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...on Women
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www.ProjectCork.org
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Summer 2012
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"Don't leave me hanging": Homeless mothers' perceptions of service providers.
Sznajder-Murray B; Slesnick N. Journal of Social Service Research 37(5): 457-468, 2011. (51 refs.)
Few interventions have been developed for substance-abusing homeless mothers. Among those interventions, high dropout rates (up to 85%) are consistently reported. Understanding homeless mothers' experiences with service providers may be an important first step to understanding ways to increase treatment engagement. Therefore, the current study used qualitative methods to gain a better understanding of homeless mothers' perceptions of service providers. A total of 28 mothers who were currently residing at a homeless shelter in a Midwestern city participated in three focus groups. Overall, mothers held negative perceptions of service providers related to understanding, support, and fear. Based upon this study's findings, recommendations are offered to improve service delivery and guide future research. Copyright 2011, Taylor & Francis.
Age at menarche and current substance use among Canadian adolescent girls: Results of a cross-sectional study.
Al-Sahab B; Ardern CI; Hamadeh MJ; Tamim H. BMC Public Health 12: e-article 195, 2012. (34 refs.)
Background: Substance use is among the key public health threats that find its genesis during adolescence. Timing of puberty has been lately researched as a potential predictor of subsequent substance abuse. The present study, therefore, aims to assess the effect of age at menarche on current practices of smoking, alcohol drinking and drug use among 14-15 year old Canadian girls. Methods: The analysis of the study was based on all female respondents aged 14 to 15 years during Cycle 4 (2000/2001) of the National Longitudinal Survey of Children & Youth (NLSCY). The main independent variable was age at menarche assessed as the month and year of the occurrence of the first menstrual cycle. The dependent variables were current smoking, heavy alcohol drinking in the past 12 months and drug use in the past 12 months. Three logistic regression models were performed to investigate the association between age at menarche and each of the substance use outcomes, adjusting for possible confounders. Bootstrapping was performed to account for the complex sampling design. Results: The total weighted sample included in the analysis represented 295,042 Canadian girls. The prevalence of current smokers, heavy drinkers (drunk in the past 12 months) and drug users in the past 12 months was approximately 22%, 38% and 26%, respectively. After adjusting of all potential confounders, no association was found between age at menarche and any of the substance use outcomes. School performance and relationship with the father, however, stood out as the main variables to be associated with smoking, heavy drinking and drug use. Conclusions: Qualitative studies understanding the social and psychological changes experienced by early maturing Canadian adolescents are warranted to identify other correlates or pathways to substance use in this higher risk population. Copyright 2012, BioMed Central.
Alcohol intake and mortality among women with invasive breast cancer.
Harris HR; Bergkvist L; Wolk A. British Journal of Cancer 106(3): 592-595, 2012. (26 refs.)
Background: Alcohol intake has consistently been associated with increased breast cancer incidence in epidemiological studies. However, the relation between alcohol and survival after breast cancer diagnosis is less clear. Methods: We investigated whether alcohol intake was associated with survival among 3146 women diagnosed with invasive breast cancer in the Swedish Mammography Cohort. Alcohol consumption was estimated using a food frequency questionnaire. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs). Results: From 1987 to 2008 there were 385 breast cancer-specific deaths and 860 total deaths. No significant association was observed between alcohol intake and breast cancer-specific survival. Women who consumed 10 g per day (corresponding to approximately 0.75 to 1 drinks) or more of alcohol had an adjusted HR (95% CI) of breast cancer-specific death of 1.36 (0.82-2.26; p(trend) = 0.47) compared with non-drinkers. A significant inverse association was observed between alcohol and non-breast cancer deaths. Those who consumed 3.4-9.9 g per day of alcohol had a 33% lower risk of death compared with non-drinkers (95% CI 0.50-0.90; p(trend) = 0.04). CONCLUSION: Our findings suggest that alcohol intake up to approximately one small drink per day does not negatively impact breast cancer-specific survival and a half drink per day is associated with a decreased risk of mortality from other causes. Copyright 2012, Nature Publishing Group.
Alcohol use, problems, and the course of posttraumatic stress disorder: A prospective study of female crime victims.
Kaysen D; Atkins DC; Moore SA; Lindgren KP; Dillworth T; Simpson T. Journal of Dual Diagnosis 7(4, special issue): 262-279, 2011. (58 refs.)
Objective: In this study the authors examine whether alcohol use disorder status and consequences of drinking moderate the course of posttraumatic stress disorder (PTSD) over the first 6 months following trauma exposure in a sample of female victims of interpersonal violence. Methods: Female sexual and physical assault victims (N = 64) were recruited through police, hospital, and victim service agencies. Women completed structured clinical interviews and self-report measures within the first 5 weeks, 3 months, and 6 months post-trauma with 73% retention across all three time points (n = 47). Analyses were conducted using Hierarchical Linear Modeling using alcohol abuse/dependence, peak alcohol use, and consequences during the 30 days prior to assault as moderators of the course of PTSD over time. Results: Women with alcohol use disorder at baseline had lower initial PTSD symptoms but also less symptom recovery over time than women without alcohol use disorder. This pattern of results was also found for those with high negative drinking consequences during the month prior to the assault. Baseline alcohol use was not found to significantly moderate PTSD course over the 6 months. Conclusions: Findings suggest that negative consequences associated with alcohol use may be a risk factor for PTSD. Incorporating assessment of drinking problems for women presenting early post-trauma may be useful for identifying PTSD risk. Copyright 2011, Taylor & Francis.
Characteristics and behaviors of mothers who have a child with fetal alcohol syndrome.
Cannon MJ; Dominique Y; O'Leary LA; Sniezek JE; Floyd RL. Neurotoxicology and Teratology 34(1): 90-95, 2012. (32 refs.)
Fetal alcohol syndrome (FAS) is a leading cause of birth defects and developmental disabilities. The objective of this study was to identify the characteristics and behaviors of mothers of children with FAS in the United States using population-based data from the FAS Surveillance Network (FASSNet). FASSNet used a multiple source methodology that identified FAS cases through passive reporting and active review of records from hospitals, specialty clinics, private physicians, early intervention programs, Medicaid, birth certificates and other vital records, birth defects surveillance programs, and hospital discharge data. The surveillance included children born during January 1, 1995-December 31, 1997. In the four states included in our analysis - Arizona, New York, Alaska, and Colorado - there were 257 confirmed cases and 96 probable cases for a total of 353 FAS cases. Compared to all mothers in the states where surveillance occurred, mothers of children with FAS were significantly more likely to be older, American Indians/Alaska Natives, Black, not Hispanic, unmarried, unemployed, and without prenatal care, to smoke during pregnancy, to have a lower educational level, and to have more live born children. A significant proportion of mothers (9-29%) had another child with suspected alcohol effects. Compared to all US mothers, they were also significantly more likely to be on public assistance, to be on Medicaid at their child's birth, to have received treatment for alcohol abuse, to have confirmed alcoholism, to have used marijuana or cocaine during pregnancy, to have their baby screen positive for alcohol or drugs at birth, to have had an induced abortion, to have had a history of mental illness, to have been involved in binge drinking during pregnancy, and to have drunk heavily (7 days/week) during pregnancy. These findings suggest that it is possible to identify women who are at high risk of having a child with FAS and target these women for interventions. Copyright 2012, Elsevier Science.
Child care in outpatient substance abuse treatment facilities for women: Findings from the 2008 National Survey of Substance Abuse Treatment Services.
Brown JD; Vartivarian S; Alderks CE. Journal of Behavioral Health Services & Research 38(4): 478-487, 2011. (23 refs.)
Mothers with substance use disorders who lack access to child care are often unable to enter or remain in substance abuse treatment. This study examined the availability of child care in outpatient substance abuse treatment facilities and whether or not certain facility characteristics were associated with the availability of child care. Using data from the 2008 National Survey of Substance Abuse Treatment Services, 6.5% of outpatient substance abuse treatment facilities that served women provided child care. The results of multivariate logistic regression found that child care was more common among facilities that were located in metropolitan areas, were operated by non-profit or government agencies, received public funding, or provided free services or other ancillary services including case management, domestic violence counseling, and transportation assistance. Facilities that served only women had more than three times higher odds of providing child care compared with mixed-gender facilities. Further research is needed to identify strategies for expanding child care in outpatient substance abuse treatment facilities. Copyright 2011, Springer.
Do co-morbid anxiety disorders predict drinking outcomes in women with alcohol use disorders?
Farris SG; Epstein EE; McCrady BS; Hunter-Reel D. Alcohol and Alcoholism 47(2): 143-148, 2012. (33 refs.)
Aims: It is unclear whether co-morbid anxiety disorders predict worse drinking outcomes during attempts to change drinking behavior. Studies have yielded mixed results, and have rarely examined drinking outcomes based on a specific type of anxiety disorder. Women with alcohol use disorders (AUDs) are of particular interest as they are at risk for co-morbid anxiety [Kessler et al. (1997) Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the national co-morbidity survey. Arch General Psychiatry 54:313-21]. Methods: Participants were 260 women with AUDs participating in an alcohol-treatment outcome studies. The Timeline Follow-Back was used to assess drinking frequency (percent days drinking) prior, within and 6 months post-treatment. The current study tested the hypothesis that having at least one lifetime anxiety disorder diagnosed at baseline using the Structured Clinical Interview for DSM Disorders would be associated with more drinking at all study time points. Exploratory analyses examined patterns of drinking outcomes by specific anxiety diagnoses. Results: Lifetime anxiety diagnosis was linked to poorer drinking outcomes post-treatment (beta = 0.15, P = 0.020), despite less frequent drinking prior to treatment. Analyses by specific anxiety diagnosis indicated that generalized anxiety disorder predicted poorer drinking outcomes within treatment (beta = 0.14, P = 0.018) and during follow-up (beta = 0.16, P = 0.014). Conclusion: Co-morbid anxiety problems complicate treatment for AUDs among women. Further, specific anxiety disorders should be evaluated as distinct constructs as evidenced by the differential outcomes related to generalized anxiety disorder. Implications for treatment development for women with AUDs are discussed. Copyright 2012, Oxford University Press.
Familial influence and childhood trauma in female alcoholism.
Magnusson A; Lundholm C; Goransson M; Copeland W; Heilig M; Pedersen NL. Psychological Medicine 42(2): 381, 2012. (40 refs.)
Background. To assess the role of genetic and environmental factors in female alcoholism using a large population-based twin sample, taking into account possible differences between early and late onset disease subtype. Method. Twins aged 20-47 years from the Swedish Twin Registry (n = 24 119) answered questions to establish lifetime alcohol use disorders. Subjects with alcoholism were classified for subtype. Structural equation modeling was used to quantify the proportion of phenotypic variance due to genetic and environmental factors and test whether heritability in women differed from that in men. The association between childhood trauma and alcoholism was then examined in females, controlling for background familial factors. Results. Lifetime prevalence of alcohol dependence was 4.9% in women and 8.6% in men. Overall, heritability for alcohol dependence was 55%, and did not differ significantly between men and women, although women had a significantly greater heritability for late onset (type I). Childhood physical trauma and sexual abuse had a stronger association with early onset compared to late onset alcoholism [odds ratio (OR) 2.54, 95% confidence interval (CI) 1.53-3.88 and OR 2.29, 95% CI 1.38-3.79 respectively]. Co-twin analysis indicated that familial factors largely accounted for the influence of physical trauma whereas the association with childhood sexual abuse reflected both familial and specific effects. Conclusions. Heritability of alcoholism in women is similar to that in men. Early onset alcoholism is strongly association with childhood trauma, which seems to be both a marker of familial background factors and a specific individual risk factor per se. Copyright 2012, Cambridge University Press.
Helping alliance, retention, and treatment outcomes: A secondary analysis from the NIDA Clinical Trials Network Women and Trauma Study.
Ruglass LM; Miele GM; Hien DA; Campbell ANC; Hu MC; Caldeira N et al. Substance Use & Misuse 47(6): 695-707, 2012. (49 refs.)
We examined the association between the therapeutic alliance and treatment outcomes among 223 women with posttraumatic stress disorder (PTSD) and substance use disorders who participated in a multisite clinical trial of group treatments for trauma and addictions in the United States throughout 2004 and 2005. General linear models indicated that women who received Seeking Safety, a cognitive-behavioral treatment, had significantly higher alliance ratings than those in Women's Health Education, a control group. Alliance was related to significant decreases in PTSD symptoms and higher attendance in both interventions. Alliance was not related to substance use outcomes. Implications and limitations of the findings are discussed. Copyright 2012, Informa HealthCare.
A qualitative study of incarcerated mothers' perceptions of the impact of separation on their children.
Gilham JJM. Social Work in Public Health 27(1-2, special issue): 89-103, 2012. (50 refs.)
Many incarcerated women are mothers, and their children exhibit various responses to the separation that incarceration commands. This exploratory qualitative study examines incarcerated women's perceptions of the consequences of their illegal activity, confinement, and separation from their children on their offspring. The results indicate that although mothers are concerned about their children, they are typically unable to recognize the negative consequences of their actions on their children and their relationship with their children until beginning intensive treatment. Effective treatment must focus on the woman's personal issues along with their parenting abilities and skills to repair these relationships and promote healthy family functioning. Copyright 2012, Taylor & Francis.
Impact of health education on women in residential substance abuse treatment: A pilot study.
Young BB. Journal of Addictions Nursing 22(4): 200-207, 2011. (30 refs.)
There is limited knowledge on the assessment of health education needs in women who are in substance abuse treatment. This pilot study tests the use of a health education program designed to increase health knowledge among a small group of women in active treatment, living in a residential center. The USDHHS Office on Women's Health has published model guides for women's health education in A Lifetime of Good Health-Your Guide to Staying Healthy (2009) and the 2009 Women's Health Calendar (2008). The health education program EMPOWER was developed from these materials and presented to 16 women over a 7 week period. Impact was measured by (1) responses to a health perception survey (SF-36v2) before and after the intervention, and (2) review of weekly reflective journal entries. Findings suggest that women did have improved perceptions of health in important physical and mental health domains. This study also reveals a need for development of a more accurate tool for measuring health education. Women express fear and worry about the future in terms of health, and see their children as huge motivators for improving health. The USDHHS publications do provide a roadmap for women in high risk groups to guide self-care. Copyright 2011, Informa Healthcare.
Investigating the use of social media to help women from going back to smoking post-partum.
Lowe JB; Barnes M; Teo C; Sutherns S. Australian and New Zealand Journal of Public Health 36(1): 30, 2012. (18 refs.)
Objective: To investigate the social factors that would help women who had quit smoking due to pregnancy from returning to smoking after delivery of their baby. Methods: Women who attended their first antenatal check-up at a general public hospital were invited to participate in pre- and postpartum interviews. Results: A total of 24 women were interviewed pre- and postpartum. They reported isolation as a factor that influenced how they dealt with stress. This stress was linked to relapse. The use of electronic media through the Internet was a way women could interact with the outside community without having to leave home. Conclusions: Women who had strong family relationships in geographic proximity were not as likely to use the computer to interact with relatives and friends. Women who did not have strong local and family ties that support their desire to not go back to smoking, reported using Facebook and other Internet activities to keep in touch while they stayed at home with their new infant. Implications: The use of electronic media may help facilitate interaction between new mothers, which could prevent isolation and relapse back to smoking after delivery. This mechanism might also be used to enhance skill-development and problem-solving by these women. Copyright 2012, Wiley-Blackwell.
Maternal representations and emotional availability among drug-abusing and nonusing mothers and their infants.
Flykt M; Punamaki RL; Belt R; Biringen Z; Salo S; Posa T et al. Infant Mental Health Journal 33(2): 123-138, 2012. (92 refs.)
Both negative and idealized maternal prenatal representations may constitute a risk for mother-infant interaction. This study analyzed the role of maternal prenatal representations and pre- to postnatal representational change in predicting mother-infant emotional availability (EA) among 51 drug-abusing mothers and their infants who participated in either psychodynamic group therapy (PGT) or received psychosocial support (PSS) and among 50 nonusing comparison dyads. Maternal representations of her child, the child's father, her own mother, self-as-mother, and self-as-woman were measured during pregnancy and at 4 and 12 months' postpartum with the Interview of Maternal Representations (M. Ammaniti et al., 1992; M. Ammaniti, R. Tambelli, & P. Perucchini, 1998). EA was measured with the Emotional Availability Scales, fourth edition (Z. Biringen, 2008) at 4 and 12 months. The results showed that drug-abusing mothers had more negative prenatal representations of the self-as-woman and of the child's father. Postnatally, PSS mothers tended to first idealize their child, but later to experience disillusionment of idealization. Both negative and idealized prenatal representations of the self-as-mother predicted mother-infant EA problems, but only among the PGT mothers. For all mothers, negative representational change was detrimental for the mother-infant EA whereas for drug-abusing mothers, also increasing idealization from the prenatal period to the postnatal period was harmful. Clinicians working with drug-abusing mothers should aim at supporting the development of a realistically positive view of motherhood. Copyright 2012, Wiley-Blackwell.
Husband and wife alcohol use as independent or interactive predictors of intimate partner violence.
Testa M; Kubiak A; Quigley BM; Houston RJ; Derrick JL; Levitt A et al. Journal of Studies on Alcohol and Drugs 73(2): 268-276, 2012. (42 refs.)
Objective: Men's heavy drinking has been established as a risk factor for their perpetration of intimate partner violence (IPV); however, the role of women's drinking in their perpetration of IPV is less clear. The current study examined the relative strength of husbands' and wives' alcohol use and alcohol dependence symptoms on the occurrence and frequency of husbands' and wives' IPV perpetration. Method: Married and cohabiting community couples (N = 280) were identified and recruited according to their classification in one of four drinking groups: heavy episodic drinking occurred in both partners (n = 79), the husband only (n = 80), the wife only (n = 41), and neither (n = 80). Husband and wife alcohol consumption, alcohol dependence symptoms, and IPV perpetration were assessed independently for both partners. Results: Husband and wife consumption and alcohol dependence symptoms contributed to the likelihood and frequency of husband IPV, both independently and interactively. Husband, but not wife, alcohol dependence symptoms contributed to the occurrence of any wife IPV, although both partners' alcohol dependence symptoms predicted the frequency of wife aggression. Couples with discrepant drinking were not more likely to perpetrate IPV. Conclusions: Findings for husband IPV support previous research identifying alcohol use of both partners as a predictor. However, for wives, alcohol appears to play less of a role in IPV perpetration, perhaps reflecting that women experience less inhibition against physical aggression in their intimate relationships than do men. Copyright 2012, Alcohol Research Documentation.
Prenatal methamphetamine exposure and short-term maternal and infant medical outcomes.
Shah R; Diaz SD; Arria A; LaGasse LL; Derauf C; Newman E et al. American Journal of Perinatology 29(5): 391-400, 2012. (37 refs.)
Objective: Examine maternal and infant medical outcomes of prenatal exposure to methamphetamine (MA). Study Design: Four hundred and twelve mother-infant pairs (204 MA-exposed and 208 unexposed matched comparisons) were enrolled in the Infant Development, Environment and Lifestyle (IDEAL) study. Exposure was determined by maternal self-report during this pregnancy and/or positive meconium toxicology. Maternal interviews assessed prenatal drug use, pregnancy course, and sociodemographic information. Medical chart reviews provided medical history, obstetric complications, infant outcomes, and discharge placement. Results: MA-using mothers were more likely to be poor, to have a psychiatric disorder/emotional illness and less prenatal care, and to be less likely to breast-feed their infant than comparison mothers. After adjusting for covariates, MA-exposed infants were more likely to exhibit poor suck, to have smaller head circumferences and length, to require neonatal intensive care unit (NICU) admission, and to be referred to child protective services (CPS). Several outcomes previously reported from studies that lacked adequate control groups or adjustment for covariates were not significantly different in this study. Conclusion: Prenatal MA exposure is associated with maternal psychiatric disorder/emotional illness, poor suck, NICU admission, and CPS involvement, and MA-exposed infants were less likely to be breast-fed; however, the absence of many serious complications, such as fetal distress, chronic hypertension, preeclampsia, placenta previa, abruptio placentae, and cardiac defects, suggests confounding variables influenced prior studies. Copyright 2012, Thieme Medical Publishing.
Unplanned pregnancy and contraceptive use in women attending drug treatment services.
Black KI; Stephens C; Haber PS; Lintzeris N. Australian & New Zealand Journal of Obstetrics & Gynaecology 52(2): 146-150, 2012. (24 refs.)
Background: At an international level, there are calls for a greater focus on women and harm reduction in recognition that female drug users have a unique set of issues that are not routinely assessed in drug treatment programs. Aims: To assess the pregnancy history, current pregnancy risk and contraceptive use of nonpregnant women attending opioid treatment programs (OTPs). Methods: This study involved a structured questionnaire survey of 204 women attending outpatient OTP services within the Sydney South West Area Health Service. Results: Two hundred and four women of 302 (67.5%) enroled in OTPs at the time completed surveys. Key findings were high pregnancy rates, with 28.9% of women reporting six or more pregnancies, high rates of adverse pregnancy outcomes (miscarriage, termination and stillbirth) compared with national data and poor uptake of contraception, with only 54.7% of sexually active women not wanting to get pregnant using a method. Women expressed diverse preferences for the type and location of women's health services they felt would meet their needs. Conclusion: Women in OTP clinics have unaddressed reproductive health issues, particularly around contraception. Addressing these will potentially minimise the risk of material deprivation and social exclusion in these women and improve their well- being through greater control and choice over their fertility. Current women's health service provision in OTP programs involves referral to external services, but an integrated model of care may best address the unmet contraceptive needs of these women. Copyright 2012, Wiley-Blackwell.
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