Examining Women's HIV Protective Behaviors in Nepal.

Women's autonomy in decision making has important sexual and reproductive health implications. This study uses a nationwide analysis in Nepal to examine women's autonomy, attitude toward intimate partner violence (IPV) behaviors, and HIV-related knowledge in the execution of HIV protective behaviors such as having one sexual partner or getting an HIV test to prevent HIV transmission. Secondary data analysis was conducted using the nationally represented Nepal Demographic and Health Survey (2016-2021) dataset. The sample included 9,904 women ages 15 to 49 who self-identified as ever married. Factor analysis for women's autonomy, attitude toward IPV behaviors, and HIV-related knowledge were conducted based on social dominance theory. Structural equation modeling was conducted, and the results indicated that higher autonomy decreased the risk of HIV infection through having one sexual partner. Factors related to multiple sex partners included unemployment, religious affiliation, and age. Similarly, higher autonomy, HIV-related knowledge, having a formal job, and urban residence increased women's likelihood of taking an HIV test. Women's higher education, greater wealth, religious affiliation, and youth also correlate with HIV testing. Future HIV prevention interventions should include strategies that support women's social and economic empowerment and enhance women's ability to make informed choices about their health and risks.

The Flint women's study: community perspectives on contraception and family planning, sexuality education and barriers to reproductive health.

Teenage pregnancy can have adverse social and health outcomes, and rates are high in Flint, Michigan as compared to the rest of the state and the USA. It is important to understand contributing factors to adolescent pregnancy to be able to better address this issue. This study examined qualitative data from interviews with 100 community members who participated in the Flint Women's Study, a study designed to better understand the hopes, dreams and needs of women in Flint, and their suggestions for how to address identified needs. Using a Community Based Participatory Approach, data were collected and analysed by a team of community members and academic researchers. The paper focuses on the theme of family planning among young women which included attitudes about contraception, sexuality education and bio-medical and structural barriers to accessing reproductive health. Community members emphasised the need for increased access to comprehensive contraception options, improved sexuality education in schools and from health care providers, and ultimately valuing young women.

Social Work Care in Traumatic Brain Injury and Substance Use Disorder Treatment: A Capacity-Building Model.

Co-occurring traumatic brain injury (TBI) and substance use disorders (SUD) are a major public health concern, yet TBI is often underrecognized within SUD treatment organizations. Social workers in these organizations are well positioned to deliver tailored treatment, but little is known about what social workers are doing to address the needs of these clients. The purpose of this study was to examine current social work practices in providing care to clients with co-occurring TBI and SUD. Using grounded theory methodology, authors conducted semistructured interviews with 17 licensed social workers employed in various SUD treatment settings. Transcript coding was conducted through an iterative process and data were analyzed using NVivo (version 12.0). Results demonstrated that social workers lack basic knowledge on the relationship between TBI and SUD. Additional barriers to providing care included lack of skills to identify history of TBI, lack of community resources, poor agency collaboration, and access-to-care restrictions. Social workers identified their primary roles as advocacy, care coordination, and serving on multidisciplinary teams. These results informed development of a capacity-building model, with recommendations for social work situated in each level of the socioecological framework. This study has important implications for building workforce capacity and collaborative care systems to improve client outcomes.

Mental Health Service Utilization among Adults with Head Injury with Loss of Consciousness: Implications for Social Work.

The purpose of this study was to identify factors associated with mental health service utilization among adults with head injury with loss of consciousness (LOC) using Andersen's model of health. This secondary data analysis used the 2011-2014 National Health and Nutrition Examination Survey with data collected from 7,399 adults. Binary logistic regression was conducted to determine odds associated with predisposing, enabling, and needs factors on head injury with LOC and mental health service utilization. A total of 948 (12.8 percent) adults 40 years and older self-reported head injury with LOC. Head injury with LOC was higher among men and people with lower income, illicit drug use history, and moderate to severe depression. Mental health service utilization for people with head injury with LOC was lower among older-age adults and those with no health insurance. However, utilization was higher among adults with military service, history of drug use, and moderate to severe depression. Social workers in health care settings play critical roles serving adults with traumatic brain injury (TBI) through mental health and substance use disorder treatment and bridging gaps in service access. Social workers should recognize the complex needs of clients with TBI and factors affecting mental health service use.

Substance Use, Service Provision, Access & Utilization among Foreign-Born Communities in the United States: A Mixed Methods Study.

BACKGROUND: The prevalence of substance use among the foreign-born has gained increasing attention. Cumulative migration stressors - including historical trauma, violence, family separation, and poverty - present challenges to human service systems wherein services may not adequately meet the needs of these groups. Objectives: This study explores the challenges and realities of substance use, substance use service provision, and delivery of services among the increasingly diverse immigrant population using multiple perspectives. This study is based on data from a larger mixed methods study that assessed the human service landscape pertaining to the immigrant population in a mid-western region of the United States. Methods: This transformative mixed methods study used a community based participatory research approach. Data were collected from human service providers (HSPs), informal service providers, and local community leaders through surveys (n = 64), in-depth interviews (n = 23), and six focus group discussions (n = 48). A weaving approach was used to integrate findings from quantitative and qualitative data. Results: Participants recognize substance use as an issue that needs immediate attention among increasingly diverse immigrant communities. Community members and human service organizations identified several emergent themes including patterns and occurrence of substance use, barriers to care, and proposed system changes. Conclusions: Given that only 28% of responding organizations list substance use as part of their core services, the need for organizational collaborations with a focus on culturally responsive evidence-based services is proposed.

"They make money off of us": a phenomenological analysis of consumer perceptions of corruption in Kenya's HIV response system.

BACKGROUND: Problems with misallocation and redirection of critical resources and benefits intended for PLHIV are not uncommon in Kenya. This study explores corruption in Kenya's HIV response system and the implications for health outcomes from the perspective of people living with HIV (PLHIV). Although they might not be directly responsible for health care fund management, PLHIV and their advocacy efforts have been central to the development of HIV system response and they have a vested interest in ensuring proper governance. METHODS: This phenomenological study was conducted in 2012 in Kiambu County in Kenya. The study was designed to capture the experiences of a select group of individuals living with HIV and AIDS and subsequent effects on intergenerational wealth transmission. Four focus groups were conducted with self-convened HIV/AIDS peer support groups. Findings related to corruption emerged unexpectedly, albeit consistently, across all four focus groups. To validate core themes within the data, including corruption, two coders independently reviewed and coded the data. RESULTS: Participants described incidences of resource misallocation, theft, and denial of services across three thematic levels namely at the interpersonal, provider, and institutional levels. Participants described the negative influence of corruption on their health and financial well-being, and propose: (1) strengthening legal protections for assets belonging to PLHIV, (2) direct representation of PLHIV within service agencies, (3) and addressing information asymmetries to inject transparency into the response system. CONCLUSION: Our findings add to the growing literature that identifies advocacy among individuals and families impacted by HIV and AIDS to be a useful tool in drawing attention to harmful practices in the HIV response infrastructure; consistent with this movement, communities in Kenya demand greater control over programmatic interventions both at the national and local levels.

Sarah Waller's Help-Seeking Model: Understanding African American Women Intimate Partner Violence Survivors' Help-seeking Process.

African American women overwhelmingly experience the poorest outcomes resulting from intimate partner violence (IPV) victimization. Despite theoretical advancements, there remain a paucity of theories that explicate this marginalized population's comprehensive help-seeking process that includes the domestic violence service provision system and the Black church. We conducted 30 in-depth, semi-structured interviews with women who self-identified as African American. We utilized sensitizing concepts from the Transtheoretical Model of Change and Intersectionality theories, along with Agency framework and employed constructivist grounded theory methodology. Sarah's Help-Seeking Model emerged from the data and includes nine phases: (1) Awareness, (2) Acknowledgment, (3) Assessment, (4) Enough, (5) Enlist, (6) Escalate, (7) Reject, (8) Resolve, and (9) Restoration. This is the first theory that identifies how this vulnerable and underserved population's mental health and social support-seeking process is partially mediated by mistrust of law enforcement, disappointment in linkage to care and services, fear of death, and willingness to survive.

Correlates of depression among caregivers of children affected by HIV/AIDS in Uganda: findings from the Suubi-Maka family study.

This study uses the baseline (wave 1) data from a four-year (2008-2012) longitudinal study called the Suubi-Maka family economic empowerment intervention for AIDS-orphaned children in Uganda funded by the National Institute of Mental Health (Grant # RMH081763A). Specifically, using baseline data from the Suubi-Maka study, this article provides a contextualized understanding of depression levels among caregivers for AIDS-orphaned children in two rural communities heavily affected by AIDS in Uganda: Rakai and Masaka districts. Using baseline data collected from caregivers of children orphaned by AIDS (N=297) the study examines the factors that influence reported depression levels of caregivers of AIDS-orphaned children in rural communities of Uganda. We specifically use ordinary least squares regression methods. In the analysis we control for several demographic factors, including age, gender, assets, social support, and caregiving status. We find that caregivers' reported economic status and social support system are highly correlated with caregivers' reported depression scores. Specifically, caregivers with cash savings and a strong family support system reported better depression scores. These findings have implications for community development practice and programming. Specifically, the study highlights a need for family economic empowerment programs and, strengthened family support among caregivers for AIDS-orphaned children, especially those caregivers with reported poor mental health functioning.

A Review of Prevalence Estimation Methods for Human Trafficking Populations.

Human trafficking has long-lasting implications for the well-being of trafficked people, families, and affected communities. Prevention and intervention efforts, however, have been stymied by a lack of information on the scale and scope of the problem. Because trafficked people are mostly hidden from view, traditional methods of establishing prevalence can be prohibitively expensive in the recruitment, participation, and retention of survey participants. Also, trafficked people are not randomly distributed in the general population. Researchers have therefore begun to apply methods previously used in public health research and other fields on hard-to-reach populations to measure the prevalence of human trafficking. In this topical review, we examine how these prevalence methods used for hard-to-reach populations can be used to measure the prevalence of human trafficking. These methods include network-based approaches, such as respondent-driven sampling and the network scale-up method, and venue-based methods. Respondent-driven sampling is useful, for example, when little information about the trafficked population has been produced and when an adequate sampling frame does not exist. The network scale-up method is unique in that it does not target the hidden population directly. The implications of our work internationally include the need for documenting and validating the various prevalence estimation methods in the United States in a more robust way than was done in existing efforts. In providing this roadmap for estimating the prevalence of human trafficking, our overarching goal is to promote the equitable treatment and overall well-being of the socially disadvantaged populations who disproportionately experience human trafficking.

Predictors of prostate cancer screening among older immigrant men.

OBJECTIVE: To examine the predictors of prostate cancer screening among immigrant men aged > or =50 years who hold legal permanent residency status. METHODS: A modified version of the behavioral model of health services use for vulnerable populations. A logistic regression model was used to test predisposing, enabling and need factors related to prostate cancer screening among older immigrant men. RESULTS: Region of origin, access to medical care, age, education and visa adjustment status were significant contributors to the multivariate model. DISCUSSION: The important role played by respondents' access to medical care and culture in accessing prostate screening is discussed as well as the importance of respondents' visa adjustment status. CONCLUSION: Practitioners working with immigrants should be cognizant of the role culture plays in preventive healthcare behaviors.

Assessing the Association Between Depression and Savings for Kenyan Youth Using a Validated Child Depression Inventory Measure.

PURPOSE: The Child Depression Inventory (CDI) is a commonly used measure of depression among youth and has been used in studies conducted in sub-Saharan Africa demonstrating positive effects of financial asset-building interventions on physical and mental health outcomes. However, before we can be certain that asset building does indeed improve mental health functioning, we must first be sure that the instruments used to measure mental health in this population are valid and culturally appropriate. METHODS: This two-part study used baseline data from a sample of youth (N = 1,348, 13-18 years) participating in the YouthSave-Impact Study Kenya to clarify the psychometric properties of the 10-item CDI (study A), and then used the 10-item CDI to assess the relationship between financial assets and mental health functioning among this sample of adolescents (study B). RESULTS: Factor analysis on the 10-item CDI indicated a one-factor eight-item measure with excellent model fit. Invariance testing indicated that the measure performed differently for male and female respondents. Finally, using the latent structure as the dependent variable, the second part of the analysis established that cash savings were associated with depression. Female and male adolescents with savings reported lower depression (female ß = -.17, p ≤ .003; male ß = -.12, p ≤ .020) than other youth. CONCLUSION: This study identified a reasonable one-factor eight-item depression measure that was noninvariant across gender. This validated measure was used to confirm the association between financial assets and mental health outcomes, hence, supporting the hypothesis that financial assets are associated with mental health outcomes.

Testing the Financial Capability Framework: Findings from YouthSave-Impact Study Kenya.

In sub-Saharan Africa (SSA), youths (23 years or younger)-who account for almost half the population-are particularly vulnerable to poverty and exclusion from financial markets and intermediaries. In addition, a significant factor in the financial instability of the region appears to be the economic functioning of its youths. In recent years, social work interventions throughout the region have focused on investing in the economic functioning of youths. This study looked at baseline data from one such intervention in Kenya (N = 3,965), using the financial capabilities framework to evaluate the factors related to youths' saving behaviors. Authors investigated the association between youths' financial literacy (that is, knowledge, socialization), financial access, and financial capabilities and savings behaviors. Results indicate that adolescents who rate themselves as financially literate and those living in close proximity to a bank are more likely to report higher capabilities. Furthermore, financial capabilities in turn partially mediate the relationship between financial literacy, access, and savings. Overall, the study's findings point to the positive effect of enhanced financial capabilities among youths and offer support for asset-based interventions targeting youths in SSA.

Mood, anxiety, and personality disorders among first and second-generation immigrants to the United States.

A careful examination of the multigenerational relationship between immigrant status and mental disorders can provide important information about the robustness and nature of the immigrant-mental health link. We examine immigrant status as a protective factor against mental illness, assess intergenerational effects, examine differences across race/ethnicity, and report the prevalence of mood, anxiety, and personality disorders of immigrants across major world regions. We employ data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and compare first (n=5363) and second-generation (n=4826) immigrants from Asia, Africa, Europe, and Latin America to native-born Americans (n=24,461) with respect to mental disorders. First-generation immigrants are significantly less likely than native-born Americans to be diagnosed with a mood, anxiety, or personality disorder, though the prevalence of mental health diagnoses increases among second generation immigrants. Similar results were observed for immigrants from major world regions as the prevalence of psychiatric morbidity was lower among immigrants from Africa, Latin America, Europe, and Asia compared to native-born Americans. Findings provide evidence in support of the notion that the immigrant paradox may be extended to include mood, anxiety, and personality disorders in the United States.

Health insurance disparities among immigrants: are some legal immigrants more vulnerable than others?

This study examined health insurance disparities among recent immigrants. The authors analyzed all working-age adult immigrants between the ages of 18 and 64 using the New Immigrant Survey data collected in 2003.This survey is a cross-sectional interview of recent legal permanent residents on their social, economic, and health status. Respondents were interviewed in English or in their preferred languages. Nearly two-thirds of immigrants were uninsured, in spite of their strong labor force participation. Of the four key classes of immigration--employment based, family sponsored, refugee/asylum program, and diversity program--the diversity program immigrants were least likely to be insured, controlling for a wide array of demographic, human capital, acculturation, and assets-related variables. Strategies to increase health insurance coverage among legal immigrants, especially diversity immigrants, are discussed.

Funneling Child Welfare Consumers into and through the Mental Health System: Assessment, Referral, and Quality Issues.

This qualitative study explores how consumers of child welfare services reach nonpsychiatric mental health providers and the perceived quality of these services. It relies on iterative interviews with individuals and groups, as well as on court observations from one metropolitan area. Results suggest that, consistent with theories of street-level bureaucracy, efficiency issues drive mental health service use, as clients are routinely subjected to psychological evaluations and funneled into mental health services as a matter of course. Referral practices are shaped by child welfare professionals' routines, discretion, and desire to meet such system objectives as providing short turnaround times for reports. The results suggest that, despite stakeholders' best intentions, maltreated children are not benefiting from thoughtful processes geared to screen for, assess, and provide targeted treatment for unmet mental health needs.