Substance Misuse Themes Among Women Living in Transitional Housing: Effects on Children, Intimate Partner Relationships, and Social Relationships.

ABSTRACT: Traditional substance misuse treatments have not always taken women or marginalized populations into consideration. A holistic approach that addresses how drugs may be used to cope with trauma caused by violence, poverty, and neglect as well as employment of engagement strategies that connect populations with culturally relevant support systems are key, especially in treating African American women. As substance misuse rates rise among African American women, characterizing how this may influence or be influenced by relationships (such as with children, intimate partners, and social relations) is especially important in the context of effective treatment. The purpose of this qualitative study was to examine the themes surrounding substance misuse and close relationships among women previously enrolled in a transitional housing treatment program grounded in social support. Many women discussed how the program itself was an impetus in addressing not only their own substance use but also intergenerational substance use within their families. Women also noted how relationships with their children were vastly different pretreatment compared with during and after treatment, specifically emphasizing a positive improvement. Regarding intimate relationships, African American women learned to establish assertiveness and navigate healthier social relationships, all while sustaining drug abstinence. It is important to acknowledge the role of the healthcare professional in ensuring effective and culturally relevant treatment for African American women; nursing curricula should include evidence-based practice education and training on mental health and substance misuse specific to marginalized communities to more deeply understand the complex intersections of substance misuse, poverty, and social relationships in the lives of women.

Barriers Faced by American Indian Women in Urban Wisconsin in Seeking Help Following an Experience of Intimate Partner Violence.

American Indian1 (AI) women experience high rates of intimate partner violence (IPV) and face many barriers when help-seeking. This study aims to understand better the context of IPV and help-seeking behaviors for urban AI women after experiences with IPV. Postcolonial and Indigenous feminist frameworks framed this critical ethnography study. Semistructured interviews with 34 AI IPV survivors2 living in Wisconsin urban areas were conducted. Our findings highlight context-specific structural barriers to help-seeking after experiences of IPV heightened by the COVID-19 pandemic. Context-specific and survivor-led interventions are necessary to address and reduce barriers that urban AI women face.

Centering Our Voices: Experiences of Violence Among Homeless African American Women.

Women experiencing homelessness who are also survivors of violence require uniquely tailored programs to accommodate complex needs. To understand how violence shaped the lives of formerly homeless African American women, an instrumental case study design and community-based participatory research approach was utilized in this qualitative study. Focus group interviews with graduates (N = 40) from a long-term transitional housing program were conducted. Using thematic analysis, identified themes included: cycles of violence, violence in the community, relationships with children, and coping with violence. These themes illustrated survivors' growth through supportive programming and highlighted services dedicated to empowering women who have experienced violence.

Successful substance use disorder recovery in transitional housing: Perspectives from African American women.

Through the lens of Black Feminist Thought, the intersectionality of poverty, racism, and sexism in the lives of urban dwelling African American women was explored. Reflections on recovery among women previously enrolled in a transitional housing treatment program were gathered via semistructured interviews, using an instrumental case study design. Four major themes surrounding the context of recovery were identified and analyzed: Knowledge and awareness of addiction, importance of social support and support groups, peace of mind that resulted from a new lifestyle, and women's desire to maintain their recovery status. Many women did not realize that their drug use constituted an addiction prior to their enrollment in the program. Social support and support groups such as AA, NA, and AODA helped the women to maintain their recovery, and this newfound recovery resulted in additional stress relief. Finally, many women felt empowered to maintain their recovery, not only for themselves but also their children. Paradigm shifts in treatment and recovery processes are needed to better serve minority populations, specifically focusing on women and African Americans. Recovery services must shift from previously male centered, hegemonic, pathology-oriented treatment modalities to serve populations more efficiently and equitably. Furthermore, to create effective social change in recovery, programs must address the social determinants of substance misuse, addictive behaviors, and underlying structural inequalities resulting from the intersection of racism, sexism, and classism. Deeper understandings of complex social issues must be disseminated, particularly for women battling substance misuse who are homeless, racially discriminated against and marginalized. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A qualitative analysis of perceptions of and reactions to COVID-19.

OBJECTIVE: To understand communities' perceptions, beliefs, and health-related behavior choices related to COVID-19 in order to guide public health nursing communication and interaction with patients and the community. DESIGN: A qualitative study, guided by the Health Belief Model (HBM), strove to comprehend the perceptions and reactions to COVID-19 among Wisconsinites. SAMPLE: Twenty-five diverse Wisconsin residents aged 18 or older. MEASUREMENTS: Semi-structured interviews provided information about individuals' attitudes, perceptions, and reactions to COVID-19. Interviews were audio-recorded, transcribed, and thematic analysis was conducted to identify themes. RESULTS: We identified three major themes: (1) "health care starts way before you ever enter the doors of a healthcare facility"; (2) "to live in a society is to help each other"; and (3) mental health as impacted by COVID-19. CONCLUSIONS: This study demonstrated the need for greater public health support, as well as the role of Social Determinants of Health. Understanding perceptions and reactions to COVID-19 can help public health nurses understand and better respond to future pandemics.

Adverse childhood experiences among previously homeless African American women.

OBJECTIVE: To learn how adverse childhood experiences (ACEs) impacted the life course trajectory of formerly homeless and at-risk African American women. DESIGN: Intersectionality and life course theory informed this qualitative pilot study, based on an instrumental case study design. SAMPLE: Forty previously homeless and at-risk African American women, who were graduates from a long-term transitional living facility in Milwaukee, Wisconsin. MEASUREMENTS: Focus group interviews and one individual interview provided data about participants' life experiences prior to, during, and following their time at the transitional living facility, which provided supportive wrap-around services. Interviews were audiotaped, transcribed, and line-by-line thematic analysis was conducted to identify themes. Fifteen focus group participants also completed ACE questionnaires. RESULTS: Participants reported a high prevalence of multiple ACEs, and three themes were identified: childhood experiences with family conflict, childhood experiences of abuse, and negative coping mechanisms. One-hundred percent of women had experienced at least one ACE, based on ACE questionnaire responses. CONCLUSIONS: ACEs affect various parts of patient's lives as adults. For nurses and other healthcare professionals, connecting with community resources provides the opportunity to strategically approach health improvement with wrap-around resources to improve health outcomes.

'I was broken in so many different ways': The intersection of complex factors impacting homeless and at-risk African American women's mental health and well-being.

African American women are at higher risk of poor mental ill health compared with other racial and ethnic groups in the United States. For low-income and homeless African American populations, the risk of poor mental ill health is even higher. The purpose of our study was to learn what programmes at a long-term transitional living centre helped at-risk and homeless African American mothers to succeed on their own, in accordance with self-identified goals. We conducted ten focus group interviews with 39 graduates of a long-term transitional living centre located in a Midwestern city, and an individual interview with the founder of that centre (N = 40). Our study was informed by Black Feminist Thought, Life Course Theory, and an instrumental case study design. Thematic analysis was used to identify patterns in the qualitative data collected. Findings pertaining to mental health included impacts of adverse childhood experiences, lack of social networks, child placement in foster care, and implications on self-esteem and self-worth. Our findings demonstrate the need for healthcare providers to take into account the intersecting factors facing African American women experiencing homelessness undergirded by systemic racism, which impacts their mental health and well-being.

Promoting the health of refugee women: a scoping literature review incorporating the social ecological model.

The health of refugee women after settlement in a new country, can be adversely or positively affected by individual, interpersonal, community, and organizational factors. While much of the previous literature highlights these factors individually, there is a lack of comprehensive synthesis regarding how the factors interact to influence the health of refugee women. We conducted a thematic analysis in our literature review to elucidate how providers can work with refugee women to prevent adverse health outcomes and intervene at multiple levels to improve their health outcomes after resettlement. We reviewed peer-reviewed literature from 2009 to 2019 from Google Scholar, JSTOR, Global Health, PubMed, CINAHL, Sociological Abstracts, and Social Service Abstracts, and also used citation chaining, to identify relevant information pertaining to refugee women's health. The key terms used for our literature review were, health care, violence, social support, and mental health. In total, we included 52 articles, 3 books, and 8 other sources. We found that refugee women are vulnerable to violence during migration and typically have high rates of post-traumatic stress disorder. There were also concerns of secondary victimization by providers after resettlement. We also found that social support is an important factor for reducing isolation, and improving access to health care, as well as improving mental health outcomes. However, social support was often difficult to maintain, and was moderated by factors such as English language fluency. Health care was influenced by health literacy, cultural difference, communication concerns, and access issues. The findings suggest that at the individual and interpersonal levels there is a need to address language barriers, improve provider-patient communication, and provide appropriate medical and mental health screenings. At the organizational level, inter-organizational communication and awareness are vital. At the community level, providers can work with community leaders, to educate, create dialogue and collaboration, to help facilitate understanding and bolster community social support. Improved communication and knowledge about the unique needs and concerns of refugee women through an integrated, multi-system approach is necessary to improve their health outcomes.

Prediction and management of CAD risk based on genetic stratification.

Discovery of genetic risk variants for CAD and their assembly on a computerized microarray enables a genetic risk score (GRS) to be expressed as a single number. Utilizing this array, genetic risk stratification has been performed in over 1 million cases and controls. The genetic score based on one's DNA can be determined anytime from birth on and is independent of age and conventional risk factors. Utilizing the GRS, one can select those at highest risk and would benefit most from primary prevention. Clinical trials have shown that modifying lifestyle or using statin therapy reduces the risk for CAD by approximately 50%. The use of the GRS for primary prevention will have a transformative effect on preventing the spread of CAD.