RECAPTURING THE ESSENCE OF SPIRITUALITY: A LETTER TO THE GUEST EDITOR

More older African American women are homeless, with this issue receiving little research attention. An exploratory study examined demographics and health characteristics of 100 women. Their mean age was 52.55 years (SD = 3.57) and ranged from 50 to 74 years. Most were unmarried, homeless more than three months, reported more than two diagnoses, and self-rated their health as fair or good. Length of time homeless did not significantly influence self-reported health. Medical diagnoses increased with time homeless, and rates of some chronic diseases were higher than domiciled African American elders 60 years of age and over. Nearly half (48.5%) of women who were homeless more than 12 months reported emotional/mental illness.     

Homeless Shelter Policies for Women in an Urban Environment

A survey of shelters serving women in Chicago (N = 43) identified admission criteria, policies and services, estimated the number of homeless women in childbearing years served by the shelters, the number who were pregnant or mothers with children, and identified unmet health needs and health services provided. The majority (64%) of the women using shelters were African American and there was great variability in shelter policies. Women with male children more than seven years old, pregnant women and substance abusers were less likely to be admitted.     

Two-year follow-up of AIDS education programs for impoverished women

The long-term effects of two culturally competent AIDS education programs with different content on the risk behavior and AIDS-related knowledge of 410 homeless African American women 2 years after program completion were examined. Participants were members of a larger cohort of impoverished African American and Latina women recruited in Los Angeles from 1989 to 1991. Of a subsample of 527 African American women selected randomly for a 2-year follow-up interview, 410 (78%) were located and agreed to participate. Women participating in both AIDS education programs reported reduced HIV risk behaviors and demonstrated greatly improved AIDS knowledge at 2-year follow-up (p < .001). Women in a specialized program were less likely than those in a traditional program to report noninjection drug use at 2 years. Women in the traditional program had significantly better AIDS knowledge at follow-up (p < .001). These findings suggest that educational programs can produce sustained benefits among impoverished women.     

Physical and mental health in African American mothers with HIV.

This article examines the physical and mental health of African American mothers during a 2-year period following the birth of an infant seropositive for human immunodeficiency virus (HIV). Participants were 34 African American mothers enrolled when the infants were approximately 3 months of age and reinterviewed when the infants were 6, 12, 18, and 24 months. Three self-report questionnaires were used to assess physical health (perception of health, activity limitation, and physical symptoms) and mental health (depressive symptoms and stigma). Health symptoms most often reported were infections, problems thinking and remembering, low energy, and gynecologic problems. Moderate levels of perceived stigma were reported. Depressive symptoms were high; a large number of women at each data point had depressive symptom scores above the cutoff, indicating risk for depression. There were significant correlations between depressive symptoms and health, suggesting a link between mental and physical health. These findings have significance for the health of the mother and the parenting of her infant. Attention should be paid to the mental and physical health of mothers with HIV, especially during the first 2 years after the birth of a child.     

Ethnicity and prenatal health promotion content

Prenatal care health promotion education is an important strategy for reducing perinatal health disparities. The purposes of this study were to (a) identify differences between the health promotion content women wanted to discuss and the content women reported discussing and (b) determine whether ethnicity was related to health promotion content. A cross-sectional study used face-to-face interviews to obtain data about 159 Mexican American and African American pregnant women's prenatal experience. Women wanted more health promotion content than they discussed. Despite wanting information about more health promotion topics than African American women. Mexican American women discussed fewer topics. Ethnicity, number of topics women wanted to discuss, whether a woman had a primary provider, and type of prenatal provider model were also related to content.     

Predictors of perceived health status of tuberculosis-infected homeless

This study examines the predictors of perceived health status among homeless adults with latent tuberculosis (TB) in Los Angeles, especially in relation to gender differences. Total, 415 men and women enrolled in a TB-adherence trial completed baseline assessments concerning health status. Results indicated that women were more likely than men to report being in fair or poor health and to have experienced health problems. More women than men self-reported daily drug use and poor mental health. Homeless women were also more likely than their male counterparts to receive support from non-drug-users. Homeless adults who reported fair or poor health were also more likely than those who reported better health to have used injection drugs, to report experiencing depressive symptoms and poor mental health, and to have been homeless more than 3 years. Predictors of fair or poor health included being female and experiencing more depressive symptoms.     

Sexual Risk Behavior Among Urban Women of Childbearing Age: Implications for Clinical Practice

Cox's interaction model of client health behavior was used as an organizing framework to describe the demographic characteristics, motivation, problem-solving, self-esteem, and sexual risk behaviors among urban women of childbearing age ( N = 125; average age = 32 years). Eighty-five percent of the women were African American. Sexual risk behaviors were defined as more than one sex partner and not using a condom. Eight women were at the highest risk in that they reported having more than one sex partner and not using condoms. Participants reported low self-esteem, intrinsic motivation, and adequate problem-solving abilities. Motivation scores were significantly different based on number of sex partners ( t = 2.26, p = .03). Women with more than one partner had lower scores compared to women with only one partner. There was a significant variation in reported self-esteem among women who used condoms ( t = 2.36; p = .22). Women who did not use condoms reported lower self-esteem than women who said that they used condoms.     

Relationship of abuse and pelvic inflammatory disease risk behavior in minority adolescents

PURPOSE: Little is known about the relationship between minority adolescent's experiences of sexual or physical abuse and the pathology of gynecological symptoms that might have an impact on the diagnosis of sexually transmitted disease (STD) or risk for pelvic inflammatory disease (PID). The objective of this study was to determine the relationship of sexual or physical abuse to the pathology of genitourinary symptoms that impact diagnoses of STD and risk for PID among Mexican American and African American adolescent women with a current STD. METHODS: Mexican American and African American adolescent women (n = 373) with an STD underwent a targeted physical exam and questioning regarding sexual or physical abuse, current genitourinary symptomatology, and risk behaviors known to be associated with PID to determine the relationship of sexual or physical abuse to the pathology of genitourinary symptoms that impact diagnoses of STD and risk for PID. RESULTS: Bivariate comparisons found that abused adolescents (n = 232) reported more behaviors associated with increased risk for PID, including earlier coitus, more sex partners, higher STD recurrence, and delayed health-seeking behavior. Multivariate comparisons found that abused adolescents were more likely to report pathologic genitourinary symptomatology than those who were not abused. Clinicians reported more abnormal physical exams but did not make any more presumptive diagnoses of PID for abused than nonabused adolescents. CONCLUSIONS: Delayed treatment for PID dramatically worsens future fertility and chronic pelvic pain. These findings demonstrate that abused adolescent women are at high risk for PID. Because of its considerable impact on risk for PID, an assessment for abuse is essential in clinical management of adolescent women with STD and diagnosis of PID.     

Length of stay, admission types, psychiatric diagnoses, and the implications of stigma in African Americans in the nationwide inpatient sample

African Americans purportedly have a higher prevalence of mental illnesses but are often misdiagnosed and less likely to seek treatment. Delayed treatment has been associated with the stigma related to these disorders. The demographic characteristics, length of stay, most prevalent psychiatric diagnoses, and hospital admissions of African Americans were compared to other U.S. populations using a nationwide sample (N = 4,474,732). African American participants were younger, had significantly longer lengths of stay, and were admitted more often through the emergency room than the other groups in this sample. Psychosis, alcohol/drug dependence, and depressive neurosis were the most prevalent psychiatric diagnoses reported for African American participants. Research is needed to explain these results so that strategies can be instituted to improve the poor mental health outcomes often observed in African American populations.     

LENGTH OF STAY,ADMISSION TYPES,PSYCHIATRIC DIAGNOSES,AND THE IMPLICATIONS OF STIGMA IN AFRICAN AMERICANS IN THE NATIONWIDE INPATIENT SAMPLE

African Americans purportedly have a higher prevalence of mental illnesses but are often misdiagnosed and less likely to seek treatment. Delayed treatment has been associated with the stigma related to these disorders. The demographic characteristics, length of stay, most prevalent psychiatric diagnoses, and hospital admissions of African Americans were compared to other U.S. populations using a nationwide sample (N = 4,474,732). African American participants were younger, had significantly longer lengths of stay, and were admitted more often through the emergency room than the other groups in this sample. Psychosis, alcohol/drug dependence, and depressive neurosis were the most prevalent psychiatric diagnoses reported for African American participants. Research is needed to explain these results so that strategies can be instituted to improve the poor mental health outcomes often observed in African American populations.     

Extending the extended family for homeless and marginally housed African American women

Young homeless African American women and elderly marginally housed African American women have health, housing, and personal concerns specific to their age cohort, yet they also have parallel and complementary needs. The young struggle to find affordable housing, while the old may have difficulty in maintaining their homes. This article reports select findings from a pilot study designed to describe these two groups of women. The preliminary study was conducted preparatory to the development of a larger study to explore factors that would facilitate or hinder linking the two groups of women for mutual assistance in housesharing arrangements. Interviews and housing history findings revealed contrasts and similarities among the women and between both cohorts that reflected individual differences, common yet divergent life courses, and collective responses to family life situations, societal trends, and policies. Advantages and disadvantages of housesharing were delineated with 56.3% of the homeless women and 81.3% of the elderly women viewing coresidential living as an option worth considering. Housesharing arrangements should be further investigated by nurses and colleagues. Findings from this study are foundational for establishing alliances that may be a means to promote health and strengthen "family" in both populations.     

Managing Health Problems among Homeless Women with Children in a Transitional Shelter

Purpose: To describe health problems among homeless women with children living in a transitional shelter, analyze how they managed various ailments and when and how they sought care.
Design: Qualitative using grounded theory and dimensional analysis.
Sample: During 1992 and 1993, data were gathered from a convenience sample of 13 Latina, 11 White, and 6 African American women (n=30) who lived in a transitional shelter in California, USA.
Methods: In-depth, semi-structured interviews
Findings: Despite many supportive services in transitional shelter, respondents had difficulty managing health problems. Typically, a woman reported she managed a health problem by overcoming it alone.
Conclusions: The pattern of overcoming it alone existed years before transitional shelter life, and, in many instances, persisted during shelter years.
Clinical Implications: Clinical nursing interventions that address shame, fear, lack of information, and eligibility for services could improve health outcomes among women and children living in transitional shelters.     

‘I was broken in so many different ways’: The intersection of complex factors impacting homeless and at-risk African American women's mental health and well-being

African American women are at higher risk of poor mental ill health compared with other racial and ethnic groups in the United States. For low-income and homeless African American populations, the risk of poor mental ill health is even higher. The purpose of our study was to learn what programmes at a long-term transitional living centre helped at-risk and homeless African American mothers to succeed on their own, in accordance with self-identified goals. We conducted ten focus group interviews with 39 graduates of a long-term transitional living centre located in a Midwestern city, and an individual interview with the founder of that centre (N = 40). Our study was informed by Black Feminist Thought, Life Course Theory, and an instrumental case study design. Thematic analysis was used to identify patterns in the qualitative data collected. Findings pertaining to mental health included impacts of adverse childhood experiences, lack of social networks, child placement in foster care, and implications on self-esteem and self-worth. Our findings demonstrate the need for healthcare providers to take into account the intersecting factors facing African American women experiencing homelessness undergirded by systemic racism, which impacts their mental health and well-being.     

A pilot study to examine patient awareness and provider discussion of the impact of cancer treatment on fertility in a registry-based sample of African American women with breast cancer

Purpose

Fertility is a concern for many cancer patients diagnosed during their reproductive years. Although African American women are more likely to be diagnosed with early breast cancer (i.e., ≤age 40), little is known about patient awareness of or provider discussion related to fertility in this group. We examined African American women's awareness of the possible impact of cancer treatment on fertility.

Methods

In a cross-sectional survey of African American women with early-onset breast cancer, demographic and clinical variables were compared with patient awareness and physician discussion of potential fertility loss.

Results

For women in our sample (N?=?48), 45.8% reported being aware of the potential impact of cancer treatment on fertility, and 56.3% reported that their providers discussed fertility with them. Bivariate analyses demonstrated that awareness was significantly higher in women diagnosed at age ≤45 (p?p?p?p?p?Conclusion Study results suggest potential health disparities in reproductive health among early-onset breast cancer patients and demonstrate missed clinical opportunities to provide information about fertility that may impact long-term quality of life in early-onset African American breast cancer patients.     

Abused women and risk for pelvic inflammatory disease

Mexican and African American women with sexually transmitted diseases (STDs) underwent targeted physical exams and questioning regarding sexual or physical abuse, current genitourinary symptomatology, and pelvic inflammatory disease (PID) risk behaviors to determine the relationship of sexual or physical abuse to the pathology of genitourinary symptoms affecting diagnoses of STDs and risk for PID. Bivariate comparisons found abused women reported more PID risk behaviors including earlier coitus, more sex partners, higher STD recurrence, and delayed health-seeking behavior. Multivariate comparisons found abused women were more likely to report pathologic genitourinary symptomatology than nonabused women. Clinicians made more presumptive diagnoses of PID for abused than for nonabused women upon physical examination. These findings indicate abused women are at high risk for PID. Its considerable impact on genitourinary symptomatology and risk for PID make assessment for abuse essential in clinical management of women with STDs and diagnosis of PID.     

Health Beliefs of African American Women on Breast Self-Exam

PurposeInvestigate the relationship between African American women's health beliefs in regard to breast cancer screening behaviors.Data sourcesA sample of 131 African American women, age 20–65, from a family practice clinic and 3 rural churches in Southeast.ConclusionsOne-hundred and nine of the participants reported practicing breast self-exam (BSE) within the past 12 months. However, 21 women had never practiced BSE. Fear of not doing it correctly was a main barrier.Implication for practiceSteps should be taken to increase confidence and resolve barriers of African American women through the development of culturally sensitive educational training on BSE and cancer prevention.     

Racial and age-related disparities in obtaining screening mammography: results of a statewide database

BACKGROUND: This study compared mammography rates in Arkansas, based on race and age, to identify any disparities in obtaining mammography. METHODS: The Arkansas Mammography Data Collection Project contained data on 133,549 women, 87,680 of them aged 40 to 64 and 45,869 aged 65 years or older. Race data were available on 64,526 women. Mammography rates were compared by patient age and race. RESULTS: Women aged 65 years and older were less likely to obtain mammograms than younger women: 21.67% versus 23.30%. Mammograms were more likely to be classified as diagnostic in older women and as screening in younger women. Older African American women were less likely to obtain mammograms than younger women of the same race (7.23% vs 8.02%), while older white women were more likely to obtain mammograms than younger white women (11.64% vs 11.31%). African Americans were less likely to obtain mammograms in both age groups. CONCLUSIONS: Older African American women are less likely to obtain mammograms than white and younger women. The reasons for this disparity warrant further evaluation.