Using an intersectional life course perspective to understand familial environment and its impact on sexuality development among Asian American sexual minority college students

There is a dearth of research understanding the sexual health of Asian American adolescents, and even more so for those who identify as sexual minorities (lesbian, gay, bisexual, queer, asexual, and other sexual orientations). This study is a secondary qualitative analysis focused on young adults' recollections of their formal and informal sex education experiences in childhood and adolescence using a sub-sample of in-depth interviews from students who self-identified as both Asian and sexual minorities living in the USA (n = 9). Results were organised into three sections: (1) latent cultural factors (e.g. stigma surrounding sex, self-sufficiency, filial piety); (2) the downstream effects of latent cultural factors (e.g. sex-related discussions, rules disallowing dating, role of lateral family members); and (3) the impact of deficient familial sex-related discussions (e.g. Internet, resentment). Study findings underscore the links between identity concealment and relationship concealment that are unique to Asian sexual minority individuals. We suggest that interventions involving Asian American US youth and their families should be culturally informed and promote cross-generational sex-related discussion. Future research should further explore the role of chosen family and non-parental family members as a point of intervention as they can be helpful sources of informal sex education.

Factors Associated with Engaging in Bystander Intervention Behavior Among College Students

Sexual violence (SV) is a well-documented and highly prevalent issue on college campuses that disproportionately impacts women, students of color, and students who identify as lesbian, gay, bisexual, transgender, queer (LGBTQ). In recent years, bystander intervention programming has emerged as a promising prevention strategy for colleges due to its success in preventing SV before it occurs using community involvement; however, little consideration has been given to the power, status, or position that a bystander has when deciding whether to intervene and weighing the potential consequences of their actions. In order to inform university campus bystander intervention programming and increase its effectiveness, more work is needed to understand specific student characteristics (e.g., race/ethnicity, gender identity, sexual orientation, history of SV) that may be associated with engaging in bystander behavior in SV risk situations. Using cross-sectional data from a large west-coast university, 592 students were surveyed about their SV-related experiences. Poisson regression models were utilized to determine the relative risk of engaging in bystander behavior by sociodemographic identities and history of SV victimization. Our fully adjusted model indicated that experiencing attempted and completed sexual assault was associated with engaging in bystander behavior; belonging to specific minority groups was differentially associated with engaging in bystander behavior, as was belonging to a minority group and having a history of SV. Personal histories, identities, and power inequity matter when deciding to engage in bystander behavior. Additional research is needed to create more well-rounded and population-specific bystander intervention programs that are inclusive of diverse student voices and experiences.

Graduate students' knowledge and utilization of campus sexual violence and sexual harassment resources

Graduate students are uniquely vulnerable to sexual violence and harassment (SVSH) and largely marginalized in campus-based prevention and response efforts. Objective: This study is a preliminary investigation of graduate students' experiences with on-campus SVSH training and knowledge and utilization of SVSH resources. Methods: We conducted 21 in-depth interviews and 8 focus group discussions with 43 graduate students on three public university campuses in California. Results: Graduate students had limited knowledge of SVSH services, and mandatory SVSH training curricula was perceived to center around "responsible employee" duties rather than information about how to prevent or seek help for SVSH themselves. Graduate students had mixed experiences seeking SVSH-related assistance. Conclusions: Graduate students should be prioritized in SVSH prevention and education efforts beyond required responsible employee training. Graduate students are invaluable to the everyday success of universities; accounting for their vulnerabilities in SVSH prevention and response is vital for campus communities everywhere.

Exploring intimate partner violence among pregnant Eswatini women seeking antenatal care: How agency and food security impact violence-related outcomes

Women with agency (i.e. the ability to make choices and act on them) may experience reduced food insecurity (FI) and intimate partner violence (IPV). Reducing FI and IPV among women are global goals; however, research focused on agency among Eswatini women has been overlooked, though they experience high rates of FI and IPV. We analysed cross-sectional data from 406 Swazi women who sought care at one rural and one urban-public antenatal clinic in 2013-2014 to understand how FI and agency, our independent variables, are associated with IPV. We assessed the incidence rate ratio (IRR) of number of violent events (including emotional, physical and sexual IPV) in the previous 12 months using Poisson regressions. We found significant relationships between FI and IPV, where higher levels of FI were associated with IPV risk (weekly: IRR = 2.18, 95% CI = 1.82-2.61; Daily: IRR = 3.53, 95% CI = 2.89-4.32) and constrained agency increased women's risk of IPV (IRR = 1.44; 95% CI = 1.22-1.70). Our findings suggest that FI and agency independently impact women's experience(s) of IPV. Interventions focused on women simultaneously experiencing severe FI and constrained agency may have the highest impact; however, providing focused and moderate FI relief (e.g. reducing FI daily to monthly) could potentially reduce women's risk of experiencing violence.

Structural Barriers to Accessing the Campus Assault Resources and Education (CARE) Offices at the University of California (UC) Campuses

In order to continue pushing college campuses to the forefront of survivor-centered practice and student-centered care, it is imperative that the barriers students experience in accessing campus sexual violence resource centers be documented and addressed. This research evaluates student and staff perceptions of barriers to accessing the Campus Assault Resources and Education (CARE) offices on three University of California (UC) campuses. Data were collected by researchers from UC Speaks Up, a cross-campus research initiative at UC Los Angeles (UCLA), UC Santa Barbara (UCSB), and UC San Diego (UCSD) aimed at understanding factors that both contribute to and prevent sexual violence among college students. This analysis only included data that yielded insights into CARE's accessibility. Thematic analysis of 63 interviews and 27 focus group discussions was conducted using Dedoose. The following six thematic codes emerged from the data: (1) awareness of office, (2) confidentiality of services, (3) physical accessibility, (4) accessibility for vulnerable and marginalized groups, (5) utilization experiences, and (6) limited institutional support. To increase the accessibility of sexual violence resource centers in higher education, this study indicates that universities and campus sexual violence resource centers should (1) encourage survivor-centered cross-campus collaborations between sexual violence resource centers and other campus entries, (2) add more trainings that are tailored to the needs of vulnerable and marginalized communities, (3) increase the resource's campus-wide office exposure through multiple prevention education opportunities, and (4) better fund sexual violence resource centers. Implications for future research are discussed to maximize this study's public health impact.

Opening the "Black Box": Student-Generated Solutions to Improve Sexual Violence Response and Prevention Efforts for Undergraduates on College Campuses

Campus-based sexual violence and sexual harassment (SVSH) are prevalent issues that impact students detrimentally. Guided by community-based participatory research, this qualitative study assessed undergraduate students' perceptions of available campus SVSH resources, gaps in services, and recommendations for solutions for SVSH at three universities in California via interviews and focus groups. Approximately half of participants were unaware of available SVSH services, while others had varying knowledge of service availability and experiences with services. Students want better-funded, trauma-informed, and survivor-centered services and providers who share their identities and lived experiences. We provide multi-level student-centered solutions to improve current campus-based SVSH prevention efforts.

Perspectives of Women Living With HIV on Addressing Violence and Use of Alcohol During HIV Services: Qualitative Findings From Fishing Communities in Uganda

The syndemic relationship between harmful alcohol use, intimate partner violence (IPV), and HIV is well established across international settings. Less is known about how these health issues are perceived by women living with HIV (WLWH), who are disproportionately affected by these intertwined epidemics. A qualitative study was undertaken with 20 WLWH in Rakai, Uganda, to assess their perceptions of how these issues have affected their lives and their communities and to assess the acceptability of integrating a screening and brief intervention for alcohol use and IPV into HIV posttest counseling. Recommendations for intervention programming arising from the results are discussed.

'Endure and excuse': a mixed-methods study to understand disclosure of intimate partner violence among women living with HIV in Uganda

Intimate partner violence and HIV remain significant health challenges among women living with HIV. Intimate partner violence has been linked to negative health outcomes and poorer HIV care engagement. This study examined intimate partner violence among Ugandan women living with HIV, their experiences disclosing such violence and how culturally normative factors affected disclosure-related outcomes. In a mixed-methods study conducted in Uganda in 2018, 168 women participated in interviewer-administered surveys; a sub-set who reported experiencing intimate partner violence participated in in-depth interviews (IDIs). Intimate partner violence was prevalent among women in the sample (68.0%); almost half experienced emotional violence (45.2%), while a smaller proportion had experienced physical (32.1%) and/or sexual violence (19.6%). Most women living with HIV (61.8%) had disclosed their experience of intimate partner violence to someone. Women who experienced intimate partner violence had higher odds of disclosure if they feared their partner and perpetrated violence against their partner. Thematic analysis of IDIs revealed enduring violence and blaming alcohol for men's perpetration of violence. Traditional cultural and gender norms, especially concerning motherhood and partnership, influenced women's experiences of intimate partner violence and disclosure. Multi-sectoral responses to challenge and reform cultural norms that perpetuate violence are needed, including mobilising key stakeholders (e.g. family, community, policy-makers) to serve as catalysts for change and encourage resource- and safety-seeking for women living with HIV to escape violence.

Employees, Advisees, and Emerging Scholars: A Qualitative Analysis of Graduate Students' Roles and Experiences of Sexual Violence and Sexual Harassment on College Campuses

Sexual violence and sexual harassment (SVSH) are pervasive across university campuses. SVSH research rarely focuses on graduate students, who occupy unique positions within university settings due to their multiple responsibilities (e.g., teaching, research, mentoring), including managing unequal power dynamics with mentors and advisors. As part of a larger qualitative study, we sought to better understand SVSH generally and, when applicable, experiences of SVSH among graduate students on three campuses. Our primary research questions were: (a) How graduate students understand SVSH on their campus and whether they are at risk, (b) How graduate students navigate power dynamics that position them to experience SVSH, and (c) What graduate student-centered solutions and improvements can make campuses safer, more equitable spaces for all students. To answer these questions, we conducted 21 in-depth interviews and 8 focus group discussions with a diverse group of graduate students across various graduate programs. Using grounded theory and implementing student-centered approaches to data collection and analysis, we identified multiple themes, including graduate students' uncertainty regarding SVSH on campus; and how power relations with faculty, combined with distrust of university processes, keep many graduate students silent about SVSH. Finally, employing graduate students' suggestions, we offer recommendations for how universities can improve campus climate and SVSH resources for graduate students.

Self-perception of assisting with future injection drug initiation: The influence of relationships in the process of drug injecting initiation

INTRODUCTION AND AIMS

People who inject drugs (PWID) play critical roles in assisting others into injection drug use (IDU) initiation. Understanding perceptions of PWID's risk of initiating others is needed to inform interventions for prevention. The objective was to examine factors associated with self-perception of assisting with future IDU initiation events. The primary variables of interest are the relationships of PWID with the person(s) they assisted and their reasons for previously providing initiation assistance.

DESIGN AND METHODS

Data from Preventing Injecting by Modifying Existing Responses, a multi-site prospective community-recruited cohort study, were analysed. Analyses were restricted to PWID who reported ever providing IDU initiation assistance. Site-specific (Vancouver, Canada [n = 746]; San Diego, USA [n = 95] and Tijuana, Mexico [n = 92]) multivariable logistic regression analyses were performed to determine factors associated with self-perception of assisting with future IDU initiation.

RESULTS

Having provided IDU initiation assistance to a family member or intimate partner decreased the odds of self-perception of assisting with future IDU initiation in Vancouver (AOR = 0.4; 95% CI 0.2-0.8); however, previous IDU initiation assistance to an 'other' increased the odds of self-perception of assisting with future IDU in Tijuana (AOR = 12.0; 95% CI 2.1-70.3). Daily IDU (Vancouver: AOR = 3.7; 95% CI 2.1-6.4) and less than daily IDU (San Diego: AOR = 5.9; 95% CI 1.3-27.1) (Vancouver: AOR = 2.6; 95% CI 1.4-2.9) were associated with increased self-perception of assisting with future IDU compared to current non-injectors.

DISCUSSION AND CONCLUSIONS

Relationship to past initiates and IDU frequency might increase PWID's self-perception of assisting with future IDU. Interventions focused on social support and reducing IDU frequency may decrease occurrences of IDU initiation assistance.

Early life adversity, use of specialist care and unmet specialist care need among children

Adverse childhood experiences (ACEs) are linked to increased utilization of health care among adults; however, the impact of ACEs on nonmental health specialist care has been largely overlooked. To address this, data from the 2011-2012 National Survey of Children's Health (n = 89,357) were used to assess the health of children aged 0-17 living with a parent or guardian. Use of specialist care among children in the past 12 months was the outcome of interest and experiencing any one of nine ACEs was the independent variable of interest. After adjusting for confounders in logistic regression modeling, children who experience specific ACEs had higher odds of receiving specialist care. All ACEs were associated with higher unmet need of specialist care, and each additional ACE was independently associated with higher odds of needing specialist care among those who had not received it. This study provides evidence of that experiencing specific ACEs lead to increased demand of nonmental health specialist services among children and adds to the growing body of research indicating that individual ACE items may be differentially associated with health-care utilization or not associated with health-care utilization at all.

Intimate Partner Violence Screening Practices in California After Passage of the Affordable Care Act

Under the Affordable Care Act (ACA), insurance coverage should include screening for intimate partner violence (IPV). In this article, we present self-reported IPV screening practices and provider confidence from a post-ACA cross-sectional survey of 137 primary care clinicians in California. Only 14% of the providers reported always screening female patients for IPV and about one third seemed never to screen. Female providers were more likely to screen and use recommended direct questioning. Most providers lacked confidence in screening, referral, and record-keeping. Serving a low-income population predicted more frequent screening and better record-keeping. Overall, IPV screening in primary care was inadequate and needs attention.

Infection control in the dental office: has anything changed?

Using data collected in two studies, the authors compare infection control practices used in dental offices in 1988 and 1992. During that time, dentists increased their use of barrier protection but still asked and learned very little about their patients. This lack of communication hinders dentists' ability to deliver the best care possible. The authors recommend that dentists improve communication with their patients to obtain better information about their health status.