Reasons for past abortions among women in treatment for opioid use disorder.

OBJECTIVE: The main reasons women in the general population seek abortion are financial, timing, and partner-related reasons. While women with opioid use disorder (OUD) appear to use abortion services more than women in the general population, reasons for abortion in this group have not been examined to our knowledge. METHOD: Female patients aged 18-50 years in OUD treatment at 22 randomly selected facilities in Michigan were surveyed. The survey included items assessing reproductive health history. Women who reported having one or more abortions were asked to think back to that time and their reasons for choosing abortion. Twenty potential reasons and a write-in option were offered; women could endorse as many as applied. RESULTS: Of 260 women surveyed, 84 reported having an abortion. Of these, most (77.4%) reported multiple reasons for having an abortion. The most common reasons for having an abortion were not having money to take care of a baby (54.8%), feeling too young to have a child and not feeling ready to be a mother (both 42.9%), not loving the father and other partner-related concerns (25.0%-32.1%), and having concerns about the effects of their drug use (28.6%). No combination of reasons for abortion emerged as more prevalent than any other. CONCLUSIONS: Like women in the general population, women in treatment for OUD had not only abortions because of financial, timing, and partner-related reasons but also concerns about the effects of their drug use. These results underscore the multiple and often interrelated reasons that lead women to seek abortion. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Patient satisfaction with Sexual Assault Nurse Examiner services and post-assault resource utilization at a university health center and emergency department.

Objective: Describe a model for incorporating campus-based Sexual Assault Nurse Examiner (SANE) services. Describe differences in patient satisfaction and utilization of follow-up resources between patients seeking SANE services at a university health center (UHC) compared to an emergency department (ED). Participants: Patients seeking SANE services at the UHC or ED of a large Midwestern university from January 2016-April 2018. Fifty-eight participants completed a satisfaction survey, including 28 students. Twenty-eight participants completed a follow-up survey, including 15 students. Methods: A Qualtrics survey assessed: 1) satisfaction following the SANE exam and 2) use of follow-up services 4-6 weeks later. Descriptive analyses, exact logistic regressions, and OLS regressions were calculated. Results: There were no differences in satisfaction, services received, or follow-up services accessed between patients at the UHC and ED, including between students. Conclusions: Campus-based SANE services meet the expectations of survivors and do not differ significantly from services at the ED.

Stigma and Reproductive Health Service Access Among Women in Treatment for Substance Use Disorder.

OBJECTIVE: We aimed to examine the role of perceived and direct stigma on access to reproductive health services among women in treatment for substance use disorders in Michigan. METHODS: We draw on self-interview data from a cross-sectional study of female patients aged 18-50 years who accessed substance use disorder treatment at 22 randomly selected facilities in Michigan from December 2015 to May 2017. We conducted logistic regressions to examine associations between perceived stigma and access to three types of reproductive health services (screening exams, birth control, and prenatal care), as well as direct stigma and access to birth control. RESULTS: The final sample included 260 women. A notable percentage of women reported inability to access reproductive health services (24% for screening exams, 14% for birth control, and 12% for prenatal care). Women with higher levels of perceived stigma because of substance use were significantly more likely to report inability to access screening exams (odds ratio [OR]: 2.14; confidence interval [CI]: 1.43-3.20) and birth control (OR: 2.17; CI: 1.36-3.77). Women reporting higher levels of direct stigma were also significantly more likely to report inability to access birth control (OR: 3.87; CI: 2.29-6.53), even after accounting for perceived stigma. CONCLUSION: Perceived and direct stigma because of substance use may be significant barriers to seeking and accessing reproductive health services for women. Health professionals should reduce stigma in health care in order to increase access to necessary services for this population.

Faculty, Preceptor, and Students' Perceptions of the Need for Trauma-Informed Education: Recommendations for Implementation.

BACKGROUND: The widespread physical, mental, and emotional health impacts of trauma are well established. Trauma-informed care (TIC) is an approach that uses knowledge about trauma and its effects to create safe care environments. PURPOSE: Using a concurrent mixed-methods design, this study assessed faculty, preceptor, and students' perceptions about the need for TIC content in nursing education. METHODS: Semistructured interviews were conducted with 15 faculty, and cross-sectional survey data were collected from a nonprobability sample of 99 nursing students at a large Midwestern university to evaluate the need for education on TIC. RESULTS: Faculty and preceptors stressed the importance of education on TIC and discussed barriers and facilitators to implementation. Nursing students reported that it is important to learn about TIC, yet do not feel prepared to provide TIC. CONCLUSIONS: The results illustrate the need for nursing content on TIC and provide recommendations for trauma-informed educational practices.

Menstrual irregularity as a biological limit to early pregnancy awareness.

US state legislatures have proposed laws to prohibit abortion once the earliest embryonic electrical activity is detectable (fetal "heartbeat"). On average, this occurs roughly 6 wk after the last menstrual period. To be eligible for abortion, people must recognize pregnancy very early in gestation. The earliest symptom of pregnancy is a missed period, and irregular menstrual cycles-which occur frequently-can delay pregnancy detection past the point of fetal cardiac activity. In our analysis of 1.6 million prospectively recorded menstrual cycles, cycle irregularity was more common among young women, Hispanic women, and women with common health conditions, such as diabetes and polycystic ovary syndrome. These groups face physiological limitations in detecting pregnancy before fetal cardiac activity. Restriction of abortion this early in gestation differentially affects specific population subgroups, for reasons outside of individual control.

Understanding Stalking Among University Students in Ghana: A Mixed-Methods Study.

The purpose of this study is to explore experiences of stalking behaviors among midwifery students at one Ghanaian university, as well as their association with mental health disorders. Specifically, this study had the following three aims: (a) to identify the frequency of stalking experiences in this population; (b) to explore mental health symptoms, such as depression and anxiety, within this population; and (c) to better understand intervention opportunities related to stalking, including bystander intervention and use of available resources. The study utilized an exploratory mixed-methods design with surveys (n = 118) and focus group discussions (n = 2 with 16 participants) with midwifery students recruited from a centrally located Ghanaian university campus in July of 2018 using convenience sampling. Results indicate a large percentage (80.3%) of participants have experienced stalking behavior(s) within the last six months. Multiple regression analyses demonstrate a statistically significant relationship between any stalking behaviors and depressive symptomatology as well as between unwanted monitoring/following and anxiety. This was reinforced by focus group discussions in which participants discussed the themes of: (a) types of stalking, with a heavy emphasis on using technology for unwanted following/monitoring; (b) positive versus negative perceptions of stalking intentions, where some types of monitoring and following could be seen as forms of flattery or interest; and (c) barriers to seeking help that focused on stigma, cultural barriers, systemic barriers, and personal barriers. Future research should delve more deeply into barriers to existing resources to identify ways to increase accessibility for stalking survivors in connection with mental health services. This study also highlights the need for additional research to more clearly understand stalking in Ghana so that interventions can begin to address mental health services, healthy relationships, communication, and consent.

The Dynamics of Interpersonal Relationships: Understanding Power and Control Tactics Among College Students.

Intimate partner violence (IPV) is a significant public health problem among college students and many students have difficulty identifying unhealthy and abusive behaviors. The aims of this mixed methods study are to: (a) create an inclusive tool that illustrates the power and control experiences of a diverse group of young adult college students, (b) ensure a broad scope of tactics are illustrated (related to technology and different types of relationships), and (c) measure the experience of these tactics, including how IPV knowledge, attitudes, and self-efficacy are influenced by a more inclusive tool. In Phase I, semi-structured interviews were conducted with students (n = 33) and staff (n = 10) at campus sexual assault centers at the three University of Michigan (UM) campuses to explore power and control tactics utilized by perpetrators on college campuses. Content analysis revealed 13 categories of tactics in college relationships. A draft tool was created and assessed for accuracy using cognitive interviews with students (n = 20) from all three campuses in Phase II. Cognitive interviews resulted in the following changes to the final tool: (a) new presentation of the Socioecological Model, (b) identification of substance use as a facilitator for multiple forms of violence, and (c) edits to tactic descriptions. In Phase III, 250 students at UM-Ann Arbor participated in a quasi-experimental evaluation in which 133 interacted with the tool and 117 received access to usual care (campus sexual misconduct policy). Both groups answered survey questions about IPV knowledge, attitudes, self-efficacy, and experiences at baseline, and after one month and five months. Among all college participants in Phase III, 33.5% had experienced lifetime IPV and 25.2% had experienced IPV in the past year. There were no significant differences among IPV knowledge, attitudes, or self-efficacy by group. The Dynamics of Interpersonal Coercion Among College Students tool was created by incorporating current tactics utilized among a diverse college population.

Accessing Healthcare Services During the COVID-19 Pandemic: The Plight of Sexual Assault Survivors.

INTRODUCTION: Despite a global focus on intimate partner violence during the COVID-19 pandemic, there has been little exploration into how the pandemic and its associated restrictions have impacted sexual assault survivors and their ability to access specialized care and resources. The purpose of this research brief is to use longitudinal data to compare the number of medical forensic examinations done seasonally prepandemic and during the COVID-19 pandemic shelter-in-place order. METHODS: This analysis uses retrospective data on medical forensic examinations from January 2010 through November 2020 from one large academic Midwestern hospital. RESULTS: Results show that monthly medical forensic examinations have increased over time, from a mean of 4.5 cases per month (range: 1-9) in 2010 to a mean of 9 cases per month (range: 7-11) in 2019. In April 2020, when COVID-19-related shutdowns were at their first peak, cases dropped to a historic low of 0 examinations (the lowest number of cases in the past 10 years). CONCLUSIONS: The data show an initial drop in the number of survivors seeking postassault care after the COVID shutdown; however, cases rebounded through the second full month of shutdown orders. Programs that provide medical forensic examinations need to be prepared for subsequent waves of survivors, who may be COVID-19 positive. We must be better prepared for many of the adverse consequences impacting individuals around the country related to COVID-19 responses.

A Retrospective Descriptive Analysis of Sexual Assault Nurse Examiner Records From Sexual Assault Survivors at a Large University Emergency Department From 2003 to 2017.

This retrospective descriptive analysis of 837 patients seeking postassault care at an academic hospital in the United States describes characteristics of sexual assault survivors from a sociocultural context, with a specific focus on describing survivors presenting for sexual assault nurse examiner (SANE) exams and confirming existing literature on assault characteristics, such as disabilities and alcohol and/or drug use. Assaults resulting in SANE exams increased over time. Drug and/or alcohol use at the time of the assault was reported in 44.8% of cases and 20.8% of survivors reported having a disability. Understanding the demographic and sexual assault characteristics of survivors is fundamental to providing sensitive and responsive care.

Building Master Trainers to Facilitate Sexual Violence Prevention: A Pilot Study in Ghana.

Background: Sexual violence is a widespread human rights violation that affects women and girls throughout the world, with particularly high rates among college-age youth. In the United States, many universities have developed primary prevention education programs to comply with federal mandates; however, these programs are limited in sub-Saharan Africa. Objectives: The purpose of this pilot study is to describe and evaluate the training of peer facilitators for a sexual violence prevention program at two universities in Ghana; the University of Cape Coast and Kwame Nkrumah University of Science and Technology. Methods: A three-day "master trainer" training was held focusing on sexual violence, sexual health, bias, healthy relationships, and facilitation skills. Participants completed pre- and post-test evaluations on knowledge, attitudes, and skills related to the topics and participants from the University of Cape Coast also participated in a focus group about bias and self-care. Findings: Participants (n = 23) at both universities demonstrated significant changes in the domains of: self-care knowledge, sexual violence knowledge, rape myth acceptance, and facilitation skills. Conclusions: This study provides early evidence about training methods for primary prevention programs aimed at students on university campuses in sub-Saharan Africa. Further research is needed on peer-facilitation, training, and primary prevention programs related to sexual violence for university students in sub-Saharan Africa.

Understanding the healthcare provider response to sexual violence in Ghana: A situational analysis.

OBJECTIVES: Gender-based violence is a global public health crisis, which has health, social, and economic impacts on survivors. In Ghana, responding to and preventing sexual violence on university campuses, has become a priority area. However, data are lacking on the healthcare provider response to students who have experienced sexual violence. The purpose of this study was to conduct a situational analysis to better understand the healthcare provider response to sexual violence in Cape Coast, Ghana. METHODS: First, an observational facility assessment about healthcare services for survivors of sexual violence was conducted at two hospitals serving university students in Cape Coast, Ghana. Next, healthcare providers at the two hospitals completed: 1) a 113-item questionnaire about healthcare services, knowledge, and attitudes related to sexual violence and 2) in-depth semi-structured interviews describing their experiences providing healthcare to survivors of sexual violence. Descriptive statistics and frequencies were computed, and thematic analysis was used to analyze the qualitative data. RESULTS: Both sites lacked supplies, including pre-packed rape kits, post-exposure HIV prophylaxis, and informational handouts on medications and support services for survivors. Further, healthcare providers lacked training on gender-based violence, including best practices for caring for survivors and evidence collection procedures. Providers described the clinical management for survivors of sexual violence, including providers' role in reporting sexual violence to authorities, medical forensic exams, reproductive and sexual health services, and referral for mental healthcare. Finally, providers described a number of barriers to survivors accessing post-assault healthcare, including stigma and structural barriers, such as cost of medical supplies and lack of privacy within the healthcare facilities. CONCLUSIONS: The current healthcare response to sexual violence in Ghana is limited by lack of supplies, knowledge, and training for healthcare providers. Personal and structural barriers may prevent survivors from accessing needed healthcare following sexual violence.

Sexual and Reproductive Health Characteristics of Women in Substance Use Treatment in Michigan.

OBJECTIVE: To evaluate the sexual and reproductive health characteristics of women in treatment for opioid use disorder in Michigan and explore services provided and desired. METHODS: We conducted a cross-sectional study of female patients aged 18-50 years who accessed opioid use disorder treatment at 22 randomly selected facilities in Michigan from December 2015 to May 2017. Computer-assisted self-interviews were completed using online survey management software to assess prior substance use and use disorder treatment, sexual and reproductive health history, and sexual and reproductive health services received in the previous 12 months through a treatment program, and desire for and barriers to sexual and reproductive health services within substance use disorder treatment. Descriptive statistics were calculated. RESULTS: The final sample consisted of 260 participants. About half (51.5%) had ever had an abnormal Pap test result, and 57.3% had ever tested positive for a sexually transmitted infection. Unintended pregnancy was common (61.2%), as was substance use during pregnancy (74.2%). Nearly half (46.5%) were not currently using a method of contraception, and only 28.5% were using a highly effective method. Common barriers to accessing reproductive health services included fear of being treated poorly or judged because of substance use, fear of child protective services, and structural barriers such as cost and lack of transportation. Most participants (80.4%) indicated interest in receiving sexual and reproductive health services on site or by referral from their substance use disorder treatment programs. CONCLUSION: Women in treatment for opioid use disorder in Michigan have high rates of adverse sexual and reproductive health experiences and face barriers to accessing care.

Substance Use Treatment Patient and Provider Perspectives on Accessing Sexual and Reproductive Health Services: Barriers, Facilitators, and the Need for Integration of Care.

Background: Women with substance use disorders have high rates of adverse sexual and reproductive health (SRH) outcomes, including unintended pregnancy, sexually transmitted infections, and contraceptive nonuse. Little research has explored barriers and facilitators to accessing SRH services experienced by women with substance use disorders. Objectives: To investigate barriers and facilitators to accessing SRH services experienced by women with substance use disorders. To assess perspectives on integration of SRH services into substance use treatment. Methods: Twenty-nine semi-structured interviews were conducted with female patients (N = 17) and providers (N = 12) at four substance use treatment facilities in Michigan between October 2015 and January 2016. Respondents were asked about experiences accessing SRH services and perspectives on integration of SRH services into substance use treatment. Data were analyzed using the constant comparative method. Results: Patients and providers discussed barriers to accessing SRH services, including competing priorities, structural barriers, lack of knowledge on SRH services and substance use, fear of Child Protective Services and law enforcement, and stigma. Facilitators included reprioritization of SRH, accessible transportation, insurance coverage and funding for SRH services, and education and training on SRH. Finally, participants expressed support for integration of SRH services into substance use treatment. Conclusions/Importance: Understanding the barriers to accessing SRH services is essential to reducing the adverse SRH outcomes experienced by women with substance use disorders. Substance use treatment is a critical time to offer SRH services. Integration of care is a potential model for improving the SRH of women with substance use disorders.

Trauma-informed education: Creating and pilot testing a nursing curriculum on trauma-informed care.

BACKGROUND: Trauma is a significant contributor to morbidity and mortality. Trauma-informed care (TIC) provides a safe and supportive healthcare environment for patients who have experienced trauma. Educating healthcare providers improves knowledge, attitudes, and skills related to TIC. However, nursing programs do not systematically integrate TIC education. PURPOSE: To create, implement, and evaluate nursing content on TIC at the graduate and undergraduate levels at one university. METHOD: A pretest-posttest survey was utilized to assess changes in TIC knowledge, attitudes, and skills related to the delivery of content on trauma and TIC to students in three courses at one large Midwestern university in January 2019. Safety, acceptability, and transferability were also measured. FINDINGS: The content improved nursing students' knowledge and skills related to providing TIC. Further, content on TIC is acceptable to both undergraduate and graduate students and is transferrable to non-nursing students. DISCUSSION: The current study provides a trauma-informed nursing education model that is safe, appropriate, acceptable, and efficacious.

The Eco-Social Trauma Intervention Model.

OBJECTIVES: We describe a transdisciplinary theory of change for interventions to promote trauma recovery that utilizes an eco-social approach to enhance health status and well-being following trauma exposures. This four-level theory of change could be applied to other population health problems, as well. METHODS: This theory-development process included reviewing existing literature, identifying assumptions, defining core concepts, stating propositions, depicting concepts and propositions for clarity, and illustrating with case examples grounded in our focus on trauma. RESULTS: The resulting Eco-Social Trauma Intervention Model offers a framework for interventions that address the impact of trauma on the individual level through self-regulation, interpersonal level through relationships, community/organizational level through safety, and societal level through identities. Application of this model to intervention development for those affected by trauma is intended to promote resilience, recovery, posttraumatic growth, and positive adaptations to traumatic stress for populations, going beyond the current Western paradigm of treating individuals for psychopathology. CONCLUSIONS: The Eco-Social Trauma Intervention Model offers an adaptable transdisciplinary framework for developing and researching scalable trauma interventions for individuals, communities, and populations.

Current State of Trauma-Informed Education in the Health Sciences: Lessons for Nursing.

BACKGROUND: Trauma has significant effects on individuals' health. Nurses are well-positioned to deliver trauma-informed care; however, there is a lack of trauma nursing education. The development of trauma education in nursing is just beginning; therefore, it is unclear what details should be integrated into nursing courses. METHOD: CINAHL, PsycINFO, MEDLINE, PubMed, and Google Scholar databases were searched to identify theoretical and empirical literature regarding trauma-information educational practices in health sciences. RESULTS: Given that different disciplines have their specific training goals and requirements, trauma-related course goals, content, format, and structure are distinct and unique across disciplines. Educators in health sciences developed guidelines for trauma curricula and strategies for maintaining classroom safety. CONCLUSION: Trauma curricula in other health science disciplines provide a framework for creating trauma curricula in nursing programs. More groundwork is needed to integrate trauma into nursing education. [J Nurs Educ. 2019;58(2):93-101.].