Strategies for Recruiting Young African American Men for Primary Stroke Prevention Research.

BACKGROUND: African American (AA) men bear a disproportionate burden of cardiovascular disease and stroke but are often underrepresented in research. OBJECTIVE: This article describes the development and evaluation of a recruitment plan to reach young AA men for the Stroke Counseling for Risk Reduction in Men project. METHODS: The plan was developed from researchers' previous experiences and a literature review, and used to recruit AA men, ages 20 to 35 years, for focus groups about stroke and Stroke Counseling for Risk Reduction. RESULTS: Screening survey respondents (N = 81) were reached mostly by word of mouth (42%) and social media (28%). Focus group participants (N = 32) recommended appropriate incentives and social media to recruit young AA men for research. They also suggested learning about the study from a friend, colleague, or study participant could motivate participation. CONCLUSION: The plan was successful in reaching and enrolling an adequate sample. Findings and recommendations highlight the importance of social networks and trusted sources.

State of the Science: The Relevance of Symptoms in Cardiovascular Disease and Research: A Scientific Statement From the American Heart Association.

Symptoms of cardiovascular disease drive health care use and are a major contributor to quality of life. Symptoms are of fundamental significance not only to the diagnosis of cardiovascular disease and appraisal of response to medical therapy but also directly to patients' daily lives. The primary purpose of this scientific statement is to present the state of the science and relevance of symptoms associated with cardiovascular disease. Symptoms as patient-reported outcomes are reviewed in terms of the genesis, manifestation, and similarities or differences between diagnoses. Specifically, symptoms associated with acute coronary syndrome, heart failure, valvular disorders, stroke, rhythm disorders, and peripheral vascular disease are reviewed. Secondary aims include (1) describing symptom measurement methods in research and application in clinical practice and (2) describing the importance of cardiovascular disease symptoms in terms of clinical events and other patient-reported outcomes as applicable.

Stroke Counseling Intervention for Young Adult African Americans: A Randomized Controlled Trial.

BACKGROUND: African Americans have a higher incidence of early-onset stroke and poorer stroke-related outcomes than other race/ethnic groups. OBJECTIVES: Our two-arm, randomized controlled trial was implemented to assess efficacy of the nurse-led Stroke Counseling for Risk Reduction (SCORRE) intervention in reducing stroke risk in young African American adults by improving accuracy of perceived stroke risk and lifestyle behaviors (i.e., diet, physical activity, and smoking cessation). Stroke knowledge, behavior change readiness, and perceived competence to live a healthy lifestyle were also explored as secondary outcomes. METHODS: African Americans aged 20-35 years, recruited from an urban university and surrounding community, were randomized to SCORRE or an attention placebo control group receiving safe sex education. Data were collected pre-intervention, immediate post-intervention, and at 8 weeks. Multilevel models were used for primary outcome analyses. RESULTS: Participants ( n = 106) were mostly in their mid-20s, female, college students, and averaged about three modifiable stroke risk factors. Compared to the control group, participants in the intervention group had, on average, a significant increase in accuracy of perceived stroke risk post-intervention, a greater change in perceived competence to live healthy, and a greater increase in dietary components at 8 weeks. Significant changes were not found in physical activity and other outcomes. DISCUSSION: These findings suggest that SCORRE is a promising intervention to reduce stroke risk among young African American adults. Results will inform a more robust, randomized controlled trial of SCORRE to have an age, culture, and gender-focused intervention that effectively reduces stroke risk among African Americans early in life.

Racial Identity Clusters and Their Relation to Postpartum Maternal Functioning in Black Women.

OBJECTIVES: Racial identity, which is the degree that individuals define themselves regarding their racial group membership, may influence the mental well-being of Black adults. To gain an understanding of the role Black racial identity may have on postpartum mental health, the researchers performed a secondary data analysis to examine the relationship between six Black racial identity clusters (Low Race Salience, Assimilated and Miseducated, Self-Hating, Anti-white, Multiculturalist, and Conflicted) and postpartum maternal functioning in Black women living in Georgia. METHODS: Black women completed Cross's Racial Identity Scale, the Barkin Index of Maternal Functioning, and demographic questionnaires online via Qualtrics®. PARTICIPANTS: A total sample of 116 self-identified Black postpartum women were included in the analysis. Women ranged in age from 18 to 41 years (M = 29.5 ± 5.3) and their infants were 1 to 12 months old (M = 5.6 ± 3.5). The majority of women were married/cohabitating with their partner (71%), had a college degree (53%), and employed (69%). RESULTS: It was determined through Kruskal Wallis test, χ2(5) = 20.108, p < 0.05, that the women belonging to the Assimilated and Miseducated cluster had higher levels of maternal functioning when compared to the women in the Self-Hating and Anti-white clusters. CONCLUSION: This study is novel in its exploration of the relationship between Black racial identities and postpartum maternal functioning. Findings support the need for further research with larger sample and cluster sizes to determine the relationship between racial identity and maternal functioning.

Factors Facilitating Academic-Community Research Partnerships With African American Churches: Recruitment Process for a Community-Based, Cluster Randomized Controlled Trial During the COVID-19 Pandemic.

African American (AA) churches are valuable partners in implementing health promotion programming (HPP) to combat health disparities. The study purpose was to evaluate AA church characteristics associated with enrollment into the FAITH! (Fostering African American Improvement in Total Health) Trial, a community-based, cluster randomized controlled trial (RCT) of a mobile health intervention for cardiovascular health promotion among AA churches. Churches located in Minneapolis-St. Paul and Rochester, Minnesota were invited to complete an electronic screening survey and follow-up telephone interview including the PREACH (Predicting Readiness to Engage African American Churches in Health) tool to assess church characteristics and infrastructure for HPP. The primary outcome was church enrollment in the FAITH! Trial. Key predictors included overall PREACH scores and its subscales (Personnel, Physical Structure, Faith-based Approach, Funding), congregation size, and mean congregation member age. Of the 26 churches screened, 16 (61.5%) enrolled in the trial. The enrolled churches had higher overall mean PREACH scores (36.1 vs. 30.2) and subscales for Personnel (8.8 vs. 5.6), Faith-based Approach (11.0 vs. 9.6), and Funding (7.3 vs. 4.8) compared with non-enrolled churches; all differences were not statistically significant due to small sample size. Twelve (75.0%) of the enrolled churches had >75 members versus six (60.0%) of the non-enrolled churches. Twelve (80.0%) of the enrolled churches had an average congregation member age ≤54 years versus six (67.0%) of the non-enrolled churches. AA churches enrolling into a community-based RCT reported greater infrastructure for HPP, larger congregations, and members of younger age. These characteristics may be helpful to consider among researchers partnering with AA churches for HPP studies.

Black nurse scientists and the undeniable role of historically Black colleges and universities.

The pandemics of COVID-19 and systemic racism highlighted health inequities that have existed for decades among Black communities. Nurses are positioned to address these health inequities through innovative ideas and research. More specifically, Black nurses, because of their shared lived experience, understand sociostructural factors underpinning health inequities and how to best engage with Black communities. However, only 8% of Black nurses make up the overall nursing workforce and far fewer are nurse scientists. Historically Black Colleges and Universities (HBCUs) can offer critically important options for success in addressing the dearth of Black nurse scientists working across sectors and contributing to rich academic milieu, informing innovative national policy, and creating impactful practice. We discuss challenges and strategies to promoting research careers at HBCUs to attract Black nurse scientists as the next leaders in health inequities research.

The Alter Program: A Nurse-Led, Dementia-Friendly Program for African American Faith Communities and Families Living With Dementia.

Dementia is a stigmatizing condition requiring enhanced awareness and understanding. Churches are a trusted source of support for African Americans, a demographic disproportionately affected by dementia. However, many African American churches are not equipped with the knowledge and means to provide safe environments, resources, and spiritual and social support for their parishioners living with dementia and their families. This protocol is written to detail the design and implementation of a nurse-led, dementia-friendly congregation program, Alter. The Alter program was developed to increase dementia awareness, develop a supportive, faith-based dementia-friendly infrastructure, and create a community supporting the well-being of African Americans living with dementia and their families. Engagement in this program aims to improve brain health status of older adults, improve physical and mental health outcomes, reduce dementia stigma, and enhance personal agency. Improved outcomes for persons living with dementia translate into lower use of acute and emergency services due to more stability in community care. It is expected that the churches participating in this program will be recognized by their community as a great resource for dementia information and support. The long-term goal of the Alter program is to be widely adapted in various health systems to reduce health disparities associated with dementia in the African American community.

Examining the Relationship Between Black Racial Identity Clusters and Postpartum Depressive Symptoms.

BACKGROUND: This study examined the relationship between racial identity clusters and postpartum depressive symptoms (PPDS) in Black postpartum mothers living in Georgia. AIMS: A cross-sectional study design using Cross's nigrescence theory as a framework was used to explore the relationship between Black racial identity and PPDS. METHOD: Black mothers were administered online questionnaires via Qualtrics. A total sample of 116 self-identified Black mothers were enrolled in the study. Participants ranged in age from 18 to 41 years (M = 29.5 ± 5.3) and their infants were 1 to 12 months old (M = 5.6 ± 3.5). The majority of mothers were married or cohabitating with their partner (71%), had a college degree (53%), and worked full-time (57%). RESULTS: Hierarchical cluster analysis identified six racial identity clusters within the sample: Assimilated and Miseducated, Self-Hating, Anti-White, Multiculturalist, Low Race Salience, and Conflicted. A Kruskal-Wallis H test determined there was no difference in PPDS scores between racial identity clusters. CONCLUSIONS: This study is the first to explore the relationship between Black racial identity clusters of postpartum mothers and their mental health. Findings emphasize the complexity of Black racial identity and suggest that the current assessment tools may not adequately detect PPDS in Black mothers. The implications for these findings in nursing practice and future research are discussed.

Strategies and Resources for Increasing the PhD Pipeline and Producing Independent Nurse Scientists.

Nurse scientists play an indispensable role in developing new knowledge to advance the health of patients, families, and communities. Yet PhD nurse enrollment has significantly dropped, and many later career nurse scientists are nearing retirement. The purpose of this article is to outline potential strategies to enhance the PhD nurse pipeline. Potential strategies are identified at three distinct time points along the PhD trajectory: (a) prior to a PhD program (increasing the pipeline), (b) during a PhD program (enhancing graduation rates and transitioning into research-focused careers), and (c) in the postdoctoral or early career period (establishing scholarly independence and an active program of research). Talented students should be approached early on in their education to ascertain interest in a scientific research-based career, and all students could be engaged in research opportunities while in undergraduate programs. During a PhD program, supportive mentors are a key component for student success and may provide assistance in obtaining ongoing funding and scholarship support. Throughout doctoral study and into early career, less structured opportunities can be influential, including conference support, online and face-to-face training, and ongoing funding and scholarship support for postdoctoral study or fellowships. At each career stage, there should be a focus on designing scientifically sound nursing research that will impact outcomes in measurable and sustainable ways. We must not focus our attention only on student recruitment. Public messaging efforts are needed to raise awareness of the role of nurse researchers. In addition, several stakeholders play a role in increasing the PhD pipeline and producing independent nurse scientists, and they should be acknowledged in these efforts. The strategies described may be beneficial for any nurse contemplating a research career as well as for those who may serve as mentors to these individuals. More broadly, these strategies may be employed by colleges and universities, funding bodies, professional nursing societies, and healthcare organizations in the United States and abroad. Increasing the PhD pipeline, and fostering a more robust field of independent nurse scientists, will translate into improved patient outcomes.

Essential considerations in developing attention control groups in behavioral research.

Attention control groups strengthen randomized controlled trials of behavioral interventions, but researchers need to give careful consideration to the attention control activities. A comparative effectiveness research framework provides an ideal opportunity for an attention control group as a supplement to standard care, so participants potentially receive benefit regardless of group assignment. The anticipated benefit of the control condition must be independent of the study outcome. Resources needed for attention control activities need to be carefully considered and ethical considerations carefully weighed. In this paper we address nine considerations for the design and implementation of attention control groups: (1) ensure attention control activities are not associated with the outcome; (2) avoid contamination of the intervention or control group; (3) design comparable control and intervention activities; (4) ensure researcher training to adequately administer both treatment arms; (5) design control activities to be interesting and acceptable to participants; (6) evaluate attention control activities; (7) consider additional resources needed to implement attention control activities; (8) quantifying the effects of attention control and intervention groups; and (9) ethical considerations with attention control groups. Examples from the literature and ongoing research are presented. Careful planning for the attention control group is as important as for the intervention group. Researchers can use the considerations presented here to assist in planning for the best attention control group for their study.

Reducing Stroke Risk Among Young Adult African Americans: A Feasibility Study.

African Americans are disproportionately affected by stroke and its modifiable risk factors, and strategies are needed to help African Americans adopt healthy lifestyles early in life. The purpose of this study was to assess the feasibility of the Stroke Counseling for Risk Reduction (SCORRE) intervention, a tailored, theory-based intervention consisting of a motivational video of young African American stroke survivors, the American Heart Association's Life's Simple 7® (LS7) risk assessment and education tool, and a 6-week behavioral risk reduction diary. Feasibility and changes in theoretical variables were evaluated over 6 weeks. In four months, 30 participants were enrolled and randomized and 29 (97%) completed the study. Participants averaged 23 years old, most were female university students, and they had an average of 2.1 out of 7 risk factors for stroke. Only 7% had missing items on questionnaires, and 17% had missing daily diary entries. Although statistical significance of differences was not assessed, both intervention and control groups had improvements in knowledge scores following the initial session, and larger improvements in accuracy of perceived stroke risk and in health behaviors (physical activity and diet quality) were observed among participants receiving SCORRE. An exit survey indicated the majority of participants receiving SCORRE were motivated to achieve better health; enjoyed the video, LS7 and diary; and felt the program length was appropriate. Results suggest that SCORRE is feasible and acceptable, and with additional refinement and further testing has potential for reducing stroke risk among African Americans. © 2016 Wiley Periodicals, Inc.

Family history of stroke among African Americans and its association with risk factors, knowledge, perceptions, and exercise.

BACKGROUND: African Americans are at greater risk for stroke than whites are; however, it is unclear what role family history of stroke (FHS) plays in the adoption of healthier lifestyles among African Americans. OBJECTIVE: The aim of this study was to compare modifiable risk factors, knowledge of stroke risk factors, perceived threat of stroke, perceived control of stroke, and exercise behaviors and intentions in African Americans with a FHS and those without a FHS. METHODS: A cross-sectional study was conducted with rural African Americans aged 19 to 54 years participating in a mobile health clinic. Participants' stroke knowledge, perceptions of risk, exercise history and intent, physiologic data, and health history were collected. RESULTS: Participants (N = 66) had a mean (SD) age of 43.3 (9.4) years and were mostly women, high school graduates, and unemployed. Participants with a FHS (n = 33) did not differ on average number of risk factors from those without a FHS. However, participants with a FHS were more likely to report a history of hypertension than were those without. There were no significant differences between groups in stroke knowledge, perceived threat and perceived control, or recent exercise performance, although participants with a FHS had significantly lower future intentions to exercise than did those without a FHS. CONCLUSIONS: Family history of stroke was common in this sample; however, it did not translate into better understanding of stroke or better exercise behaviors and intentions. More can be done to identify African Americans with a FHS, especially those with multiple risk factors, to educate them about the significance of FHS while promoting lifestyle change and self-management.

Potential benefits for caregivers of stroke survivors receiving BTX-A and exercise for upper extremity spasticity.

PURPOSE: To explore possible extended benefits to caregivers of stroke survivors receiving a treatment of onabotulinumtoxinA (BTX-A) or saline with a structured exercise program. DESIGN: A comparative, prospective, companion study using a nonrandom sample of 16 caregivers of stroke survivors enrolled in a pilot clinical trial comparing BTX-A or saline and exercise for upper extremity spasticity. METHODS: The caregiver measures were depressive symptoms, care demands, family conflict surrounding stroke recovery, and mental and physical health status. FINDINGS: There were no statistically significant differences between caregiver groups. Caregivers of stroke survivors who received BTX-A had a greater change in depressive symptoms that may reflect a clinically important change. Estimates of effect sizes between the groups, controlling for baseline values, indicate a trend for moderate to large effects (last evaluation) for fewer depressive symptoms (d = 0.52) and less caregiver burden (d = 0.77 time, 0.85 difficulty) for caregivers of the BTX-A group. CONCLUSIONS AND CLINICAL RELEVANCE: Receiving BTX-A did not alter caregiving demands or depressive symptoms compared to those receiving saline. Further research with larger sample sizes is needed to better understand the interdependence of stroke survivors and caregivers on the health of each.

Outreach for Young Adult African Americans with Risk Factors for Stroke.

BACKGROUND: Research suggests that younger adult African American people (age 18-35 years) have more than double the risk of having a stroke than White people. Stroke risk education is lacking for this cohort; there is a dearth of materials that are targeted and focused for young adult African Americans. There is also little research on developing and testing age and culturally appropriate health literate materials that may help this population better understand personal risk factors for stroke. OBJECTIVE: The aim of this study was to understand factors to guide creating and disseminating plain language health messages about stroke risk awareness among young adult African Americans. METHODS: African American participants age 18 years and older completed an online survey (N = 413). Descriptive statistics, one-way analysis of variance, and two-step cluster analyses were used to evaluate stroke risk awareness, perceived risk of stroke, message creation factors, and online health information seeking behavior. Open-ended survey items described modifiable and non-modifiable reasons for perceived risk of stroke. KEY RESULTS: Participants reported differences on overall stroke risk factor awareness by perceived risk of stroke was significant (F[2, 409] = 4.91, p = .008) with the very low/low group (M = 1.66, p < .01), showing significantly lower overall stroke risk factor awareness compared to the moderate and high/very high groups. Both respondents who thought their stroke risk was very low/low and moderate/high/very high commented about family history (54.1% and 45.9%, respectively) as the reason and 88.2% of very low/low commented that they did not have risk factors for stroke because they were young. Cluster analysis indicated the Mostly Clear Preferences cluster was more likely to select mostly/very on positive, informational, and long-term messages and medical authority sources. The largest of three clusters reported medical sources as the highest rated source for both finding and trusting health information (47.2%, n = 195). CONCLUSION: Young adult African Americans have a scarce understanding of modifiable stroke risk factors; health education materials should focus on positive information messaging that shows a long-term result and is presented by a medical authority. We did not observe any age or sex differences among the data, which suggests different message modalities may not be needed. [HLRP: Health Literacy Research and Practice. 2024;8(1):e38-e46.].

PLAIN LANGUAGE SUMMARY: In this study, we collected data to create a targeted stroke risk awareness health education video for young African American adults (age 18 years and older). The video was based on analysis of data from 413 participants focusing on perception of stroke risk, stroke risk knowledge, as well as preference for message type, source credibility, and modality.

Leadership in Nursing Science: Four Scholarly Journeys Rooted in Historically Black College and University Excellence.

The intricacies of the unique educational and leadership development trajectories of Black PhD-prepared nurse scientists are largely invisible in nursing faculty development literature. A broadened understanding of nursing leadership development and science mentorship can facilitate support for the next generation of Black nurse scientists. Historically Black Colleges and Universities (HBCUs) can serve as formative launch pads for nurse scientist development. However, the role of HBCUs and strategies for supporting robust educational and mentor/training opportunities for Black PhD-prepared nurse scientists require thoughtful description and application. Incorporating an intrapersonal, interpersonal, and integrative leadership framework, we describe and synthesize four Black nurse scientists and HBCU graduates' experiences to highlight early science mentorship and leadership resilience through the excellent educational foundations provided at HBCUs.

A deep learning approach for mental health quality prediction using functional network connectivity and assessment data.

While one can characterize mental health using questionnaires, such tools do not provide direct insight into the underlying biology. By linking approaches that visualize brain activity to questionnaires in the context of individualized prediction, we can gain new insights into the biology and behavioral aspects of brain health. Resting-state fMRI (rs-fMRI) can be used to identify biomarkers of these conditions and study patterns of abnormal connectivity. In this work, we estimate mental health quality for individual participants using static functional network connectivity (sFNC) data from rs-fMRI. The deep learning model uses the sFNC data as input to predict four categories of mental health quality and visualize the neural patterns indicative of each group. We used guided gradient class activation maps (guided Grad-CAM) to identify the most discriminative sFNC patterns. The effectiveness of this model was validated using the UK Biobank dataset, in which we showed that our approach outperformed four alternative models by 4-18% accuracy. The proposed model's performance evaluation yielded a classification accuracy of 76%, 78%, 88%, and 98% for the excellent, good, fair, and poor mental health categories, with poor mental health accuracy being the highest. The findings show distinct sFNC patterns across each group. The patterns associated with excellent mental health consist of the cerebellar-subcortical regions, whereas the most prominent areas in the poor mental health category are in the sensorimotor and visual domains. Thus the combination of rs-fMRI and deep learning opens a promising path for developing a comprehensive framework to evaluate and measure mental health. Moreover, this approach had the potential to guide the development of personalized interventions and enable the monitoring of treatment response. Overall this highlights the crucial role of advanced imaging modalities and deep learning algorithms in advancing our understanding and management of mental health.

Hypertension education and screening in African American churches.

A major disparity among African Americans is undiagnosed and uncontrolled hypertension. This exploratory study examined hypertension education and screening activities of 45 African American churches. A cross-sectional telephone survey was used to interview church representatives with knowledge of their church's health activities. Most churches (87%) offered at least 1 activity and 40% offered all 4 (i.e., screenings, materials, talks, health-fairs) within 2 years of the interview. Larger churches and those with an active health ministry offered more activities. More information about resources, program ideas, and collaborators was desired. Research is needed to examine factors that act as barriers and facilitators to implementing church based programs and to examine the effectiveness of these programs in reducing hypertension.

Remote Delivery of the Fugl-Meyer Assessment for the Upper Extremity: A Pilot Study to Assess Feasibility, Reliability, and Validity.

Objective: To develop a remote protocol for the upper extremity Fugl-Meyer Assessment (reFMA) and assess the reliability and validity with in-person delivery. Design: Feasibility testing. Setting: Remote/virtual and in-person in participants' homes. Participants: Three triads of therapists, stroke survivors, and carepartners (N=9) participated in Phases 1 and 2. Twelve different stroke survivors participated in Phase 3. Intervention: The FMA was administered and received remotely using the instructional protocol (Phases 1 and 2). Pilot testing with the delivery of the reFMA remotely and the FMA in-person occurred in Phase 3. Main Outcome Measures: Feedback for refinement and feasibility of obtaining the reFMA (including the System Usability Scale) and the FMA scores remotely and in-person to assess reliability and validity of the reFMA. Results: The reFMA was refined to incorporate feedback and suggestions from users. Interrater reliability between 2 therapists evaluating the FMA remotely was found to be poor with little agreement. For criterion validity, only 1 out of 12 (8.3%) total scores were in agreement between the in-person and remote assessments. Conclusion: Reliable and valid remote administration of the FMA is an important aspect of telerehabilitation for the upper extremity after stroke, but further research is needed to address current protocol limitations. This study provides preliminary support for the need for alternative strategies to improve appropriate implementation of the FMA remotely. Possible explanations for the poor reliability are explored and suggestions for improvement of the remote delivery of the FMA are provided.

The Real Secret to Getting Published: Responding to Reviewers.

Authors submitting a paper often receive an opportunity to revise and resubmit the paper. Authors may find addressing reviewers' comments challenging. We posit authors should welcome expert suggestions for revisions that strengthen the paper and develop a persuasive response if they disagree with the reviewer. A thoughtful, detailed response allows authors to dialogue with reviewers. Our paper uses exemplars of responses to reviewers to illustrate the effectiveness of clear and compelling author responses. Addressing reviewers' comments ultimately results in a better paper-more likely to be accepted. Developing skills in resubmitting research and clinical scholarship reports is essential to the dissemination process.

Stressors Associated with Tobacco Use Among Trans Women.

Purpose: Tobacco use is prevalent among sexual and gender minorities (SGM), yet few studies have examined the specific drivers of tobacco use among trans women. The purpose of this study is to examine the impact of proximal, distal, and structural stressors associated with tobacco use among trans women. Methods: This study is based on a cross-sectional sample of trans women (n=162) living in Chicago and Atlanta. Analyses were conducted to examine the association between stressors, protective factors, and tobacco use using a structural equation modeling framework. Proximal stressors (transgender roles scale, transgender congruence scale, internalized stigma, and internalized moral acceptability) were operationalized as a higher order latent factor, while distal stressors were operationalized as observed variables (discrimination, intimate partner violence, sex work, rape, child sexual abuse, HIV, and violence). Protective factors included social support, trans-related family support, and trans-related peer support. All analyses adjusted for sociodemographic variables (age, race/ethnicity, education, homelessness and health insurance). Results: The prevalence of smoking among trans women in this study was 42.9%. In the final model, homelessness (odds ratio [OR]: 3.78; 95% confidence interval [CI]: 1.97, 7.25), intimate partner violence (OR: 2.14; 95% CI: 1.07, 4.28), and commercial sex work (OR: 2.22; 95% CI: 1.09, 4.56) were all associated with tobacco use. There was no association between proximal stressors and tobacco use. Conclusion: Among trans women, tobacco use prevalence was high. Tobacco use was associated with homelessness, intimate partner violence, and commercial sex work. Targeted tobacco cessation programs should account for the co-occurring stressors that trans women face.