Scholars' experiences made them more aware of the power of mentoring, provided them with insights into how they might do the same, convinced them that mentoring shouldn't be confined to one advisor, made them realize that one style of mentoring doesn't work for everyone, and improved their likelihood of using an individual development plan when they mentored. Conclusions Effective mentoring does seem to beget effective mentoring because the interaction with mentors seems to leave a lasting impression and the perceived obligation to “pay it forward.”

This pilot study examined whether an evidence-based intervention for preventing HIV that was adapted for women residing in domestic violence shelters improved residents’ HIV knowledge and condom use self-efficacy. The intervention acceptability, feasibility, and fidelity were also assessed. Seven domestic violence shelter workers facilitated the intervention to 32 shelter residents. Residents had significantly higher HIV knowledge and condom use self-efficacy after the intervention. Residents found the intervention highly acceptable. Intervention facilitators generally agreed that the intervention was acceptable and feasible. Facilitators taught the intervention mostly as suggested, but with some changes. Study implications are discussed.

Severe intimate partner violence (IPV) including loss of consciousness from head injuries and/or strangulation can result in traumatic brain injury (TBI), a brain pathology characterized by altered brain function, cognitive impairment, and mental health disorders, including depression and posttraumatic stress disorder (PTSD). This study examines the prevalence of probable TBI (defined as loss of consciousness from a blow to the head and/or strangulation) and its association with comorbid PTSD and depression among Black women, who experience both higher rates of IPV and greater mental health burden than White and Latina women. Data come from a retrospective cohort study of 95 Black women with abuse history including IPV, forced sex, and childhood maltreatment. About one-third of women (n=32) had probable TBI. Among them, 38% (n=12) were hit on the head, 38% (n=12) were strangled to unconsciousness, and 25% (n=8) were strangled and hit on the head. Women with IPV history and probable TBI had significantly greater odds of various physical injuries including those that required medical care compared to other abused women. Probable TBI significantly increased comorbid PTSD and depression by 8.93 points (SE=3.40), after controlling for past violence (F((4, 90))=3.67, p

Awareness of the highly detrimental and long-term sequelae of brain injuries, and in particular repetitive mild traumatic brain injuries (mTBIs/concussions), has been rapidly growing. Specifically,...

PURPOSE OF REVIEW: This theoretical review identifies physiological mechanisms by which violence against women (VAW) may increase women’s susceptibility to HIV through trauma, stress, and immune dysfunction. RECENT FINDINGS: Research documents systemic and local immune responses are related to stress and trauma from abuse across the life course (i.e., childhood, IPV, adulthood re-victimization). Findings are interpreted within a theoretical framework grounded in the Social Stress Theory and the concept of toxic stress, and highlight the current state of the science connecting: (1) VAW to the physiological stress response and immune dysfunction, and (2) the physiological stress response and inflammation to HIV susceptibility and infection in the female reproductive tract. SUMMARY: Despite a dearth of research in human subjects, evidence suggests that VAW plays a significant role in creating a physiological environment conducive to HIV infection. We conclude with a discussion of promising future steps for this line of research.

Intimate partner violence (IPV) disproportionately affects marginalized women in the United States. This calls for effective safety planning strategies to reduce the risk for future revictimization and address safety needs of survivors from marginalized groups. This review identified types of interventions that incorporated safety planning and were successful in reducing the risk for future revictimization among IPV survivors from diverse groups, examined elements of safety planning in effective interventions, and described challenges or limitations in safety planning intervention research with marginalized women. A systematic search of five databases was performed. The search resulted in inclusion of 17 studies for synthesis. The included studies were quantitative, U.S.-based, evaluated interventions with a safety planning component, and had an outcome of change in IPV. Effective interventions that incorporated safety planning were empowerment and advocacy focused. Elements included were comprehensive assessments of survivors’ unique needs and situations, educating them about IPV, helping them identify threats to safety, developing a concrete safety plan, facilitating linkage with resources, providing advocacy services as needed, and conducting periodic safety check-ins. For survivors with mental and behavioral health issues, effective interventions included psychotherapeutic approaches along with safety planning to address survivors’ co-occurring health care needs. Although most studies reported positive findings, there were limitations related to designs, methods, adequate inclusion, and representation of marginalized women and cultural considerations. This calls for additional research using rigorous and culturally informed approaches to establish an evidence base for effective interventions that specifically address the safety planning needs of marginalized survivors of IPV.

Despite the importance of intimate partner violence (IPV) and homicide research to women’s health and safety, much remains unknown about risk factors for intimate partner homicide (IPH). This article presents the Arizona Intimate Partner Homicide Study, pilot research that is being conducted in one U.S. state to update and expand on risk factors for IPH. In the context of presenting this study, we summarize the literature on data collection techniques, various marginalized and under researched populations, and the importance of gathering data about the victim-offender relationship and situational IPH risk factors. Additional research is needed to update risk factors for IPH to account for changes in technology and to examine differential risk across diverse populations. Local, community based data collection strategies are likely to provide more comprehensive and nuanced insight into IPH; though, to understand risk factors among marginalized populations, it may be necessary to increase sample size through a national strategy. Although not a panacea, we present this ongoing research as a model for other states to emulate and improve upon, in the hopes of developing more comprehensive data examining risk for IPH among victims of IPV.

Background Large gaps exist in research on alcohol use and intimate partner aggression (IPA) among sexual minority women (SMW; eg, lesbian, bisexual). Dyadic research with SMW and their partners can illuminate how couple-level factors operate in conjunction with individual-level factors to shape well-being in this understudied and vulnerable population. Given the traditionally gendered lens with which women are primarily viewed as victims and men as perpetrators, understanding the dynamics of IPA in same-sex female couples can also advance research and practice related to IPA more generally. Objective Guided by a recent extension of the minority stress model that includes relational (couple-level) sexual minority stress and the I-cubed theoretical perspective on IPA, we will collect individual and dyadic data to better characterize the links between hazardous drinking and IPA among SMW and their partners. First, this study aims to examine the associations among minority stress, hazardous drinking, and IPA in SMW and their partners. Minority stressors will be assessed as both individual and couple-level constructs, thus further extending the minority stress model. Second, we aim to examine potential mediators and moderators of the associations among minority stress, hazardous drinking, and IPA. Finally, we aim to test models guided by the I-cubed theoretical perspective that includes instigating (eg, relationship conflict), impelling (eg, negative affect and trait anger), and inhibiting (eg, relationship commitment and emotion regulation) or disinhibiting (eg, hazardous drinking) influences on IPA perpetration. Methods This United States National Institutes of Health–funded project will draw from a large and diverse cohort of SMW currently enrolled in the Chicago Health and Life Experiences of Women (CHLEW) study—a 21-year longitudinal study of risk factors and consequences associated with SMW hazardous drinking. SMW currently enrolled in the CHLEW and their partners will be invited to participate in the CHLEW Couples Study. By analyzing dyadic data using actor-partner interdependence models, we will examine how each partner’s minority stress, hazardous drinking, and IPA experiences are associated with both her own and her partner’s minority stress, hazardous drinking, and IPA perpetration. Results Data collection began in February 2021 and will likely continue through 2023. Initial results should be available by mid-2024. Conclusions The CHLEW Couples Study will fill important gaps in knowledge and provide the basis for future research aimed at clarifying the causal pathways linking hazardous drinking and IPA among SMW. This will support the development of culturally appropriate targeted individual and dyadic prevention and intervention strategies. International Registered Report Identifier (IRRID) DERR1-10.2196/28080

IntroductionPhysical elder abuse is common and has serious health consequences but is under-recognised and under-reported. As assessment by healthcare providers may represent the only contact outside family for many older adults, clinicians have a unique opportunity to identify suspected abuse and initiate intervention. Preliminary research suggests elder abuse victims may have different patterns of healthcare utilisation than other older adults, with increased rates of emergency department use, hospitalisation and nursing home placement. Little is known, however, about the patterns of this increased utilisation and associated costs. To help fill this gap, we describe here the protocol for a study exploring patterns of healthcare utilisation and associated costs for known physical elder abuse victims compared with non-victims.Methods and analysisWe hypothesise that various aspects of healthcare utilisation are differentially affected by physical elder abuse victimisation, increasing ED/hospital utilisation and reducing outpatient/primary care utilisation. We will obtain Medicare claims data for a series of well-characterised, legally adjudicated cases of physical elder abuse to examine victims’ healthcare utilisation before and after the date of abuse detection. We will also compare these physical elder abuse victims to a matched comparison group of non-victimised older adults using Medicare claims. We will use machine learning approaches to extend our ability to identify patterns suggestive of potential physical elder abuse exposure. Describing unique patterns and associated costs of healthcare utilisation among elder abuse victims may improve the ability of healthcare providers to identify and, ultimately, intervene and prevent victimisation.Ethics and disseminationThis project has been reviewed and approved by the Weill Cornell Medicine Institutional Review Board, protocol #1807019417, with initial approval on 1 August 2018. We aim to disseminate our results in peer-reviewed journals at national and international conferences and among interested patient groups and the public.

Emerging data show associations between violence victimisation and negative HIV outcomes among youth in sub-Saharan Africa. We conducted in-depth interviews with adolescents and young adults living with HIV (aged 15-24 years) in Ndola, Zambia, to better understand this relationship. We purposively selected 41 youth (24 females, 17 males) with varied experiences of violence and virologic results. Analysis used thematic coding. Two-thirds of participants said violence affected their medication adherence, clinic attendance, and/or virologic results. They focused on the negative effects of psychological abuse from family members in homes and peers at schools, which were the most salient forms of violence raised, and sexual violence against females. In contrast, they typically depicted physical violence from caregivers and teachers as a standard discipline practice, with few impacts. Youth wanted HIV clinic settings to address verbal abuse and emotional maltreatment, alongside physical and sexual violence, including through peer mentoring. Violence - especially verbal and emotional forms - must be recognised as a potential barrier to HIV self-management among youth living with HIV in the region. Further testing of clinic, home, and school-based interventions may be critical to reducing levels of violence and improving HIV outcomes in this vulnerable but resilient population.