Identifying Factors Associated With Disparities in Access to Integrative Oncology Program.

CONTEXT AND OBJECTIVES: Cancer centers are increasingly providing complementary medicine as part of an emerging discipline termed 'integrative oncology' (IO). The present study explored factors associated with disparities in referral and adherence to a freely-provided IO program. METHODS: The databases of three oncology centers in northern Israel were searched retrospectively for chemotherapy-treated oncology patients eligible for referral by their oncology healthcare professionals to an integrative physician (IP) consultation. Demographic and cancer-related variables associated with the referral, and attendance by patients at the consultation were identified, as was adherence to the 6-week IO treatment program (high adherence, attending ≥4 IO treatment sessions; low adherence, 0-3 sessions). RESULTS: Of 4988 eligible patients, 1694 (34%) were referred to the IP consultation, with 1331 (78.6%) attending the consultation of which 766 (57.6%) were adherent to IO treatments. Multivariate analysis revealed lower referral rates among patients speaking primarily Arabic and Russian vs. Hebrew (OR = 3.0, 95% CI = 2.0-4.6, P < 0.0001); males vs. females (OR = 1.94, CI = 1.3-2.9, P = 0.001); those not reporting emotional distress (OR = 1.5, CI = 1.02-2.16, P = 0.037); and older age (OR = 1.04, CI = 1.03-1.06, P < 0.0001). Arabic and Russian-speaking patients were less likely to adhere to IO treatments (OR = 0.52, 95% CI = 0.32-0.83, P = 0.006). CONCLUSION: Patients' ethno-national origin and immigration status (primary language, Arabic and Russian), male gender and older age were associated with lower rates of referral to and attendance of the IP consultation, with reduced adherence to weekly IO treatments. These findings require further study to identify barriers toward diversity, equity and inclusion in IO care, increasing awareness among healthcare professionals regarding the benefits of these services for improving patient wellbeing.

Inequalities in intimate partner violence screening and receiving information among diverse groups of women: an online survey during COVID-19 lockdowns.

BACKGROUND: Research shows violence against women likely increases during emergencies. COVID-19's emergence exacerbated intimate partner violence (IPV), suggesting that healthcare services (HCS) should have increased IPV screening efforts and referrals of victims to support services. However, little is known about the prevalence of IPV screening and information provision during COVID-19 lockdowns. METHODS: We examined prevalence of 'ever been screened' (ES) for IPV and 'receiving information about support services' (RI) in HCS during COVID-19 lockdowns and compared these among non-immigrant Jewish women, immigrant Jewish and other women, and Palestinian women citizens in Israel. We collected data during Israel's second and third COVID-19 lockdowns (October 2020-February 2021) using a structured, online, self-administrated Arabic-language and Hebrew-language questionnaire. Eligibility criteria included women ≥18 years old, citizens of Israel, in a current intimate relationship (permanent or occasional) who used social media or smartphones. In total, 519 women completed the survey: 73 Palestinian, 127 Jewish immigrants and others, and 319 non-immigrant Jewish. RESULTS: Overall, 37.2% of women reported any IPV, of whom just 26.9% reported ES, 39.4% reported RI and 13.5% reported both (ES&RI). Palestinian women reported higher IPV rates (49.3%) compared with non-immigrant Jewish (34.2%) and immigrant Jewish and other (37.8%) women; however, they reported lower ES (OR 0.64, 90% CI (0.34 to 1.86) and RI 0.29 (0.17 to 0.50). CONCLUSIONS: In a survey during COVID-19 lockdowns, only about one-quarter of women who reported IPV were ES for IPV, or RI about support services, suggesting strengthened IPV screening is needed in HCS during emergencies, particularly targeting minority women, who report higher IPV but receive fewer services.

Promoting Positive Masculinities to Address Violence Against Women: A Multicountry Concept Mapping Study.

Interventions engaging men that challenge unequal gender norms have been shown to be effective in reducing violence against women (VAW). However, few studies have explored how to promote anti-VAW positive masculinity in young adults. This study aims to identify key multicountry strategies, as conceived by young adults and other stakeholders, for promoting positive masculinities to improve gender equity and prevent and target VAW. This study (2019-2021) involved young adults (aged 18-24 years) and stakeholders from Ireland, Israel, Spain, and Sweden. We applied concept mapping, a participatory mixed-method approach, in phases: (1) brainstorming, using semi-structured interviews with young adults (n = 105) and stakeholders (n = 60), plus focus group discussions (n = 88), to collect ideas for promoting anti-VAW positive masculinity; (2) development of an online questionnaire for sorting (n = 201) and rating ideas emerging from brainstorming by importance (n = 406) and applicability (n = 360); (3) based on sorting and rating data, creating rating maps for importance and applicability and clusters/strategies using multidimensional scaling and hierarchical cluster analysis with groupwisdom™ software; and (4) interpretation of results with multicountry stakeholders to reach agreement. The cluster map identified seven key strategies (41 actions) for promoting anti-VAW positive masculinities ranked from highest to lowest: Formal and informal education and training; Preventive education and activities in different settings/areas; Skills and knowledge; Empathy, reflection, and understanding; Media and public efforts; Policy, legislation, and the criminal justice system; and Organizational actions and interventions. Pattern matches indicated high agreement between young people and stakeholders in ranking importance (r = 0.96), but low agreement for applicability (r = 0.60). Agreement in the total sample on prioritizing statements by importance and applicability was also low (r = 0.20); only 14 actions were prioritized as both important and applicable. Young people and stakeholders suggested seven comprehensive, multidimensional, multi-setting strategies to facilitate promoting positive masculinity to reduce VAW. Discrepancy between importance and applicability might indicate policy and implementation obstacles.

Inequalities in Trust Levels and Compliance With Physical Distancing During COVID-19 Outbreaks: Comparing the Arab Minority and Jewish Populations in Israel.

Objectives: This study explores associations between trust in directives and compliance with physical distancing by comparing two populations in Israel. Methods: Following two lockdowns, we conducted two cross-sectional surveys among the Arab minority and Jewish citizens of Israel (first survey, N = 613; second survey, N = 542). We conducted multivariable logistic regression analyses for the association between trust and compliance with physical distancing separately for each group in each survey. Results: In both surveys trust levels were significantly lower among Arabs than Jews (p < 0.001). Compared to Jews, Arabs were less likely to report compliance with physical distancing in the first and second surveys (OR = 0.52, 95% CI 0.32-0.84 and OR = 0.62, 95% CI 0.39-0.98, respectively). In both surveys trusting the directives was an important determinant of compliance with physical distancing among Jews only. Conclusion: Our findings indicate that momentum is important in building and maintaining public trust and compliance during pandemics. Policymakers should note the lack of trust among Arabs, which warrants further research and interventions.

Mechanisms for racial separation and inequitable maternal care in hospital maternity wards.

Few studies have examined mechanisms of racial maternal separation (RMS) of birthing mothers in hospital maternity wards (MWs), and how separation might reinforce institutional healthcare racism and discrimination, leading to inequitable maternal care (MC). In Israel, while birth mothers report mostly pleasant experiences, RMS has become a matter of public debate. Although the Ministry of Health (MoH) condemns the practice, birthing Palestinian-Arab women have sued hospitals for discrimination after being assigned to separate MW rooms from other women. We drew on critical race theory (CRT) and intersectionality to uncover mechanisms for RMS and inequitable MC in hospital MWs at three levels-policy, practice, and women's experiences. In 2019-2020 we conducted 10 in-depth interviews with hospital directors (HDs) and 8 focus groups (FGs) with 40 midwives and nurses; then, in 2020-2021, we held 26 in-depth Zoom interviews with birthing women. Our findings reveal intersecting mechanisms for RMS through which structural racism and institutional discrimination outside hospitals in the form of ethno-racial residential segregation penetrate hospitals via women's requests to maintain separation in MWs. While all HDs opposed RMS and prized quality care, they instituted insufficient mechanisms to prohibit racial separation, which helped to institutionalize the practice. Commodification of Healthcare services (HCS) accelerates RMS as hospitals compete for funds derived from birthing mothers' care. Under the guise of cultural sensitivity and indirect pressure of hospital management, nursing staff comply with requests for RMS. Nurses assigned rooms based on stereotypical categorizations of women's group membership (ethno-national, religiosity level, class). RMS targeted mostly visibly religious Muslim Palestinian-Arab women. These mothers felt MC discrimination; others normalized RMS as preference. While the MoH cannot eliminate outside-hospital structural discrimination, more efforts should be made to eradicate inside-hospital RMS, as the practice violates the principle of universality enshrined in the National Health Insurance Law.

Understanding the health needs of internally displaced persons: A scoping review.

We seek to strengthen understanding of the health needs of internally displaced persons (IDPs) in contexts of conflict or violence. Based upon a scoping review, our paper identified limited evidence on IDP health, but nevertheless indicates that IDPs tend to experience worse health outcomes than other conflict-affected populations across a range of health issues; and this is due to the particularly vulnerable situation of IDPs relative to these other populations, including reduced access to health services. Further research is required to better understand these needs and the interventions that can most effectively address these needs.

Long-distance travel for birthing among Indigenous and non-Indigenous pregnant people in Canada.

BACKGROUND: For Indigenous Peoples in Canada, birthing on or near traditional territories in the presence of family and community is of foundational cultural and social importance. We aimed to evaluate the association between Indigenous identity and distance travelled for birth in Canada. METHODS: We obtained data from the Maternity Experiences Survey, a national population-based sample of new Canadian people aged 15 years or older who gave birth (defined as mothers) and were interviewed in 2006-2007. We compared Indigenous with non-Indigenous Canadian-born mothers and adjusted for geographic and sociodemographic factors and medical complications of pregnancy using multivariable logistic regression. We categorized the primary outcome, distance travelled for birth, as 0 to 49, 50 to 199 or 200 km or more. RESULTS: We included 3100 mothers living in rural or small urban areas, weighted to represent 31 100 (1800 Indigenous and 29 300 non-Indigenous Canadian-born mothers). We found that travelling 200 km or more for birth was more common among Indigenous compared with non-Indigenous mothers (9.8% v. 2.0%, odds ratio [OR] 5.45, 95% confidence interval [CI] 3.52-8.48). In adjusted analyses, the association between Indigenous identity and travelling more than 200 km for birth was even stronger (adjusted OR 16.44, 95% CI 8.07-33.50) in rural regions; however, this was not observed in small urban regions (adjusted OR 1.04, 95% CI 0.37-2.91). INTERPRETATION: Indigenous people in Canada experience striking inequities in access to birth close to home compared with non-Indigenous people, primarily in rural areas and independently of medical complications of pregnancy. This suggests inequities are rooted in the geographic distribution of and proximal access to birthing facilities and providers for Indigenous people.

Residential segregation, neighborhood violence and disorder, and inequalities in anxiety among Jewish and Palestinian-Arab perinatal women in Israel.

BACKGROUND: Residential segregation can foster health inequality mechanisms by increasing stress related to neighborhood violence and disorder. AIMS: We studied the association between neighborhood violence and disorder and inequalities in anxiety between two groups of perinatal Israeli women (Jewish, Palestinian-Arab) living in ethno-nationally segregated neighborhoods, and explored the influence of neighborhood characteristics; social support and chronic stress to this inequality. METHODS: We linked survey data on neighborhood violence and disorder, neighborhood social characteristics (collective efficacy, social capital and social support) and aggregate discrimination to neighborhood SES census data. The survey data was obtained from the "Family Relations, Violence and Health" study (2014-2015) and included a stratified national sample of women (Palestinian-Arab = 436, Jewish = 965) residing in 63 segregated neighborhoods. We conducted multi-variable logistic regression analysis for anxiety (measured based on State-trait Anxiety Inventory) using generalized estimating equation (GEE) to estimate odds ratios of the association with neighborhood violence and disorder (total score for 10 problems) while considering neighborhood characteristics (SES; social characteristics; aggregate discrimination), social support and chronic stress in different models for the total sample, and separately for Palestinian-Arab and Jewish women. RESULTS: Palestinian-Arab women had higher anxiety (60.5% vs. 42.1%, respectively) and higher severity of neighborhood violence and disorder (49.5% vs. 16.2%, respectively) compared to Jewish women. After considering individual and neighborhood variables, adjusted odds ratio (AOR) and 95% confidence intervals (CI) = 1.63, 1.04-2.56. The association between neighborhood violence and disorder and anxiety was significant for low vs. no problems in the final model for the total sample (AOR, 95%CI = 1.28, 1.00-1.64). Similarly, significant association was found only for low severity vs. no problems for Jewish women (1.40, 1.07-1.86). While among Palestinian-Arab women the association between neighborhood violence and disorder and anxiety rendered insignificant in the final model. Neighborhood social cohesion and social support were protective factors from anxiety in both groups, high neighborhood SES was protective factor only among Jewish women, and neighborhood aggregate discrimination was a risk factor only in Palestinian-Arab women. CONCLUSIONS: Inequalities in anxiety related to neighborhood violence and disorder in ethno-national perinatal groups of women likely reflect residential segregation. Policies entrenching segregation might have affected neighborhood mechanisms (SES inequalities, aggregate discrimination and low social cohesion) that lead to higher stress and ethno-national inequalities in anxiety among perinatal women.

Postpartum depression among Arab and Jewish women in Israel: Ethnic inequalities and risk factors.

OBJECTIVE: The aim of the current study was to compare the prevalence of, and risk factors for postpartum depression (PPD) among Jewish and Arab women in Israel. DESIGN: Data were obtained from a study on 'Family Relations and Violence' conducted in Israel in 2014-2015 using a multilayered nationwide representative sample of mothers who were interviewed face to face using a structured questionnaire in each woman's native language (Arabic / Hebrew) 6 weeks to 6 months postpartum. SETTING: 63 Maternal and Child Health (MCH) clinics from five geographical districts. PARTICIPANTS: Jewish (N = 853) and Arab (N = 275) women aged 16-48 who were 6 weeks to 6 months postpartum. MEASUREMENTS: PPD was measured by the Edinburgh Postnatal Depression Scale with a cutoff of ≥10. We examined a range of risk factors using multivariate logistic regression analysis and Generalized Estimating Equations (GEE) for the total sample, then separately for each ethnic group. RESULTS: For the total sample (n = 1128). Prevalence of PPD was 10.3%. Prevalence among Arab women was significantly higher compared to Jewish women (20.8% vs 7%, respectively). In the multivariable analysis, chronic stress, low social support, and unwanted pregnancy were major risk factors for PPD for Arab women. Among Jewish women the risk factors for PPD included chronic stress, low level of education, and intimate partner violence. CONCLUSIONS: Our findings indicate ethnic inequalities in the prevalence of, and risk factors for PPD in Israel that should be considered in health planning and policymaking. IMPLICATIONS FOR PRACTICE: Maternal health care nurses and other professionals should be aware of these inequalities and provide culturally sensitive health care services and programs to protect women in these population groups from PPD.

Barriers to Health Care Services Among Palestinian Women Denied Family Unification in Israel.

Family unification received public and political attention following recent global immigration crises, though less within health research. In Israel, under the Family Reunification Order, about 20,000 Palestinian women from the Occupied Palestinian Territories are denied residency and the right to universal health care services (HSC) after marrying Palestinian citizens and moving to Israel. To better understand the relationship between lacking residency and barriers to accessing HCS, we conducted in-depth interviews with 21 Palestinian women (ages 22-59) denied family unification. Our findings revealed that in addition to hindering access to HCS, lacking residency intersects with other political, social, and economic determinants of these women's health and disrupts normal family life. Lacking residency intensifies poverty (via private health insurance and legal fees, permit extensions) and leads to family separations and risky crossings at military checkpoints into the West Bank for medical treatment. Restrictions on freedom of movement engender fear of deportation and precarity. Denial of residency also exacerbates gender inequality (increased dependence on husbands) and can endanger child custody when mothers' lack of residency passes to children, violating children's basic rights. Allowing family unification to Palestinian women would remove barriers to HCS access, allow normal family life, and permit social integration.

"Practice What You Teach" Public Health Nurses Promoting Healthy Lifestyles (PHeeL-PHiNe): Program Evaluation.

Healthy lifestyle programs are essential for meeting the challenge of noncommunicable diseases. The Public Health Nurses Promoting Healthy Lifestyles (PHeeL-PHiNe) program engaged nurses from family health clinics in Jerusalem District and included physical activity, healthy nutrition, and motivational skills. Questionnaires were completed at baseline, postintervention, and at 18 months. Results showed a marked effect on health practices. The proportion of nurses consuming a balanced diet and the use of food labels significantly increased and were maintained over time. Short-term improvements in physical activity were also observed. Nurses who practiced a healthy lifestyle were significantly more likely to provide guidance and counseling to families on healthy behaviors.

Ethnic inequalities in health between Arabs and Jews in Israel: the relative contribution of individual-level factors and the living environment.

OBJECTIVES: Ethnic inequalities in health (EIH) are unjust public health problem that emerge across societies. In Israel, despite uniform healthcare coverage, marked EIH persist between Arabs and Jews. METHODS: We draw on the ecosocial approach to examine the relative contributions of individual socioeconomic status (SES), psychosocial and health behavioral factors, and the living environment (neighborhood problems, social capital, and social participation) to explaining ethnic differences in self-rated health (SRH). Data were derived from two nationwide studies conducted in 2004-2005 of stratified samples of Arabs (N = 902) and Jews (N = 1087). RESULTS: Poor SRH was significantly higher among Arabs after adjustment for age and gender [odds ratio and 95% confidence interval (CI) = 1.94 (1.57-2.40)]. This association was reversed following adjustment for all possible mediators: OR (95% CI) = 0.70(0.53-0.92). The relative contribution of SES and the living environment was sizable, each attenuating the EIH by 40%, psychosocial factors by 25%, and health behaviors by 16%. CONCLUSIONS: Arabs in Israel have poorer SRH than Jews. Polices to reduce this inequality should mainly focus on improving the SES and the living conditions of the Arabs, which might enhance health behaviors and well-being.

Disorganization Theory, Neighborhood Social Capital, and Ethnic Inequalities in Intimate Partner Violence between Arab and Jewish Women Citizens of Israel.

We draw on social disorganization (SD) theory and social capital to examine the impact of neighborhood environment on the ethnic gap in intimate partner violence (IPV) between Arab and Jewish women in Israel. We linked census data on neighborhood socioeconomic status (SES) to national data we gathered in 2014-2015 on 1401 women (436 Arab, 965 Jewish) age 16-48. Women were interviewed while visiting 65 maternal and child health clinics throughout Israel. We used General Estimated Equation (GEE) multivariate logistic regression models to adjust for clinic cluster effects and estimated the contribution of neighborhood collective efficacy, problems, relative socioeconomic status (SES), bridging and linking social capital, and social support to explaining ethnic inequalities in IPV, while adjusting for women's socioeconomic and socio-demographic characteristics. We found that any IPV is higher among Arab compared to Jewish women (odds ratio (OR) and 95% confidence intervals (CI) = 4.19 (2.72,6.42)). Collective efficacy and social group membership (bridging social capital) had no effect on the ethnic inequality in any IPV and types of IPV. Women's active participation in social groups (linking social capital), higher social support, and living in neighborhoods with relative SES similar to the ethnic group average) had a protective effect from any IPV and physical IPV. Neighborhood problems were associated with increased any IPV and physical IPV. In the final model, the ethnic gap in IPV was reduced but not eliminated (OR (95%CI) = 3.28 (2.01, 5.35). Collective efficacy did not explain the ethnic gap in IPV, while women's active participation (linking social capital) had a protective effect from IPV. Given the protective nature of women's activism in this population, future research should investigate how this might be incorporated into solutions to IPV. In addition, reducing neighborhood problems, improving neighborhood SES, and increasing social support might help reduce IPV among Arab women, thus decreasing the ethnic gap in IPV.

Strategizing Safety: Theoretical Frameworks to Understand Women's Decision Making in the Face of Partner Violence and Social Inequities.

Women in physically and psychologically abusive relationships face numerous decisions related to their safety: decisions that historically have been viewed by researchers and human service practitioners as related to individual or interpersonal factors, such as how they feel about their partner, what they (or those they are close to) think is best for their children, or whether they have a safe place to go to. Social and structural factors, such as poverty, sexism, and barriers related to disability, are either left out or viewed at their individual-level consequence, such as a woman's employment status. Using interview data and case studies from a larger study on housing instability, partner violence, and health, the authors apply ecological and macro-level theoretical models that go beyond the individual level to the stories of women who struggled with partner violence, arguing that it is critical to examine the large social and structural forces that impact women's lives if we are to understand the decisions women make when facing a violent partner.

Partner Disengagement from Pregnancy and Adverse Maternal and Infant Outcomes.

OBJECTIVE: To assess whether partner disengagement from pregnancy is associated with adverse maternal and infant outcomes. MATERIALS AND METHODS: We analyzed data from the 2006-2007 Canadian Maternity Experiences Survey, comprising a cross-sectional representative sample of 6,421 childbearing women. Multiple logistic regression assessed the association between adverse outcomes and three indicators of partner disengagement: (1) partner did not want the pregnancy, (2) partner argued more than usual in the year prior to the baby's birth, and (3) partner was absent at the delivery. RESULTS: Of all respondents, 3.8% had partners who did not want the pregnancy, 16.1% argued more than usual with their partner in the past year, and 7.6% had partners who were absent at the delivery. Women whose partner did not want the pregnancy were more likely to report intimate partner violence (IPV) (adjusted odds ratio [AOR] 3.55; 95% confidence interval [95% CI] 2.36-5.14), elevated depressive symptoms in the extended postpartum period (AOR 2.56, 95% CI 1.70-3.83), and nonroutine child healthcare visits after birth (AOR 1.54, 95% CI 1.13-2.11). Women whose partner argued more in the past year had higher odds of IPV (AOR 4.82, 95% CI 3.69-6.30), elevated depressive symptoms in the extended postpartum period (AOR 3.63; 95% CI 2.84-4.64), and nonroutine child healthcare visits (AOR 1.49, 95% CI 1.26-1.77), after adjustment for potential confounders. CONCLUSIONS: Partner disengagement is common and is associated with adverse maternal and infant outcomes. Affected women may benefit from special assistance during pregnancy and after delivery.

Social characteristics associated with disparities in smoking rates in Israel.

BACKGROUND: Cigarette smoking is a major cause of health disparities. We aimed to determine social characteristics associated with smoking status and age at smoking initiation in the ethnically-diverse population of Israel. METHODS: This is a cross-sectional survey, based on data collected during 2010 by the Israel Bureau of Statistics, in a representative nationwide sample of 7,524 adults (≥20 years). Information collected by personal interviews included a broad set of demographic and socio-economic characteristics and detailed information on smoking habits. Associations between social characteristics and smoking habits were tested in multivariable regression models. RESULTS: Current smoking was more frequent among men than among women (30.9 % vs. 16.8 %; p < 0.0001). In multivariable regression analysis, the association of some social characteristics with smoking status differed by gender. Lower socioeconomic status (reflected by higher rate of unemployment, lower income, possession of fewer material assets, difficulty to meet living expenses) and lower educational level were significantly associated with current smoking among men but not among women. Family status other than being married was associated with higher likelihood of being a current smoker, while being traditional or observant was associated with a lower likelihood of ever smoking among both gender groups. Arab minority men and male immigrants from the former Soviet Union countries were more frequently current smokers than Israeli-born Jewish men [adjusted odds ratio (95 % confidence interval): 1.53 (1.22, 1.93) and 1.37 (1.01-1.87), respectively]. Compared to Israeli-born men, the age at smoking initiation was younger among male immigrants, and older among Arab minority men [adjusted hazard ratio (95 % confidence interval): 1.360 (1.165-1.586), and 0.849 (0.749-0.962), respectively]. While the prevalence of current smoking was lower in younger birth cohorts, the age at smoking initiation among ever-smokers declined as well. CONCLUSIONS: Among several subgroups within the Israeli population the smoking uptake is high, e.g. Arab men, men who are less affluent, who have lower educational level, and male immigrants. These subgroups should be prioritized for intervention to reduce the burden of smoking. To be effective, gender, cultural background and socioeconomic characteristics should be considered in the design and implementation of culturally-congruent tobacco control and smoking prevention and cessation interventions.

Where Did She Go? The Transformation of Self-Esteem, Self-Identity, and Mental Well-Being among Women Who Have Experienced Intimate Partner Violence.

BACKGROUND: Discussions on intimate partner violence (IPV) often focus on physical abuse, ignoring psychological and sexual abuse and controlling behaviors. The damage of varied forms of IPV on mental well-being in its broader form have been far less explored, especially among low-income women. Our aim was to improve our understanding of self-perceptions of mental well-being among low-income women who have experienced IPV by considering a broader definition of mental well-being that includes self-esteem and self-identity as core components. METHODS: Using qualitative methods, we present findings from in-depth interviews with 41 low-income women currently or recently experiencing abuse and housing instability. RESULTS: Women experienced varied types of violence (physical, sexual, emotional, psychological, social isolation, and controlling behaviors). Injuries resulting from physical abuse were viewed differently from those arising from emotional and psychological control. Physical injuries healed faster, whereas damage to self-esteem and identity lingered. The journey through and out of IPV is often marked by an initial erosion of sense of self (identity deconstruction) followed by the identity reconstruction through an extended process of change aimed at rebuilding self-esteem, mental well-being, self-efficacy, and ultimately self-identity. CONCLUSIONS: IPV-related training for physicians and allied health professionals should emphasize the varied nature of IPV and its impact on identity, self-esteem, and self-efficacy. Treatment should be holistic to address comorbid needs, including physical injury, mental health, and addiction problems. Consider supportive programs that integrate those living with or leaving IPV with women with past lived experience who can help women to understand the process of change and support this change in a nurturing setting.

Patterns of social inequalities across pregnancy and birth outcomes: a comparison of individual and neighborhood socioeconomic measures.

BACKGROUND: This paper identifies patterns of health inequalities (consistency and magnitude) of socioeconomic disparities for multiple maternal and child health (MCH) outcomes that represent different health care needs of mothers and infants. METHODS: Using cross-sectional national data (unweighted sample = 6,421, weighted =76,508) from the Canadian Maternity Experiences Survey linked with 2006 Canadian census data, we categorized 25 health indicators of mothers of singletons into five groups of MCH outcomes (A. maternal and infant health status indicators; B. prenatal care; C. maternal experience of labor and delivery; D. neonatal medical care; and E. postpartum infant care and maternal perceptions of health care services). We then examined the association of these health indicators with individual socioeconomic position (SEP) (education and income), neighborhood SEP and combined SEP (a four-level measure of low and high individual and neighborhood SEP), and compared the magnitude (odds ratios and 95% confidence intervals) and direction of the associations within and between MCH outcome groups. RESULTS: We observed consistent positive gradients of socioeconomic inequalities within most groups and for 23/25 MCH outcomes. However, more significant associations and stronger gradients were observed for the MCH outcomes in the maternal and infant health status group as opposed to other groups. The neonatal medical care outcomes were weakly associated with SEP. The direction of associations was negative between some SEP measures and HIV testing, timing of the first ultrasound, caesarean section, epidural for vaginal births, infant needing non-routine neonatal care after discharge and any breastfeeding at 3 or 6 months. Gradients were steep for individual SEP but moderate for neighborhood SEP. Combined SEP had no consistent gradients but the subcategory of low individual-high neighborhood SEP often showed the poorest health outcomes compared to the categories within this SEP grouping. CONCLUSION: By examining SEP gradients in multiple MCH outcomes categorized into groups of health care needs, we identified large and consistent inequalities both within and between these groups. Our results suggest differences in pathways and mechanisms contributing to SEP inequalities across groups of MCH outcomes that can be examined in future research and inform prioritization of policies for reducing these inequalities.

Polygamy and poor mental health among Arab Bedouin women: do socioeconomic position and social support matter?

OBJECTIVES: Polygamy is a complex phenomenon and a product of power relations, with deep cultural, social, economic, and political roots. Despite being banned in many countries, the practice persists and has been associated with women's marginalization and mental health sequelae. In this study, we sought to improve understanding of this ongoing, complex phenomenon by examining the contribution of socioeconomic position (SEP) and social support to the excess of depressive symptoms (DS) and poor self-rated health (SRH) among women in polygamous marriages compared to women in monogamous marriages. Measuring the contribution of these factors could facilitate policies and interventions aimed at protecting women's mental health. DESIGN: The study was conducted among a sample of Arab Bedouin women living in a marginalized community in southern Israel (N=464, age 18-50). The women were personally interviewed in 2008-2009. We then used logistic regression models to calculate the contribution of SEP (as defined by the women's education, family SEP, and household characteristics) and social support to excess of depressive symptoms and poor SRH among participants in polygamous versus monogamous marriages. RESULTS: About 23% of the participants were in polygamous marriages. These women reported almost twice the odds of depressive symptoms (OR=1.91, 95%CI=1.22, 2.99) and poorer SRH (OR=1.73, 95%CI=1.10, 2.72) than those in monogamous marriages. Women's education changed these associations slightly, but family SEP and household characteristics resulted in virtually no further change. Social support reduced the odds for poor SRH and DS by about 23% and 28%, respectively. CONCLUSION: Polygamy is associated with higher risk for poor mental health of women regardless of their SEP and education. Social support seems to have some protective effect.