The Relationship between Body Esteem,Exercise Motivations,Depression, and Social Support Among Female Free Clinic Patients

PurposeObesity is a significant public health problem in women's health. This study examined relationship between body esteem, exercise motivations, depression, and social support among female free clinic patients. Low-income women who are at risk for obesity and other health concerns would benefit from health education efforts.MethodsWe compared 299 female and 164 male free clinic patients 18 years or older using assessments for body esteem, motivation to exercise, depression, and social support.ResultsAlthough female participants reported lower levels of body esteem and higher levels of depression compared with male participants (p < .01), female participants were more motivated to exercise for weight-related reasons than male participants (p < .05). U.S.-born female participants reported lower exercise motivations compared with non–U.S.-born female participants (p < .01). Social support might be an important factor to increase exercise motivation among female free clinic patients (p < .05); depression lowers levels of body esteem (p < .01).ConclusionsThe results of this study suggest that female free clinic patients should receive gender-specific interventions to promote positive body image and physical activity. It is important for health educators to engage a myriad of physical activity motives to increase the likelihood that clients will experience enjoyment and sustained adoption of exercise into their lifestyle. Future practice and research should warrant the implementation of body image and physical activity programs and the potential impact of using exercise to reducing depression among female patients at free clinics.     

Differences in Health and Social Support between Homeless Men and Women Entering Permanent Supportive Housing

BackgroundPermanent supportive housing (PSH) is the leading intervention to end chronic homelessness. Little is known, however, about gender differences, including potential disparities in physical and mental health and social support, that might inform services available through PSH.MethodsThis study included 421 homeless adults, at least 39 years old, English- or Spanish-speaking, who were moving into PSH through 26 different agencies in the Los Angeles area.ResultsCompared with men entering PSH, homeless women (28% of the sample) were younger (p < .01), less likely to have achieved at least a high school education (p < .05), and had lower incomes (p < .01). Women had more chronic physical health conditions (p < .01), were more likely to have any chronic mental health condition (odds ratio, 2.5; p < .01), and had more chronic mental health conditions than men (p < .01). Women had more relatives in their social networks (Coefficient, 0.79, p < .01) and more relatives who provided support (coefficient, 0.38; p < .05), but also more relatives with whom they had conflict (coefficient, 0.19; p < .01). Additionally, women were less likely to have caseworkers (coefficient, −0.59; p < .001) or physical and mental health care providers in their networks (coefficient, −0.23 [p < .01]; coefficient, −0.37 [p < .001], respectively). However, after correcting for multiple testing, three outcomes lost significance: number of chronic physical health conditions, number of relatives who provided any support, and number of relatives with whom there was conflict.ConclusionsThere is evidence of gender differences in mental health and social support among homeless adults moving into PSH. PSH cannot be a one-size-fits-all approach. Supportive services within housing should be tailored based on gender and other individual needs.     

Primary Care Providers with More Experience and Stronger Self-Efficacy Beliefs Regarding Women Veterans Screen More Frequently for Interpersonal Violence

BackgroundMilitary sexual trauma (MST) and/or intimate partner violence (IPV) are common experiences in the growing group of women veterans using the Veterans Health Administration health care system. And even though MST screening is closely monitored at the facility level, little is known about individual primary care provider (PCP) behavior with regard to screening women for MST and IPV.ObjectivesTo understand how PCP experiences and beliefs regarding women's health care influence PCP-reported screening for MST and IPV.Research Design and ParticipantsWe administered a cross-sectional online survey from September 2014 through April 2015 (supplemented by a mailed survey between April and May 2015) to 281 PCPs in 12 Veterans Health Administration medical centers.Measures and AnalysisSurveys measured PCP-reported screening frequency for MST and IPV, experience with women veterans, self-efficacy, gender-sensitive beliefs, and perceived barriers to providing comprehensive care for women. We used multivariable ordered logistic regression analysis to identify correlates of screening, weighted for nonresponse and adjusted for clustering.ResultsNinety-four PCPs (34%) completed the survey. Being a designated women's health provider (p < .05) and stronger self-efficacy beliefs about screening women for MST (p < .001) were associated with reporting more frequent screening for MST. Being a designated women's health provider (p < .01), seeing women patients at least once per week (p < .001), and self-efficacy beliefs about screening women for IPV (p < .001) were associated with reporting more frequent screening for IPV.ConclusionsVeterans Health Administration initiatives to enhance PCP opportunities to screen women veterans for trauma and to strengthen self-efficacy beliefs about comprehensive women's health care may increase screening of women veterans for MST and IPV.     

Older Women in a State-Wide,Evidence-Based Falls Prevention Program: Who Enrolls and What Benefits Are Obtained?

BackgroundOlder women who are vulnerable to falls and their negative consequences have been shown, in controlled randomized clinical trials, to benefit from fall prevention programs. The purpose of this study was to identify personal characteristics of female participants enrolled in a falls prevention program, the effectiveness of the program for female participants, and whether personal characteristics indicate which women might benefit most from programs delivered in real-world settings.MethodsData were collected from seniors enrolled in A Matter of Balance/Voluntary Lay Leader (AMOB/VLL) program sessions conducted in Texas over the 2-year period from 2007 to 2009. Baseline and postintervention data from 1,101 female participants were drawn from a larger, state-wide dataset and analyzed using structural equation modeling to identify relationships between variables of interest.FindingsAnalyses revealed that women who attended AMOB/VLL significantly increased falls efficacy from baseline to postintervention (t = 1.680; p < .05; d = 0.143) and reduced the number of times fallen (t = 3.790; p < .01; d = 0.313). Further, participants reported decreases in days of physical (t = 3.810; p < .01; d = 0.323) and mental health (t = 1.850; p < .05; d = 0.156) reported as not good.ConclusionFindings from this study support the effectiveness of evidence-based programs for reducing falls-related risks in older women. Identifying the characteristics of female participants enrolled in AMOB/VLL can enable public health professionals to better target and meet the health demands of the aging female population. Such translational research can help to guide the dissemination of additional state-wide health promotion programs for older women.     

Does a Primary Health Clinic for Formerly Incarcerated Women Increase Linkage to Care?

ObjectiveThis study examined a primary care-based program to address the health needs of women recently released from incarceration by facilitating access to primary medical, mental health, and substance use disorder (SUD) treatment.Study DesignPeer community health workers recruited women released from incarceration within the past 9 months into the Women's Initiative Supporting Health Transitions Clinic (WISH-TC). Located within an urban academic medical center, WISH-TC uses cultural, gender, and trauma-specific strategies grounded in the self-determination theory of motivation. Data abstracted from intake forms and medical charts were examined using bivariate and multivariable regression analyses.ResultsOf the 200 women recruited, 100 attended the program at least once. Most (83.0%) did not have a primary care provider before enrollment. Conditions more prevalent than in the general population included psychiatric disorders (94.0%), substance use (90.0%), intimate partner violence (66.0%), chronic pain (66.0%), and hepatitis C infection (12.0%). Patients received screening and vaccinations (65.9%–87.0%), mental health treatment (91.5%), and SUD treatment (64.0%). Logistic regression revealed that receipt of mental health treatment was associated with number of psychiatric (adjusted odds ratio [AOR], = 4.09; p < .01), and social/behavioral problems (AOR, 2.67; p = .04), and higher median income (AOR, 1.07; p = .05); African American race predicted lower receipt of SUD treatment (AOR, 0.08; p < .01).ConclusionsAn innovative primary care transitions program successfully helped women recently released from incarceration to receive medical, mental health, and SUD treatment. Primary care settings with specialty programs, including community health workers, may provide a venue to screen, assess, and help recently incarcerated women access needed care.     

Indicators of poor mental health and stressors during the COVID-19 pandemic,by disability status: A cross-sectional analysis

BackgroundEvidence from previous public health emergencies indicates that adults with disabilities have higher risk for morbidity (physical and mental) and mortality than adults without disabilities.ObjectiveTo provide estimates of mental health indicators and stressors for US adults by disability status during April and May 2020, shortly following the emergence of the COVID-19 pandemic.MethodsWe analyzed data from Porter Novelli View 360 opt-in Internet panel survey conducted during the weeks of April 20th and May 18th^, 2020 among 1004 English-speaking adults aged ≥18 years without and with disabilities (serious difficulty with hearing, vision, cognition, or mobility; any difficulty with self-care or independent living). Weighted logistic regression was used to test for significant differences between calculated prevalence estimates at the P ≤ .05 level.ResultsOne in four adults reported any disability. Adults with any disability were significantly more likely than adults without disability to report current depressive symptoms, frequent mental distress, suicidal ideation, and COVID-19-related initiated or increased substance use (all p values < .0001). Adults with disabilities also reported significantly higher levels of stressors, such as access to health care services (p < .0001), difficulty caring for their own (or another’s) chronic condition (p < .0001), emotional or physical abuse from others (p < .001), and not having enough food (p < .01).ConclusionsThe disproportionately high levels of poor mental health indicators among adults with disabilities as compared to those without highlight the importance of delivering timely mental health screening and treatment/intervention during and after the COVID-19 pandemic to persons with disabilities.     

Women's Substance Use and Mental Health During the COVID-19 Pandemic

PurposeWomen are experiencing greater unemployment and increased stress from childcare responsibilities than men during the COVID-19 pandemic. Women with these experiences may be at particular risk for mental illness and increased substance use during the COVID-19 pandemic. The purpose of the study was to assess women's substance use, mental health, and experiences of COVID-19 pandemic impacts.MethodsA national online survey was administered to adult women from September to November 2020. The survey included questionnaires assessing mental health, loneliness, intolerance for uncertainty, social support, substance use, and intimate partner violence (IPV).ResultsA total of 499 women responded; most were White, college educated, and in their mid-30s. Of the 20.24% who acknowledged at least one IPV problem, 29.7% stated that their IPV problems have gotten worse since the pandemic began, and 16.83% said that they have increased their drug or alcohol use to cope with their relationship problems. Anxiety, perceived daily impact of COVID-19, and lower self-efficacy were significant predictors of COVID-19 anxiety. Those with risky alcohol use had significantly higher anxiety (p = .028) and depression (p = .032) than those with low-risk alcohol use.ConclusionsGreater anxiety about COVID-19, greater reported changes in daily life due to the pandemic, and high-risk alcohol use are related to greater mental health–related distress among women. For some, IPV has gotten worse during the pandemic and drug or alcohol use is a coping mechanism.     

Intimate Partner Violence around the Time of Pregnancy and Postpartum Contraceptive Use

ObjectivesWe sought to examine postpartum contraceptive use among women who reported physical intimate partner violence (IPV) during or within 12 months before pregnancy compared with women who did not report physical IPV and to identify factors associated with nonuse of contraception among women who reported physical IPV.MethodsData were obtained from women with a recent live birth from 2012 to 2015 who participated in the Pregnancy Risk Assessment and Monitoring System. We described characteristics of women and postpartum contraceptive use by method effectiveness (most effective [female sterilization, male sterilization, intrauterine device, implant], moderately effective [injectable, pill, patch, ring], less effective [condoms, natural family planning, withdrawal, other]) or no method, stratified by reported physical IPV. Multivariable logistic regression was used to examine characteristics associated with nonuse of contraception among women who reported physical IPV.ResultsThe proportion of women using most or moderately effective contraception was similar for women reporting and not reporting physical IPV. Less effective contraceptive use was lower among women who reported physical IPV (13.9%) than those who did not report physical IPV (25.1%) (p < .001). Nonuse was higher among women who reported physical IPV (33%) than those who did not report physical IPV (21%) (p < .001). Having no health insurance at the time of survey and experiencing traumatic stress within 12 months before delivery were associated with nonuse of contraception among women who reported physical IPV.ConclusionsThe higher proportion of contraception nonuse among women who reported physical IPV indicates a potential unmet need for contraception among this vulnerable population. Recommended screening for IPV and counseling about the full range of contraceptive methods should begin during pregnancy and continue through the postpartum period.     

Differentiating among Attempted,Completed, and Multiple Nonfatal Strangulation in Women Experiencing Intimate Partner Violence

Purpose

Because identification of intimate partner violence (IPV) in health care settings is low and strangulation increases lethality risk among women experiencing IPV, we examined the prevalence and correlates of nonfatal strangulation among 1,008 women survivors of IPV.

Factors That Contribute or Impede the Physical Health Recovery of Women Exposed to Intimate Partner Violence: A Longitudinal Study

BackgroundSeveral cross-sectional studies have demonstrated the negative impact that intimate partner violence (IPV) has on the physical health of women. However, longitudinal studies are needed to establish the time course of this effect. This study assessed the physical health course of female IPV victims and established the factors that enhance or impede their recovery.MethodsWomen (n = 91) who participated in a previous cross-sectional study (T-1) and were either victims of physical/psychological IPV (n = 33) or psychological IPV (n = 23) were evaluated 3 years later (T-2). A control group of women (n = 35) was included for comparison. Structured interviews provided information regarding IPV characteristics, physical health, and lifestyle.FindingsPhysical symptoms decreased over time for both groups of abused women. Factors that contributed to this improvement were perception of social support and the cessation of physical IPV. Factors that impaired recovery included cohabitation with the aggressor, victimization experiences at T-2, negative perceptions of life events, and continuing psychological IPV.ConclusionsThis study shows that physical health improvement is possible in female victims of IPV, but that continuing psychological IPV hinders recovery. Additional longitudinal studies are needed to investigate the factors that best predict health recovery in female IPV victims to design effective intervention programs.     

Associations between intimate partner violence,violence-related policies,and HIV diagnosis rate among women in the United States

PurposeTo assess the association between state-level intimate partner violence (IPV) prevalence and HIV diagnosis rates among women in the United States and investigate the modifying effect of state IPV health care policies.MethodsData on HIV diagnosis rates were collected from HIV surveillance data from 2010 to 2015, and IPV prevalence data were collected from the National Intimate Partner and Sexual Violence Survey from 2010 to 2012. States were coded for IPV health care policies on training, screening, reporting, and insurance discrimination.ResultsStates with higher IPV prevalence was associated with higher HIV diagnoses among women (B = 0.02; 95% confidence interval [CI] = 0.003, 0.04; P = .02). State policies were a significant effect modifier (B = −0.05; 95% CI = −0.07, −0.02; P < .001). Simple slopes revealed that the association between IPV and HIV diagnosis rates was stronger in states with low IPV protective health care policies (B = 0.09; CI = 0.06, 0.13; P < .001) and moderate IPV protective policies (B = 0.05; 95% CI = 0.02, 0.07, P < .001), but not in states with high IPV protective policies (B = −0.009; 95% CI = −0.04, 0.02; P = .59).ConclusionsHIV prevention programs should target IPV and link to community resources. IPV-related policies in the health care system may protect the sexual health of women experiencing IPV.     

Prevalence and Predictors of Prenatal and Postpartum Contraceptive Counseling in Two Texas Cities

ObjectivesWe investigated the prevalence of and sociodemographic associations with receiving prenatal and postpartum contraceptive counseling, including counseling on intrauterine devices (IUDs) and implants.MethodsWe used data from a prospective cohort study of 803 postpartum women in El Paso and Austin, Texas. We examined the prevalence of prenatal and postpartum counseling, provider discouragement of IUDs and implants, and associated sociodemographic characteristics using χ² tests and logistic regression.ResultsOne-half of participants had received any prenatal contraceptive counseling, and 13% and 37% received counseling on both IUDs and implants prenatally and postpartum, respectively. Women with more children were more likely to receive any contraceptive counseling prenatally (odds ratio [OR], 1.99; p < .01). Privately insured women (OR, 0.53; p < .05) had a lower odds of receiving prenatal counseling on IUDs and implants than publicly insured women. Higher education (OR, 2.16; p < .05) and attending a private practice (OR, 2.16; p < .05) were associated with receiving any postpartum counseling. Older age (OR, 0.61; p < .05) was negatively associated with receiving postpartum counseling about IUDs and implants and a family income of $10,000 to $19,000 (OR, 2.21; p < .01) was positively associated. Approximately 20% of women receiving prenatal counseling and 10% receiving postpartum counseling on IUDs and implants were discouraged from using them. The most common reason providers restricted use of these methods was inaccurate medical advice.ConclusionsPrenatal and postpartum counseling, particularly about IUDs and implants, was infrequent and varied by sociodemographics. Providers should implement evidence-based prenatal and postpartum contraceptive counseling to ensure women can make informed choices and access their preferred method of postpartum contraception.     

On campus physical activity programming for post-secondary student mental health: Examining effectiveness and acceptability

AimProviding effective support for students with mental health concerns is a priority on post-secondary campuses. Recreational programming including physical activity is an evidence-informed approach that can be used to support mental health and well-being. Yet, limited research has examined effective and acceptable strategies for using campus-based physical activity programs to support the mental health of post-secondary students. Using a mixed-methods approach, the current study addressed the acceptability and effectiveness of a physical activity program for student mental health.MethodsIn collaboration with on-campus mental health services, a 6-week one-on-one and individualized physical activity program tailored towards students seeking mental health support was implemented. A pretest-posttest design was used to test the effectiveness of the program and participants (N = 68; M_age = 22.96 years, SD = 3.42; 82% female) completed self-report questionnaires to assess changes in symptoms of psychological distress, depression, and anxiety. Semi-structured interviews (N = 11) with program participants were conducted to explore the acceptability of the program and were analyzed using thematic analysis.ResultsPaired samples t-tests demonstrated a significant reduction in anxiety symptoms, depression symptoms, and psychological distress pre-post program (ps < .05). The generated themes suggested that the program is an acceptable and effective holistic approach for improving mental health among students.ConclusionsThe results provide implications for implementing on-campus physical activity programs as a mental health and well-being intervention. Implications for further understanding principle program design and delivery strategies are discussed.     

Cancer Risk Factors,Diagnosis and Sexual Identity in the Australian Longitudinal Study of Women's Health

PurposeWe sought to examine cancer diagnosis, cancer treatment, and related risk factors among Australian, middle-aged, exclusively heterosexual women compared with sexual minority women (SMW; mainly heterosexual, bisexual, mainly lesbian, and lesbian).MethodsSecondary data analysis of the Australian Longitudinal Study of Women's Health for women born in 1946 through 1951 (n = 10,451) included bivariate tests (i.e., contingency table analyses, independent t tests).ResultsSMW did not have significantly higher cancer diagnoses compared with exclusively heterosexual women, although they were more likely to report never having had a mammogram or pap smear. SMW were also significantly more likely to be high-risk drinkers (11.1% vs. 6.8%; p < .05), current smokers (15.1% vs. 8.3%; p < .001), report significantly higher rates of depression (mean ± SD; 6.4 ± 5.5 vs. 5.4 ± 5.1; p < .01.), have experienced physical abuse (10.2% vs. 5.1%; p < .001), and been in a violent relationship (27.2% vs. 12.8%; p < .001).ConclusionSMW had higher rates of several known cancer risk factors, ostensibly placing them at higher risk of cancer as well as chronic health conditions. Further research is needed to determine whether increased risk results in increased cancer as these women age, and to inform the development of interventions to reduce the risk of disease for SMW.     

Resilience among Cisgender and Transgender Women in Street-Based Sex Work in Baltimore,Maryland

IntroductionResilience represents adaptability and empowerment and can buffer against the consequences of traumatic events. Cisgender and transgender women in street-based sex work are at high risk for trauma, yet data on their resilience are sparse. A clearer understanding of resilience and its correlates is useful for informing sex worker-centered interventions.MethodsUsing the Connor-Davidson 10-item Resilience Scale (range, 0–40), we describe resilience among 165 cisgender and 42 transgender street-based women sex workers in Baltimore, Maryland. Longitudinal cohort data were used to examine correlates of resilience in each population. Analyses are conducted using multiple linear regression.ResultsThe mean resilience score was 24.2 (95% confidence interval, 23.6–24.8) among cisgender women sex workers and 32.2 among transgender women sex workers (95% confidence interval, 30.8–32.7). Among cisgender participants, positive correlates of resilience were being Black, Hispanic, or other race (ß = 2.7; p = .004), having housing (ß = 1.9; p = .034), social cohesion score (ß = 0.18; p = .047), and daily drug injection (ß = 3.7; p < .001); negative correlates of resilience were sexual violence (ß = –4.8; p = .006) and exposure to egregious police acts (ß = –0.6; p = .015). Among transgender participants, higher education level (ß = 8.8; p < .001), food security (ß = 3.5; p = .005), and housing stability (ß = 2.0; p < .001) were associated with increased resilience, and daily noninjection drug use (excluding marijuana; ß = –3.3; p < .001) and physical violence (ß = –2.9; p < .001) were associated with reduced resilience.ConclusionsThis study is the first to characterize factors that may influence resilience among cisgender and transgender women sex workers. Results highlight tangible intervention targets for promoting mental health and safety among a uniquely vulnerable population of women.     

Demographic,Clinical, and Counseling Factors Associated with the Selection of Pregnancy Termination Method in the Second Trimester for Fetal and Pregnancy Anomalies

ObjectiveDespite women's preference for induction of labor (IOL) or dilation and evacuation (D&E) for pregnancy termination in the setting of second trimester fetal or pregnancy abnormality, many women are not given a choice between delivery methods. We investigated patient and clinical related factors associated with selecting IOL or D&E.MethodsThis retrospective cohort experienced pregnancy termination at 17–24 weeks of gestation for fetal anomaly, intrauterine fetal demise, or premature previable rupture. We compared the demographic, reproductive, social, and clinical experience variables between women who select IOL and D&E, adjusting for confounders through logistic regression.ResultsOne hundred eleven women (21.6%) selected IOL and 403 (78.4%) selected D&E. Greater proportions of women of color (p < .01), lower education (p < .01), lower employment (p < .01), and lower status jobs (p < .01) selected IOL. Women selected D&E more often for chromosomal anomaly (p < .01). In adjusted analyses, women with intrauterine fetal demise (odds ratio [OR], 9.8; 95% confidence interval [CI], 2.8–34.7), premature previable rupture (OR, 110; 95% CI, 23.0–526.8), prior substance use disorder (OR, 35.5; 95% CI–2.7, 473.7), or counseling from obstetrics (OR, 3.3; 95% CI–1.3, 8.4), pediatrics (OR, 3.3; 95% CI–1.3, 8.6), or social services (OR, 12.6; 95% CI, 4.2–37.3) had higher odds of selecting IOL.ConclusionsPatient characteristics, medical factors, and type of counseling are associated with the selection between D&E and IOL for anomalous pregnancies. Institutional, regional, and state policies should permit women both delivery methods to preserve autonomous decision-making at the time of pregnancy termination.     

Benefits of Cognitive Behavioral Therapy for Insomnia for Women Veterans with and without Probable Post-Traumatic Stress Disorder

ObjectiveThis study compared the benefits of cognitive–behavioral therapy for insomnia for sleep, mental health symptoms, and quality of life (QoL) in a sample of women veterans with and without probable post-traumatic stress disorder (PTSD) comorbid with insomnia disorder.MethodsSeventy-three women veterans (30 with probable PTSD) received a manual-based 5-week cognitive–behavioral therapy for insomnia treatment as part of a behavioral sleep intervention study. Measures were completed at baseline, post-treatment, and 3-month follow-up. Sleep measures included the Insomnia Severity Index, Pittsburgh Sleep Quality Index, sleep efficiency measured by actigraphy, and sleep efficiency and total sleep time measured by sleep diary. Mental health measures included the PTSD Checklist-5, nightmares per week, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 scale. QoL was measured with the Short Form-12. Linear mixed models compared changes over time across groups. Independent t tests examined PTSD symptom changes in women veterans with probable PTSD.ResultsBoth groups demonstrated improvements across sleep (ps < .001–.040), mental health symptoms (ps < .001), and QoL measures (ps < .001). The probable PTSD group reported greater improvements in diary sleep efficiency (p = .046) and nightmares per week (p = .001) at post-treatment and in total sleep time (p = .029) and nightmares per week (p = .006) at follow-up. Most participants with probable PTSD experienced clinically significant reductions in PTSD symptoms at post-treatment (66.7%) and follow-up (60.0%). Significant reductions in intrusive and arousal/reactivity symptoms were maintained at follow-up.ConclusionsCognitive–behavioral therapy for insomnia improves insomnia, mental health symptoms, and QoL among women veterans, with greater improvement in those with probable PTSD.     

Physical activity and information processing speed in persons with multiple sclerosis: A prospective study

ObjectiveThere is increasing recognition of the possible association between physical activity and information processing speed (IPS) in multiple sclerosis (MS), but this is based on a limited number of cross-sectional studies with small samples. There further are unresolved methodological issues such as the appropriate mode (i.e., written or oral administration) and measure (e.g., Symbol Digit Modalities Test (SDMT) & the Paced Auditory Serial Addition Test (PASAT)) of cognitive assessment. This prospective study further examined methodological issues influencing the association between physical activity and IPS in 82 persons with MS.MethodsParticipants wore an accelerometer during the waking hours over 7 days for measuring physical activity as steps/day and six-months later completed two versions of the SDMT and the PASAT.ResultsSteps/day was significantly, moderately, and similarly associated with oral (r_s = .45, p < .01) and written (r_s = .51, p < .01) SDMT performance, but weakly associated with scores on the PASAT (r_s = .23, p = .02). After controlling for age and disability status as covariates of IPS, the associations among steps/day and oral (pr_s = .25, p = .02) and written (pr_s = .29, p = .01) SDMT performance were attenuated, but statistically significant, whereas after controlling for age and disability status, the association between steps/day and PASAT performance was not statistically significant (pr_s = .12, p = .34).ConclusionsThese results support inclusion of either oral or written administrations of the SDMT, rather than the PASAT, as measures of IPS in future physical activity interventions.     

Stress,Lifestyle, and Quality of Life in Midlife and Older Australian Women: Results From the Stress and the Health of Women Study

BackgroundChronic psychological stress may pose a serious threat to health, although the mechanisms are not fully understood. This study examines the impact of stress on modifiable lifestyle factors, depressive symptoms, health-related quality of life (HRQOL) and chronic illness in older Australian women.MethodsCross-sectional data were collected from a random sample of 181 older adults aged 60 to 70 years from rural and urban areas of South-East Queensland, Australia. We used structural equation modelling to examine associations between stress, modifiable lifestyle factors, HRQOL, and chronic illness.FindingsParameter estimates show that older women who reported life stressors where they felt helpless and feared for their life (high-magnitude stressors) also reported higher body mass index (p = .03) and more chronic illness (p < .01). In contrast, duration of exposure to life stressors was associated with higher depressive symptom scores (Center for Epidemiologic Studies Depression Scale; p = .02) and sleep disturbance scores (p < .01).ConclusionsOur findings support the link between traumatic personal histories (exposure to high-magnitude stressors) and unhealthy lifestyle factors. Findings highlight the need for more research on how stress reduction, a healthy lifestyle, and positive coping strategies can be used to reduce the effects of high-magnitude stress on HRQOL and chronic illness.     

Rapid Human Immunodeficiency Virus Testing and Risk Prevention in Residents of Battered Women's Shelters

BackgroundHuman immunodeficiency virus (HIV) infection and intimate partner violence (IPV) are interconnected public health problems. However, few HIV prevention interventions address the unique needs of IPV survivors in shelter and none of the Centers for Disease Control and Prevention’s best-evidence risk reduction interventions adequately explore the complex relationship between IPV and HIV risk. Although battered women's shelters provide a safe and supportive environment for women in crisis, most do not offer HIV risk reduction services or sexual safety planning.MethodsThis study evaluated the feasibility, acceptability, and initial efficacy of rapid HIV testing and brief risk prevention intervention developed for residents of battered women's shelters. The Safe Alternatives For Empowered sex for intimate partner violence intervention (SAFE-IPV) was evaluated in an open trial (N = 98). Participants were assessed with a series of standardized interviews and self-reports at screening and 3 months after leaving the shelter.ResultsFew eligible participants declined SAFE-IPV and participants who received SAFE-IPV reported high levels of satisfaction. No participants in the open trial tested positive for HIV. However, participants reported significantly fewer unprotected vaginal and anal sexual occasions and increased intentions to engage in risk preventative behaviors 3 months after leaving shelter compared with the 3 months before shelter. Additionally, participants reported significant improvements on HIV risk factors addressed in SAFE-IPV at the 3-month follow-up (i.e., reduced emotional, physical, and sexual harm by abuser, posttraumatic stress symptoms, hazardous alcohol use, and drug use).DiscussionThese results extend prior research on HIV prevention with women with IPV, demonstrating the acceptability, feasibility, and initial efficacy of SAFE-IPV within battered women's shelter settings.