Akiko Kamimura

Health indicators, social support, and intimate partner violence among women utilizing services at a community organization

PURPOSE Intimate partner violence (IPV) against women is a significant public health concern. This study examines the physical and mental health status and relationship to social support for women seeking services to end IPV at a walk-in community organization that serves the community at large, including a shelter for abused women. METHODS One hundred seventeen (117) English-speaking women between the ages of 18 and 61 years participated in a self-administered survey. Physical, mental, and oral health, social support, and IPV homicide lethality were measured using standardized instruments. RESULTS Social support was the most important factor related to better health. The participants who had more social support reported better physical (p < .05), mental (p < .01), and oral health (p < .05), and a lower level of psychological distress (p < .01) and depression (p < .01) compared with participants who reported less social support. The participants living in the shelter reported worse physical health (p < .05) but better mental health (p < .05) than the participants not living in a shelter. Older age and low income were related to oral health problems, whereas older age, low education level, and unemployment were related to poor mental health. CONCLUSION The present study adds to the evidence that social support contributes to improving physical and mental health for women who experience IPV. The findings also suggest the importance of providing or referring women to mental health services.

Practice Environments of Nurses in Ambulatory Oncology Settings: A Thematic Analysis

Background:The practice environments of nurses have been studied extensively in inpatient settings, but rarely in the ambulatory context. As the majority of cancer care is delivered in ambulatory settings, a better understanding of the nursing practice environment may contribute to quality improvement efforts. Objective:We sought to examine the features of nursing practice environments that contribute to quality patient care and nursing job satisfaction. Methods:In 2009–2010, we conducted focus groups with nurses who cared for adults with cancer outside inpatient units. A semistructured moderator guide explored practice environment features that promoted safe, high-quality care and high job satisfaction. We also asked nurses to identify practice environment features that hindered quality care and reduced job satisfaction. We conducted thematic analysis to report themes and to construct a conceptual framework. Results:From 2 focus groups, composed of 13 participants, nurses reported that variability in workloads, support from managers and medical assistants, and the practice’s physical resources could facilitate or hinder high-quality care and job satisfaction. High-quality communication across team members improved patient safety and satisfaction. Conclusions:Consistent with research findings from inpatient settings, nurses identified staffing and resource adequacy, management support, and collegiality as important inputs to high-quality care. Implications for Practice:These findings can inform quality improvement initiatives in ambulatory oncology practices. Strengthening nurse–medical assistant relationships, smoothing patient workload variability, and implementing strategies to strengthen communication may contribute to quality cancer care. Studies to test our proposed conceptual framework would bridge existing knowledge gaps in ambulatory settings.

Prevalence of Intimate Partner Violence and Its Impact on Health: Female and Male Patients Using a Free Clinic

Purpose. Examine the prevalence of intimate partner violence (IPV) with physical and mental health indicators among free clinic patients. Methods. A cross-sectional study conducted via self-administered surveys. English and Spanish-speaking women and men aged 18 to 64 years responded to standardized questionnaires regarding IPV, physical and mental health, depression, and emotional support. Results. The overall prevalence of IPV was 41%. U.S.-born participants reported a higher prevalence of IPV (women 61%, men 69%) compared with the national average (women 36%, men 29%) and the non-U.S.-born or immigrant participants (women 39%, men 7%). Women with IPV reported poorer mental health but the same level of physical health functioning compared with women without IPV. The impact of IPV on health was somewhat different for men. Conclusions. Intimate partner violence is associated with poor health outcomes, especially for U.S.-born participants. Further research is warranted to understand causal mechanisms and to aid patients.

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

PURPOSE Obesity is a significant public health problem in womens 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. METHODS We 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. RESULTS Although 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). CONCLUSIONS The 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.

Knowledge and Perceptions of Breast Health Among Free Clinic Patients

BACKGROUND Breast cancer is a significant womens health problem in the United States. However, critical information on specific populations is still lacking. In particular, it is not well known how free clinic patients perceive breast health. The purpose of this study was to assess knowledge and perceptions of breast health among uninsured women utilizing a free clinic that serves as a safety net for the underserved. METHODS A self-administrated survey that included knowledge and perceptions of breast health was conducted for female free clinic patients aged 40 or older in fall 2012. There were 146 participants. The participants were classified into three groups for comparison; U.S. citizen English speakers, non-U.S. citizen English speakers, and Spanish speakers. RESULTS Spanish speakers had the highest average score on the knowledge of breast health, whereas the non-U.S. citizen English speakers had the lowest average score. Free clinic patients may consider breast health screening if recommended by health care providers. The non-U.S. citizen English speakers and Spanish speakers were more likely to have negative perceptions of breast health compared with the U.S. citizen English speakers. CONCLUSIONS Promoting knowledge about breast health is important for free clinics. Recommendation by a health care provider is a key to increasing attendance at health education programs and breast health screening. Non-U.S. citizens and non-English speakers would need culturally competent interventions. Free clinics have limited human and financial resources. Such characteristics of free clinics should be considered for practice implementations.

Impact of Neighborhood Environments on Health Consciousness, Information Seeking, and Attitudes among US-Born and Non-US-Born Free Clinic Patients.

Objectives This study examined the impact of neighborhood environments on health consciousness, information seeking, and attitudes among uninsured free clinic patients to better understand the specific needs of the population for health promotion and prevention efforts. Methods US-born English-speaking, non–US-born English-speaking, and Spanish-speaking free clinic patients completed a self-administered survey using reliable measures in autumn 2014 (N = 769). Results The results of this study suggest that social cohesion is positively associated with health consciousness, information seeking, and attitudes. Lower levels of available healthy food in the community were associated with higher levels of health consciousness. Although Spanish speakers reported lower levels of the availability of healthy food, social cohesion, and access to the Internet or text messaging compared with US-born or non–US-born English speakers, they were more likely to be health conscious and have higher levels of health information seeking. Spanish speakers as well as non–US-born English speakers, were more likely to attend health education classes compared with US-born English speakers. Conclusions Health education programs for free clinic patients should include strategies to increase social cohesion. Health education programs should consider the diverse needs of these individual populations to maximize the effectiveness of the programs for free clinic patients.

Stress, Coping Strategies, and Depression--Uninsured Primary Care Patients.

OBJECTIVES People of low socio-economic status (SES) are particularly at risk for developing stress-related conditions. The purpose of this study is to examine depression, stress, and coping strategies among uninsured primary care patients who live below the 150th percentile of the federal poverty level. Specifically, this study compares the experiences of impoverished US-born English speakers, non-US-born English speakers, and Spanish speakers. METHODS Uninsured primary care patients utilizing a free clinic (N = 491) completed a self-administered survey using standardized measures of depression, perceived stress, and coping strategies in the spring of 2015. RESULTS US-born English speakers reported higher levels of depression and perceived stress compared to non-US-born English speakers and Spanish speakers. US-born English speakers are more likely to use negative coping strategies than non-US-born English speakers and Spanish speakers. Perceived stress and negative coping strategies are significant predictors of depression. CONCLUSION US-born English speakers, non-US-born English speakers, and Spanish speakers reported different coping strategies, and therefore, may have different needs for addressing depression. In particular, US-born English speakers need interventions for reducing substance use and negative psychological coping strategies.

Depression, somatic symptoms, and perceived neighborhood environments among US-born and non-US-born free clinic patients.

Objectives The study’s purpose was to examine the impact of somatic symptoms and perceived neighborhood environment on depression using a comparison among US-born and non–US-born free clinic patients. Methods US-born English speakers (n = 99), non–US-born English speakers (n = 89), and non–US-born Spanish speakers (n = 158) 18 years old or older (N = 346) were surveyed at a free clinic that provides primary care to people without health insurance. Depression, somatic symptoms, and perceived neighborhood environment were measured using standardized instruments. Results US-born English speakers reported higher levels of depression and a greater number of somatic symptoms than non–US-born Spanish speakers and non–US-born English speakers. Non–US born English speakers reported lower levels of depression and fewer somatic symptoms than Spanish speakers. Somatic symptoms and perceived neighborhood satisfaction were related to depression. Conclusions Developing mental health services for patients in a free clinic setting is needed; however, because of limited financial and human resources, providing mental health services in a free clinic setting often is difficult. Community-based health promotion programs as supplements to efforts within clinical settings would be valuable in improving the mental health of free clinic patients. Future studies should implement collaborative pilot programs and evaluate health outcomes.

Trajectory of intimate partner violence and healthcare seeking over the life course: study of Japanese women in the Tokyo metropolitan area, Japan

OBJECTIVES To describe the trajectory of, and examine factors affecting, intimate partner violence (IPV) and IPV-specific healthcare seeking among Japanese women over the life course. STUDY DESIGN Life course study. METHOD One hundred and one women, aged 24-80 years, who had a lifetime history of IPV were interviewed in the Tokyo metropolitan area, Japan in 2005 and 2006. Life course data were collected according to the life history calendar method. Hierarchical linear modelling was used to examine IPV-specific healthcare seeking over the life course. RESULTS Injury, formal or informal help seeking, public assistance, worse self-rated health status and smoking significantly increased the likelihood of IPV-specific healthcare seeking over the life course. There are significant cohort effects on healthcare seeking. The results suggest that women who experience IPV may seek healthcare services not only immediately after the first occurrence of IPV, but also later in life. CONCLUSIONS IPV is not always associated with immediate healthcare seeking. In particular, sexual IPV is not significantly associated with healthcare seeking. Pursuing formal and informal help is associated with healthcare seeking.

Intimate partner violence-related experiences and mental health among college students in Japan, Singapore, South Korea and Taiwan

Background: Intimate partner violence (IPV) is a significant public health threat that contributes to a wide range of mental and physical health problems for victims. Aims: The purpose of this study was to examine IPV-related experiences and mental health outcomes among college students in Japan, Singapore, South Korea and Taiwan. Methods: The data were obtained from the Inter-University Consortium for Political and Social Research (ICPSR), the International Dating Violence Study (IDVS) 2001–2006 (ICPSR 29583; N = 981; Japan n = 207; Singapore n = 260; South Korea n = 256; Taiwan n = 258). Results: Co-experience of physical IPV victimization and perpetration was associated with borderline personality traits and posttraumatic stress disorder (PTSD), but not with depression. Childhood sexual abuse, gender hostility and violence socialization were significant predictors of borderline personality traits, depression and PTSD. While country and gender variations in mental health are noted, there are two specific populations that may need special attention for mental health interventions: Taiwanese women especially for borderline personality traits and PTSD, and Japanese men especially for depression. Conclusion: IPV victimization and perpetration, childhood sexual abuse, gender hostility and violence socialization have a significant impact on the mental health of college students in Japan, Singapore, South Korea and Taiwan. Since IPV and mental health are significant public health issues, research on IPV and mental health consequences of IPV victimization and perpetration in these countries should be further expanded in order to better understand the interventions that will be effective in treating victims, perpetrators and victim/perpetrators of IPV.