System-level factors influencing refugee women's access and utilization of sexual and reproductive health services: A qualitative study of providers’ perspectives

Refugee women have poor outcomes and low utilization of sexual and reproductive health (SRH) services, which may be driven by access to and quality of SRH services at their resettled destinations. While healthcare providers offer valuable insights into these topics, little research has explored United States (U.S.) providers' experiences. To fill this literature gap, we investigate U.S. providers' perspectives of healthcare system-related factors influencing refugee women's access and utilization of SRH services. Between July and December 2019, we conducted in-depth, semi-structured interviews with 17 providers serving refugee women in metropolitan Atlanta in the state of Georgia (United States). We used convenience and snowball sampling for recruitment. We inquired about system-related resources, facilitators, and barriers influencing SRH services access and utilization. Two coders analyzed the data using a qualitative thematic approach. We found that transportation availability was crucial to refugee women's SRH services access. Providers noted a tension between refugee women's preferred usage of informal interpretation assistance (e.g., family and friends) and healthcare providers’ desire for more formal interpretation services. Providers reported a lack of funding and human resources to offer comprehensive SRH services as well as several challenges with using a referral system for women to get SRH care in other systems. Culturally and linguistically-concordant patient navigators were successful at helping refugee women navigate the healthcare system and addressing language barriers. We discussed implications for future research and practice to improve refugee women's SRH care access and utilization. In particular, our findings underscore multilevel constraints of clinics providing SRH care to refugee women and highlight the importance of transportation services and acceptable interpretation services. While understudied, the use of patient navigators holds potential for increasing refugee women's SRH care access and utilization. Patient navigation can both effectively address language-related challenges for refugee women and help them navigate the healthcare system for SRH. Future research should explore organizational and external factors that can facilitate or hinder the implementation of patient navigators for refugee women's SRH care

Racial and ethnic differences in physical activity among mothers of young children: 2011–2018 NHANES

Abstract Background American women tend to reduce physical activity (PA) during the transition to motherhood. Their main barrier to participation in PA is lack of time due to new/increased parenting and housework responsibilities. Because there are known racial/ethnic variations in time spent on housework among American women, their PA changes during the transition to motherhood might also differ by racial/ ethnic background. This study aimed to compare PA between American mothers of young child(ren) under age 5 years (YC) and American women without children by their racial/ethnic background. Methods Secondary data analyses were conducted using 2011–2018 US National Health and Nutrition Survey data. The study sample included 4,892 women aged 20–45 years (Asian n = 760; Black n = 1,162; Hispanic n = 1,324; White n = 1,646). Participants completed a Physical Activity Questionnaire that asked about participation in transportation and leisure-time moderate- and vigorous-intensity PA (MVPA; minutes/week). Multivariable regression analyses were conducted to compare MVPA among women living without children and with YC (no older children) in each of the racial/ethnic groups. Results Overall, the prevalence of physical inactivity, defined as zero minutes of MVPA in a typical week, was 43% (95% CI = 38–49%) vs. 32% (95% CI = 29–35%) among women living with YC vs. without children. The adjusted odds of physical inactivity for women living with YC, compared to women living without children, was significantly higher among Asian (OR = 2.08 [95% CI = 1.37–3.17]) and White women (OR = 1.63 [95% CI = 1.11–2.38]), while it was statistically insignificant among Hispanic and Black women. Among women who reported participating in MVPA, Asian women living with YC had 35 fewer minutes/week of MVPA than their counterparts living without children (p = 0.06), while other racial and ethnic groups showed no significant differences. Conclusions American mothers of YC were less likely to engage in transportation or leisure-time MVPA, compared to those living without children. This association was particularly strong among Asian women. The study results suggest that a PA reduction in the transition to motherhood may be particularly large among Asian American women, calling for targeted efforts for PA promotion among Asian American mothers of YC; e.g., culturally-tailored community-based physical activity programs for Asian American mothers

Motives for Alcohol and Marijuana Use as Predictors of Use and Problem Use Among Young Adult College Students.

This study examined (a) differences between alcohol-only users and alcohol-marijuana co-users and (b) motives for use in relation to alcohol and marijuana use and problem use. Spring 2016 data among 1,870 past 4-month alcohol users (63.6% female, 69.1% White) from seven Georgia colleges/universities were analyzed cross-sectionally and with regard to problem use measured 4 months later. Correlates of co-use (n = 345; vs. alcohol-only use, n = 1,525) included greater alcohol and marijuana use frequency, problem drinking and marijuana use, and alcohol use motives (p’s < .05). Controlling for covariates, alcohol use frequency correlated with greater marijuana use frequency and Coping and Self-enhancement alcohol use motives, but lower Conformity alcohol use motives (p’s < .001); greater Coping and Self-enhancement alcohol use motives (p’s < .01) predicted problem alcohol use. Marijuana use frequency correlated with greater Coping and Expansion marijuana use motives (p’s < .05); greater Expansion marijuana use motives (p = .005) predicted problem marijuana use. College-based substance use interventions should target Coping and Self-enhancement alcohol use motives and Expansion marijuana use motives

Potential for sustainability of strategies for implementing tobacco use treatment guidelines in the Vietnam public healthcare system: qualitative post intervention assessment

Background Tobacco cessation services are not widely available in low middle-income countries (LMICs) where smoking rates remain high. In Vietnam 45% of males are current smokers. We recently completed a two-arm randomized control trial comparing the effectiveness of two strategies for implementing tobacco use treatment (TUT) guidelines in community health centers (CHCs) in Vietnam. All sites received training and patient education materials. Intervention sites received a system for referring smokers to a village health worker (VHW) for multisession counseling. Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted a post-intervention qualitative analysis of factors that facilitate or challenge implementation and sustainability of screening and treatment of TU in CHCs in Vietnam. Methods Semi-structured interviews (N=42) were conducted with healthcare staff and VHWs in 18 CHCs. Interviews were transcribed verbatim and translated. Two investigators analyzed transcripts using an inductive and deductive approach to develop codes and identify themes relevant to the study research questions. Results Interviews explored five domains of the CFIR (Intervention characteristics, Outer and Inner settings, Characteristics of individuals, and Process). Facilitators of program implementation included perceived importance of and need for smoking cessation services, ease of integrating the TUT intervention into routine care, and a high level of satisfaction with the quality of intervention components. Challenges to implementation included patient barriers (e.g., not ready to quit) and lack of a referral resource in comparison sites. The main challenge to sustainability is competing Ministry of Health (MOH) priorities that result in a relative lack of resources for TUT (e.g., training/materials) compared with other health programs. Conclusions A robust planning process resulted in a good fit between current practice and the implementation strategies used to increase adoption of TUT guidelines in CHCs. Sustainability will depend on MOH commitment of resources, including ongoing training and integration with other programs

Sex and sexual orientation in relation to tobacco use among young adult college students in the US: a cross-sectional study

Abstract Background Sexual minority young adults represent a high-risk population for tobacco use. This study examined cigarette and alternative tobacco product (ATP) use prevalence across sexual orientation (heterosexual, gay/lesbian, and bisexual) among college-attending young adult men and women, respectively. Methods Baseline data from a two-year longitudinal study of 3386 young adult college students aged 18–25 in Georgia were analyzed. Correlates examined included sociodemographics (age, sex, sexual orientation, race/ethnicity, college type, and parental education). Outcomes included past 30-day use of tobacco (cigarette, little cigars/cigarillos [LCCs], e-cigarettes, hookah, any tobacco product used, and number of tobacco products used, respectively). Two-group, multivariate multiple regression models were used to examine predictors of tobacco use among men and women, respectively. Results Among men (N = 1207), 34.7% used any tobacco product; 18.6% cigarettes; 12.3% LCCs; 16.8% e-cigarettes; and 14.7% hookah. Controlling for sociodemographics, gay sexual orientation (OR = 1.62, p = 0.012) was associated with higher odds of cigarette use; no other significant associations were found between sexual orientation and tobacco use. Among women (N = 2179), 25.3% used any tobacco product; 10.4% cigarettes; 10.6% LCCs; 7.6% e-cigarettes; and 10.8% hookah. Being bisexual was associated with cigarette (p < 0.001), LCC (p < 0.001), and e-cigarette use (p = 0.006). Lesbian sexual orientation was associated with cigarette (p = 0.032) and LCC use (p < 0.001). Being bisexual predicted any tobacco product used (p = 0.002), as well as number of tobacco products used (p = 0.004). Group comparisons showed that the effect of sexual minority status on LCC use was significantly different for men versus women. Conclusion Sexual minority women, especially bisexual women, are at higher risk for using specific tobacco products compared to heterosexual women; homosexual men are at increased risk of cigarette use compared to heterosexual men. These nuances in tobacco use should inform interventions targeting sexual minorities

Mental health and substance use among women and men at the intersections of identities and experiences of discrimination: insights from the intersectionality framework

Abstract Background Intersectionality theory focuses on how one’s human experiences are constituted by mutually reinforcing interactions between different aspects of one’s identities, such as race, class, gender, and sexual orientation. In this study, we asked: 1) Do associations between intersecting identities (race and sexual orientation) and mental health (depressive symptoms) and substance use (alcohol, tobacco, and marijuana) differ between men and women? and 2) How do single or intersecting self-reports of perceived racial and/or sexual orientation discrimination influence mental health and substance use outcomes for men and women? We compared results of assessing identities versus experiences of discrimination. Methods Multivariable regressions were conducted on cross-sectional data from 2315 Black and White college students. Predictors included measures of sociodemographic characteristics and experiences of discrimination. Outcomes included past 2-week depressive symptoms (PHQ-9), past 30-day alcohol use, past 30-day tobacco use, and past 30-day marijuana use. Results Intersecting identities and experience of discrimination had different associations with outcomes. Among women, self-reporting both forms of discrimination was associated with higher depressive symptoms and substance use. For example, compared to women experiencing no discrimination, women experiencing both forms of discrimination had higher depressive symptoms (B = 3.63, CI = [2.22–5.03]), alcohol use (B = 1.65, CI = [0.56–2.73]), tobacco use (OR = 3.45, CI = [1.97–6.05]), and marijuana use (OR = 3.38, CI = [1.80–6.31]). However, compared to White heterosexual women, White sexual minority women had higher risks for all outcomes (B = 3.16 and CI = [2.03–4.29] for depressive symptoms, B = 1.45 and CI = [0.58–2.32] for alcohol use, OR = 2.21 and CI = [1.32–3.70] for tobacco use, and OR = 3.01 and CI = [1.77–5.12] for marijuana use); while Black sexual minority women had higher tobacco (OR = 2.64, CI = [1.39–5.02]) and marijuana use (OR = 2.81, CI = [1.33–5.92]) only. Compared to White heterosexual men, White sexual minority men had higher depressive symptoms (B = 1.90, CI = [0.52–3.28]) and marijuana use (OR = 2.37, CI = [1.24–4.49]). Conclusions Our results highlight the deleterious impacts of racial discrimination and sexual orientation discrimination on health, in particular for women. Future studies should distinguish between and jointly assess intersecting social positions (e.g., identities) and processes (e.g., interpersonal experience of discrimination or forms of structural oppression)

Prescription stimulant use among young adult college students: Who uses, why, and what are the consequences?

OBJECTIVE: To examine prescription stimulant use among college students, particularly use with versus without prescriptions or attention deficit hyperactive disorder (ADHD) diagnoses. PARTICIPANTS: Data were drawn from a diverse sample of college students from seven colleges/universities in Georgia participating. METHODS: Measures assessed ADHD-specific factors, prescription stimulant use, access, motives, side effects, and covariates. RESULTS: Of the 219 students reporting prescription stimulant use (average age 20.72 years, 54.8% female, 82.1% White), 45.7% did not have prescriptions or ADHD diagnoses. Correlates of use without prescriptions/diagnoses included lower parental education, attending private school, not having depression- or anxiety-related diagnoses, and past 30-day marijuana and tobacco use. Those without prescriptions/diagnoses were more likely to use to stay awake longer, to have more enjoyable time, and to party longer; they also reported fewer adverse side effects. CONCLUSIONS: Campuses should educate students about ADHD, facilitate screening and treatment, and emphasize adverse consequences of recreational use

Initiation, continuation of use and cessation of alternative tobacco products among young adults: A qualitative study

Introduction Diverse non-cigarette alternative tobacco products are increasingly popular in the United States. This study investigates the reasons why young adults initiate and continue the use of these products, as well as potential motivations and approaches for quitting. Products assessed include cigarettes, little cigars/cigarillos (LCCs), smokeless tobacco, e-cigarettes, and hookahs. Methods We conducted 60 telephone interviews, of 30-minute duration, with tobacco users enrolled in colleges in Georgia. Qualitative analysis was used to identify themes emerging from the data. Results Reasons for initiation, continued use, and (potential) cessation showed similarities and differences across products. Most commonly cited reasons for initiation included: peer influence (all products), flavors/tastes (all products except cigarettes), and easy environmental access and/or low costs (LCCs, smokeless tobacco, and e-cigarettes). Participants discussed several influences on continued use, such as peer influence (cigarettes, LCCs, and hookahs), stress management (all products except hookahs), and use with other substances (cigarettes, LCCs, and hookahs). Primary motivations for cessation mentioned by participants were family responsibilities (cigarettes, e-cigarettes, and hookahs) and health concerns (all products except e-cigarettes). Frequently used cessation strategies included avoidance of other tobacco users (cigarettes, LCCs, and hookahs) and a reduction of nicotine intake (cigarettes and e-cigarettes). Conclusions Our findings suggest that researchers should consider the differences in reasons for use and discontinued use of tobacco products in order to develop targeted messaging strategies, particularly noting the differential impact of interpersonal influences and health concerns. We also point to a need for regulatory action that limits diversification and accessibility of different products

Adapting a religious health fatalism measure for use in Muslim populations.

OBJECTIVE:Fatalism has been shown to influence health behaviors and outcomes among different populations. Our study reports on the adaptation of the Religious Health Fatalism Questionnaire for a Muslim population (RHFQ-M). DESIGN:The original RHFQ wording was modified for a Muslim context and cognitively tested in 6 focus groups (FG). Items were revised by Muslim and non-Muslim healthcare researchers based on FG responses regarding the theological "accurateness" of the questions. The revised 9-item measure was administered to 58 English-speaking Muslim women (≥40 years old) recruited from two mosques in the Chicago area in order to assess psychometric properties. MAIN OUTCOME MEASURES:Cronbach's alpha and exploratory factor analyses were used to assess internal consistency and measure dimensionality, respectively. Statistical correlations with several fatalism and religiosity measures were computed to assess convergent and discriminant validity. RESULTS:After testing with an ethnically and racially diverse group of Muslims, the RHFQ-M was found to be reliable (Cronbach's α is 0.79), comprised of two distinct underlying subscales, and is correlated with, but distinct from, other measures of fatalism and Islamic religiosity. CONCLUSION:Our adapted measure, RHFQ-M, appears to accurately assess Islamic dimensions of fatalism and is ready for use in the health literature