How Advocates Use CARE to Accommodate the Needs of Domestic Violence Survivors Seeking Services With Brain Injuries and Mental Health Challenges: A Process Evaluation.

We evaluated the implementation of Connect, Acknowledge, Respond, and Evaluate (CARE), an organization-level intervention, to accommodate the health needs of survivors, including brain injury. Participants were staff or administrators at agencies serving domestic violence (DV) survivors (n = 57 advocates; n = 5 agencies). Process evaluation focus groups (n = 10 groups) were conducted. Two researchers coded/analyzed focus group transcripts using grounded theory. The use of CARE increased advocate awareness/knowledge of brain injury among survivors leading to improvements to the agencies' provision of structural and functional social support to survivors. CARE is a valuable resource to accommodate survivors, thereby improving staff's perception of their ability to provide trauma-informed service provision for DV survivors.

Smoking cessation methods among homeless youth in a Midwestern city.

INTRODUCTION: Nearly three times as many homeless youth smoke cigarettes in the United States (US) compared to the general population of youth. Few studies have focused on how to help homeless youth quit smoking. As part of a series of studies to develop a smoking cessation intervention for homeless youth, this study aimed to describe methods used in past quit attempts by homeless youth. METHODS:  Recruited from a drop-in center in the Midwestern US, the analytic sample was comprised of 32 unaccompanied homeless youth aged 14-24 who smoked combustible tobacco at some point in the past week. In-person qualitative interviews were conducted to understand prior quit attempt experiences of homeless youth. RESULTS: Twenty-two youth (69%) were willing to quit smoking in the next 30 days. Most previous quit attempts were unassisted (78%). Participants frequently reported engaging in distracting behaviors (e.g., video games) or thoughts (e.g., remaining positive). Nicotine replacement therapy (NRT) was another popular method (38%), but with mostly negative reactions. While less common, vaping and use of cannabis to substitute cigarettes was reported in a notable faction of youth (28%), primarily 18-24 years of age. CONCLUSIONS: Youth are primarily engaging in non-evidence-based strategies to quit smoking. Existing evidence-based treatments are often underutilized or not used according to instructions, and youth who do use evidence-based treatments do not find them useful. Future research should explore effective cessation treatment among homeless youth that can ideally be provided at shelters and drop-in centers. IMPLICATIONS: Existing evidence-based treatments are underutilized by homeless youth in this study. Most homeless youth are willing to quit in the next month and are interested in trying behavioral counseling and monitored use of NRT. Drop-in centers may be an effective location from which to develop and offer targeted smoking cessation interventions for homeless youth.

A social-contextual investigation of smoking among rural women: multi-level factors associated with smoking status and considerations for cessation.

INTRODUCTION: The social-contextual model of tobacco control and the potential mechanisms of the maintenance or cessation of smoking behavior among disadvantaged women, including rural residents, have yet to be comprehensively studied. The purpose of this study was to determine the association between selected individual, interpersonal, workplace, and neighborhood characteristics and smoking status among women in Appalachia, a US region whose residents experience a disproportionate prevalence of tobacco-related health disparities. These findings may assist in efforts to design and test scientifically valid tobacco control interventions for this and other disadvantaged populations. METHODS: Women, 18 years of age and older, residing in three rural Ohio Appalachian counties, were recruited using a two-phase address-based sampling methodology for a cross-sectional interview-administered survey between August 2012 and October 2013 (N=408). Multinomial logistic regression was employed to determine associations between select multilevel factors (independent variables) and smoking status (dependent variable). The sample included 82 (20.1%) current smokers, 92 (22.5%) former smokers, and 234 (57.4%) women reporting never smoking (mean age 51.7 years). RESULTS: In the final multivariable multinomial logistic regression model, controlling for all other significant associations, constructs at multiple social-contextual levels were associated with current versus either former or never smoking. At the individual level, for every additional year in age, the odds of being a former or never smoker increased by 7% and 6% (odds ratio (OR) (95% confidence interval(CI)): 1.07 (1.0-1.11) and 1.06 (1.02-1.09)), respectively, as compared to the odds of being a current smoker. With regard to depression, for each one unit increase in the Center for Epidemiologic Studies Depression Scale score, the odds of being a former or never smoker were 5% and 7% lower (OR(95%CI): 0.95(0.91-0.999) and 0.93(0.88-0.98)), respectively. Five interpersonal factors were associated with smoking status. As the social influence injunctive norm score increased by one unit, indicating perception of smoking to be more acceptable, the odds of being a former or never smoker decreased by 23% and 30%, respectively. For every one unit increase in the social participation score, indicating past-year engagement in one additional activity type, the odds of being a former or never smoker increased by 17% and 36%, respectively. For every 10% increase in the percentage of social ties in the participant's advice network who smoked, the odds of being a former or never smoker were 24% and 28% less, respectively. For every 0.1 unit increase in the E/I index, indicating increasing homophily on smoking in one's social network, the odds of being a former or never smoker were 20% and 24% less, respectively, in the time network, and 18% and 20% less, respectively, in the advice network. At the neighborhood level, for every one unit increase in neighborhood cohesion score, indicating increasing cohesion, the odds of being a former smoker or never smoker were 12% and 14% less, respectively. CONCLUSIONS: These findings indicate that a social-contextual approach to tobacco control may be useful for narrowing a widening trajectory of smoking disparity for rural women. Interpersonal context, in particular, must be considered in the development of culturally targeted cessation interventions for Ohio Appalachian women.

Address-Based Sampling for Recruiting Rural Subpopulations: A 2-Phase, Multimode Approach.

PURPOSE: This article describes recruitment of a subpopulation of women in a rural area, extending an existing method of a 2-phase address-based sampling protocol to include a mixed-mode approach. METHODS: Phase 1 included a household enumeration questionnaire mailed to randomly selected households (n = 1,950) in 3 Ohio Appalachian counties to identify members of the eligible subgroup. The second phase of recruitment involved contacting 1 randomly selected eligible woman enumerated by each household, based on return of the questionnaire. These women (n = 599) were invited by field interviewers to participate in a one-time in-person health survey. FINDINGS: Of the women invited to participate, a total of 408 completed the interview. Based on American Association for Public Opinion Research Response Rate 1 calculations, the response rates were 44.4% and 70.3% for phases 1 and 2, respectively. Response rates in this study were encouraging, especially for the second phase in-person interview. CONCLUSION: We discuss implications for future research using a mixed-mode approach in this subpopulation.