Generational and gender patterns of prescription opioid misuse among Black adults.

INTRODUCTION: Opioid-related overdose mortality disproportionally affects Black adults in Kentucky, particularly overdoses associated with prescription opioid misuse (POM). Black adults also face other consequences of POM, such as disparate health and legal outcomes. While several factors effect POM, such as generational factors and gender, these risk factors are understudied among Black adults with a history of POM. Current literature primarily focuses on White individuals who use opioids. METHOD: The present study qualitatively examined reasons for POM, prescription opioids misused, how prescription opioids are obtained, and initiation of POM among Black adults using thematic analysis. Participants included a sample (n = 39) of Black adults from a southern state, stratified by gender and age across four cohorts: born (1) 1995-2001, (2) 1980-1994, (3) 1970-1979, and (4) 1955-1969. RESULTS: Results revealed similarities and differences in these themes across age cohorts and gender. CONCLUSIONS: Implications for findings include the importance of culturally responsive interventions that utilize dual diagnosis treatment and idiographic approaches due to heterogeneous experiences with POM among Black adults.

"Make Sure You Wash Your Monkey": Multigenerational Vaginal Hygiene Messages from Black Women.

In the United States, the messages Black women receive about vaginal hygiene are often rooted in misogynoir. As a result, Black women across multiple generations may engage in extensive vaginal hygiene practices that are harmful to their health as a means of decreasing the potential for dehumanization or confirming racist stereotypes. The purpose of the current qualitative study is to explore the messages four generations of Black women (n = 12) received about genital hygiene and grooming and the sociocultural factors that influence these messages. Reflexive thematic analysis was used to analyze the semi-structured interview data. The following themes were identified: (1) a culture of silence, (2) knowledge acquisition, (3) pressure to maintain Black cleanliness standards, and (4) gendered racist messaging. Subthemes emerged within the knowledge acquisition theme, including learning through word-of-mouth, observation, deduction, trial and error, and direct messaging. Overall, themes and subthemes were consistent across generations; however, some differences were discussed. Participants highlighted the importance of intergenerational conversations in promoting safe vaginal hygiene practices. Recommendations for sexuality educators and healthcare professionals are discussed.

The influence of pornography on heterosexual black men and women's genital self-image & grooming.

Pornography consumption may negatively impact Black men's and women's genital self-image. Poor genital self-image is linked to negative mental health outcomes and sexual dysfunction. Despite this, little work has examined genital self-image among Black men and women, a group whose genital self-image may be informed by racist-gendered stereotypes and perceived expectations for genital grooming. The purpose of this multigenerational qualitative study is to examine how pornography impacts genital self-image and grooming for Black heterosexual men and women. Semi-structured qualitative interviews were conducted with participants (n = 20) across four generational cohorts. An inductive content analysis resulted in three categories and four subcategories. All participants reported pornography consumption at some point in their lifetime. The degree of influence on their genital self-image and grooming was categorized in four ways: no influence, perceived influence, and direct influence, and resisting influence. There were four subcategories within the perceived and direct influence categories: pubic hair grooming & preferences, designer vaginas, penis size, and partnered expectations. Black men and women differed in their reported influence of porn on genital self-image and grooming. Implications of findings for pornography creators, sex educators, and sex partners are discussed.

"Anger, embarrassment, less than a woman": the emotional impact of Black women's sexual pain.

Limited research has examined the emotions Black women report when thinking about sexual pain. To fill this gap in the literature, we explored the types of emotions that emerged when N = 126 premenopausal Black women thought about pain during sex. Open-ended responses to the following research question were analyzed: "What feelings emerge when you think about sexual pain?" Structural tabular thematic analysis was used to find commonalities in participants' responses. Findings indicated five families, or categories, of emotions: self-judgment, anger/disgust, sadness, anxiety, and emotions felt somatically. Additionally, women's reports were predominantly within the feeling state and cognitive appraisal components of emotion. Implications for health providers and therapists are discussed.

From Sin to Sexual Self-Awareness: Black Women's Reflection on Lifetime Masturbation.

To date, there has been very little empirical research on Black women's masturbation practices and views on masturbation. This study fills the gap by exploring the messages Black women received about masturbation and self-pleasure and the sources of these messages using valence theory. Data were collected in 2021 from 242 Black women who participated in a survey during phase one of the triphasic Big Sex Study. Thematic analysis was used to analyze this short-form qualitative data. Results indicated a range of responses, with mixed messages reported more than negative, positive, and neutral messages. The three primary sources of messages were religion, family, and friends. There were several themes across the valence of messages including the development of positive messages, sexual self-awareness, masturbation as sin, health benefits and consequences, relationship difficulties, devaluation, and masturbation as dirty and gross. These results provide a basis for sexuality professionals to improve sociocultural knowledge about masturbation beliefs, practices, and message sources among Black women.

An Interpretative Phenomenological Analysis of Black Women's Meaning and Experiences of Sexual Anxiety.

Sexual anxiety can activate the stress response cycle during sex, compromising a woman's ability to experience sexual pleasure. Black women face additional cultural and contextual factors, such as hypersexualization, partner scarcity, and higher rates of sexual trauma that may increase the magnitude, frequency, and odds of experiencing sexual anxiety. However, limited research has explored this phenomenon among Black women. Thus, we sought to qualitatively explore how N = 25 premenopausal Black women living in the southern United States make meaning of experiences with sexual anxiety. We analyzed the interview data using an interpretive phenomenological approach. Three components of the phenomenon of sexual anxiety were gleaned: 1) causes of sexual anxiety, 2) characteristics of sexual anxiety, and 3) coping strategies. Each component included three to six elements of meaning making. For these Black women, causes of sexual anxiety included fears of sexual pain, partner unfamiliarity, previous traumas, mental health concerns, and intersecting socio-structural factors. Characteristics of sexual anxiety included mental, somatic, and emotional elements. Coping strategies included having a reassuring and supportive sex partner, supporting themselves with affirmations and mindfulness, attending therapy, and using substances. Through reflection about their perceived causes of, experienced characteristics of, and intentional coping with sexual anxiety, meanings were co-constructed through an intersectional frame. Implications for intersectionality-informed interventions and suggestions for mental health professionals and partners are discussed.

Social Health Care Determinants of Breastfeeding Black Women: A Multigenerational Study.

Background: Black women encounter many challenges to breastfeeding, including inequitable access to support and resources and medical racism. However, limited research investigates how Black women across generations interface with health care systems to initiate or continue breastfeeding and what factors facilitate or hinder their breastfeeding experiences. Objective: Using the social determinants of health (SDoH) theoretical framework, this study qualitatively explored how a multigenerational sample of Black mothers' interactions with health care systems facilitated or hindered their breastfeeding initiation and continuation. There were three areas of interest: (1) access and quality, (2) professional and personal support, and (3) literacy and resources. Materials and Methods: Four age cohorts and three breastfeeding length cohorts of Black mothers in Kentucky completed semi-structured interviews on their breastfeeding experiences. Responses to research questions (e.g., "What was your experience during the birthing process and how did it impact your decision to breastfeed?") informed by the SDoH were analyzed using thematic analysis. Results: Four themes emerged on how experiences within health care systems influence Black women's breastfeeding initiation and continuation: (1) health care access, (2) health care quality/bias, (3) health care-related support, and (4) health care resource use. Conclusions: Interpersonal and systemic barriers in health care related to access, quality, support, and resources hindered Black mother's breastfeeding across generations. Mothers across each age and breastfeeding cohorts emphasized a need for culturally tailored pro-breastfeeding health care systems to meet their breastfeeding needs.

"Why Would I Talk To Them About Sex?": Exploring Patient-Provider Communication Among Black Women Experiencing Sexual Pain.

Ineffective patient-provider communication poses a potential health risk to Black women if medical providers are not addressing their needs or concerns. Additionally, less than half of OBGYNs report asking their patients about sexual difficulties, which limits women's opportunities to disclose their experiences of sexual pain. The purpose of this qualitative study is to explore Black women's experiences of patient-provider communication about sexual pain (reoccurring unwanted genital pain). Specifically, we aimed to describe the pathway from sexual pain disclosure to treatment among N = 25 premenopausal Black women living in the southern United States who were experiencing sexual pain. Using constructivist grounded theory, open-ended responses to six interview questions related to healthcare experiences, treatment, and patient-provider communication were qualitatively analyzed and categorized to form a conceptual framework of patient-provider communication about sexual pain. Five key categories emerged related to Black women's experiences with their medical providers regarding sexual pain: (1) provider preferences, (2) healthcare experiences, (3) reasons for non-disclosure, (4) provider responses to sexual pain, and (5) treatment for sexual pain. Useful strategies to improve patient-provider communication are presented for both patients and providers.

"Can we get a Black rehabilitation center"? Factors impacting the treatment experiences of Black people who use opioids.

INTRODUCTION: With opioid overdose rates doubling in the state of Kentucky over the last year, the opioid crisis is having a deadly impact on the state. Among Black individuals in particular, overdose rates have increased by nearly a third. As such, we must examine ways to effectively intervene to reduce deaths among this underrepresented population. METHOD: The current study utilized a thematic analysis to examine factors influencing treatment perceptions and experiences among a sample of 39 Black adults with a recent history of opioid use. RESULTS: The primary themes highlighted in the study included "autonomous accessibility," "provider characteristics," and "relational support," which are aligned with Self-Determination Theory. CONCLUSIONS: We discuss how these themes relate to treatment initiation, engagement, and completion and discuss implications of this research in treatment for Black adults. Specifically, we discuss treatment considerations among Black adults who use prescription opioids such as ensuring autonomy and a collaborative approach to treatment, especially in mandated treatment, with strategies such as motivational interviewing. Further, we discuss the importance of nonjudgmental providers, gauging client preferences for racially, ethnically, and gender matched providers; and we assess support networks among clients and how these networks can be integrated or utilized in treatment planning.

Black sexual minority women's social well-being and psychological distress.

Black sexual minority women (SMW), the largest racial group among the sexual minority community, often report high psychological distress and decreased psychological health and social well-being. Strong, positive, social relationships positive within group identities, and support networks are a key component in coping with minority stressors and promoting overall well-being. This study explored the association between minority stressors, social support, and Black SMW's social well-being and psychological distress. Participants consisted of individuals identifying as Black (including biracial identities, n = 48) cisgender women (N = 149) who responded to the Generations Study's initial round of surveys collected in 2016-2017. Participants were between the ages of 18-60, with a mean of 29.3 years old. Descriptive and bivariate correlations were conducted for lesbian, gay, and bisexual (LGB) stigma, internalized homophobia, gender presentation, ethnic identity affiliation, LGB community connectedness, and social support. Multiple regression models were conducted to analyze correlates of social well-being and psychological distress, controlling for age and education level. LGB stigma and internalized homophobia were significant predictors of social well-being and psychological distress. Low internalized homophobia, distress, and stigma were associated with higher social well-being as were high connection to LGB and ethnic communities. Implications for therapy are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Perceived HIV Invulnerability and PrEP Knowledge and Attitudes among Black Sexual Minority Women.

Black women have disproportionate rates of HIV compared to women of all other racial groups. The purpose of this analysis was to investigate perceived HIV risk, HIV and STI testing behaviors, and PrEP knowledge and attitudes among Black sexual minority women (SMW) and examine differences based on their history of male sex partners. Secondary data analysis was conducted using data from the Generations Study. This analysis used a sample of N=149 participants who identified as Black cisgender women. Results showed Black SMW with a history of male sex partners reported a higher perceived risk of contracting HIV and significantly more frequent HIV and STI testing than those without a history of male sex partners. Overall, most of the sample was not familiar with PrEP, but one-third had favorable attitudes towards it, and half felt like they did not know enough about PrEP to form an opinion. Implications for culturally relevant public health campaigns and comprehensive sexuality education that integrate PrEP are included.

"White people stress me out all the time": Black students define racial trauma.

OBJECTIVE: Using a constructivist-interpretivist paradigm and a Black feminist qualitative framework, this study investigated how Black students at a predominantly White university in the southeast defined racial trauma. METHOD: A purposive sample of 26 participants (10 men and 16 women, aged 18-27) participated in a semistructured interview about their definitions of race-based stress and racial trauma. Data analysis consisted of a six-phase inductive, latent thematic analysis. Researcher reflexivity, interviews, observations, and research memos contributed to trustworthiness. RESULTS: Participants' understandings of race-based stress and racial trauma-informed two composite definitions of racial trauma. Participants conceptualized racial trauma and race-based stress as related and identified three salient components of racial trauma: (a) "Sticking with": temporal component, (b) "Suffering severely": intensity component, and (c) "Repeating regularly": frequency component. CONCLUSIONS: The findings of this study contribute to the existing literature by providing an academic and community definition of racial trauma grounded in the voices of Black collegians. These definitions of racial trauma may be used to inform future research, clinical services, and outreach. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Pursuing Pleasure Despite Pain: A Mixed-Methods Investigation of Black Women's Responses to Sexual Pain and Coping.

The current mixed-methods study is the first to explore Black women's (N = 153) cognitive (e.g., worry about being perceived as sexually unresponsive) and emotional (e.g., sadness) responses to sexual pain based on age and relationship status, and coping strategies. Findings indicated significant differences in younger and single Black women's cognitive and emotional responses to sexual pain compared to older and coupled Black women. Qualitative responses revealed Black women engage in several proactive coping strategies to mitigate their sexual pain, including non-penetrative activities, foreplay, tools for increasing arousal, making physical adjustments, and intimacy and sexual communication. Implications for sexual health providers are discussed.

Incarcerated Black Men's Restrictive Emotionality: The Influence of Parental Closeness and Childhood Abuse.

Black men are often socialized to limit their emotional expression, which can lead to negative relationships and emotional health outcomes. Yet, little is known about how childhood experiences influence their emotional restrictiveness in adulthood. This study examined the relationship between parental closeness, childhood abuse, and restricted emotionality among 183 Black incarcerated men nearing release. Findings conclude men who reported having a closer relationship with their parents had lower emotional restrictiveness than men who did not. Men who reported childhood sexual abuse by two people reported more restricted emotionality than their non-abused counterparts. Implications for programming, intervention and prevention strategies are discussed. PUBLIC SIGNIFICANCE STATEMENT: The present study suggests childhood abuse, specifically sexual abuse by multiple individuals, is an important risk factor for restrictive emotionality among Black incarcerated men. Additionally, this study highlights the importance of close supportive relationships, particularly with parents, as factors to consider for prevention and intervention approaches, and correctional strategies to foster emotional wellness for this population.

Critical consciousness of anti-Black racism: A practical model to prevent and resist racial trauma.

The negative impacts of racism, including experiences of racial trauma, are well documented (e.g., Bryant-Davis & Ocampo, 2006; Carter, 2007). Because of the deleterious effects of racial trauma on Black people, interventions that facilitate the resistance and prevention of anti-Black racism are needed. Critical consciousness is one such intervention, as it is often seen as a prerequisite of resistance and liberation (Prilleltensky, 2003, 2008). To understand how individuals advance from being aware of anti-Black racism to engaging in actions to prevent and resist racial trauma, nonconfidential interviews with 12 Black Lives Matter activists were conducted. Using constructivist grounded theory (Charmaz, 2014) under critical-ideological and Black feminist-womanist lenses, a model of Critical Consciousness of Anti-Black Racism (CCABR) was co-constructed. The 3 processes involved in developing CCABR include: witnessing anti-Black racism, processing anti-Black racism, and acting critically against anti-Black racism. This model, including each of the categories and subcategories, are detailed herein and supported with quotations. The findings and discussion provide context-rich and practical approaches to help Black people, and counseling psychologists who serve them, prevent and resist racial trauma. (PsycInfo Database Record (c) 2021 APA, all rights reserved).