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.

Predictors of substance use disorder treatment and mutual support group participation among Black women across the criminal legal spectrum: A latent class approach.

BACKGROUND: The purpose of this study includes: 1) identifying classes of substance-related needs among Black women, and 2) examining the effect of substance-related need classes and culturally-relevant factors on Black women's use of substance use disorder (SUD) treatment and mutual support groups. METHODS: As part of a longitudinal cohort study, Black women were recruited in prison nearing release, on probation, and in the community without involvement in the criminal legal system (CLS, n=565) and followed-up at 18-months. We conducted a baseline latent class analysis of substance-related needs among Black women. Logistic regression models adjusted for culturally-relevant factors to predict the use of treatment and frequency of mutual support group participation over 18-months among Black women who use drugs. RESULTS: Four classes by level of needs were found: low, daily marijuana use, high mental health, and high comorbidity. During the 18-month follow-up, women characterized by the high comorbidity need class and with higher scores of religious well-being were more likely to frequently participate in mutual support groups. Non-CLS-involved women were less likely to engage with both treatment and mutual support groups than women from the prison sample at 18-months. CONCLUSIONS: This study highlights four distinct classes of substance-related needs among Black women, highlighting the complex patterns of behavior and within-racial group differences among Black women. Black women with high comorbidity needs were more likely to participate in mutual support groups, but the latent classes did not predict SUD treatment indicating other non-medical and social contextual need factors may be at play.

Knowledge, experiences, and perceptions of medications for opioid use disorder among Black Kentuckians.

BACKGROUND: Opioid overdoses have continued to increase at higher rates among Black Americans compared to people from other racial groups. Despite demonstrated effectiveness of MOUD in reducing risk of opioid overdose, Black Americans face decreased access to and uptake of MOUD. The current study aimed to examine the knowledge, perceptions, and experiences with MOUD among a sample of Black adults who use prescription opioids nonmedically in order to inform tailored efforts to improve MOUD uptake. METHODS: Data were derived from a larger study assessing cultural and structural influences on drug use and drug treatment among people who use prescription opioids nonmedically. Semi-structured qualitative interviews were conducted with 34 Black men and women across four generational cohorts: born 1955-1969; 1970-1979; 1980-1994; and 1995-2001. Participant responses were analyzed using thematic analysis. RESULTS: Nearly half of participants (44.1%) reported no knowledge or experience with MOUD. Among participants who had any knowledge about MOUD, four major themes regarding their perceptions emerged: MOUD Helps with Recovery; Not Needed for Level of Drug Use; Side Effects and Withdrawal; Equivalence with Illicit Drug Use. The majority reported negative perceptions of MOUD (52.6%), and the youngest cohort (born 1995-2001) had a higher proportion of negative perceptions (80%) relative to other age cohorts (born 1980-1994: 50%; 1970-1979: 75%; 1955-1969: 16.6%). DISCUSSION: Findings indicate a significant knowledge gap and clear points of intervention for improving MOUD uptake. Interventions to improve communication of health information in ways that are culturally relevant and tailored by age group can be used in conjunction with efforts to improve MOUD access among Black individuals who use opioids nonmedically.

Half of our sample of Black Americans who use opioids nonmedically had no knowledge of medications for opioid use disorder (MOUD).For those who knew about MOUD, most reported negative perceptions, including concerns about side effects of using MOUD and believing MOUD is equivalent to illicit drug use.The youngest age group endorsed the highest rates of negative perceptions relative to older age cohorts, indicating a need for intervention approaches tailored by age group.

Associations between traumatic life events and substance use among Black Men who are incarcerated.

The current study examined associations between traumatic life events, current and lifetime importance of mental health and substance use treatment, and crack cocaine use among 201 Black men who were incarcerated and nearing community reentry. Results indicated age, sexual trauma and lifetime importance of drug treatment were significantly associated with an increased likelihood of crack cocaine use. Substance abuse treatment in correctional settings should consider culturally tailored assessment and treatment for history of unaddressed sexual trauma among Black men who are incarcerated and use crack cocaine.

Correlates of Transactional Sex Among Black Men and Women Who Misuse Opioids.

The rise in opioid misuse coincides with increased sexually transmitted infection (STI) and HIV incidence. Transactional sex is an under-researched phenomenon among Black Americans who misuse opioids, and may increase their risk of STI or HIV transmission. Given the disproportionate impact of the opioid epidemic on Black Americans and the risks associated with opioid misuse, the current study aims to investigate sociostructural factors, history of violence, and sexual risk factors associated with transactional sex among Black men and women. A sample of n = 375 Black adult Kentuckians reporting opioid misuse completed a survey including transactional sex, sociostructural, violence history, and sexual risk measures. Results of chi-squares and independent samples t-tests revealed that compared to men who did not report engaging in transactional sex, men who engaged in transactional sex were less educated, reported being sexually assaulted or having an unwanted sexual experience in their lifetime, and were more likely to use opioids or cocaine before or during sex in the last year. Women who engaged in transactional sex had a history of violence, more structural barriers, higher psychological distress, and engaged in more sexual risk behaviors compared to women who did not engage in transactional sex. Implications for future research and interventions with this population are discussed.

Adverse Childhood Experiences and Psychological Correlates of Substance Use Disorders Among Black Sexual Minority Women.

This study examined the influence of adverse childhood experiences (ACEs) on Black sexual minority women's mental health and substance use disorders in adulthood. Secondary data analysis was conducted using N = 149 Black sexual minority women's reports from the Generations Study. Study variables included psychological distress, chronic strains, stressful life events, ACEs, and substance use disorders, including alcohol use disorder and drug use disorder. Quantitative data analysis consisted of descriptives and bivariate correlations. Participants' total ACE scores were positively significantly correlated with increased alcohol misuse, chronic life strains, and stressful life events. Exposure to household interpersonal violence and household mental illness during childhood were significantly correlated with alcohol misuse. Black sexual minority women with ACEs are at higher risk for mental health concerns throughout their lifespan and maladaptive coping strategies (e.g., substance use). Implications for counselors and therapists are provided.

The roles of vicarious trauma exposure and perceived social support in codeine syrup misuse among Black men living in prisons.

Using General Strain Theory, this study investigates the effects of vicarious trauma exposure and perceived social support on nonmedical codeine syrup misuse among Black incarcerated men nearing community re-entry. Data were drawn from the Helping Incarcerated Men project, a study examining mental health, substance misuse, and human immunodeficiency virus (HIV) risk behaviors among Black men living in prisons who were within 180 days of release. A total of 200 Black men self-reported demographics (i.e., age and length of incarceration after age 18), vicarious trauma exposure (e.g., ever witnessing an assault with a weapon and a sudden accidental death), perceived social support, and nonmedical codeine syrup misuse. Findings from the logistic regression analysis showed witnessing an assault with a weapon and a sudden accidental death increased the likelihood of codeine syrup misuse. Perceived social support was not associated with codeine syrup misuse. Implications for practice and future research are discussed.

Religion, Psychiatric Symptoms, and Gender Role Conflict Among Incarcerated Black Men.

Extant literature is mixed on the role of religiosity as a protective factor for mental health concerns and the effectiveness of faith-based prison programs on a reduction in recidivism. Religiosity and psychiatric symptoms are associated with gender role conflict, yet little is known about these relationships among Black incarcerated men. Undergirded by gender role conflict theory, this study aimed to investigate the relationship between religiosity, 30-day psychiatric symptoms, and three measures of gender role conflict: emotional restrictiveness, work-family conflict, and affectionate behavior towards men. In a sample of 206 Black men nearing community re-entry, our results indicated strong religious beliefs and psychiatric symptoms were associated with less emotional restrictiveness. Religious influence and psychiatric symptoms were positively associated with perceived work-family conflict. Further, strong religious beliefs moderated the association between psychiatric symptoms and work-family conflict. Implications for faith-based prison support programs as mechanisms for reducing recidivism among Black men are discussed.

Cultural Predictors of Self-Esteem Among Black Women With Criminal Justice Involvement and Herpes Simplex Virus.

Black women have disproportionately alarming HSV-2 infection rates yet receive little attention in sexual health literature. Using a strengths-based resilience framework, this study sought to determine culturally relevant protective predictors of self-esteem for Black women who are justice-involved and have HSV-2. The authors conducted secondary data analysis on data from the "Black Women in the Study of Epidemics (B-WISE) Project," a longitudinal prospective study investigating health disparities and health services utilization among Black women with justice involvement. At baseline, N = 151 Black women with HSV-2 who were incarcerated or on probation completed survey measures assessing self-esteem, ethnic identity affirmation and belonging, perceived social support, and John Henryism Active Coping. Hierarchical linear regression analyses revealed ethnic identity affirmation and belonging and John Henryism Active Coping were significant predictors of self-esteem at 6-month follow-up. Implications are provided for current health professionals.

Race-Related and Mental Health Factors of Powder Cocaine Use Among Black Incarcerated Men.

Incarceration disproportionately impacts Black men in the United States, which can have compounding effects on mental health and substance use among this population. Cocaine use, in particular, carries higher severity of dependence and overdose risks among Black Americans, though research examining cocaine use correlates among Black incarcerated men is limited. The present study examines race-related and mental health correlates of powder cocaine use among a sample of incarcerated Black men (n = 208) using the General Strain Theory. Specifically, the present study was a secondary analysis examining race-related stress, psychological distress (i.e., anxiety and depression), and stigma about receiving psychological help as correlates of lifetime powder cocaine use. Results indicated that the likelihood of lifetime powder cocaine use was higher among those reporting lifetime psychological distress and greater race-related stress. Stigma about receiving psychological help was not significantly associated with lifetime powder cocaine use among this sample. Results of this study have important implications for substance use treatment interventions. Identifying adaptive coping strategies to manage anxiety and depression symptoms and race-related stress among incarcerated Black men may help reduce rates of cocaine use among this population and increase successful reintegration into the community post-incarceration.

'My partner will think I'm weak or overthinking my pain': how being superwoman inhibits Black women's sexual pain disclosure to their partners.

Black women experience persistent sexual pain that may often last longer than White women. Despite the value of sexual communication to alleviate sexual pain concerns, many women do not disclose sexual pain to their partners. Limited research explores barriers to disclosing sexual pain to partners among Black women. This study seeks to fill this gap. Relying on an integration of Sexual Script theory and Superwoman Schema, the study explored the barriers that premenopausal, cisgender Black women from the Southern USA perceived when disclosing sexual pain to their primary partners. We identified five common themes from women's open-ended responses to an online survey: (a) distressing emotions associated with disclosure; (b) limited knowledge and communication skills; (c) protecting partner's feelings and ego; (d) invading privacy; and (e) taking sole responsibility for managing sexual pain. Findings suggest a combination of intrapsychic, interpersonal and cultural factors influence Black women's perceived ability to have direct and open dyadic communication about sexual pain with their partners. Implications for Black women's sexual health and relationship outcomes 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.

"Don't Feel Like You Have to Do This All on Your Own": Exploring Perceived Partner Support of Breastfeeding Among Black Women in Kentucky.

BACKGROUND: Few researchers have explored partner breastfeeding support among Black women, who report low breastfeeding rates compared to women of other cultural groups. Ways to encourage partner support of Black women's breastfeeding can be understood from an Afrocentric perspective. RESEARCH AIM: To explore perceptions of partner support among Black mothers to develop a culturally relevant framework of partner breastfeeding support. METHODS: Secondary data analyses of qualitative data from a larger prospective, cross-sectional mixed methods study were utilized. Participants from Kentucky (N = 14), aged 23-71, who breastfed for at least 6 months, were recruited to participate in individual interviews. Professionally transcribed interviews were analyzed using Braun and Clarke's (2006) thematic analysis. RESULTS: By integrating the Breastfeeding Coparenting Framework and Optimal Conceptual Theory, we identified four culturally affirming partner support themes that participants believed impacted their breastfeeding experiences: (a) doing research, (b) offering care, (c) verbalizing praise, and (d) achieving teamwork, and three culturally incongruent partner support barrier themes: (e) withdrawing commitment, (f) politicking bodies, and (g) stripping agency. CONCLUSION: Participants who breastfed for at least 6 months largely attributed their breastfeeding success to the support received from their partners. Our findings offer a culturally relevant framework of partner breastfeeding support that can facilitate intervention efforts with participants and their partners to increase breastfeeding rates among this population.

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.

Experiencing Burnout: John Henryism, Gender Role Conflict, and Anxiety Among Incarcerated Black Men.

At the intersection of race and gender, Black men encounter conflicting and often stress-inducing gender norms. Research suggests Black men may utilize John Henryism Active Coping (JHAC), a culturally-relevant strategy to manage stress. However, little is known about how incarcerated Black men cope with gender role conflict (GRC) and resulting psychological distress. To better understand stressors and coping strategies among Black male prisoners, the current study examined the relationships between GRC, anxiety, and JHAC among N = 193 incarcerated Black men nearing community reentry. Hierarchical linear regression results showed length of incarceration, GRC, and anxiety were all negatively associated with JHAC. Full-time employment prior to incarceration was positively associated with JHAC. Moderation analyses indicated anxiety increased the strength of the negative association between GRC and JHAC. Implications highlight incarcerated Black men may benefit from interventions that encourage active coping strategies to manage gender-related stress and anxiety.

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.

PTSD diagnosis and nonmedical use of benzodiazepines among African American incarcerated men: the mitigating effect of John Henry active coping.

The current study examined the relationship between PTSD and nonmedical use of benzodiazepines (BZDs) based on level of John Henry Active Coping (JHAC) among African American incarcerated men. Data were derived from the Helping Incarcerated Men (HIM) Study (n = 208). Nonmedical use of BZDs was measured for the 30 days before incarceration. Current PTSD diagnosis and JHAC were determined using DSM-5 criteria and the JHAC Scale. Adjusted logistic regression analyses showed PTSD diagnosis was significantly associated with nonmedical BZD use (p = .011), but that JHAC did not significantly mitigate this relationship. African American incarcerated men may experience an unmet need with regards to mental health treatment.

"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.

Concordance between Self-Reported Drug Use and Urinalysis in a Sample of Black American Women.

BACKGROUND: Obtaining accurate drug use data is important in the field of substance use research. Urinalysis, considered gold standard, can be costly or infeasible, whereas self-report is quick and easy, but susceptible to imperfect recall or misrepresentation. It is important to determine the concordance between self-report and urinalysis, and better understand the contexts and participant characteristics that influence self-report accuracy. The current study aims to assess this concordance for marijuana and cocaine in a sample of Black American women, some with criminal justice exposure, and to investigate predictors of non-concordance. METHODS: In this longitudinal study, a sample of Black American women were recruited from community, prison, and probation settings. Self-report drug use and urine drug screens were obtained at 6-, 12-, and 18-month follow-ups, allowing for the calculation of concordance. Generalized linear mixed models were used to assess participant characteristics that predicted non-concordance (both false positives and false negatives). RESULTS: In general, there was agreement between self-report and urinalysis results for both marijuana and cocaine. Baseline drug use status was the most consistent predictor of non-concordance. Individuals recruited while on probation were more likely to have false negative results and less likely to have false positive results. Additionally, concordance rates for marijuana increased over the follow-up period. CONCLUSIONS: Self-reported marijuana and cocaine use are accurate measures of actual drug consumption in a sample of Black American women with a variety of criminal justice interactions.