Frequent Marijuana or Alcohol Use in Low-Income Emerging Adults: Impact of Adverse Life Experiences.

BACKGROUND: The transition to adulthood may be especially difficult for those who use drugs and alcohol regularly. While research clearly links adverse childhood experiences (ACEs) with later substance use, many studies have explored only a limited range of ACEs, and have focused on the number instead of specific types of ACE. Objectives: The current study examined the role of ACEs on the likelihood of frequent marijuana and alcohol use among a community sample of emerging adults (N = 185). This research builds on and extends previous work by focusing on a low-income sample, examining specific types of ACEs, and expanding categories to include some less studied ACEs. Logistic regression models examined the relationships between ACEs and frequent alcohol or marijuana use. Results: The emerging adults in the current sample experienced many ACEs in childhood, and roughly a third reported frequent (defined as using once a week or more for the past 90 days) alcohol or marijuana use. ACEs associated with both frequent marijuana and alcohol use were time spent in foster care, childhood emotional abuse, and having a close family member or friend who died violently. Alcohol use was further predicted by childhood sexual abuse and witnessing a serious injury or death, while marijuana use was further predicted by childhood physical abuse. Conclusions: Findings highlight the importance of thoroughly assessing for ACEs when addressing substance use issues in young adults. The negative impact of being in foster care may be overlooked as a trauma beyond the experiences that contributed to entering care.

"Not Just One, It's Both of Us": Low-Income Mothers' Perceptions of Structural Family Therapy Delivered in a Semi-rural Community Mental Health Center.

Qualitative methods were used to explore mothers' perceptions of structural family therapy (SFT) delivered in a semi-rural community mental health clinic. In-depth, semi-structured interviews were conducted with sixteen mothers who received SFT after seeking services for their children. Thematic analysis suggests mothers found SFT acceptable and valuable. Mothers reported using SFT strategies to regain parental authority, which they believed improved their ability to manage their child's needs and decreased their own stress. SFT also increased some mothers' receptivity to individual treatment. Mothers identified their low dose of treatment and lack of father involvement as impediments to improvement, raising concerns about intervention sustainability.

Does Sense of Control Predict Depression Among Individuals After Psychiatric Hospital Discharge?

Sense of control is known to be related to depression. Yet, few studies have examined the role of sense of control as related to depression for discharged psychiatric patients. In this study the longitudinal relationship between sense of control and depressive mood was examined using the MacArthur Violence Risk Assessment Study, a 6-wave, 1-year study of 948 ethnically diverse postdischarge psychiatric patients. Sense of control was decomposed into 2 components (i.e., a time-invariant as well as a time-varying component) and so as to examine which component of sense of control would more accurately explain this relationship. Results demonstrated that time-varying sense of control significantly predicted changes in depressive mood during the transition to community environment. Time-invariant sense of control, however, was not significantly related to changes in depressive mood. Findings of this study hold important implications for intervention practice with people before or after psychiatric discharge, including the need for incorporation of therapeutic and psychoeducational efforts that bolster sense of control.

"He gets mad that I'm sober": Experiences of substance use coercion among postpartum women in recovery.

PURPOSE: The number of women with substance use disorders (SUDs) is growing in the U.S. Many women with SUDs are of childbearing age, and studies show that women who abstain from substance use during pregnancy often relapse in the postpartum period. Given the high overlap between substance use and intimate partner violence, these women may be in relationships that make recovery more challenging. This study aimed to better understand how substance abuse coercion in intimate relationships may affect substance use and to identify and describe the presence of substance use coercion in postpartum women. METHODS: The study conducted qualitative interviews with 30 women with substance use disorders who had given birth within the past six months. Researchers recruited women from a larger intervention study providing home visit support to postpartum women in substance use recovery. Thematic analysis was then identified overarching themes in the interview data. RESULTS: Analysis of the impact of IPV on substance use revealed four themes: 1) sabotaging sobriety, 2) making substance use a condition of the relationship, 3) portraying her as a "bad mom," and 4) furthering social isolation. CONCLUSIONS: Findings showed that women with SUDs have specific vulnerabilities that partners may exploit as a way of exerting control. Implications for practice with postpartum women who are working toward recovery are discussed.

Minority stress and sleep: How do stress perception and anxiety symptoms act as mediators for sexual minority men?

OBJECTIVES: Sexual minority men experience worse sleep than heterosexuals. Little is known about how minority stress may account for these differences. Therefore, the aims of this study are to (1) understand the relationship between minority stress and sleep disturbance in a sample of sexual minority men, and (2) test whether these relationships are mediated by generalized anxiety symptoms and perception of stress. METHODS: In 2020, 239 sexual minority men were recruited to complete an online survey. Participants responded to scales assessing minority stress (ie, internalized homophobia, experiences of harassment, microaggressions), perception of stress, generalized anxiety symptoms, and sleep disturbance. Linear regressions were used to test the relationship between minority stress and sleep disturbance and to test generalized anxiety symptoms and perception of stress as mediators. RESULTS: The final model was significant (F = 16.916, p < .001) and accounted for 43.5% of the variance in sleep disturbance. Generalized anxiety symptoms and perception of stress fully mediated the relationships between minority stress and sleep disturbance. CONCLUSIONS: Findings from this study suggest the need for psychological intervention to improve sleep for sexual minority men. Future research should test this model longitudinally, and include objective measures of stress. Future interventions could target stress perception using mindfulness or cognitive-based interventions.

Differential associations between childhood maltreatment types and borderline personality disorder from the perspective of emotion dysregulation.

BACKGROUND: Borderline Personality Disorder (BPD) is characterized by pervasive instability in a range of areas including interpersonal relationships, self-image, and affect. Extant studies have consistently identified significant correlations between childhood maltreatment (CM) and BPD. While exploring this CM-BPD link, a number of cross-sectional studies commonly emphasize the role of emotion dysregulation (ED). A better understanding of the associations between BPD and (1) CM and (2) ED are essential in formulating early, effective intervention approaches, and in addressing varied adverse impacts. METHODS: This cross-sectional study analyzed a subset of baseline data collected for a larger community-based longitudinal study. Given that our current focus on CM and ED, only those participants who completed the baseline CM assessment and ED measure (N = 144) were included for the primary analyses. We conducted stepwise multivariate linear models to examine the differential relationships between BPD features, ED, and multiple CM types. A path analysis with latent factors using the structural equation modeling (SEM) method was performed to test the indirect effect from CM to BPD features via ED. RESULTS: Linear regression models revealed that only emotional abuse (relative to other trauma types) was significantly associated with high BPD features. The SEM, by constructing direct and indirect effects simultaneously, showed that (1) ED partially mediated the path from CM to BPD features; and (2) CM played an important role in which the direct effect remained significant even after accounting for the indirect effect through ED. CONCLUSIONS: Our results highlight a most consistent association between emotional abuse and BPD, indicating its unique role in understanding BPD features in the context of CM. Further, shame-related negative appraisal and ED were found critical when examining the association between CM and BPD, possibly providing promising treatment targets for future practices.

Transracial mothering and maltreatment: are black/white biracial children at higher risk?

The number of people identifying as biracial is rapidly growing, though little is known about the experiences of interracial families. Previous work indicates that biracial children may be at elevated risk of entering the child welfare system. This could underscore additional risks faced by these families. This document includes data from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), a project funded by the Administration on Children, Youth, and Families, U.S. Department of Health and Human Services, and distributed by the National Data Archive on Child Abuse and Neglect. LONGSCAN data were used to examine familial risks associated with child maltreatment. White mothers of white children were compared to white mothers of biracial children with the hypothesis that interracial families would have less social and community support. Results showed that the women were similar in terms of mental health and parenting behaviors. There were no differences in maternal age, employment status, or presence of a partner. However, mothers of biracial children were poorer, had more alcohol use, and decreased social support. They experienced more intimate partner violence and lower neighborhood satisfaction. Findings have implications for intervention programs focused on reducing social isolation within interracial families.

"The Propellers of My Life" The Impact of Domestic Violence Transitional Housing on Parents and Children.

Housing and homelessness are frequent issues facing domestic violence (DV) survivors and their children. Several DV programs provide transitional housing (DVTH) to address the housing needs of DV survivors and their children. Despite wide use, little is known about the impact of DVTH, especially on child and parenting related needs and outcomes. Multiple structured interviews (82) were conducted with 27 parents with minor children living in DVTH in order to explore housing program experiences. Thematic analysis techniques produced three themes and seven subthemes about DVTH impact on parenting and child wellness. Overarching themes include: (1) DVTH helps to strengthen the parent-child relationship through a focus on family connection and health; (2). Transitional housing provides an opportunity for family stability via housing, material, and economic stability; (3). Time at DVTH allows family to access a diverse range of trauma-informed resources and social support to meet family goals. Barriers to these potential impacts are explored. Implications for practice with youth and parents include the need for extensive mental health and legal advocacy, programmatic models that emphasize resources, safety and the transition to permanent housing, and build on family strengths. Further research is needed to evaluate DVTH program outcomes.

Pregnant Victims of Intimate Partner Homicide in the National Violent Death Reporting System Database, 2003-2014: A Descriptive Analysis.

Intimate partner homicide (IPH) is a leading cause of maternal mortality in the United States. However, very little information exists as to the circumstantial factors associated with IPH during pregnancy. We conducted a descriptive study of the demographic characteristics, psychosocial service engagement, and crises experiences (i.e., life and relationship stressors) among pregnant and nonpregnant victims to understand what differences, if any, exist in their risk profile for IPH. Data from the Centers for Disease Control and Prevention's National Violent Death Reporting System (NVDRS) were used for this study. The NVDRS is a national opt-in tracking system of all violent deaths in the United States. Pregnant victims (N = 293) were significantly more likely to be 5 years younger than nonpregnant victims, African American, and never married. Pregnant victims were more likely to be seen in the emergency room following the fatal incident. Nonpregnant victims (N = 2,089) were significantly more likely to have suspected alcohol use at the time of their death. In strictly proportional terms, we also observed higher rates of mental health problems, a history of mental health treatment, and a reported history of intimate partner violence (IPV), crisis, or family problems among nonpregnant victims. A wider range of IPH-related risk factors (e.g. substance abuse) need to be included IPV assessments. Future studies should seek to develop effective interventions to prevent IPH, particularly among reproductive aged women.

Grandparenting, Social Relations, and Mortality in Old Age.

Guided by a convoy model of social relations, this study investigates the relationships between grandparenting status, social relations, and mortality among community-dwelling grandparents age 65 and older who are caring for their grandchildren. The data were drawn from the 2008 and 2016 waves of the Health and Retirement Study (N = 564). Latent class analysis was used to identify the social network structure based on six indicators of interpersonal relationships and activities. A series of hierarchical Weibull hazard models estimated the associations between grandparent caregiving, social relations, and mortality risk. Results of survival analyses indicate that co-parenting and custodial grandparents had higher all-cause mortality risk than grandparents who babysat occasionally; however, for custodial grandparents, the association was not significant once social relation variables were added to the model. This study suggests that community-based support may be beneficial to older grandparents and improved relationship quality is integral to the well-being of older adults.

Trauma, Sleep and Mental Health Problems in Low-Income Young Adults.

Low-income young adults are more likely to have exposure to trauma, which increases risk for mental health problems. Although adequate sleep promotes good health, people with histories of trauma are more likely to have sleep problems. The current study explored whether poor sleep mediated the relationship between trauma exposure and mental health. A sample of 143 low-income 18-24-year-old young adults completed depression, anxiety, and trauma exposure measures and wore sleep monitors for four nights. Structural equation modeling (SEM) was used to examine both direct and indirect effects of variables. Results showed that higher trauma exposure was associated with depression and anxiety. Mean sleep hours per night was fewer than six, far below recommended guidelines for optimal health and functioning. Fewer sleep hours partially mediated the relationship between both trauma exposure and depression and anxiety, and the direct effect from trauma remained significant after adjusting for the partial mediation from sleep.

Factors Affecting Contraception Access and Use in Patients With Opioid Use Disorder.

Maternal opioid use disorder increased > 4-fold from 1999 to 2014 and is associated with poor maternal and fetal outcomes. Women with opioid use disorder are at 2 to 3 times greater risk for unintended pregnancy than the general population and may face additional barriers to accessing and effectively using contraception compared to women without opioid use disorder, particularly highly effective long-acting reversible contraception. Additionally, women with opioid use disorder tend to use less effective forms of contraception such as condoms alone. Barriers to contraceptive access include patient misconceptions or knowledge gaps regarding reproductive health and family planning, cost, intimate partner violence, fear of criminalization, difficulty accessing care, comorbid health conditions, and health care provider misconceptions or practice limitations. Strategies that may assist women with opioid use disorder in achieving their family planning goals include colocation of family planning services within opioid treatment facilities, optimization of patient care services to minimize the need for costly and/or time consuming follow-up, increasing provider education and awareness of best practices in family planning and opioid use disorder treatment, and providing patient-centered family planning education and counseling. Additional research is needed to identify and develop strategies that empower women who use opioids to effectively access and use their preferred contraceptive method.

Optimizing Pregnancy Treatment Interventions for Moms (OPTI-Mom): A Pilot Study.

OBJECTIVES: The public health burden of opioid use disorder (OUD) among pregnant women has significantly increased in recent years. The Optimizing Pregnancy Treatment Interventions for Moms study was a pilot project that examined the feasibility of a patient navigation (PN) intervention model to reduce substance use and improve mental health, quality of life, and to increase engagement with treatment services among pregnant women with OUD. METHODS: A 1-group repeated-measures pilot study was conducted with treatment-seeking pregnant women with opioid dependence initiating buprenorphine maintenance treatment. Participants received the PN intervention delivered as 10 sessions before delivery and 4 sessions postpartum. Participants completed assessments at baseline and after the prenatal and postnatal portions of the intervention. Demographics were assessed using descriptive statistics, and general estimating equation analyses were employed to examine changes in health and service engagement across time. RESULTS: in all, 21 women were enrolled and completed the PN intervention and follow-up assessments. Participants reported improvements in abstinence from illicit opioids (B = 0.15, 95% confidence interval [CI] 0.1-0.2), drug use (odds ratio [OR] 5.25, 95% CI 2.1-13.0), and depression (OR 7.70, 95% CI 2.4-25.1). Results also showed nonsignificant trends suggesting enhancements in general health (B = 0.17, 95% CI 0.0-0.3, P = 0.06) and increases in substance use treatment attendance (B = 2.15, 95% CI -0.2 to 4.5, P = 0.07). Most study participants achieved adequate or better prenatal care. CONCLUSIONS: These findings provide support that PN is a feasible adjunctive intervention that shows promise for health improvements and service engagement among treatment-seeking pregnant women with opioid dependence initiating buprenorphine.

Children's direct sensory exposure to substantiated domestic violence crimes.

Police officers served as public health sentinels to collect data on children exposed to domestic violence events (DVEs) across an entire municipality for 1 year. These officers used a standard, validated protocol to collect data on all investigate DVEs. This study extended previous research by including data demographic data on children in the household at the time of the DVE and investigating children's direct sensory exposure to DVEs. Findings revealed that almost half of all events had children present, and 81% of these children were directly exposed to DVEs. Children under the age of 6 years old were at greater risk of direct sensory exposure. Domestic violence households with children were more likely to be low-income, non-White, and headed by a single female compared to households at large. Logistic regressions revealed that six major DVE variables were related to children being directly exposed. These included father as perpetrator, victim injury, weapon use, non-White victim, mutual assault, and arrest of perpetrator.

Socioemotional Problems in Children Exposed to Intimate Partner Violence: Mediating Effects of Attachment and Family Supports.

Given the high likelihood of women remaining with their partner when intimate partner violence (IPV) is present, it is important to work with existing family strengths and social supports to minimize emotional harm to the children of these couples. The current study involved interviews with mothers of young children in the child welfare system across a state in the northeast ( n = 336). Roughly one third of these women reported IPV in the past year. The relationship between IPV and child socioemotional problems was explored, along with supports that might mediate this relationship. Study results showed that child exposure to IPV was directly related to socioemotional problems. This was mediated by three family and social factors: strength of mother-child attachment, overall family functioning, and level of mothers' emotional support. Findings revealed the heterogeneity among families with IPV and highlight the need for interventions focused on the ecological context in which women are parenting.

Intimate partner violence in interracial couples: a comparison to white and ethnic minority monoracial couples.

The number of interracial couples in the U.S. is growing, but they often receive little support. Although previous studies have explored the relationship between low social support and decreased relationship satisfaction in interracial couples, there are few studies on intimate partner violence (IPV) in these couples. To better understand IPV in interracial couples compared to monoracial couples, all police-reported IPV events across a municipality were examined. Odds ratios showed differences between interracial and ethnic minority monoracial couples. Interracial couples were more likely to have a history of prior IPV (OR = 2.60), engage in mutual assault (OR = 2.36), and result in perpetrator arrest (OR = 1.71) than ethnic minority monoracial couples. Victims of IPV in interracial couples were also more likely to be injured (OR = 1.37). There were no significant differences between the couples in terms of substance use or children present during the IPV event. Differences between IPV in interracial and White couples also emerged. Interracial couples were more likely to have children present (OR = 1.84), to have a prior report (OR = 1.98), to result in victim injury (OR = 1.73), and to result in perpetrator arrest than White couples (OR = 2.18). Interracial couples were more likely to engage in mutual assault than White couples (OR = 2.94). However, interracial couples were about 50% less likely than White couples to use drugs or alcohol before or during the IPV event. Research is needed to better understand the unique challenges and needs faced by interracial couples to help them sustain healthy partnerships.