Pregnant Latinas' perspectives on pursuing expanded carrier screening: "It is better to know than not".

With the advance of genetic technologies, the use of expanded carrier screening (ECS) in the prenatal setting is growing. ECS tests for a wide range of inherited genetic disorders regardless of racial/ethnic background and family history. Latinxs are an important ECS stakeholder group as they are the largest minority group with the highest fertility rate in the United States. Yet, the Latinx population has, to date, been underrepresented and understudied in genetics/genomics research. We conducted a study to explore the knowledge and perspectives of pregnant Latinas regarding ECS in which descriptive statistics and content analysis were used to analyze the data. Thirty-two pregnant Latinas - mostly of low educational levels (no education beyond high school) and with less than $20,000 annual household income living in rural areas were surveyed, provided with education about ECS, and interviewed. Participants were found to possess limited knowledge about ECS prior to being interviewed. Most (68.8%), however, expressed interest in pursuing ECS following the educational component that explained ECS. Their interest was mainly driven by the desire to know their baby's chance of developing a genetic disorder, the low risk of ECS procedures for both pregnant Latinas and their fetus, and the opportunity to better prepare for raising a child with a genetic condition. Our findings contribute to the limited research in the genetics/genomics field by providing in-depth insights into the perspectives of pregnant Latinas regarding ECS. Obstetric providers and genetic counselors should provide culturally appropriate education and counseling to empower pregnant Latinas to make informed decisions about the use of ECS.

Health and safety concerns of female asylum seekers living in an informal migrant camp in Matamoros, Mexico.

BACKGROUND: Whilst increased numbers of people worldwide exercise their human right to seek asylum, the US has greatly reduced the number of asylum seekers able to enter its southern border, resulting in informal encampments. Women and children are uniquely vulnerable to violence and other health risks. AIM: To describe the health and safety concerns of female asylum seekers living in an informal migrant camp, with a particular focus on the risks of violence against women and children. METHODS: For this qualitative descriptive study, female asylum seekers were purposively recruited in an informal tent encampment in Matamoros, Mexico (n = 43). Semi-structured interviews were conducted in January and February 2020. Qualitative data were analysed using thematic analysis. RESULTS: The themes identified were constant vigilance, the effects of constant vigilance, lack of resources, and uncertainty. Women's unrelenting fears about their own safety and that of their children impacted their ability to access the camp's meagre resources and exacerbated negative effects on women and children. CONCLUSION: Applying established guidelines and best practices for health and safety in humanitarian settings could mitigate threats to women and children. Additionally, camp conditions represent human rights violations. Nurses have an ethical duty to advocate for an end to the US policies creating and maintaining this humanitarian crisis. IMPACT: As a result of changes to the United States immigration policy, individuals seeking asylum at the Southern border of the US have been largely prevented from entering the US since early 2018. Asylum seekers living in an informal encampment on the border awaiting entry describe a public health, humanitarian and human rights crisis. Women in this already vulnerable group lacked necessities, such as housing, food security, potable water, protection against gender violence and other forms of physical threats to themselves and their children. This created a heightened sense of vigilance and fear, with implications for their mental health and well-being and that of their children. These findings highlight the need for governmental and international organizations to implement the best health and safety practices for humanitarian settings to ensure equity in relation to the social determinants of health. Nurses have an ethical obligation to be strong human rights advocates. PATIENT OR PUBLIC CONTRIBUTIONS: One member of the research team has extensive experience as an advocate for recently immigrated women experiencing intimate partner violence. The study procedures were reviewed with advocates providing direct services to migrant women and children.

Pregnant Latinas' views of adopting exome sequencing into newborn screening: A qualitative study.

PURPOSE: There are, currently, conflicting opinions about the adoption of exome sequencing (ES) into the standard newborn screening program. This study aimed to explore the views of pregnant Latinas, a hard-to-reach, underserved, and understudied population, about pursuing ES for their newborns. METHODS: We conducted semistructured interviews with 32 pregnant Latinas who predominately lived in rural areas and had low levels of income and education. An emergent coding approach was used to analyze the qualitative data collected. RESULTS: Our entire sample believed that ES should be offered as a part of newborn screening, which could empower pregnant Latinas to better understand their children's health and take early treatment actions. Although some participants were concerned about potentially bad ES results and had questions about the accuracy of ES results, nearly all interviewees reported that they would be willing to have their newborns undergo ES. The main reasons given were to be informed of diseases that the baby may have, and the perception that ES is a procedure that involves minimal risk. CONCLUSION: Pregnant Latinas in this study had favorable attitudes toward newborn ES. Their perspectives should be considered when decisions are made about incorporating ES into newborn screening.

Ethno-Racial Differences in Children's Attitudes and Beliefs About Violence.

One in 15 children in the United States are exposed to intimate partner violence (IPV) each year. Although much is known about the adverse effects of witnessing IPV on children, little attention has been given to the impact of IPV on children of diverse ethno-racial backgrounds. In particular, the association between IPV and children's attitudes and beliefs about violence across different ethno-racial populations remains to be explored. One hundred ninety children between the ages of 4 and 12 years of varying ethno-racial backgrounds who had witnessed recent IPV were interviewed regarding their attitudes and beliefs about IPV. Results show that younger children and White, Black, and Biracial children exhibited more deleterious attitudes and beliefs about violence after exposure to IPV than did older and Latina or Latino children. These findings may indicate the need for more tailored intervention programs that target the specific maladaptive beliefs expressed by children of various demographic groups.

The Intersection of Partner Violence and Adverse Childhood Experiences: Implications for Research and Clinical Practice.

Violence against women continues to be a serious public health issue afflicting women worldwide. The intersection of Adverse Childhood Experiences (ACEs) and intimate partner violence is detrimental to a woman's well-being. This review aims to identify the types of ACEs reported by women who also report partner violence and the subsequent negative impact of this combination of experiences on the women's health. The evidence supports the cumulative effects of Adverse Childhood Experiences on women, particularly when coupled with experiences of intimate partner violence. Early interventions by providers have the potential to mitigate negative health outcomes of abused women and interrupt the intergenerational transmission of violence to their children.

Women's functioning following an intervention for partner violence: new knowledge for clinical practice from a 7-year study.

Intimate partner violence affects one in three women worldwide, with women who experience violence almost twice as likely to experience poor mental health, especially depression, compared with women who are not abused. To learn the impact of interventions of safe shelter and justice services on improved mental health and behavior functioning, 300 abused women are interviewed every 4 months in a 7-year prospective study. For this paper, abuse, mental health and resiliency status of these women, 1 year after accessing services for the first time, are reported. Measures of mental health (depression, anxiety, post-traumatic stress disorder (PTSD), somatization), and adult behavioral functioning are reported. At 4 months following a shelter stay or justice services, a large effect size was measured for improvement in all mental health measures; however, improvement was the lowest for PTSD. All mental health measures plateaued at 4 months with minimum further improvement at 12 months. Both internal behavioral dysfunctions (withdrawal and somatic complaints) were worse with increased depressive symptoms, as were external behavioral dysfunctions (aggressive and rule-breaking behaviors). A concerning 39.2% of the women had clinical PTSD scores at 12 months following receipt of safe shelter or justice services, compared with a much lower percentage of women with clinical depression (14.2%), clinical somatization (9.4%), and clinical anxiety (13.5%). Depression was a significant positive predictor of internal and external behavioral dysfunctions, indicating that women who had higher levels of depression tended to report more internal dysfunctions (withdrawal, anxiety, somatization) and more external behaviors (aggression and rule-breaking).

Benefits and concerns of expanded carrier screening: what do pregnant Latina women in Texas think?

The American College of Medical Genetics and Genomics (ACMG) recommends carrier screening for all pregnant women regardless of race or ethnicity. In recent years, the ACMG broadened the guidelines to include expanded carrier screening (ECS) which can screen for 112 conditions. This study seeks to explore the perceptions of pregnant Latina women about the benefits and concerns related to ECS use. Partnering with prenatal clinics in Texas, we conducted semi-structured qualitative interviews with 32 pregnant Latina women in their second or third trimester of pregnancy. NVivo 8 was used to conduct content analysis and emergent coding of the data. Participants reported the benefits of ECS as helping them prepare for the baby's arrival, informing them of the baby's risk for genetic conditions, ensuring the health of their baby, and preventing diseases before birth. The ECS-related concerns expressed by the participants included worries surrounding potential positive ECS results, insufficient knowledge about the genetic diseases screened for by ECS, the accuracy of the ECS, the potential harm ECS may cause the baby, and the affordability of ECS. After weighing both their perceived benefits and concerns, nearly all the participants believed that ECS should be offered to all pregnant women. This study contributes to an understudied research area in the genetic/genomic field. Our findings can help increase the awareness of obstetricians, genetic professionals, and other healthcare providers regarding pregnant Latina women's views on ECS and inform the design of culturally appropriate care as ECS is adopted into routine clinical practice.

'Now My Eyes are Open': Latina women's experiences in long-term support groups for intimate partner violence survivors.

One in four women has experienced intimate partner violence in their lifetimes. The effects of intimate partner violence on women's mental health may be long-term; possible conditions include post-traumatic stress disorder, depression, and anxiety. Latina women may be particularly vulnerable to long-term effects of intimate partner violence. The purpose of this study was to describe Latina women's experiences in long-term support groups for survivors of intimate partner violence. Forty-nine Latina women were interviewed about their experiences in a nurse-led long-term support group, with participation from 2 months to 9 years. The women ranged in age from 26 to 73 years and all but two interviews were in Spanish. Five themes emerged from the qualitative data: awakening, transformation, community, empowerment, and advocate. Women described their thoughts of still feeling the 'ugliness of the abuse', even years after it occurred with some women enduring abuse for as long as 32 years. The need for long-term support groups was evident as women described the value of the group for providing support and gaining an understanding that they are not alone, or their awakening to the idea that they can have a life without abuse. Long-term support groups give voice to Latina women who are survivors of intimate partner violence. By raising their awareness and sense of community, women survivors can be transformed and empowered to improve their lives and advocate for others who face similar struggles.

Factors influencing disclosure of abuse by women of Mexican descent.

PURPOSE: The purpose of this study was to describe the factors that influence disclosure of abuse by women of Mexican descent. Few published studies describe the experiences of women of Mexican descent with a history of intimate partner abuse, specifically in terms of their process of disclosure of abuse. METHODS: A qualitative research design was used to conduct this study in south Texas adjacent to the United States-Mexico border. Twenty-six key informants were recruited from two different sites. An open-ended approach with a semistructured interview guide was used to collect the narrative information from the 26 participants. RESULTS: The findings illuminated that many factors hindered disclosure. Some of these factors included protecting their partners, avoidance of worrying their mothers, and fear of losing their children. CONCLUSIONS: The study may help healthcare providers to understand the complexity of disclosure by women with a history of intimate partner abuse and may help explain why women do not readily disclose their abusive situations. CLINICAL RELEVANCE: This study on the disclosure decision process of abuse by women of Mexican descent provides some understanding on the cultural or situational factors that hindered or encouraged disclosure; ultimately this knowledge can help healthcare providers and others to provide for the woman's health, welfare, and safety.

Cross-cultural factors in disclosure of intimate partner violence: an integrated review.

AIM: This paper is a report of an integrated review to identify cross-cultural factors that have an impact on women's disclosure of intimate partner violence, specifically related to Mexican-American women. BACKGROUND: Intimate partner violence was once recognized as a private matter. Disclosure is a complex concept; furthermore in our multi-cultural society, a woman's decision whether or not to disclose abuse can be attributed to several factors influenced by her culture. DATA SOURCES: The World Wide Web and multiple databases including Academic Premier, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsychArticles, PsychInfo, Medline, Eric, MedicLatina, and Psychology and Behavioral Science Collection were searched for studies published between 1996 and 2007. METHODS: A search was conducted using databases including the CINAHL, PsychINFO, MEDLINE, ERIC and MedicLatina. Both qualitative and quantitative studies published between May 1996 and July 2007 were included. Forty-two studies were included in the review. Appraisal of study quality was not undertaken. RESULTS: Fear was the most common cross-cultural factor interfering with disclosure. Most of the literature examines factors influencing and interfering with disclosure of abuse among white and African-American women. Only one study was found to include a sample of Mexican-American women. CONCLUSION: Increased efforts are needed to understand disclosure of intimate partner violence in minority women so that service providers can tailor services and ways to encourage disclosure with appropriate strategies based on women's culture. Further research is needed to understand the lived experiences of minority women, including Mexican-American women living in intimate partner violence.

Men of Mexican Origin Who Abuse Women: A Qualitative Study.

BACKGROUND: Current literature indicates that intimate partner violence is a complex phenomenon that exists worldwide. PURPOSE: However, little is known about why some men of Mexican origin abuse women. This descriptive study was conducted to understand the experiences of men of Mexican origin who abuse their intimate partners. METHOD: A qualitative research design was used to conduct this study in a south Texas border community adjacent to the United States-Mexico border. RESULTS: This study builds on existing research and furthers the knowledge related to the factors contributing to intimate partner violence, including cultural factors. The results also reinforce the negative impacts of intimate partner violence on children and the family structure. DISCUSSION: Further research is needed to support the development of a culturally appropriate prevention and intervention program for men of Mexican origin who abuse women and their families.

Empowerment in Latina Immigrant Women Recovering From Interpersonal Violence: A Concept Analysis.

Latina immigrant women are vulnerable and may experience higher levels of interpersonal or intimate partner violence (IPV) due to their immigrant status and cultural emphasis on familism. The concept of empowerment within the cultural context of Latina immigrant women experiencing IPV was analyzed using a modified version of Walker and Avant's concept analysis technique. The technique considers usage and definitions in the literature, antecedents, attributes, empirical referents, and the inclusion of a model and contrary case. This analysis encompasses a comparative approach and includes a discussion of how the definition of empowerment compares across the nursing literature. Defining attributes include reciprocal relationships, autonomy, and accountability. Antecedents comprise willingness to learn and motivation to create change. Consequences encompass self-esteem, self-efficacy, and competence for making life decisions. Empowerment has the potential to improve total well-being, having a positive and profound impact on the lives of women experiencing IPV.

Ethnoracial Variation in Depression Symptoms.

INTRODUCTION: While there is a long-standing tradition of research on the predictors of depression among women exposed to violence, little of this research has been conducted across ethnic and racial groups. METHOD: A cross-sectional study comparing a total of 191 women with a history of intimate partner violence were recruited from commercial, medical, and educational settings and by contact with agencies serving the needs of abused women, for example, shelters, community outreach. The study examined intimate partner violence and the adjustment of mothers of children ages 5 to 12 to explore both commonalities and differences in the ways in which four groups of women (African American, Biracial, Latina, and White women) cope with violence in their lives. In addition to demographic information, depression symptoms were assessed by self-report with the Center for Epidemiologic Studies Depression scale. RESULTS: The findings indicate that Latina women had significantly higher depression symptoms than did African American and White women. CONCLUSION: While it is important to assess the mental health needs of all abused women, these results show additional need for Latina women, those with low income and high violence exposure.

Ethnoracial Variation in Women's Exposure to Intimate Partner Violence.

While intimate partner violence (IPV) has been acknowledged as a national public health concern, little research exists that directly assesses differential exposure to IPV for distinct ethnoracial groups. The current study compared the rate, severity, and type of IPV exposure across samples of White, African American, and Latina women (N = 180). Participants reported rates of exposure to violence on measures of physical assault, psychological aggression, injury, and sexual coercion; each subscale contained items denoting both mild and severe levels of violence. Multiple regression analyses indicated that women's frequency of exposure to sexual coercion, and severe and injurious violence significantly differed based on participants' ethnoracial identification, such that Latina women experienced disproportionate levels of violence relative to White and African American peers. Mothers' monthly income, level of education, general health, and relationship status also emerged as significant predictors of violence exposure. Results support the development of culturally sensitive adaptations of IPV interventions, targeting not only Latina populations but also women who are single, low-income, and educationally underserved.

Predicting Abused Women With Children Who Return to a Shelter: Development and Use of a Rapid Assessment Triage Tool.

To develop a tool to predict risk for return to a shelter, 150 women with children, exiting a domestic violence shelter, were evaluated every 4 months for 24 months to determine risk factors for returning to a shelter. The study identified four risk factors, including danger for murder, woman's age (i.e., older women), tangible support (i.e., access to money, transportation), and child witness to verbal abuse of the mother. An easy to use, quick triage tool with a weighted score was derived, which can identify with 90% accuracy abused women with children most likely to return to shelters.

Behavioral functioning of children of abused women who seek services from shelters or the justice system: new knowledge for clinical practice.

Millions of women worldwide are victims of partner violence annually and their children are at-risk for psychological and physical dysfunctions. A total of 300 children (ages 18 months to 16 years), whose abused mothers sought safe shelter or a protection order for the first time, were studied. Data revealed internalizing behaviors, such as depression and externalizing behaviors, such as bullying decreased 4 months after mothers obtained help. Children's scores from the shelter group indicated more dysfunction. Although no direct program was offered to the children studied, routine child care presents opportunities for nurses in pediatric settings to assess mothers for abuse and intervene with guided referrals and safety information that may promote better child functioning.

U.S.-born compared to non-U.S.-born abused women: analysis of baseline data.

It is evident from recent studies that a woman's citizenship status does not exempt her from exposure to partner violence. The purpose of this article was to examine if social support, self-efficacy, and marginalization of abused women differ based on U.S. born compared to non-U.S. born with and without documentation. The findings suggest that women who were born in the United States had significantly higher self-efficacy scores compared to non-U.S.-born women without documents. There were no significant differences in social support among abused women who are U.S. born compared to non-U.S. born with and without documentation. In addition, women who were not born in the United States and did not have documents had higher marginalization.