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Engaging in well-being behaviors may promote resilience, which can protect against burnout. This descriptive, correlational analysis utilized baseline data from health care workers enrolled in the Web-based Implementation of the Science for Enhancing Resilience longitudinal study ( N = 2,383). The study aimed to describe the association of (a) types of well-being behaviors (regular exercise, yoga, meditation, spent time with a close friend, vacation) and (b) total number of well-being behaviors with resilience (emotional thriving and emotional recovery), covarying for sociodemographic and professional characteristics. General linear model findings indicated that each well-being behavior was significantly associated with greater emotional thriving, while only exercise and spending time with friends were significantly related to greater emotional recovery. Emotional thriving and emotional recovery were also significantly higher among health care workers reporting more well-being behaviors. Engaging in well-being behaviors may be one part of the solution toward increasing resilience in health care workers that warrants further investigation.

The unique, individual nature of traumatic experiences and trauma symptoms and the limited healthcare resources typically allocated for individual patients pose barriers to implementing trauma-informed care. Developing knowledge on how survivors of violence engage in healthcare and self-advocate can lead to more empowering and efficient implementation of trauma-informed care. However, survivor perspectives on trauma-informed care are underrepresented in current literature and survivors' strategies for navigating healthcare are understudied. The aims of this participatory Photovoice study were to describe the healthcare experiences of female survivors of violence and their strategies for dealing with difficult healthcare experiences, healthcare providers, and the healthcare system. A sample of community-based women participated in an iterative series of five Photovoice meetings. Participants discussed multifaceted vulnerability in healthcare settings with regard to past traumatic violence, triggering or retraumatizing health care experiences, medical knowledge, and provider-patient relationships. They agreed that providers believing their symptoms, health concerns, and trauma disclosures was essential for positive provider-patient relationships and healthcare experiences. Findings on the importance of perceived belief with regard to trauma disclosure and health concerns and survivors' healthcare strategies are unique contributions to the literature. Providers should be accountable for integrating survivors' self-knowledge in collaborative healthcare decision-making, for making medical records and information easily accessible, and for expressing belief in trauma disclosures and health concerns. Future research should continue using participatory methods to assess evolving trauma-informed practices and patient engagement among survivors and to hasten progress toward trauma-informed care that effectively meets the needs of survivors.

Context Cancer and its treatment are inherently stressful and stress impacts important patient outcomes. Patients vary considerably in their response to stress. Understanding this variability requires a patient-centered multidimensional approach. Objectives The objectives of this study were to identify and characterize patient subgroups with distinct multidimensional stress profiles (stress appraisal, exposure, and adaptation) during cancer treatment. Methods Among 957 patients undergoing chemotherapy for breast, gastrointestinal, gynecological, or lung cancer, latent profile analysis was performed to identify patient subgroups using concurrent evaluations of global (Perceived Stress Scale) and cancer-specific (Impact of Events Scale–Revised) stress, lifetime stress exposure (Life Stressor Checklist–Revised), and resilience (Connor-Davidson Resilience Scale-10). Results Three latent classes were identified: “Normative” (54.3%; intermediate global stress and resilience, lower cancer-related stress, lowest life stress); “Stressed” (39.9%; highest global and cancer-specific stress scores, lowest resilience, most life stress); and “Resilient” (5.7%; lowest global stress, cancer-specific stress comparable to Normative class, highest resilience, intermediate life stress). Characteristics that distinguished the Stressed from the Normative class included the following: younger age, female gender, lower socioeconomic status, unmarried/partnered, living alone, poorer functional status, and higher comorbidity burden. Compared to Stressed patients, Resilient patients were more likely to be partnered, to not live alone, and had a higher functional status. No demographic or clinical characteristics differentiated Normative from Resilient patients. Exposure to specific life stressors differed significantly among the classes. Conclusion A subset of patients warrants intensive psychosocial intervention to reduce stress and improve adaptation to cancer. Intervention efforts may be informed by further study of Resilient patients.

This integrated literature review, framed by the gender affirmation framework, sought to contextualize the experiences of transgender adults interfacing with health care after the release of Healthy People 2020 . The constructs of the gender affirmation framework represented 4 a priori themes used to organize the findings. The 23 articles synthesized (quantitative, n = 13; qualitative, n = 7; case studies, n = 2; and mixed methods, n = 1) revealed numerous obstacles accessing health care, discrimination from health care professionals and clinicians, restricted health insurance benefits for medically necessary care, and barriers to medically necessary care, such as cross-sex hormones, as well as primary and preventative health care.

Women who have experienced intimate partner violence suffer from symptoms that persist long after the abuse has ended. However, the patterns and trajectory of these symptoms are poorly understood. The objective of this longitudinal research was to explore symptom trajectory typologies. A latent class growth analysis with multi-outcomes modeling was used to explore typologies based on women's (

Background Obtaining representative data from the transgender population is fundamental to improving their health and well-being and advancing transgender health research. The addition of the Behavioral Risk Factor Surveillance System (BRFSS) gender identity measure is a promising step toward better understanding transgender health. However, methodological concerns have emerged regarding the validity of data collected from transgender participants and its effect on the accuracy of population parameters derived from those data. Objectives The aim of the study was to provide rationale substantiating concerns with the formulation and application of the 2015 BRFSS sampling weights and address the methodological challenges that arise when using this surveillance data to study transgender population health. Methods We examined the 2015 BRFSS methodology and used the BRFSS data to present a comparison of poor health status using two methodological approaches (a matched-subject design and the full BRFSS sample with sampling weights applied) to compare their effects on parameter estimates. Results Measurement error engendered by BRFSS data collection procedures introduced sex/gender identity discordance and contributed to problematic sampling weights. The sex-specific "raking" algorithm used by BRFSS to calculate the sampling weights was contingent on the classification accuracy of transgender by participants. Because of the sex/gender identity discordance of 74% of the transgender women and 66% of transgender men, sampling weights may not be able to adequately remove bias. The application of sampling weights has the potential to result in inaccurate parameter estimates when evaluating factors that may influence transgender health. Discussion Generalizations made from the weighted analysis may obscure the need for healthcare policy and clinical interventions aimed to promote health and prevent illness for transgender adults. Methods of public health surveillance and population surveys should be reviewed to help reduce systematic bias and increase the validity of data collected from transgender people.

PURPOSE: This study addressed the experiences of older caregivers of cancer patients in the 2 weeks following a hospital discharge. It sought to understand the challenges they face in providing supportive care to patients at home. METHODS: Qualitative descriptive interviews with a narrative approach were conducted with each caregiver at 1 and 2 weeks following the patient’s discharge from the hospital. A thematic analysis approach was used to identify the themes that emerged from the caregiver interviews. RESULTS: Caregivers were primarily Caucasian (77%), were mostly 68 years of age or older (62%), and were primarily caring for a spouse (69%). Three key themes emerged from the qualitative analysis: Caregiver and patient wellness are connected, caregivers’ struggle with control issues, and challenges in communication with health professionals. CONCLUSIONS: These findings highlight psychosocial changes that caregivers experience over the 2-week time period following hospital discharge. Implications include the need to identify interventions to better prepare caregivers for the post-discharge period.

Aim and objective The purpose of this study was to develop knowledge on women survivors' healthcare experiences and strategies. Background Survivors of traumatic life events are at an increased risk for an array of negative health consequences, which can be complicated when distressing healthcare experiences act as a barrier to accessing needed care. Implications for trauma-informed and sensitive practice are well established, but evidence to date on survivors' healthcare experiences and patient engagement is limited. Design This study utilized individual interviews and qualitative description methods. Methods Fourteen participants completed a demographic questionnaire and one semistructured interview focused on their exposure to violence, healthcare experiences and strategies for navigating health care. Thematic analysis in alignment with qualitative description methods was used to analyse interview transcripts and identify themes. Results Participants in this study reported a variety of traumatic life experiences, ranging from childhood sexual abuse and intimate partner violence to severe car accidents. Experiencing a multiplicity of trauma sometimes complicated participants' later healthcare experiences. Although participants described ways in which providers helped them attain positive care experiences, they also acknowledged that limitations of the healthcare system could make trauma-informed practices difficult to implement. Participants described strategies they use to prepare for, navigate and recover after healthcare encounters including selecting providers, bringing support persons to appointments and engaging in relaxing activities after appointments. Conclusions Participants emphasised the importance of trusting and equitable provider-patient relationships and described several ways they prepare for, cope with and care for themselves after difficult healthcare experiences. Descriptive data on the patient engagement behaviours of survivors of violence is a unique contribution of this study to existing research. Relevance to clinical practice Findings from this study indicate the importance of comprehensive trauma history screening during health assessments, development of trusting and mutually respectful provider-patient relationships and provider training programmes focused on trauma-informed care practices.

Preparing future nursing leaders to be successful is important because many current leaders will retire in large numbers in the future. A structured nursing leadership development program utilizing the Essentials of Nurse Manager Orientation online program provided future nursing leaders with content aligned with nursing leadership competencies. Paired with assigned mentors and monthly leadership sessions, the participants increased their perception of leadership competence.

OBJECTIVE Lifetime stressful life events (SLEs) may predispose oncology patients to cancer-related distress (i.e., intrusive thoughts, hyperarousal, avoidance). Coping may influence cancer-related distress by mediating this relationship. This study sought to (a) determine the prevalence and impact of lifetime SLEs among oncology outpatients receiving chemotherapy and (b) examine the relationship between SLEs and cancer-related distress and the mediating role of coping on this relationship. METHOD Patients (n = 957), with breast, gastrointestinal, gynecologic or lung cancer, who were undergoing chemotherapy, completed the Life Stressor Checklist-Revised (LSC-R), a measure of lifetime SLEs. Cancer-related distress was assessed with the Impact of Event Scale-Revised. Coping strategies since beginning chemotherapy were assessed with the Brief COPE; 2 latent variables (engagement and disengagement coping) were identified based on these scores. LSC-R scores (number of SLEs and perceived impact during the prior year) were evaluated in relation to demographic and clinical characteristics. Structural equation modeling was used to evaluate the relationship between LSC-R and Impact of Event Scale-Revised scores and the mediating role of engagement and disengagement coping on this relationship. RESULTS On average, patients reported 6.1 (SD = 4.0; range = 0-23 out of 30) SLEs. Patients who were not married/partnered, had incomes

PURPOSE Healthcare professionals who provide services in the immediate or long-term aftermath of traumatic events need to understand the nature and frequency of traumatic events in the lives of women. However, research on trauma exposure in women has only recently begun to assess events other than intimate partner and sexual violence and has not supported direct statistical comparison of cross-national and cross-cultural data. The purpose of this descriptive, correlational study was to describe and compare trauma exposure prevalence and type in community-based samples of women in the United States, Colombia, and Hong Kong. DESIGN Women were recruited through posted notices at community health sites, snowball sampling, and online advertisements (N = 576). The Life Stressor Checklist-Revised (total score range 0 to 30) was used to determine the type and prevalence of trauma exposure. Data were collected by native language members of the research team. METHODS Descriptive statistics were used to summarize demographic characteristics and trauma exposure for the total sample and each community-based sample (location). Between-location differences were tested using Fisher's exact tests for categorical measures and general linear models with pairwise a posteriori least squares t-test for continuous measures. Responses to open-ended questions were translated and categorized. FINDINGS Over 99% of women in the total sample reported at least one traumatic life event. The mean number of traumatic life events per participant was 7, ranging from 0 to 24. Although there was consistency in the most commonly reported trauma exposures across locations, the rates of specific events often differed. CONCLUSIONS Historical, political, geographic, and cultural factors may explain differences in trauma exposure among women in the four locations studied. CLINICAL RELEVANCE This study offers relevant knowledge for providers in diverse locations who provide services to women who have experienced traumatic events and provides evidence for the need for future research to further enhance knowledge of trauma exposure among women, and on the effects of trauma in women's lives.

The goal of this exploratory study was to delineate health differences among transgender subpopulations (transgender women/TW, transgender men/TM, gender nonbinary/GNB adults). 2015 Behavioral Risk Factor Surveillance System data were analyzed to compare the health of three groups (TW:N = 369; TM:N = 239; GNB:N = 156). Logistic regression and adjusted odds ratios were used to determine whether health outcomes (fair/poor health, frequent physical and mental unhealthy days, chronic health conditions, and health problems/impairments) are related to group and its interaction with personal characteristics and socioeconomic position. Group was a significant predictor of fair/poor health and frequent mental unhealthy days, revealing significant health differences between the transgender groups. The odds of poor/fair health were approximately 2.5 times higher in TM and GNB adults relative to TW. The odds of frequent mental unhealthy days for TM were approximately 1.5-2 times greater than TW and GNB adults. Among those with health insurance, the odds of fair/poor health for GNB adults was more than 1.5-2 times higher that of TM and TW. Among those without health insurance, TM had over 7 times greater odds of fair/poor health than TW. This study underscores the importance of classifying and examining the health of the transgender population as unique subpopulations, as notable health differences were discovered. TM and GNB adults have significant health concerns, requiring the attention of clinical interventions aimed at promoting health and preventing illness.

Young Black men who have sex with men’s (YBMSM) attitudes and personal beliefs about themselves and their risk for HIV can be modified as a result of experiences with racism and HIV stigma. In-depth qualitative interviews were conducted with 25 HIV-negative YBMSM, aged 18–24, in North Carolina and Maryland. Data were thematically analyzed to capture participants’ experiences and thoughts related to stigmatizing experiences and their perception of risk for HIV. Participants reported experiencing HIV stigmatizing and blatant racist commentary related to their identities as YBMSM. Participants described diverse strategies to distance themselves from these negative stereotypes and decrease their sexual risk for HIV. The findings highlight that HIV stigma and racial stereotypes are one of the many types of discrimination that YBMSM experience within the Black and gay communities and in society; leading to psychological distress and an altered perception of self and sexual risk.

Objective To understand the processes that couples navigate as they cope with maternal postpartum depression (PPD) in early parenthood. Design Qualitative, interpretive phenomenological study. Setting Community setting in the western United States. Participants A convenience sample of 10 couples (N = 20, 10 mothers and 10 fathers) who indicated they had maternal diagnoses of PPD after the births of their first children within the last 3 years. Methods Couples were interviewed together and then individually with the use of a semistructured interview guide. Narrative and thematic analyses were used to understand couples' lived experiences of PPD. Results Participants cocreated their experiences of maternal PPD. Three primary phases in the pattern of coping with PPD were identified: Dismissal (couples attempted to normalize their experiences and protect the mother from judgment), Acknowledgment (couples revealed their concerns, the first step in the process of seeking help), and Accommodation (process of trial and error used to find a way to meet the needs of the mother). Conclusion Our findings suggest that practitioners must support the needs of the entire family, including fathers, when mothers have a diagnosis of PPD. Fathers support mothers during this difficult experience but not without an increased burden of stress to themselves.

This exploratory study examined the association between exposure to stressful life events, polymorphisms (rs165774 and rs4680) in the catechol-O-methyltransferase (COMT) gene, and risk of depression in women.A cross-sectional design gathered information from 150 Australia women, aged 60-70 years, on sociodemographics, stressful life events, and depressive symptoms. Participants also provided buccal cell swabs for genetic analysis.Among women exposed to stressful life events, the odds of depressive symptoms increased by 18% with each additional exposure (95% confidence interval [95% CI] 1.04-1.33, p = 0.007). Women who carried at least one "A" allele (AA/AG) for both rs165774 and rs4680 single nucleotide polymorphisms were less likely to report depressive symptoms (compared with women with the GG genotype; p = 0.019 and p = 0.037, respectively), although moderation analysis did not support the hypotheses of an interaction with stressful life events (rs165774: odds ratio [OR] = 1.13, 95% CI 0.87-1.46, p = 0.347; rs4680: OR = 1.15, 95% CI 0.91-1.44, p = 0.238).Our research suggests that women with polymorphisms in COMT were less susceptible to depressive symptoms but these polymorphisms do not appear to influence susceptibility to depression in those exposed to life stressors. Further research should consider other genetic variants in catecholamine pathways and their potential impact on women's mental health.

Current understandings of the effects trauma exposure on women's health are limited because prior research has largely focused on intimate partner and sexual violence in homogenous samples. In this descriptive study, the authors examined the relationships between lifetime trauma exposure and psychological well-being among women across the Pacific Rim. Psychological well-being differed significantly between the four locations and increased trauma exposures were related to poorer psychological well-being across and within locations. The authors report relevant findings on the relationship between trauma exposure and psychological well-being and provide evidence for future research to enhance knowledge on the effects of trauma in women's lives.

The purpose of this investigation was to gain an understanding of the levels of distress in resettled refugee women as a basis for the development of improved community based interventions to enhance the resettlement experience. A convenience sample of female refugees (n = 23) in a southern US city were interviewed using a socio-demographic questionnaire; the Refugee Health Screener-15 (RHS-15); and semi-structured, exploratory questions. Results showed consistently high levels of distress, indicated by responses to the RHS-15. Women ages 19-25 and over 50 displayed the highest risk. Categories of stressors included a lack of access to health and psycho-social support services, difficulty with communicating in the English language, and social isolation. In addition, women reported that a lack of trained interpreters contributes to reduced access to health and social service, causing further distress.

Background A dearth of effective and affordable treatment options has rendered nonpharmacological self-management a crucial part of living with migraine—a debilitating neurobiological condition without cure that disproportionately disables vulnerable women. Objective The aim of the study was to describe the development and use of a systems thinking, problem-structuring data collection approach that was applied to the study of migraine self-management with women in diverse social locations. Methods Two systems mapping activities were developed for use in focus groups: one to unpack a migraine episode (system support map) and the other (connection circle [CC]) to construct a mental model of self-management. Later in the process, a strengths-based problem-solving tool was developed to replace the CC. Results The CCs—often enlightening for affluent participants—left marginalized women feeling overwhelmed and defeated, as a solution to one challenge became the cause of another. Through constant comparison analysis, we recalibrated the approach using a theory, clinical experience, and participant feedback and replaced the CC with a strengths-based problem-solving activity highlighting relationships and trade-offs in a more agential, actionable way. Discussion Bringing a critical lens and strengths-based approaches to work with vulnerable populations can replace traditional deficit thinking in healthcare, developing options for leveraging resources and understanding complex health behaviors without losing sight of systemic, distributional justice issues. These systems thinking tools can provide a way to extrapolate the complexities of actual self-management behaviors and challenges faced by vulnerable women with migraine versus what they may be instructed to do by a medical model that does not always account for the social and structural determinants of equity and health

Title Provision of guideline-based care for drug-resistant tuberculosis in South Africa: Level of concordance between prescribing practices and guidelines. Objective We examined the influence of individual and site characteristics on the concordance between prescribed treatment regimens and recommended standardized regimen according to national guidelines for patients with drug-resistant tuberculosis (DR-TB) in South Africa. Methods Participants were 337 youth and adults treated for DR-TB between November 2014 and August 2016 at ten DR-TB treatment sites in Eastern Cape and KwaZulu Natal provinces, South Africa. Logistic regression was used to determine individual and system characteristics related to concordance at treatment initiation between the prescribed treatment regimens in terms of medication composition, dosage, and frequency and guideline-based standardized regimen that included four oral and one injectable medications. Results The sample was 19% (n = 64) youth (15–24 years), 53% (n = 179) male, 73% (n = 243) HIV coinfected, and 51% (n = 169) with prior history of TB treatment. Guideline medications were correctly prescribed for 88% (n = 295) of patients, but only 33% (n = 103) received the correct medications and doses. Complete guideline adherence to medications, doses, and frequency was achieved for 30% (n = 95) of patients. Younger age, HIV coinfection, and rural treatment setting were associated with the prescription of correct medications. Conclusion Most individuals are prescribed the correct DR-TB medications, yet few individuals receive correct medications, dosages, and frequencies. Further study is needed to examine the root causes for treatment guideline deviations and opportunities for improvement.

The purpose of this article is to examine the factors associated with women's mental health. A random sample of 340 Australian women aged 40-55 completed surveys on menopausal and lifestyle factors and mental health at three time points. We used hierarchical models to show that decrements in mental health were associated with a corresponding increase in some midlife symptoms (p < .01), time (p < .01), and poor physical health (p < .01), but the effect was not permanent. In older women, mental health was associated with physical functioning, climacteric symptoms, and time, while individual variations in mental health score were largely explained by lifestyle factors.

This study used mixed methods to examine the experiences and health of rural, young adult women ( N = 100) who self-reported past experience of physical, emotional and verbal, sexual, and relational abuse in adolescent dating relationships. Few studies have examined the lasting health ramifications of adolescent dating abuse adolescent dating abuse in rural populations, and almost no mixed methods studies have explored adolescent dating abuse. Participants completed questionnaires on demographics, relationship behaviors, and mental health symptoms. A subsample ( n = 10) of participants also completed semi-structured, in-depth interviews with the primary investigator. Results suggest that depressive symptoms and self-rating of health in these women are associated with particular kinds and severity of abusive experiences, and that adolescent dating abuse has ramifications for health and development beyond the duration of the original relationship. Self-rated health (SRH) was inversely associated with abusive behaviors in the relationship, whereas depressive symptoms were positively correlated with such behaviors. Self-rated health was also negatively correlated with depressive symptoms. The results of this study represent an important step toward establishing lifetime health risks posed by adolescent dating abuse.

Background - Chronic psychological stress may pose a serious threat to health, although the mechanisms are not fully understood. This study examines the impact of stress on modifiable lifestyle factors, depressive symptoms, health-related quality of life (HRQOL) and chronic illness in older Australian women. Methods - Cross-sectional data were collected from a random sample of 181 older adults aged 60-70 years from rural and urban areas of South-East Queensland, Australia. We used structural equation modelling to examine associations between stress, modifiable lifestyle factors, HRQoL, and chronic illness. Findings - Parameter estimates show that older women who reported life stressors where they felt helpless and feared for their life (high magnitude stressors) also reported higher body mass index (p = 0.03) and more chronic illness (p

Chronic pain in adults with sickle cell disease (SCD) is a complex multidimensional experience that includes biologic, psychologic, sociologic, and spiritual factors. To date, three models of pain associated with SCD (i.e., biomedical model, biopsychosocial model for SCD pain, and Health Beliefs Model) have been published. The biopsychosocial multidimensional approach to chronic pain developed by Turk and Gatchel is a widely used model of chronic pain. However, this model has not been applied to chronic pain associated with SCD. In addition, a spiritual/religious dimension is not included in this model. Because spirituality/religion is central to persons affected by SCD, that dimension needs to be added to any model of chronic pain in adults with SCD. In fact, data from one study suggest that spirituality/religiosity is associated with decreased pain intensity in adults with chronic pain from SCD. A biopsychosocial-spiritual model is proposed for adults with chronic pain from SCD, because it embraces the whole person. This model includes the biologic, psychologic, sociologic, and spiritual factors relevant to adults with SCD based on past and current research. The purpose of this paper is to describe an adaptation of Turk and Gatchel's model of chronic pain for adults with SCD and to summarize research findings that support each component of the revised model (i.e., biologic, psychologic, sociologic, spiritual). The paper concludes with a discussion of implications for the use of this model in research.

The purposes of this study were to describe the occurrence of chronic pain and to evaluate for differences in pain characteristics and intimate partner violence between women who reported mild compared with moderate to severe chronic pain. A convenience sample of community-based women ( N = 84) was recruited. The 77% of women who reported chronic pain were dichotomized into two groups. Women with moderate to severe pain ( n = 49) were significantly more likely to be unemployed, to be in the abusive relationship longer, to report more minor injuries and threats of violence, and to report pain in multiple locations that significantly interfered with every aspect of their lives.

Recent studies suggest that chronic psychological stress may accelerate aging at the cellular level. Telomeres are protective components that stabilize the ends of chromosomes and modulate cellular aging. Women exposed to intimate partner violence (IPV) experience chronic stress and report worse health. The purpose of this exploratory study was to examine telomeric DNA length in women who have experienced chronic stress related to IPV. We hypothesized that IPV exposure would be associated with shorter telomere length. The investigation used a cross-sectional design to study telomere length in women with a history of IPV exposure and control women who reported no prior exposure to IPV. Advertisements and public notices were used to recruit a convenience sample of healthy women. Mean leukocyte telomere length was measured in DNA samples from peripheral blood mononuclear cells (PBMCs) by a quantitative polymerase chain reaction assay (qPCR). Telomere length was significantly shorter in the 61 formerly abused women compared to the 41 controls ( t = 2.4, p = .02). Length of time in the abusive relationship and having children were associated with telomere length after controlling for age and body mass index (BMI) ( F(2, 99) = 10.23, p < .001). Numerous studies suggest that women who experience IPV have poorer overall health. It is often presumed that the stress of IPV may be causing greater morbidity. Findings from this descriptive study suggest a link between IPV exposure, duration of IPV-related stress, and telomere length molecular mechanisms that regulate cellular aging.

Purpose: To report the effectiveness of a prenatal intervention and to provide evidence that prenatal visits provide an opportune time for health assessment and counseling with abused women. Methods: Fifty ethnically diverse pregnant women who presented for routine prenatal care and who also reported being at risk for intimate partner violence (IPV) were recruited to the study. Participants were assigned to either usual care or the Video Doctor plus Provider Cueing intervention. At baseline and 1 month later at another routine prenatal visit, intervention group participants received a 15-minute Video Doctor assessment and interactive tailored counseling. Their providers received a printed Cue Sheet alert and suggested counseling statements. Main Findings: Participants in the intervention group were significantly more likely to report provider-patient discussions of IPV compared with participants receiving usual care at baseline (81.8% vs. 16.7%; p < .001) and at the 1-month follow-up (70.0% vs. 23.5%; p = .005). Summing the number of patient-provider discussions across the two visits at baseline and 1 month later, intervention participants were significantly more likely to have IPV risk discussion with their providers at one or both visits (90.0% vs. 23.6%; p < .001) compared with the participants who received usual care. When specifically asked about the helpfulness of these IPV-related discussions, 20 out of 22 (90.9%) participants rated the discussion as helpful or very helpful at baseline and all 18 (100%) participants rated the discussion as helpful or very helpful at the 1-month follow-up. Conclusion: Video Doctor plus Provider Cueing intervention significantly increases the likelihood of provider-patient IPV discussion with pregnant women with a history of abuse. © 2011 Jacobs Institute of Women's Health.

burton c.w., halpern-felsher b., rankin s.h., rehm r.s. & humphreys j.c. (2011) Relationships and betrayal among young women: theoretical perspectives on adolescent dating abuse. Journal of Advanced Nursing ABSTRACT: Aims. Adolescent dating abuse is not specifically described by any current nursing theory, and this article presents discussion of some existing theories that could inform a nursing theory of adolescent dating abuse. To account for the effects of gender, this discussion is limited to young women. Background. Adolescent dating abuse is an important and understudied international issue for nursing. Theoretical frameworks can support development of nursing scholarship for such issues. No single theory yet exists in nursing to explain the experiences and health ramifications of dating abuse among young women. Data sources. A summary table of theories is provided. Literature was gathered via database search and bibliographic snowballing from reference lists of relevant articles. Included literature dates from 1982 through 2010. Discussion. Theories of relationship formation and function are discussed, including attachment, investment, feminist and gender role conflict theories. Betrayal trauma theory is considered as a mechanism of injury following an abusive dating experience. Implications for nursing. Gender, relationship and adolescence combine in a complex developmental moment for young women. To improve nursing care for those at risk for or in the throes of abusive relationships, it is critical to develop specific nursing approaches to understanding these relationships. Conclusion. Existing theories related to relationship and traumatic experiences can be combined in the development of a nursing theory of adolescent dating abuse among young women. Language: en

Objectives: To describe depressive symptomatology and examine the relationship between social stressors and depressive symptoms in pregnant African American women. Design and Sample: Cross‐sectional study of 119 women receiving care at 2 prenatal clinics in Northern California. Measures: Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES‐D). Social stress variables included discrimination, trauma exposure, social conflict, and economic stress. Results: In this sample, mean CES‐D score was 15.88. Forty‐two percent of the women had CES‐D scores ≥16 (possible risk), and 23% had CES‐D scores ≥23 (probable risk). There were significantly positive relationships between the social stress variables (discrimination, trauma exposure, social conflict, economic stress) and CES‐D scores. Stepwise multiple regression analysis indicated that together discrimination and social conflict accounted for 36% of the variance in antepartum depressive symptoms. Conclusions: Discrimination and social conflict are considerable sources of stress that contribute to levels of antepartum depressive symptoms in African American women. While the results reinforce the importance of universal prenatal screening, comprehensive strategies are also needed to help ameliorate the impact that social stressors such as discrimination and social conflict have on the mental health of pregnant African American women.

Child physical abuse is recognized as a major public health problem that affects children and is likely to become increasingly common. The objective of this study was to examine the effects of a cognitive adjustment program on parental attitudes toward child rearing and the potential for this abuse. Child-care centers were randomly allocated to either the intervention or the control group. The sample included 116 Thai parents of children aged 1-6 years. The intervention group attended the cognitive adjustment program while the control group received the usual services. The results showed that, after program completion, the intervention group had statistically significantly better parental attitudes toward child rearing, but not a significantly lower potential for CPA than the control group. We concluded that the cognitive adjustment program was effective in altering parental attitudes toward child rearing. However, in order to enhance its efficacy, the program should be modified to be more intensive and it should be studied further for its effect on the potential for abuse.

Although associations between intimate partner violence, chronic pain, depression, posttraumatic stress disorder (PTSD), and lifetime trauma exposure are well known, previous studies are limited by their recruitment of women from shelters. These relationships were explored with a community-based sample of formerly abused women ( N = 84). Seventy-seven percent of women reported pain of >" xbd="604" xhg="581" ybd="1721" yhg="1685"/>3 months duration, and 75% had moderate to severe pain. Based on logistic regression analysis, women with moderate to severe chronic pain were significantly less likely to be employed, had more depressive symptoms, and were in the abusive relationship longer than women in mild chronic pain. Both pain severity groups had equally high levels of depressive and PTSD symptoms and multiple trauma exposures. Findings document the persistence of significant symptomatology in formerly abused women.

Objective To describe levels of anxiety and self‐efficacy for childbirth in nulliparous women during the late third trimester and to identify relationships among those variables, prehospitalization labor pain, management strategies, and hospital admission status. Design A longitudinal, descriptive study. Participants Thirty‐five English‐speaking nulliparous women, 18 to 40 years of age, more than or equal to 38 week’s gestation, with uncomplicated pregnancies. All participants had a significant other (husband or partner) and attended childbirth education programs. Main Outcome Measures Spielberger Trait Anxiety Inventory, Prenatal Self‐Evaluation Questionnaire, Childbirth Self‐Efficacy Inventory, McGill Pain Questionnaire‐Short Form, postpartum interviews, and medical records review. Results Prenatal anxiety was significantly related to self‐efficacy for childbirth in late pregnancy, labor pain, number of hours at home in labor, and admitting cervical dilation. The number of management strategies used was related to pain scores during labor before hospital admission. Women who spent longer periods of time at home in labor arrived at the hospital with a greater cervical dilation. Conclusions Antenatal characteristics influence intrapartal outcomes in nulliparas. Labor environment, at home and in the hospital, is recognized as an important component of the first childbirth experience.

Objective To evaluate the effectiveness of an empowerment intervention in reducing intimate partner violence (IPV) and improving health status. Design Randomised controlled trial. Setting Antenatal clinic in a public hospital in Hong Kong. Sample One hundred and ten Chinese pregnant women with a history of abuse by their intimate partners. Methods Women were randomized to the experimental or control group. Experimental group women received empowerment training specially designed for Chinese abused pregnant women while the control group women received standard care for abused women. Data were collected at study entry and six weeks postnatal. Main outcomes measures IPV [on the Conflict Tactics Scale (CTS)] health-related quality of life (SF-36) and postnatal depression [Edinburgh Postnatal Depression Scale (EPDS)]. Results Following the training the experimental group had significantly higher physical functioning and had significantly improved role limitation due to physical problems and emotional problems. They also reported less psychological (but not sexual) abuse minor (but not severe) physical violence and had significantly lower postnatal depression scores. However they reported more bodily pain. Conclusion An empowerment intervention specially designed for Chinese abused pregnant women was effective in reducing IPV and improving the health status of the women. (authors)

This study describes objective and subjective sleep in a convenience sample of 29 battered women living in specialized transitional housing programs compared to 30 women living in their own stable home environment. Compared to healthy controls, battered women living in transitional housing experienced longer sleep onset latencies by both subjective and objective measures and higher percentage of time awake during the night by objective measure. Poor sleep quality may reflect the relative contributions of less total sleep time, difficulty falling asleep, and more awakenings during the night rather than just one aspect of disturbed sleep. Findings suggest that battered women in transitional housing programs may improve daytime alertness and benefit from interventions directed toward reducing sleep onset latency as well as increasing total sleep time.

The objective of this qualitative study was to examine extrinsic barriers to substance abuse treatment among pregnant and parenting women enrolled in residential perinatal substance abuse treatment programs in Northern California. Life history interviews were conducted with 36 women to examine help-seeking behaviors before treatment enrollment. Data analysis used the analytic framework of Mandelbaum (1973) to describe dimensions, turnings, and adaptations of participants. Results indicated that the majority (n = 34) of participants sought prenatal care but identified fear of punitive actions from helping institutions and individuals as a major barrier. Other extrinsic barriers included substance abuse treatment program barriers, partners, the status of opiate dependency, and the status of pregnancy. Biological, socio-cultural, and psychosocial dimensions of participants' care-seeking experiences were identified. The turning was pregnancy and adaptations included preserving the family, managing fear and manifesting faith. Findings describe the transformation of the therapeutic alliance and the gendered impact of two decades of the War on Drugs in the United States. Participants' coping strategies suggest that the desire for child custody and concern for fetal and child well-being was a priority and motivated care seeking despite extrinsic barriers perceived to be threatening to the woman's safety and autonomy.

Although children of battered women have received increased attention in recent years, little is known about the lived experience of growing up in a home in which the mother and possibly others are regularly abused. To better understand the family as context, life histories were collected from 10 resilient adult daughters who had grown up in violent homes. This report of the biological, social, cultural, and psychosocial dimensions of their experience reveals lives in which tension, fear, and episodes of violence were pervasive. Although not invulnerable, these daughters of battered women were able to maintain a sense of self and live rewarding lives, despite concerns about stigma and retribution.

Purpose: To examine the relationship between spiritual beliefs and psychological distress in sheltered battered women. Design: A convenience sample of 50 ethnically diverse women who had resided for at least 21 days in battered women's shelters participated. Data were obtained over a 7-month period in 1998 and 1999. Methods: Participants completed the Spiritual Perspective Scale (SPS), Symptom Checklist- 90-Revised (SCL-90), Conflict Tactics Scale, and a demographic data sheet. Results: These sheltered battered women placed high value on their spiritual beliefs and used a variety of spiritual practices to aid them. The relationship between the Global Severity Index as measured by the SCL-90 and SPS scores approached statistical significance (r = -.27, p = 0.06). However, a significant inverse relationship was found between the SPS score and the obsessive-compulsive score (r = -.34, p < 0.05), interpersonal sensitivity score (r = -.31, p

The purpose of this nursing research was to describe the trauma experience of sheltered battered women. Trauma history was operationalized as the participant's experience with traumatic life events in general (Trauma History Questionnaire [B. L. Green, 1995]) and with battering specifically (Conflict Tactics Scale, including a Physical Injury Severity scale). A convenience sample of 50 ethnically diverse women in the San Francisco Bay area was obtained from those residing in 2 shelters. Participants had experienced an average of 8.1 +/- 4.6 traumatic events (battering and nonbattering) over the course of their lives. Analysis of relationships between selected biopsychosocial and trauma history variables revealed the importance and beneficial effects of spiritual beliefs to many sheltered battered women.

Background and study objective Telomere length provides an estimate of cellular aging and is influenced by oxidative stress and health behaviors such as diet and exercise. This article describes relationships between telomere length and sleep parameters that included total sleep time (TST), wake after sleep onset (WASO), and self-reported sleep quality in a sample of adults with chronic illness. Design and participants Cross-sectional study of 283 adults (74% male, 42% Caucasian) infected with human immunodeficiency virus (HIV) while living in the San Francisco Bay area, CA, USA. Ages ranged from 22-77 y. Measurements and results TST and WASO were estimated with wrist actigraphy across 72 h; self-reported sleep quality was assessed with the Pittsburgh Sleep Quality Index. Relative telomere length (RTL) in leukocytes was estimated by quantitative polymerase chain reaction assays. Shorter RTL was associated with older age, and RTL was shorter in males than females. RTL was unrelated to HIV disease characteristics. RTL was not associated with WASO or self-reported sleep quality. Participants with at least 7 h sleep had longer RTL than those with less than 7 h, even after controlling for the effects of age, sex, race, education, body mass index, metabolic hormones (i.e., leptin, ghrelin, adiponectin, and resistin), depression and anxiety, and sleep quality. Conclusion Results suggest that sleep duration is associated with preserving telomere length in a population of human immunodeficiency virus-infected adults. Getting at least 7 hours of sleep at night may either protect telomeres from damage or restore them on a nightly basis.

The mental health impact of abusive adolescent dating relationships has not been well described, but fear related to abuse has been reported. We elaborate the theme of fear in women's descriptions of a history of adolescent dating abuse. A sample of community-based women, ages 19-34, who experienced an abusive dating relationship during adolescence (ages 11-20) was used. Data were analyzed via thematic analysis. Fear was a consistent and resonant theme. Three types of fear were identified: fear for self, fear for other relationships, and fearful expectation. These results offer important insights into the impact of abusive adolescent relationships on women's mental health. © 2013 Informa Healthcare USA, Inc.

Objective To examine the extent to which socio-demographics, modifiable lifestyle, and physical health status influence the mental health of post-menopausal Australian women. Methods Cross-sectional data on health status, chronic disease and modifiable lifestyle factors were collected from a random cross-section of 340 women aged 60–70 years, residing in Queensland, Australia. Structural equation modeling (SEM) was used to measure the effect of a range of socio-demographic characteristics, modifiable lifestyle factors, and health markers (self-reported physical health, history of chronic illness) on the latent construct of mental health status. Mental health was evaluated using the Medical Outcomes Study Short Form 12 (SF-12 ® ) and Center for Epidemiologic Studies Depression Scale (CES-D). Results The model was a good fit for the data ( χ 2 = 4.582, df = 3, p = 0.205) suggesting that mental health is negatively correlated with sleep disturbance ( β = −0.612, p β = −0.141, p = 0.024).While mental health was associated with poor sleep, it was not correlated with most lifestyle factors (BMI, alcohol consumption, or cigarette smoking) or socio-demographics like age, income or employment category and they were removed from the final model. Conclusion Research suggests that it is important to engage in a range of health promoting behaviors to preserve good health. We found that predictors of current mental health status included sleep disturbance, and past mental health problems, while socio-demographics and modifiable lifestyle had little impact. It may be however, that these factors influenced other variables associated with the mental health of post-menopausal women, and these relationships warrant further investigation.

Advocacy intervention has been shown to be efficacious at reducing depressive symptoms in women who suffer from intimate partner violence (IPV). However, the intervention effect among abused immigrant women has not been well studied. This study compares the demographic and psychosocial characteristics between abused immigrant and nonimmigrant women, and evaluates the impact of immigration status on the efficacy of an advocacy intervention in reducing depressive symptoms and improving perceived social support. Two hundred abused Chinese women recruited from a local community center in Hong Kong were randomized to receive either the advocacy intervention or usual care. The advocacy intervention was found to be effective at reducing depressive symptoms and improving social support for abused Chinese nonimmigrant women, but the same effects were not seen for abused immigrant women. The findings provide essential insights into the need for developing targeted and efficacious advocacy interventions for abused immigrant women. Effective services to address abused immigrant women’s needs were also suggested.

Emergency contraceptive pills (ECP) are a safe and efficacious backup method of birth control. Despite widespread availability, ECP is underutilized by young women. While partner level of involvement has been shown to influence contraceptive behavior, there is a dearth of knowledge regarding any possible association between partner influence and ECP use. To better understand the reasons for the seemingly underuse of ECP, a grounded theory study was conducted to elucidate the relationship of couple dynamics and knowledge of, attitudes toward, and decision making regarding the use of ECP in coupled young adults. Consistent with contemporary constructivist grounded theory methods, several categories were identified including the meanings associated with ECP use. This article presents an elaboration of this particular finding. The meanings that participants ascribed to ECP use represented a continuum of value attributes regarding ethics, safety, efficacy, and responsibility.

Identifying the incidence and severity of types of intimate partner violence against women exposed to this in their communities and the pertinent socio-demographic characteristics.This was a cross-sectional descriptive study of 150 women suffering intimate partner violence. The Severity of Violence Against Women Scale was used to explore demographic variables, e.g. age, sex, socioeconomic status, educational level, marital status and occupation.Mean age was 37 years, 74 % were mestizos, 68 % were living in socioeconomic groups 2 and 3, 43 % were living with a permanent partner and 31 % had experienced violence by other people than their intimate partner. There was high exposure (96.3 %) to more than one type of violence; 88% had suffered physical and 53 % sexual threats. All types were correlated with each other (r ranged from 0.42 to 0.84 (p0.01)). Socioeconomic status had a significant negative correlation with threats of violence (p0.01) and positive correlation with physical violence (p0.01); other socio-demographic variables did not correlate.Psychosocial factors are heavily involved in the phenomenon. Screening and intervening in forms of violence other than physical ones means protecting women and reducing the harm being done to them and alleviating their suffering. It is vital that interventions should be undertaken for preventing different types of violence according to socioeconomic group and accompany women and their assailants in recognising such violence and seeking help.

We undertook the translation and adaptation of an instrument developed to measure women's lifetime trauma exposure, the Life Stressor Checklist-Revised (LSC-R), in order to determine its utility and cultural appropriateness with Colombian Spanish-speaking women. The LSC-R was forward and backward translated and administered to a sample (N = 217) of community-based women volunteers in Medellin, Colombia. Open-ended questions were included to assess the construct validity and cultural appropriateness of the LSC-R. The LSC-R was found to be valid and easily understood. Trauma exposure was common, but its assessment was not overly distressing to Colombian women.

To examine the effect of an advocacy intervention on the use of safety-promoting behaviors in community-dwelling abused Chinese women as compared to a control condition of usual care.This efficacy trial used a randomized controlled, parallel group design.A total of 200 Chinese women in a community setting who screened positive for intimate partner violence using the Chinese version of the Abuse Assessment Screen were randomized to receive either an advocacy intervention (intervention group, n=100) or usual community care (control group, n=100). The outcome measured was the change in the self-reported safety-promoting behaviors as measured by the Safety-promoting Behavior Checklist over three time-points (baseline, 3-month follow-up and 9-month follow-up). Participants and assessors were blinded to the study hypothesis. Assessors were further blinded to the group membership of the participants.The Safety-promoting Behavior Checklist scores in the intervention group increased from the baseline on average by 5.65 (95% confidence interval [CI], 4.92-6.39) at 3-month and 6.65 (95% CI, 5.90-7.39) at 9-month follow-ups, while the scores in the control group also increased by 1.71 (95% CI, 1.06-2.37) at 3-month and 1.79 (95% CI, 1.15-2.43) at 9-month follow-ups. After adjusting for baseline differences, the between-group differences in scores were significant at 3-month and 9-month follow-ups (p=0.04). The intervention group increased the scores by 3.61 (95% CI, 2.61-4.61, p0.001) more than the control group at 3-month and by 4.53 (95% CI, 3.53-5.53, p0.001) at 9-month follow-ups.An advocacy intervention is efficacious in increasing the use of safety-promoting behaviors as compared to usual community care in community-dwelling abused Chinese women.