Publications by authors named "Janice C Humphreys"

19 Publications

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The health status of transgender and gender nonbinary adults in the United States.

PLoS One 2020 21;15(2):e0228765. Epub 2020 Feb 21.

School of Nursing, Duke University, Durham, North Carolina, United States of America.

The goal of this exploratory study was to delineate health differences among transgender subpopulations (transgender women/TW, transgender men/TM, gender nonbinary/GNB adults). 2015 Behavioral Risk Factor Surveillance System data were analyzed to compare the health of three groups (TW:N = 369; TM:N = 239; GNB:N = 156). Logistic regression and adjusted odds ratios were used to determine whether health outcomes (fair/poor health, frequent physical and mental unhealthy days, chronic health conditions, and health problems/impairments) are related to group and its interaction with personal characteristics and socioeconomic position. Group was a significant predictor of fair/poor health and frequent mental unhealthy days, revealing significant health differences between the transgender groups. The odds of poor/fair health were approximately 2.5 times higher in TM and GNB adults relative to TW. The odds of frequent mental unhealthy days for TM were approximately 1.5-2 times greater than TW and GNB adults. Among those with health insurance, the odds of fair/poor health for GNB adults was more than 1.5-2 times higher that of TM and TW. Among those without health insurance, TM had over 7 times greater odds of fair/poor health than TW. This study underscores the importance of classifying and examining the health of the transgender population as unique subpopulations, as notable health differences were discovered. TM and GNB adults have significant health concerns, requiring the attention of clinical interventions aimed at promoting health and preventing illness.
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April 2020

Application of Behavioral Risk Factor Surveillance System Sampling Weights to Transgender Health Measurement.

Nurs Res 2020 Jul/Aug;69(4):307-315

Ethan C. Cicero, PhD, RN, is Postdoctoral Scholar Fellow, Department of Community Health Systems, School of Nursing, University of California, San Francisco. Sari L. Reisner, ScD, is Assistant Professor, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Associate Scientific Researcher, Division of General Pediatrics, Boston Children's Hospital, Massachusetts; Assistant Professor, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; and Affiliated Research Scientist and Director, Transgender Health Research Team, The Fenway Institute, Fenway Health, Boston, Massachusetts. Elizabeth I. Merwin, PhD, RN, FAAN, is Dean, College of Nursing and Health Innovation, University of Texas at Arlington. Janice C. Humphreys, PhD, RN, FAAN, is Professor, Duke University School of Nursing, Durham, North Carolina. Susan G. Silva, PhD, is Associate Professor, Duke University School of Nursing and School of Medicine, Durham, North Carolina.

Background: Obtaining representative data from the transgender population is fundamental to improving their health and well-being and advancing transgender health research. The addition of the Behavioral Risk Factor Surveillance System (BRFSS) gender identity measure is a promising step toward better understanding transgender health. However, methodological concerns have emerged regarding the validity of data collected from transgender participants and its effect on the accuracy of population parameters derived from those data.

Objectives: The aim of the study was to provide rationale substantiating concerns with the formulation and application of the 2015 BRFSS sampling weights and address the methodological challenges that arise when using this surveillance data to study transgender population health.

Methods: We examined the 2015 BRFSS methodology and used the BRFSS data to present a comparison of poor health status using two methodological approaches (a matched-subject design and the full BRFSS sample with sampling weights applied) to compare their effects on parameter estimates.

Results: Measurement error engendered by BRFSS data collection procedures introduced sex/gender identity discordance and contributed to problematic sampling weights. The sex-specific "raking" algorithm used by BRFSS to calculate the sampling weights was contingent on the classification accuracy of transgender by participants. Because of the sex/gender identity discordance of 74% of the transgender women and 66% of transgender men, sampling weights may not be able to adequately remove bias. The application of sampling weights has the potential to result in inaccurate parameter estimates when evaluating factors that may influence transgender health.

Discussion: Generalizations made from the weighted analysis may obscure the need for healthcare policy and clinical interventions aimed to promote health and prevent illness for transgender adults. Methods of public health surveillance and population surveys should be reviewed to help reduce systematic bias and increase the validity of data collected from transgender people.
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November 2020

Couples' Experiences of Maternal Postpartum Depression.

J Obstet Gynecol Neonatal Nurs 2019 05 26;48(3):341-350. Epub 2019 Apr 26.

Objective: To understand the processes that couples navigate as they cope with maternal postpartum depression (PPD) in early parenthood.

Design: Qualitative, interpretive phenomenological study.

Setting: Community setting in the western United States.

Participants: A convenience sample of 10 couples (N = 20, 10 mothers and 10 fathers) who indicated they had maternal diagnoses of PPD after the births of their first children within the last 3 years.

Methods: Couples were interviewed together and then individually with the use of a semistructured interview guide. Narrative and thematic analyses were used to understand couples' lived experiences of PPD.

Results: Participants cocreated their experiences of maternal PPD. Three primary phases in the pattern of coping with PPD were identified: Dismissal (couples attempted to normalize their experiences and protect the mother from judgment), Acknowledgment (couples revealed their concerns, the first step in the process of seeking help), and Accommodation (process of trial and error used to find a way to meet the needs of the mother).

Conclusion: Our findings suggest that practitioners must support the needs of the entire family, including fathers, when mothers have a diagnosis of PPD. Fathers support mothers during this difficult experience but not without an increased burden of stress to themselves.
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May 2019

Health Care Experiences of Transgender Adults: An Integrated Mixed Research Literature Review.

ANS Adv Nurs Sci 2019 Apr/Jun;42(2):123-138

School of Nursing, University of California, San Francisco (Dr Cicero); Harvard Medical School and Boston Children's Hospital, and Department of Epidemiology, Harvard T.H. Chan School of Public Health, and The Fenway Institute, Fenway Health, Boston, Massachusetts (Dr Reisner); Duke University School of Nursing, Durham, North Carolina (Drs Silva, Merwin, and Humphreys); and Duke University School of Medicine, Durham, North Carolina (Dr Silva).

This integrated literature review, framed by the gender affirmation framework, sought to contextualize the experiences of transgender adults interfacing with health care after the release of Healthy People 2020. The constructs of the gender affirmation framework represented 4 a priori themes used to organize the findings. The 23 articles synthesized (quantitative, n = 13; qualitative, n = 7; case studies, n = 2; and mixed methods, n = 1) revealed numerous obstacles accessing health care, discrimination from health care professionals and clinicians, restricted health insurance benefits for medically necessary care, and barriers to medically necessary care, such as cross-sex hormones, as well as primary and preventative health care.
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June 2020

Trauma-related symptoms and severity among women in the Pacific Rim.

Health Care Women Int 2019 01 24;40(1):102-117. Epub 2019 Jan 24.

c Duke University School of Nursing , Durham , North Carolina , USA.

Current understandings of the effects trauma exposure on women's health are limited because prior research has largely focused on intimate partner and sexual violence in homogenous samples. In this descriptive study, the authors examined the relationships between lifetime trauma exposure and psychological well-being among women across the Pacific Rim. Psychological well-being differed significantly between the four locations and increased trauma exposures were related to poorer psychological well-being across and within locations. The authors report relevant findings on the relationship between trauma exposure and psychological well-being and provide evidence for future research to enhance knowledge on the effects of trauma in women's lives.
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January 2019

Measuring Distress Levels of Refugee Women to Enhance Community-Based Psycho-social Interventions.

Issues Ment Health Nurs 2019 Apr 11;40(4):310-316. Epub 2019 Jan 11.

b Duquesne University School of Nursing , Pittsburgh , Pennsylvania , USA.

The purpose of this investigation was to gain an understanding of the levels of distress in resettled refugee women as a basis for the development of improved community based interventions to enhance the resettlement experience. A convenience sample of female refugees (n = 23) in a southern US city were interviewed using a socio-demographic questionnaire; the Refugee Health Screener-15 (RHS-15); and semi-structured, exploratory questions. Results showed consistently high levels of distress, indicated by responses to the RHS-15. Women ages 19-25 and over 50 displayed the highest risk. Categories of stressors included a lack of access to health and psycho-social support services, difficulty with communicating in the English language, and social isolation. In addition, women reported that a lack of trained interpreters contributes to reduced access to health and social service, causing further distress.
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April 2019

A Qualitative, Systems Thinking Approach to Study Self-Management in Women With Migraine.

Nurs Res 2018 Sep/Oct;67(5):395-403

Deanna R. Befus, PhD, RN, is Research Fellow, Center for Integrative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. Kristen Hassmiller Lich, PhD, is Associate Professor, Gillings School of Global Public Health, University of North Carolina-Chapel Hill. Shawn M. Kneipp, PhD, RN, FAANP, is Associate Professor, School of Nursing, University of North Carolina-Chapel Hill. Janet P. Bettger, ScD, is Associate Professor, Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina. Remy R. Coeytaux, MD, PhD, is Professor, Center for Integrative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. Janice C. Humphreys, PhD, RN, FAAN, is Professor, Duke University School of Nursing, Durham, North Carolina.

Background: A dearth of effective and affordable treatment options has rendered nonpharmacological self-management a crucial part of living with migraine-a debilitating neurobiological condition without cure that disproportionately disables vulnerable women.

Objective: The aim of the study was to describe the development and use of a systems thinking, problem-structuring data collection approach that was applied to the study of migraine self-management with women in diverse social locations.

Methods: Two systems mapping activities were developed for use in focus groups: one to unpack a migraine episode (system support map) and the other (connection circle [CC]) to construct a mental model of self-management. Later in the process, a strengths-based problem-solving tool was developed to replace the CC.

Results: The CCs-often enlightening for affluent participants-left marginalized women feeling overwhelmed and defeated, as a solution to one challenge became the cause of another. Through constant comparison analysis, we recalibrated the approach using a theory, clinical experience, and participant feedback and replaced the CC with a strengths-based problem-solving activity highlighting relationships and trade-offs in a more agential, actionable way.

Discussion: Bringing a critical lens and strengths-based approaches to work with vulnerable populations can replace traditional deficit thinking in healthcare, developing options for leveraging resources and understanding complex health behaviors without losing sight of systemic, distributional justice issues. These systems thinking tools can provide a way to extrapolate the complexities of actual self-management behaviors and challenges faced by vulnerable women with migraine versus what they may be instructed to do by a medical model that does not always account for the social and structural determinants of equity and health.
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February 2019

Describing the healthcare experiences and strategies of women survivors of violence.

J Clin Nurs 2018 Mar 8;27(5-6):1170-1182. Epub 2018 Jan 8.

Duke University School of Nursing, Durham, NC, USA.

Aim And Objective: The purpose of this study was to develop knowledge on women survivors' healthcare experiences and strategies.

Background: Survivors of traumatic life events are at an increased risk for an array of negative health consequences, which can be complicated when distressing healthcare experiences act as a barrier to accessing needed care. Implications for trauma-informed and sensitive practice are well established, but evidence to date on survivors' healthcare experiences and patient engagement is limited.

Design: This study utilized individual interviews and qualitative description methods.

Methods: Fourteen participants completed a demographic questionnaire and one semistructured interview focused on their exposure to violence, healthcare experiences and strategies for navigating health care. Thematic analysis in alignment with qualitative description methods was used to analyse interview transcripts and identify themes.

Results: Participants in this study reported a variety of traumatic life experiences, ranging from childhood sexual abuse and intimate partner violence to severe car accidents. Experiencing a multiplicity of trauma sometimes complicated participants' later healthcare experiences. Although participants described ways in which providers helped them attain positive care experiences, they also acknowledged that limitations of the healthcare system could make trauma-informed practices difficult to implement. Participants described strategies they use to prepare for, navigate and recover after healthcare encounters including selecting providers, bringing support persons to appointments and engaging in relaxing activities after appointments.

Conclusions: Participants emphasised the importance of trusting and equitable provider-patient relationships and described several ways they prepare for, cope with and care for themselves after difficult healthcare experiences. Descriptive data on the patient engagement behaviours of survivors of violence is a unique contribution of this study to existing research.

Relevance To Clinical Practice: Findings from this study indicate the importance of comprehensive trauma history screening during health assessments, development of trusting and mutually respectful provider-patient relationships and provider training programmes focused on trauma-informed care practices.
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March 2018

Trauma Exposure Among Women in the Pacific Rim.

J Nurs Scholarsh 2017 05 7;49(3):286-293. Epub 2017 Apr 7.

Professor and Associate Dean for Academic Affairs, Duke University School of Nursing, Durham, NC, USA.

Purpose: Healthcare professionals who provide services in the immediate or long-term aftermath of traumatic events need to understand the nature and frequency of traumatic events in the lives of women. However, research on trauma exposure in women has only recently begun to assess events other than intimate partner and sexual violence and has not supported direct statistical comparison of cross-national and cross-cultural data. The purpose of this descriptive, correlational study was to describe and compare trauma exposure prevalence and type in community-based samples of women in the United States, Colombia, and Hong Kong.

Design: Women were recruited through posted notices at community health sites, snowball sampling, and online advertisements (N = 576). The Life Stressor Checklist-Revised (total score range 0 to 30) was used to determine the type and prevalence of trauma exposure. Data were collected by native language members of the research team.

Methods: Descriptive statistics were used to summarize demographic characteristics and trauma exposure for the total sample and each community-based sample (location). Between-location differences were tested using Fisher's exact tests for categorical measures and general linear models with pairwise a posteriori least squares t-test for continuous measures. Responses to open-ended questions were translated and categorized.

Findings: Over 99% of women in the total sample reported at least one traumatic life event. The mean number of traumatic life events per participant was 7, ranging from 0 to 24. Although there was consistency in the most commonly reported trauma exposures across locations, the rates of specific events often differed.

Conclusions: Historical, political, geographic, and cultural factors may explain differences in trauma exposure among women in the four locations studied.

Clinical Relevance: This study offers relevant knowledge for providers in diverse locations who provide services to women who have experienced traumatic events and provides evidence for the need for future research to further enhance knowledge of trauma exposure among women, and on the effects of trauma in women's lives.
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May 2017

Depression and Self-Rated Health Among Rural Women Who Experienced Adolescent Dating Abuse: A Mixed Methods Study.

J Interpers Violence 2016 Mar 11;31(5):920-41. Epub 2014 Nov 11.

Duke University, Durham, NC, USA.

This study used mixed methods to examine the experiences and health of rural, young adult women (N = 100) who self-reported past experience of physical, emotional and verbal, sexual, and relational abuse in adolescent dating relationships. Few studies have examined the lasting health ramifications of adolescent dating abuse adolescent dating abuse in rural populations, and almost no mixed methods studies have explored adolescent dating abuse. Participants completed questionnaires on demographics, relationship behaviors, and mental health symptoms. A subsample (n = 10) of participants also completed semi-structured, in-depth interviews with the primary investigator. Results suggest that depressive symptoms and self-rating of health in these women are associated with particular kinds and severity of abusive experiences, and that adolescent dating abuse has ramifications for health and development beyond the duration of the original relationship. Self-rated health (SRH) was inversely associated with abusive behaviors in the relationship, whereas depressive symptoms were positively correlated with such behaviors. Self-rated health was also negatively correlated with depressive symptoms. The results of this study represent an important step toward establishing lifetime health risks posed by adolescent dating abuse.
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March 2016

"It was pretty scary": the theme of fear in young adult women's descriptions of a history of adolescent dating abuse.

Issues Ment Health Nurs 2013 Nov;34(11):803-13

Virginia Commonwealth University , Richmond, Virginia , USA.

The mental health impact of abusive adolescent dating relationships has not been well described, but fear related to abuse has been reported. We elaborate the theme of fear in women's descriptions of a history of adolescent dating abuse. A sample of community-based women, ages 19-34, who experienced an abusive dating relationship during adolescence (ages 11-20) was used. Data were analyzed via thematic analysis. Fear was a consistent and resonant theme. Three types of fear were identified: fear for self, fear for other relationships, and fearful expectation. These results offer important insights into the impact of abusive adolescent relationships on women's mental health.
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November 2013

Social stressors associated with antepartum depressive symptoms in low-income African American women.

Public Health Nurs 2011 May-Jun;28(3):203-12. Epub 2010 Dec 15.

Department of Family Health Care Nursing, University of California San Francisco, San Francisco, California, USA.

Objectives: To describe depressive symptomatology and examine the relationship between social stressors and depressive symptoms in pregnant African American women.

Design And Sample: Cross-sectional study of 119 women receiving care at 2 prenatal clinics in Northern California.

Measures: Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D). Social stress variables included discrimination, trauma exposure, social conflict, and economic stress.

Results: In this sample, mean CES-D score was 15.88. Forty-two percent of the women had CES-D scores ≥ 16 (possible risk), and 23% had CES-D scores ≥ 23 (probable risk). There were significantly positive relationships between the social stress variables (discrimination, trauma exposure, social conflict, economic stress) and CES-D scores. Stepwise multiple regression analysis indicated that together discrimination and social conflict accounted for 36% of the variance in antepartum depressive symptoms.

Conclusions: Discrimination and social conflict are considerable sources of stress that contribute to levels of antepartum depressive symptoms in African American women. While the results reinforce the importance of universal prenatal screening, comprehensive strategies are also needed to help ameliorate the impact that social stressors such as discrimination and social conflict have on the mental health of pregnant African American women.
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August 2011

Relationships and betrayal among young women: theoretical perspectives on adolescent dating abuse.

J Adv Nurs 2011 Jun 24;67(6):1393-405. Epub 2011 Jan 24.

Department of Family and Community Health Nursing, Virginia Commonwealth University, Richmond, USA.

Aims: Adolescent dating abuse is not specifically described by any current nursing theory, and this article presents discussion of some existing theories that could inform a nursing theory of adolescent dating abuse. To account for the effects of gender, this discussion is limited to young women.

Background: Adolescent dating abuse is an important and understudied international issue for nursing. Theoretical frameworks can support development of nursing scholarship for such issues. No single theory yet exists in nursing to explain the experiences and health ramifications of dating abuse among young women.

Data Sources: A summary table of theories is provided. Literature was gathered via database search and bibliographic snowballing from reference lists of relevant articles. Included literature dates from 1982 through 2010.

Discussion: Theories of relationship formation and function are discussed, including attachment, investment, feminist and gender role conflict theories. Betrayal trauma theory is considered as a mechanism of injury following an abusive dating experience.

Implications For Nursing: Gender, relationship and adolescence combine in a complex developmental moment for young women. To improve nursing care for those at risk for or in the throes of abusive relationships, it is critical to develop specific nursing approaches to understanding these relationships.

Conclusion: Existing theories related to relationship and traumatic experiences can be combined in the development of a nursing theory of adolescent dating abuse among young women.
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June 2011

Effects of a cognitive adjustment program for Thai parents.

Nurs Health Sci 2010 Sep;12(3):306-13

Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.

Child physical abuse is recognized as a major public health problem that affects children and is likely to become increasingly common. The objective of this study was to examine the effects of a cognitive adjustment program on parental attitudes toward child rearing and the potential for this abuse. Child-care centers were randomly allocated to either the intervention or the control group. The sample included 116 Thai parents of children aged 1-6 years. The intervention group attended the cognitive adjustment program while the control group received the usual services. The results showed that, after program completion, the intervention group had statistically significantly better parental attitudes toward child rearing, but not a significantly lower potential for CPA than the control group. We concluded that the cognitive adjustment program was effective in altering parental attitudes toward child rearing. However, in order to enhance its efficacy, the program should be modified to be more intensive and it should be studied further for its effect on the potential for abuse.
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September 2010

Why some women have an optimistic or a pessimistic bias about their breast cancer risk: experiences, heuristics, and knowledge of risk factors.

Cancer Nurs 2010 Jan-Feb;33(1):64-73

University of Michigan School of Nursing, Ann Arbor, MI, USA.

Perceived risk to a health problem is formed by inferential rules called heuristics and by comparative judgments that assess how one's risk compares to the risk of others. The purpose of this cross-sectional, community-based survey was to examine how experiences with breast cancer, knowledge of risk factors, and specific heuristics inform risk judgments for oneself, for friends/peers, and comparative judgments for breast cancer (risk friends/peers - risk self). We recruited an English-speaking, multicultural (57% nonwhite) sample of 184 middle-aged (47 + or - 12 years old), well-educated women. Fifty percent of participants perceived that their breast cancer risk was the same as the risk of their friends/peers; 10% were pessimistic (risk friends/peers - risk self < 0), whereas 40% were optimistic (risk friends/peers - risk self > 0). Family history of breast cancer and worry informed risk judgments for oneself. The availability and cultural heuristics specific for black women informed risk judgments for friends/peers. Knowledge of risk factors and interactions of knowledge with the availability, representativeness, and simulation heuristics informed comparative judgments (risk friends/peers - risk self). We discuss cognitive mechanisms with which experiences, knowledge, and heuristics influence comparative breast cancer risk judgments. Risk communication interventions should assess knowledge deficits, contextual variables, and specific heuristics that activate differential information processing mechanisms.
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January 2011

HIV-infected mothers' foci of concern during the viral testing of their infants.

J Assoc Nurses AIDS Care 2008 Mar-Apr;19(2):114-26

Nursing and Dental Hygiene, University of Hawaii, Manoa, USA.

The objective of this study was to explore HIV-infected mothers' most worrisome concerns during their infants' HIV viral testing. A total of 20 HIV-infected women consented to one antepartum and five postpartum study visits clustered around infant HIV viral testing time points. Content analysis was used to categorize maternal responses about their concerns. The majority (80%) of mothers identified infant health as the most worrisome concern during the prenatal and early postpartum periods. This concern declined after the second infant viral test result but rebounded before obtaining the final viral test. Once the final viral test result was known, the majority (60%) of mothers identified psychosocial issues as most worrisome. Maternal health did not surpass infant health or psychosocial issues as a primary concern. The primary concern of the HIV-infected mothers in this study was infant health during the infant viral testing period. Maternal health issues remained secondary to infant health and psychosocial issues as major concerns several months after infant viral testing was completed.
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May 2008

An exploration of lifetime trauma exposure in pregnant low-income African American women.

Matern Child Health J 2011 Apr 6;15(3):410-8. Epub 2008 Feb 6.

Family, Maternal & Child Health Programs, Department of Public Health, Contra Costa Health Services, 597 Center Avenue, Martinez, CA, USA.

Objectives: The objective of this study was to describe the occurrence of lifetime trauma exposure in relation to perinatal health outcomes in low-income African American women.

Methods: One hundred and sixteen pregnant African American women recruited from two public prenatal clinics participated in this exploratory study. Information was obtained about psychological symptoms, medical conditions, prenatal care utilization, and health behaviors. To measure lifetime trauma exposure, women completed the Trauma History Questionnaire. Maternal and infant outcome data were obtained from the medical records following delivery.

Results: The occurrence of trauma exposure was high, with 87% of the women reporting at least one traumatic event. Their mean age was 25 years, 21% were primiparas, and they reported a mean of 4.3 ± 3.5 (median = 3) traumatic events during their lifetime. Crime-related experiences were common and included incidents of family or friends being murdered or killed (40%), robberies (23%), home burglaries (14%), attacks with weapons (13%), and muggings (12%). Lifetime trauma exposure was significantly associated with depressive symptoms, anxiety, and generalized stress. Women with greater lifetime trauma exposure had a higher rate of tobacco use, higher rate of premature rupture of membranes, and longer maternal hospital stay.

Conclusion: Low-income African American women in this sample experienced a variety of traumatic events. Lifetime trauma exposure was associated with adverse perinatal health. Findings suggest the need to further investigate trauma across the lifespan to better understand the impact of these experiences on the reproductive health and well-being of women and their infants.
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April 2011

Sleep of children of abused women in transitional housing.

Pediatr Nurs 2006 Jul-Aug;32(4):311-6

Department of Family Health Care Nursing, University of California, San Francisco, USA.

Children of abused women have been reported to experience a variety of behavioral problems including disturbed sleep. Sleep is essential for health, growth, and development. Yet, to date no one has described the sleep behaviors of these children. The purpose of this study was to describe the sleep-related behaviors of children of abused women living in transitional housing programs. A convenience sample of mothers (N = 32) residing in transitional housing programs for abused women was recruited. Using the Sleep Behavior Scale (Fisher, Pauley, & McGuire, 1989), data were gathered from the mothers on 43 children 2 to 18 years of age. Approximately one-third of the children in this study were reported to experience sleep-related behavior problems four or more times per week. Some of these behaviors were likely to be burdensome to abused women. Behavioral interventions, however, offer promise for these children and their mothers.
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October 2006

Perceived breast cancer risk: heuristic reasoning and search for a dominance structure.

Soc Sci Med 2005 Jan;60(2):421-32

Department of Physiological Nursing, University of California San Francisco (UCSF), 2 Koret Way, Box 0610, San Francisco, CA 94143, USA.

Studies suggest that people construct their risk perceptions by using inferential rules called heuristics. The purpose of this study was to identify heuristics that influence perceived breast cancer risk. We examined 11 interviews from women of diverse ethnic/cultural backgrounds who were recruited from community settings. Narratives in which women elaborated about their own breast cancer risk were analyzed with Argument and Heuristic Reasoning Analysis methodology, which is based on applied logic. The availability, simulation, representativeness, affect, and perceived control heuristics, and search for a dominance structure were commonly used for making risk assessments. Risk assessments were based on experiences with an abnormal breast symptom, experiences with affected family members and friends, beliefs about living a healthy lifestyle, and trust in health providers. Assessment of the potential threat of a breast symptom was facilitated by the search for a dominance structure. Experiences with family members and friends were incorporated into risk assessments through the availability, simulation, representativeness, and affect heuristics. Mistrust in health providers led to an inappropriate dependence on the perceived control heuristic. Identified heuristics appear to create predictable biases and suggest that perceived breast cancer risk is based on common cognitive patterns.
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January 2005