Challenges and strategies for conducting intervention research with culturally diverse populations.

Conducting intervention research with culturally diverse, underserved, and often hard to reach populations in naturalistic or field settings presents investigators with a number of practical challenges. This article describes four special challenges and strategies for dealing with them that clients, service providers, and researchers experienced in conducting a prevention intervention to reduce substance use and sexual risky behaviors with low-income Latina young women. The challenges are (a) building community partnerships; (b) developing interventions that are acceptable and relevant; (c) promoting successful recruitment, participation, and retention of participants; and (d) developing a diverse, cohesive, and committed research team and effective managerial information support systems.

Correlates of alcohol and drug use among low-income Hispanic immigrant childbearing women living in the USA.

Alcohol and drug use is a widespread and serious problem with deleterious consequences for the health and well-being of childbearing-age women and their children. Little information exists regarding etiological factors for substance use among Hispanic childbearing-age women immigrating to the United States (USA). This research provides a correlational analysis of factors associated with alcohol and drug use. The Social Stress Model for Substance Use Prevention provided the conceptual framework for this cross-sectional, interview-administered survey of 60 low-income predominantly Mexican-American women. The outcome variable was alcohol and drug use (alcohol, cigarettes, marijuana, cocaine and opiates). Independent variables included the major constructs of the model: stress, social support, social influences, personal competencies and community resource utilization patterns. Findings suggested that the levels of drug use were lower among this study sample than in the general USA population regardless of pregnancy status. Bivariate correlations demonstrate that women with higher drug use indices had more lenient attitudes regarding drug use and were more likely to have family and friends that used alcohol and drugs. Although drug use was relatively low among this sample of women, both women who used alcohol themselves and women whose partners used alcohol and drugs reported significantly higher levels of stress, weaker social support and poorer levels of self esteem. Implications for practice and future research are suggested.

Competence and drug use: theoretical frameworks, empirical evidence and measurement.

Statistics show that use of harmful substances (alcohol, cigarettes, marijuana, cocaine) among women of childbearing age is widespread and serious. Numerous theoretical models and empirical studies have attempted to explain the complex factors that lead individuals to use drugs. The Social Stress Model of Substance Abuse [1] is one model developed to explain parameters that influence drug use. According to the model, the likelihood of an individual engaging in drug use is seen as a function of the stress level and the extent to which it is offset by stress modifiers such as social networks, social competencies, and resources. The variables of the denominator are viewed as interacting with each other to buffer the impact of stress [1]. This article focuses on one of the constructs in this model: that of competence. It presents a summary of theoretical and conceptual formulations for the construct of competence, a review of empirical evidence for the association of competence with drug use, and describes the preliminary development of a multi-scale instrument designed to assess drug protective competence among low-income Hispanic childbearing women. Based upon theoretical and empirical studies, eight domains of drug protective competence were identified and conceptually defined. Using subscales from existing instruments with psychometric evidence for their validity and reliability, a multi-scale instrument was developed to assess drug protective competence. Hypothesis testing was used to assess construct validity. Four drug protective competence domains (social influence, sociability, self-worth, and control/responsibility) were found to be statistically associated with drug use behaviors. Although not statistically significant, expected trends were observed between drug use and the other four domains of drug protective competence (intimacy, nurturance, goal directedness, and spiritual directedness). Study limitations and suggestions for further psychometric testing of the instrument are described.

Substance abuse among inner-city Hispanic women: exploring resiliency.

OBJECTIVE: To identify factors that prevent drug abuse among young Hispanic women living in inner cities and to acquire ideas for preventive strategies. DESIGN: Qualitative interviews of focus group participants to explore perceptions about drug use. SETTING: An urban location adjacent to a neighborhood health clinic. PARTICIPANTS: Twenty-four young Hispanic women recruited from an inner-city prenatal clinic. MAIN OUTCOME MEASURES: Identification of themes that trigger or deter drug use. Acquisition of preliminary knowledge required for further development of data collection instruments and design of interventions for use with inner-city Hispanic women. RESULTS: Identified six themes through qualitative data analysis of interview narratives. CONCLUSIONS: Compared themes with existing theoretical models and described implications for nursing practice.

The social stress model of substance abuse among childbearing-age women: a review of the literature.

The Social Stress Model of Substance Abuse has been derived from numerous psychosocial theories and models. This model suggests that the likelihood of an individual engaging in drug abuse is influenced by the stress level and the extent to which it is offset by stress modifiers such as social networks, social competence and resources. This article synthesizes current empirical evidence for this model. Thirteen primary research studies of women are synthesized and described, with special attention to the four key constructs inherent in the model: stress, social networks, social competencies, and resources. Consistencies and inconsistencies in the findings, a critique of key methodological issues, implications for future research, and implications for clinical policy and practice are provided.

Empirical evidence for the Social Stress Model of Substance Abuse.

The Social Stress Model of Substance Abuse builds upon and integrates knowledge from numerous psychosocial theories and models. According to this model, the likelihood of an individual engaging in drug abuse is a function of the stress level and the extent to which it is offset by stress modifiers such as social networks, social competence, and resources. This article synthesizes current empirical evidence for this model. Thirty-five primary research studies are described, with special attention to the four psychosocial constructs inherent in the model: stress, social networks, social competence, and resources. Consistencies and inconsistencies in the findings, a critique of key methodological issues, and suggestions for future research are provided.

Involving the target population and their providers in evaluation of substance abuse videos.

Substance abuse prevention and case finding are serious challenges to nurses who care for pregnant women and their infants. Audiovisual media can be useful in helping these nurses and their patients. This article discusses the insights of pregnant, low-income, minority women and their health care providers regarding selected substance abuse prevention videos. Focus group sessions were used to elicit valuable information, not only about reactions to substance abuse media but on their use in facilitating communication between patients and providers. Through this process, collaborative relationships were fostered among pregnant inner-city women, nurse clinicians, and nursing faculty, all of whom share a concern about substance abuse and an interest in working together to combat the problem.

A review of the literature on cocaine abuse in pregnancy.

The primary research literature on cocaine abuse in pregnancy from 1982 to 1989 was reviewed. This article is a synthesis of current knowledge regarding the effects of maternal cocaine use during pregnancy on obstetrical, neonatal, and infant health and developmental outcomes. Consistencies and inconsistencies in the findings, a critique of key methodological issues, and suggestions for future research are provided.

Determinants of early infant weaning: a multivariate approach.

This research provides a multivariate analysis of factors associated with prolonged breast-feeding and conversely early infant weaning. Infant care practices associated with early infant weaning during the first four months of life were: early introduction to artificial milk, the infant sleeping in its own crib versus with its mother, and in general a more rigid feeding schedule. The weaned infant lived in a family with higher economic means, also maternal employment and the availability of a support person to care for the infant were variables more frequently found among infants weaned early. These infants had greater than average numbers of curative health care visits and gained less weight during the first four months of life than breast-fed infants. This study's findings suggest that as changes in life styles and cultural norms are molded by levels of modernization and urbanization, with greater participation of women in the workforce, the tendency to wean early may become even greater.

The effect of early post-partum mother-infant contact and breast-feeding promotion on the incidence and continuation of breast-feeding.

Three maternity hospital practices of post-partum mother-infant contact and breast-feeding promotion on the incidence and continuation of breast-feeding among 375 urban poor healthy Nicaraguan primigravid women were investigated. Infant feeding patterns were evaluated at 1 week and 4 months post-partum. Eighty-seven per cent of all infants initiated breast-feeding, but only 54% continued breast-feeding for at least 4 months. There was a significant association between both a short 45-min contact period and rooming-in combined with standard breast-feeding promotion, resulting in greater initial rates of breast-feeding (P less than 0.05). There was only a significant relationship between prolonged contact (rooming-in) and standard breast-feeding promotion and the continuation of breast-feeding (P less than 0.05). These findings suggest that in populations in which a majority of women initiate breast-feeding, post-partum mother-infant contact practices combined with standardized breast-feeding promotion may influence the initial choice to breast-feed, but these practices alone are clearly not enough to prolong breast-feeding.