The CARE Health Advocacy Intervention Improves Trauma-Informed Practices at Domestic Violence Service Organizations to Address Brain Injury, Mental Health, and Substance Use.

OBJECTIVE: The aim of this study was to evaluate the impact that domestic violence (DV) service organizations' (SO) agency-wide adoption of CARE had on improving DVSO trauma-informed care (TIC) practices, overall, and in relation to addressing brain injury and mental health. CARE is an advocacy intervention designed to raise DVSOs' capacity to C ONNECT with survivors; A CKNOWLEDGE that head trauma, strangulation, and mental health challenges are common; R ESPOND by accommodating needs in services and providing targeted referrals; and E VALUATE effectiveness of response to meet survivors' stated concerns. We hypothesized that TIC would significantly improve among DVSO staff with the agency's use of CARE. SETTING/PARTICIPANTS/DESIGN: Pre- ( n = 53) and 1-year post-CARE ( n = 60) implementation online surveys were completed by staff at 5 DVSOs in Ohio from 2017 to 2019. MAIN MEASURES: Trauma-Informed Practice Scales (TIPS) were used to assess agency support and overall staff impression of implementing TIC; scales were modified to assess the use of TIC-practices related to head trauma, strangulation, mental health, suicide, and substance use. Attitudes Regarding Trauma-Informed Care (ARTIC-45) subscales assessed DVSO staff's endorsement of personal and organizational support in implementing TIC practices. Response options on the Survivor Defined Practice Scale (SDPS) were modified to gain staff insight into DVSO's ability to facilitate survivor empowerment. Differences in endorsement of TIC practices between pre- and post-CARE implementation were evaluated using regression models. RESULTS: DVSO agency environment ( P < .01) and overall staff impression ( P < .001) regarding implementing TIC practices, and in respect to head trauma ( P < .01), strangulation ( P < .01), mental health ( P < .01), suicide ( P = .04), and substance use ( P < .01), significantly improved with the agency's use of CARE. CARE increased DVSO staff's belief in personal and organizational support to implement TIC ( P < .01 and P = .02, respectively) and in their agency's ability to foster survivor empowerment ( P < .01). CONCLUSION: CARE improved TIC practices of DVSOs, overall, and to address brain injury and mental health.

The Use and Effectiveness of the Whole School Approach in School-Based Interventions Addressing Gender-Based Violence in Sub-Saharan Africa: A Systematic Review.

Adolescents and young people in sub-Saharan Africa (SSA) experience high rates of gender-based violence (GBV). The whole school approach (WSA) is an established benchmark of effective school-based interventions to address this issue. We conducted a systematic review of peer-reviewed literature using PubMed/Medline, EMBASE, Scopus, Web of Science, Cochrane Library, Clinicaltrials.gov, and Google Scholar (1) to determine the characteristics, measured outcomes, and effectiveness of school-based GBV interventions and (2) to examine each papers' alignment with WSA and methodological quality. We developed a comprehensive intervention characteristics form for data extraction and analyzed the selected studies' quality using the modified Methodological Quality Rating Scale. To measure alignment with WSA implementation standards, we expanded the application of the WSA by creating the Whole School Approach Rating Scale (WSARS) for assessing school-based GBV interventions. Most interventions (n = 14/16) we reviewed effectively addressed at least one of the three outcomes of interest (i.e., sexual violence, physical violence, and GBV-related knowledge/attitudes). Over half (n = 9/16) of the studies were rated high on the WSARS. However, we observed no significant differences in effectiveness between studies rated high and those rated low on the WSARS. Our results indicate that school-based GBV interventions could be an effective and sustainable strategy for addressing GBV in and around schools.

Informal and formal systems of care for women experiencing intimate partner violence in Kenya.

Several factors influence a victim's decision on whether or not to seek help after experiencing Intimate Partner Violence (IPV). This study used data from the Demographic and Health Surveys (DHS) for Kenya (2014) of ever married women (n = 5265). Majority of the women did not seek help after experiencing IPV (55.5%). Women justification for IPV decreased the odds of seeking help from informal services by 0.75 times and formal services by 0.58 times. Understanding cultural determinants of help seeking would contribute in the development of effective policies and programs for preventing and responding to IPV in Kenya and across the world.

Trauma Bonding Perspectives From Service Providers and Survivors of Sex Trafficking: A Scoping Review.

A trauma bond is an emotional attachment between an abuser and victim. Trauma bonds in sex trafficking compel victims to submit to continued exploitation and protect the trafficker. This scoping review examines trauma bonds in sex trafficking situations, its conceptualizations, and key characteristics. Ten databases were searched using sex trafficking AND trauma bonding-related terms; sex trafficking AND Stockholm syndrome, attachment, coercion, and manipulation. Articles were included if they featured trauma bonding, were published in English after 2013, or featured sex trafficking victims or traffickers in a Western country. Fifteen articles were included. The features of trauma bonding identified in these articles were (1) imbalance of power that favors trafficker, (2) traffickers' deliberate use of positive and negative interactions, (3) victim's gratitude for positive interactions and self-blame for the negative, and (4) victim's internalization of perpetrator's view. We also identified four aspects related to trauma bonding: (1) prior trauma made victims vulnerable, (2) victim's feelings of love remained even after exiting trafficking, (3) love is why victims do not prosecute traffickers, and (4) traffickers' intentional cultivation of the trauma bond. No article indicated how trauma bonds could be severed and replaced with healthy attachments. These findings reveal the need for practitioners and law enforcement and criminal justice professionals to address trauma bonding in both trafficking and posttrafficking situations. The findings also represent potential targets for urgently needed interventions that promote the replacement of trauma bonds with healthy attachments.

A Scoping Review of Resilience in Survivors of Human Trafficking.

Resilience is critical among survivors of trafficking as they are mostly vulnerable populations who face multiple adversities before, during, and after trafficking. However, resilience in survivors of trafficking is understudied. This scoping review aims to clarify the current state of knowledge, focusing on definitions of resilience, how resilience has been studied, and factors associated with resilience among survivors. Five databases were searched using key words related to trafficking and resilience. Studies were included if they were published in English between 2000 and 2019 and focused on resilience with the study design including at least one of these four features: (a) use of standardized measures of resilience, (b) qualitative descriptions of resilience, (c) participants were survivors or professionals serving survivors, and (d) data sources such as case files or program manuals directly pertained to survivors. Eighteen studies were identified. Findings indicated that resilience was primarily described as emergent from interactions between the survivor and the environment. Resilience in trafficking appeared largely similar to resilience in other kinds of victimization. Nonetheless, trafficking survivors also may display resilience in alternative ways such as refusing treatment. Positive interpersonal relationships were the most commonly mentioned resilience factor. In addition, current research lacks studies featuring longitudinal designs, interventions, participatory methods, types of trafficking other than sexual trafficking, and demographic characteristics such as age, gender, and national origin. Future research needs to establish definitions and measures of resilience that are culturally and contextually relevant to survivors and build knowledge necessary for designing and evaluating resilience-enhancing interventions.

Societal, Organizational, Relational, and Individual Perceptions of Sexual Violence Against Older Adults and Its Prevention: A Systematic Scoping Review.

BACKGROUND AND OBJECTIVES: Older adults are not regarded as sexual and are widely excluded from sexual violence (SV) research, policies, and practice; little is known about SV against older adults and its prevention. RESEARCH DESIGN AND METHODS: An 8-database scoping review explored perceptions of SV against older adults, barriers to prevention, and solutions for prevention. Included were peer-reviewed and gray sources published since 2010, supported by primary research, on perceptions of SV in later life and prevention. A thematic analysis was conducted to explore key themes. RESULTS: Of 148 potentially relevant sources returned, 95 were fully read after screening titles and abstracts; 19 were critically appraised and 18 were assessed for analysis. Seven overarching themes emerged, surrounding (a) knowledge and awareness, (b) research, (c) policy changes and development, (d) intersectional prejudice, (e) SV being taboo, (f) sociocultural differences, and (g) confusion regarding the definition and nature of SV. DISCUSSION AND IMPLICATIONS: These findings offer relevant considerations for practice, policy, and research, which will be further discussed.

Socioeconomic Factors and Patterns of Intimate Partner Violence among Ever-Married Women in Uganda: Pathways and Actions for Multicomponent Violence Prevention Strategies.

Intimate partner violence (IPV) is a severe public health problem in sub-Saharan Africa (SSA) with harmful effects on the physical, psychological, and socioeconomic wellbeing of survivors and their families. In SSA, IPV is associated with mental health disorders, high-risk behaviors, and HIV vulnerability, especially among women. In Uganda, poor socioeconomic status increases women's vulnerability to IPV. Yet there is limited evidence on the association between socioeconomic factors and IPV severity in Uganda. Our study used population-based data to (a) establish different patterns describing the severity of IPV experiences, (b) explore associations between socioeconomic factors and severity of IPV experiences among Ugandan ever-married women, and (c) examine direct and indirect pathways from socioeconomic factors to severity of IPV experiences. Data were drawn from the 2016 Uganda Demographic and Health Survey's sample of 7,536 ever-married women aged 15-49 years. A latent class analysis examined distinct patterns of IPV severity among this sample, yielding a four-class solution: low violence (n = 5,059; 67.1%); high physical violence, low sexual violence (n = 1,501; 19.9%); high sexual violence, moderate physical violence (n = 535; 7.1%); and high sexual and severe physical violence (n = 441; 5.9%). Using the low violence group as the reference category, we conducted a multinomial logistic regression that found significant associations between secondary education (aOR 2.35, 95% CI: [1.06, 5.24]), poorest on the wealth index (aOR 2.00, 95% CI: [1.13, 3.54]), and severe IPV experiences. Decision-making (aOR 0.81, 95% CI: [0.68, 0.96]) played a protective role against membership in the high sexual and physical violence class compared to the reference category. Using path analysis, we found that labor force participation partially mediated the path from wealth index and education to IPV severity. Findings indicate the need for interventions that aim to keep girls in school and target schools, communities, and media platforms to address gender norms, economic vulnerability, and comprehensive screening for multiple forms of violence.

History of Physical Teen Dating Violence and Its Association With Suicidal Behaviors Among Adolescent High School Students: Results From the 2015 Youth Risk Behavior Survey.

Although studies have investigated and found physical teen dating violence (TDV) has a significant negative impact on mental health outcomes, few studies are yet to investigate the effect of physical TDV on suicidal behaviors among adolescents. The objectives of this study are to examine the prevalence of physical TDV, suicidal ideation, suicide plan, and suicide attempt among adolescents aged 14 to 18 years and the association between physical TDV and these suicidal behaviors. Data for this study were obtained from the 2015 Youth Risk Behavior Survey. A sample of 9,693 adolescents aged 14 to 18 years (50.4% males) was analyzed using logistic regression with suicidal ideation, suicide plan, and suicide attempt as outcome variables and physical TDV as the main explanatory variable. About 17% of the adolescent students experienced suicidal ideation, 13.7% made a suicide plan, and 7.6% attempted suicide during the past 12 months. Among those who were dating, 9.9% experienced physical TDV. In the multivariate logistic regression, adolescent students who experienced physical TDV were 1.92 times more likely to have experienced suicidal ideation, 1.67 times more likely to have made a suicide plan, and 2.42 times more likely to have attempted suicide during the past 12 months when compared with their counterparts who were dating but experienced no physical TDV. Other significant predictors of suicidal behaviors include being a sexual minority, experiencing forced sex, bullying, feeling sad or hopeless, and binge drinking. Having sufficient sleep lowered the odds of suicidal ideation and suicide plan. The topic of physical TDV and its association with suicidal behaviors among adolescents is such an important issue for researchers, policymakers, and practitioners in the United States and around the world. Prevention and intervention efforts should be culturally tailored to reflect the unique experiences with physical TDV and suicide among minority populations such as sexual minority adolescents.

Intimate Partner Violence and Women's Mental Health: The Mediating Role of Coping Strategies Among Women Seeking Help From the Police.

Many variables explain the link between intimate partner violence (IPV) and its impact on women's mental health. This proposition is mostly from samples drawn from battered women's shelters, batterer intervention programs (BIPs), emergency rooms, and medical clinics. We know little about the psychological well-being of women who report abuse to police departments. This study used data from case records of women who experience IPV and sought help from a city police station located in the southwest United States. These case records were examined to identify how sociodemographic characteristics of age, ethnicity, marital status, financial dependence, resources of social support, and coping strategies related with type and number of IPV incidents as well as mental health symptoms. The sample consisted of 154 women, majority of whom experienced physical violence (70.1%), sexual violence (9.1%), emotional violence/stalking (14.9%), and combined, that is, reporting more than one (5.8%). Approximately 67.5% of the women reported some mental health symptoms. Social support and coping strategies significantly distinguished women's experience of mental health symptoms. Unexpectedly, the current data indicate that women who scored higher in perceived social support significantly reported more mental health symptoms. Coping strategies mediated the relationship between IPV and mental health symptoms. The findings suggest that availability of coping resources may mitigate repeated IPV and modify the impact of mental health. In discussing prevention and intervention efforts with women who have experienced or are at risk of experiencing IPV, practitioners can help women employ empowering coping strategies that are built on their resilience. In addition, mental health professionals working with the police, especially in community policing setting, can achieve promising outcomes for women experiencing violence.

Substance Use, Service Provision, Access & Utilization among Foreign-Born Communities in the United States: A Mixed Methods Study.

BACKGROUND: The prevalence of substance use among the foreign-born has gained increasing attention. Cumulative migration stressors - including historical trauma, violence, family separation, and poverty - present challenges to human service systems wherein services may not adequately meet the needs of these groups. Objectives: This study explores the challenges and realities of substance use, substance use service provision, and delivery of services among the increasingly diverse immigrant population using multiple perspectives. This study is based on data from a larger mixed methods study that assessed the human service landscape pertaining to the immigrant population in a mid-western region of the United States. Methods: This transformative mixed methods study used a community based participatory research approach. Data were collected from human service providers (HSPs), informal service providers, and local community leaders through surveys (n = 64), in-depth interviews (n = 23), and six focus group discussions (n = 48). A weaving approach was used to integrate findings from quantitative and qualitative data. Results: Participants recognize substance use as an issue that needs immediate attention among increasingly diverse immigrant communities. Community members and human service organizations identified several emergent themes including patterns and occurrence of substance use, barriers to care, and proposed system changes. Conclusions: Given that only 28% of responding organizations list substance use as part of their core services, the need for organizational collaborations with a focus on culturally responsive evidence-based services is proposed.

Intimate Partner Violence in India: Abuse in India's Empowered Action Group States.

Married women in India experience intimate partner violence (IPV) at alarming rates. This study explores regional differences in Indian women's physical IPV experiences by looking at the effect of living in eight Empowered Action Group (EAG) states. It is hypothesized that women in EAG states will be more likely to have experienced physical IPV than women living outside EAG states. A sample of 65,587 women was selected from the 2005-2006 India National Family Health Survey (NFHS-3). Counter to our hypothesis, logistic regression results show that living in an EAG state decreases likelihood of physical IPV in the past 12 months.

When Abused Women Decide to Seek Help From a Victims Assistance Program: Their Perceived Needs and Self-Reported Mental Health Symptoms.

This study examines the nature of perceived needs of women victims of intimate partner violence (IPV) and their association with social demographic characteristics and self-reported mental health symptoms. The study uses data from case records of women victims of IPV (n = 154) seeking help from a victim assistance program housed within city police station located in the southwest, United States. The majority of the women in this study reported needs related to counseling, protection orders, Crime Victims' Compensation Rights, legal services, and Temporary Aid for Needy Families. Findings also indicate that perceived needs of women were significantly associated with self-reported mental health symptoms. Some needs had a stronger relationship to women's mental health symptoms than others. Overall these findings suggest that it is imperative to emphasize responses that can address all the needs of women (in addition to stopping IPV) to reduce mental health symptoms.

Cultural roadblocks on women's reproductive health rights: a qualitative interpretive meta-synthesis from South Asia and Sub-Saharan Africa.

Women disproportionately confront disparate barriers in accessing reproductive health services across the world. We used qualitative interpretive meta-synthesis (QIMS) to explore cultural barriers that women face in reproductive health decision making and access to reproductive health services in developing countries of South Asia and sub-Saharan Africa. Our findings indicated that experience with domestic violence, son preference, and lack of financial independence were some of the crucial obstacles that women face to enjoy reproductive rights. Findings pointed to the need for targeted sexual and reproductive health educational policies and training for all in order to reduce gender based health disparities.

Marital Rape and HIV Risk in Uganda: The Impact of Women's Empowerment Factors.

This study used Uganda Demographic Health Survey data (2011) to examine the role of women's empowerment in reducing HIV risk among married women who experienced sexual violence in Uganda. The sample size was 8,674 ever-married women aged 15-49 years. Significant differences were revealed for marital rape, women's empowerment variables, and reducing HIV risk according to sociodemographic characteristics. Women's labor force participation partially mediated the relationship between sexual violence and reducing HIV risk, but decision making did not. Findings highlight the need for the development and implementation of policies and programs to address marital rape and reduce HIV risk within institutions of marriage.

Investigating the association between age at first alcohol use and suicidal ideation among high school students: Evidence from the youth risk behavior surveillance system.

BACKGROUND: Although various studies have investigated and found a significant link between age at first alcohol use and health risk behaviors, few studies have investigated the effect of age at first alcohol use on suicidal ideation among adolescents. The objective of this study was to investigate the effect of age at first alcohol use on suicidal ideation. METHODS: Data for this study were obtained from the 2015 Youth Risk Behavior Surveillance system. A sample of 10,745 adolescents aged 14-18 years (50.9% males) were analyzed using logistic regression with suicidal ideation as the outcome variable and age at first alcohol use as the main explanatory variable. RESULTS: About 17% of adolescents experienced suicidal ideation during the past 12 months and 15.6% started having alcohol before age 13. Adolescents who started having alcohol before age 13 had 1.60 times higher odds of experiencing suicidal ideation and adolescents who started having alcohol by age 13 or over had 1.47 times higher odds of experiencing suicidal ideation. Other significant factors associated with suicidal ideation include experience of forced sex, physical teen dating violence, bullying, and feeling sad or hopeless. Having sufficient sleep lowered the odds of suicidal ideation. LIMITATIONS: The use of cross-sectional data limits the extent to which we can make causal claims regarding age at first alcohol use and suicidal ideation. CONCLUSIONS: Younger age at first alcohol use was associated with increased likelihood of suicidal ideation. Public health initiatives that seek to address the co-occurring problems of alcohol use and mental health illness, sexual violence, and victimization among sexual minority youth could help in reducing suicidal ideation.

The association between school bullying victimization and substance use among adolescents in Malawi: the mediating effect of loneliness.

Background and objectives Research has shown an increased prevalence of substance use among adolescents in countries in Sub-Saharan Africa. Peer affiliation, bullying, and psychological stress are significantly associated with substance use. This study empirically tested theoretical frameworks linking peer affiliation, bullying victimization, loneliness and substance use (specifically tobacco or alcohol use) among adolescents. Materials and methods Data were obtained from the 2009 Malawi Global School-based Health Survey (GSHS) with a representative sample of 2359 students aged 13-17 years in Malawi, Sub-Saharan Africa. Missing data were handled using multiple imputation. The study conducted path analyses using Mplus to test the conceptual models of tobacco use and alcohol use. Results The results showed that loneliness partially mediated the association between bullying victimization and tobacco use in the first model, as well as the relationship between bullying victimization and alcohol use in the second model. Results indicated statistically significant indirect paths from bullying victimization to tobacco use and alcohol use through the mediation of loneliness. However, peer affiliation did not directly predict bullying victimization in the two path models; it directly predicted tobacco use only. Conclusions These findings have important implications in early intervention for health practitioners in school and mental health settings to prevent feelings of loneliness and substance use among adolescents who have experience with bullying victimization but no experience with depression, alcohol use or tobacco use.

Bullying and HIV Risk Among High School Teenagers: The Mediating Role of Teen Dating Violence.

BACKGROUND: Teen dating violence (TDV), bullying, and HIV risk behaviors are public health concerns that impact adolescents in the United States. National estimates reveal high rates of these risk behaviors among high school students. Based on theoretical and empirical evidence, we hypothesized that experiencing teen dating violence (sexual and physical) would mediate the impact of bullying on HIV risk. METHODS: Data were from the 2013 National Youth Behavior Risk Surveillance Survey (YRBSS) among students who answered questions on bullying, TDV, and HIV risk (N = 13,571). The YRBSS is conducted biennially among 9th- to 12th-grade students nationally. We used multiple regression analysis and Hayes' SPSS process macro to examine the 2 study hypotheses. RESULTS: Findings from bivariate analysis suggest an association between bullying and HIV risk. The study also found associations between physical, sexual teen dating violence and HIV risk. Results also indicate that both physical and sexual teen dating violence mediate the association between bullying and HIV risk. CONCLUSION: Our findings suggest that multidimensional interventions should be developed to reduce the rate of teen dating violence and combat bullying as a preventative method for HIV risk among high school students.

Women's Autonomy and Attitudes toward Condom Use: A Multicountry Analysis.

Autonomy gives women the ability to negotiate safe sex and make decisions on their health. This study explores the gender stratification framework to understand the intertwined nature of HIV and women's autonomy using the nationally representative Demographic Health Survey. It examines women's autonomy and attitudes toward condom use for prevention of HIV/AIDS in four culturally diverse countries. Findings from the logistic regression indicate that labor force participation, individual autonomy, and decision making significantly increased the odds of always using a condom during sex in all countries. Promoting prevention policies highlighting women's autonomy may contribute in reducing the spread of HIV infection.

Aggression behavior and substance use among immigrant children: Mediating effect of antisocial attitudes.

In 2010, approximately one out of four youths in the United States were immigrant children. Hispanics and Asians comprised the largest groups (58% and 16%), respectively. Today, the Hispanic population is the largest ethnic minority in the United States (15%) and is a majority of the U.S. foreign-born population (47%). While immigration is a positive process for most immigrants, resettlement into a new country has challenges, including acculturation adjustments. Youth engage in risky behaviors such as substance use and antisocial behaviors. For immigrant youth with limited supportive opportunities, however, the acculturation process can be difficult. Stress, alienation, and stigma often manifest and cause behavioral problems, including aggression. This pilot study examines the mediating effect of antisocial attitudes using sociocultural, developmental, and environmental factors to understand Hispanic youth problem behaviors. We sampled 136 youths, ages 6-12, from predominantly Hispanic elementary schools in the southwestern United States to ascertain the role of aggression and antisocial behavior in substance use attitudes. The results show significant differences in aggression, antisocial attitudes, and substance use according to (1) age, (2) years in the United States, (3) English level, and (4) relationship with mother. Aggression significantly predicted antisocial attitudes and substance use, with antisocial attitudes having a mediating effect on the relationship between aggression and substance use. In developing social service programs to prevent substance use among children from immigrant families, social work educators and practitioners may consider addressing the role of aggression in Hispanic adolescents' future behavior.

Components of resilience in gender: a comparative analysis of HIV outcomes in Kenya.

Gender is a critical concept of human immunodeficiency virus (HIV) sexual risk; yet, few studies have examined the intersection between risk and protective factors associated with incidence of HIV among couples. The paper examines gender-specific constructs of resiliency among couples in Kenya. Using data from the Demographic and Health Surveys, Kenya (2008/2009), we apply logistic regression techniques to analyse three resilience-related outcomes (condom use, HIV test and knowing an HIV test place) in estimating the gender differences and barriers to HIV/AIDS sexual risk. Men's outcomes were significantly associated with previous HIV testing, urban residence, being insured and higher levels of education. Predictors for women's indicators included previous experience of sexual violence, previous HIV test, urban residence, number of children and willingness to care for a relative with AIDS. Practical implications are discussed to include providing protective factors to women and formulating policies that minimise the challenges faced by women.