The roles of spirituality in the relationship between traumatic life events, mental health, and drug use among African American women from one southern state

Predictors of substance use disorder treatment and mutual support group participation among Black women across the criminal legal spectrum: A latent class approach

BACKGROUND

The purpose of this study includes: 1) identifying classes of substance-related needs among Black women, and 2) examining the effect of substance-related need classes and culturally-relevant factors on Black women's use of substance use disorder (SUD) treatment and mutual support groups.

METHODS

As part of a longitudinal cohort study, Black women were recruited in prison nearing release, on probation, and in the community without involvement in the criminal legal system (CLS, n=565) and followed-up at 18-months. We conducted a baseline latent class analysis of substance-related needs among Black women. Logistic regression models adjusted for culturally-relevant factors to predict the use of treatment and frequency of mutual support group participation over 18-months among Black women who use drugs.

RESULTS

Four classes by level of needs were found: low, daily marijuana use, high mental health, and high comorbidity. During the 18-month follow-up, women characterized by the high comorbidity need class and with higher scores of religious well-being were more likely to frequently participate in mutual support groups. Non-CLS-involved women were less likely to engage with both treatment and mutual support groups than women from the prison sample at 18-months.

CONCLUSIONS

This study highlights four distinct classes of substance-related needs among Black women, highlighting the complex patterns of behavior and within-racial group differences among Black women. Black women with high comorbidity needs were more likely to participate in mutual support groups, but the latent classes did not predict SUD treatment indicating other non-medical and social contextual need factors may be at play.

ACEs and Mental and Behavioral Health: Examining Maltreatment vs. Household Dysfunction and the Moderating Role of Spirituality

Purpose

Different types of adverse childhood experiences (ACEs) may be differentially linked to mental and behavioral health. Additionally, spirituality is associated with well-being, but little research has examined whether it is protective in the context of ACEs. The present study examines the influence of maltreatment and household dysfunction ACEs on distress, substance use, and sexual risk taking, and tests whether spirituality moderates the associations between childhood maltreatment, household dysfunction and distress, substance use, and sexual risk taking.

Method

314 college students completed the ACE-Q and measures of general mental (distress) and behavioral (substance use, sexual risk taking) health. To examine the distinct effects of maltreatment and household dysfunction on mental and behavior health, linear regression models that included both ACE types as predictors were constructed for each of the health variables. Moderation between spirituality and each type of ACEs was then examined for each outcome.

Results

Childhood maltreatment predicted greater distress and sexual risk-taking even after accounting for household dysfunction, and household dysfunction predicted greater substance use even after accounting for childhood maltreatment. Childhood maltreatment interacted significantly with spirituality to predict distress, but in the opposite direction than was hypothesized. That is, the relationship between cumulative childhood maltreatment ACEs and distress was stronger among those with higher levels of spirituality.

Conclusions

Results suggest that childhood maltreatment and household dysfunction ACEs are linked to distinct mental and behavioral health consequences among young adults. Additionally, while spirituality is associated generally with better mental and behavioral health, our findings suggest that it does not buffer the impacts of childhood maltreatment or household dysfunction.

Psychometric Analysis of the Shortened Version of the Spiritual Well-Being Scale on the Slovak Population (SWBS-Sk)

This study was focused on verifying the factor structure of the shortened version of the Spiritual Well-Being Scale (SWBS) on a representative sample of adult Slovak citizens (N = 1018, 49% men, age 18-85 years, and mean age 46.2). The shortened version of the SWBS consists of 10 items divided into two subscales: religious well-being (RWB) and existential well-being (EWB). Results of confirmatory factor analysis (CFA) showed insufficient parameters of the full two-factor model due to three negatively formulated items. After their exclusion, the two-factor model was found to be valid in the Slovakian population (χ (13) = 53.1, p < 0.001, χ2/df = 4.1, CFI = 0.999, TLI = 0.999, RMSEA = 0.055, and SRMR = 0.028). The reliability of the final version of the SWBS-Sk, consisting of seven positively worded items, is high, with α = 0.86 and ω = 0.94. Religious respondents and women scored significantly higher on the whole scale (p = 0.001) as well as on the two subscales (p < 0.05). A higher age was associated with a higher RWB score (p = 0.001) and a lower EWB score (p = 0.002). The shortened version of the SWBS-Sk consisting of positively worded items was found to be valid and reliable for further use in the Slovak environment.

"I Struggle with Breast Cancer and I Struggle with God": Insights from African American Breast Cancer Survivors

PURPOSE

Recognizing that spiritual and religious beliefs are personal and vary within communities, the purpose of this qualitative study was to explore the influence of these beliefs on experiences with breast cancer care and social support among African American Christian breast cancer survivors.

METHODS

Forty-seven African American breast cancer survivors participated in focus groups (n = 7) in three northeastern urban cities. We used thematic analyses to identify major themes.

RESULTS

Three themes emerged relating to how spirituality influenced participants' cancer journeys: (1) struggling with God, (2) reclaiming my power, and (3) needing religious social support. Participants described the rhythmic flow of their spiritual beliefs as they navigated their lived experiences during diagnosis, treatment, and post-treatment. Spirituality was intimately intertwined with their illness experience as they grappled with their health and well-being.

CONCLUSIONS

Participants used spirituality as an avenue to cope and navigate through their diagnosis and treatment. These spiritual relationships created "church families" and provided the survivors' access to cancer support groups, financial support, and therapeutic support. Our findings support faith-based approaches to health promotion and call for more studies to understand the influence of religion on health.

Spirituality and Parenting among Women Experiencing Intimate Partner Violence

PURPOSE

While spirituality and parenting have been examined among caregivers experiencing adversity, less research has explored these factors among mother survivors of intimate partner violence (IPV). Given the potentially protective role of spirituality, understanding how parenting is associated with spirituality is important.

METHOD

The current study explored parenting practices, parent-child communication, and spirituality among 175 women caregivers who had experienced recent IPV. Hierarchical linear regression was used to examine associations between maternal age, education, HIV status, and illicit substance use (model 1); child age and gender (model 2); parent-child comfort communicating about sexual practices, IPV, HIV/AIDS, and substance use (model 3); and positive and negative parenting practices (model 4) with spirituality.

RESULTS

Findings suggested positive parenting practices, greater comfort talking about IPV, and greater discomfort talking about substance use were associated with higher spirituality.

CONCLUSIONS

Results highlight the value of parenting and communication strategies among women caregivers experiencing recent adversity.

The Role of Stressful Life Events and Cultural Factors on Criminal Thinking among African American Women Involved in the Criminal Justice System

African American women are positioned at the intersection of multiple disadvantaged statuses and disproportionately impacted by criminal justice policies, as evinced by their increased likelihood of incarceration. Yet, they continue to be overlooked in mainstream criminological research. Using data from 418 African American women in the B-WISE (Black Women in a Study of Epidemics) project, the current study investigates the relationship between several prominent stressors occurring in five social contexts and criminal thinking as a coping strategy. Findings indicate that criminal thinking may be one maladaptive coping mechanism to manage stressors, such as gendered racism, financial stress, and network loss, that occur across these multiple social contexts for African American women in prison and on probation. Spirituality, on the other hand, seems to operate as a buffer. Implications for practice include promoting programs that strengthen a sense of collective identity in the community, as well as hiring more African American women who could provide additional culturally-competent behavioral health services in criminal justice professions.

A comparison of African American and Caucasian stimulant users in 12-step facilitation treatment

Engagement in 12-step meetings and activities has been shown to be a powerful aid to recovery from substance use disorders. However, only limited attention has been given to ethnic and racial differences in attitudes toward 12-step and involvement. This study utilized data from a large multisite trial testing the effectiveness of a 12-step facilitation therapy with stimulant-dependent treatment seekers. We compared baseline differences and treatment outcomes between African American and Caucasian participants. A select few baseline differences were found (i.e., African Americans reported higher levels of spirituality than Caucasians; African American participants indicated more perceived benefits of 12-step involvement; Caucasians were more likely to endorse future involvement in 12-step). There were no outcome differences (e.g., substance use outcomes, 12-step meeting attendance). The tested intervention produced similar outcomes for both groups, indicating that it may be useful across racial categories.

Associations Between Religiosity, Perceived Social Support, and Stimulant Use in an Untreated Rural Sample in the U.S.A

BACKGROUND

Religiosity and perceived social support (SS) may serve as protective factors for more severe substance use in adults.

OBJECTIVES

This study sought to examine whether aspects of religiosity and SS are associated with longitudinal reductions in stimulant use over three years in an untreated sample of rural drug users.

METHODS

Respondent-driven sampling was used to recruit stimulant users (N = 710) from Arkansas, Kentucky, and Ohio. Follow-up interviews were conducted at 6-month intervals for 36 months.

RESULTS

Our bivariate findings indicate that higher religiosity was associated with lower odds and fewer days of methamphetamine and cocaine use. After controlling for covariates, higher religiosity was associated with fewer days of crack cocaine use, but more days of methamphetamine use among a small sample of users in the two final interviews. Higher SS from drug-users was also associated with higher odds and days of methamphetamine and powder cocaine use, while higher SS from nondrug users was associated with fewer days of methamphetamine use.

CONCLUSIONS/IMPORTANCE

Our bivariate findings suggest that higher levels of religiosity may be helpful for some rural individuals in reducing their drug use over time. However, our multivariate findings suggest a need for further exploration of the potential effects of religiosity on longer-term drug use, especially among those who continue to use methamphetamine and/or remain untreated. Our findings also highlight the potential deleterious effect of SS from drug users on the likelihood and frequency of methamphetamine and powder cocaine use over time among untreated rural drug users.

John Henryism Active Coping as a Cultural Correlate of Substance Abuse Treatment Participation Among African American Women

The rates of illicit drug use among African American women are increasing, yet African American women are least likely to participate in treatment for substance use disorders when compared to women of other racial groups. The current study examined family history of substance use, perceived family support, and John Henryism Active Coping (JHAC) as correlates to seeking treatment for substance abuse. The underlying theoretical frame of JHAC (James et al., 1983) suggests that despite limited resources and psychosocial stressors, African Americans believe that hard work and self-determination are necessary to cope with adversities. The current study is a secondary data analyses of 206 drug-using African American women (N=104 urban community women with no criminal justice involvement and N=102 women living in the community on supervised probation) from urban cities in a southern state. It was expected that African American women with a family history of substance abuse, higher levels of perceived family support, and more active coping skills would be more likely to have participated in substance abuse treatment. Step-wise logistic regression results reveal that women on probation, had children, and had a family history of substance abuse were significantly more likely to report participating in substance abuse treatment. Perceived family support and active coping were significant negative correlates of participating in treatment. Implication of results suggests coping with psychosocial stressors using a self-determined and persistent coping strategy may be problematic for drug-using women with limited resources.

African American Female Offender's Use of Alternative and Traditional Health Services After Re-Entry: Examining the Behavioral Model for Vulnerable Populations

This is the first known study to use the Gelberg-Andersen Behavioral Model for Vulnerable Populations to predict African American women's use of three types of health services (alternative, hospitalization, and ambulatory) in the 18 months after release from prison. In the multivariate models, the most robust predictors of all three types of service utilization were in the vulnerable theoretical domains. Alternative health services were predicted by ethnic community membership, higher religiosity, and HIV/HCV. Hospitalizations were predicted by the lack of barriers to health care and disability. Ambulatory office visits were predicted by more experiences of gendered racism, a greater number of physical health problems, and HIV/HCV. Findings highlight the importance of cultural factors and HIV/HCV in obtaining both alternative and formal health care during community re-entry. Clinicians and policymakers should consider the salient role that the vulnerable domain plays in offender's accessing health services.

Spirituality moderates the relationship of psychosocial stress to metabolic risk factors among Afro-Caribbean immigrants in the US Virgin Islands

OBJECTIVE

Spirituality may contribute to the health advantage of foreign-born blacks compared to United States (US)-born blacks. The objective of this study was to test the hypothesis that spirituality attenuates the association of psychosocial stress to stress-associated metabolic risk factors among foreign-born Caribbean blacks living in a US jurisdiction.

METHODS

Data on demographic factors, anthropometric measurements (height, weight and waist), fasting glucose and insulin, lifestyle behaviors (smoking and alcohol use), psychosocial stress and spirituality were collected from a population-based sample of 319 Afro-Caribbean immigrants, ages 20 and older, who were recruited between 1995 and 2000 in the Virgin Islands of the United States (USVI). Glucose and insulin measurements were used to estimate insulin resistance by the homeostasis model assessment (HOMA-IR) method. Participants were classified into three levels of spirituality, "low", "medium" and "high" based on the distribution of spirituality scores. Stepwise regression analyses were used to identify the significant predictors of waist circumference and HOMA-IR within each level of spirituality.

RESULTS

The predictors of waist circumference and HOMA-IR varied across the levels of spirituality. Psychosocial stress was an independent predictor of waist and HOMA-IR only among participants with a low level of spirituality.

CONCLUSION

Spirituality appears to attenuate the association of psychosocial stress to waist circumference and insulin resistance among Afro-Caribbean immigrants in the USVI.