Brooke E. E. Montgomery

Parental Recognition of Overweight in School-age Children

Objective: Examine the accuracy of parental weight perceptions of overweight children before and after the implementation of childhood obesity legislation that included BMI screening and feedback.

Violence against women in selected areas of the united states

OBJECTIVES We determined the prevalence of recent emotional, physical, and sexual violence against women and their associations with HIV-related risk factors in women living in the United States. METHODS We performed an assessment of women ages 18 to 44 years with a history of unprotected sex and 1 or more personal or partner HIV risk factors in the past 6 months from 2009 to 2010. We used multivariable logistic regression to examine the association of experiencing violence. RESULTS Among 2099 women, the prevalence of emotional abuse, physical violence, and sexual violence in the previous 6 months was 31%, 19%, and 7%, respectively. Nonmarried status, food insecurity, childhood abuse, depression symptomology, and posttraumatic stress disorder were significantly associated with multiple types of violence. All types of violence were associated with at least 3 different partner or personal HIV risk behaviors, including unprotected anal sex, previous sexually transmitted infection diagnosis, sex work, or partner substance abuse. CONCLUSIONS Our data suggested that personal and partner HIV risk behaviors, mental illness, and specific forms of violence frequently co-occurred in the lives of impoverished women. We shed light on factors purported to contribute to a syndemic in this population. HIV prevention programs in similar populations should address these co-occurring issues in a comprehensive manner.

The “Translators”: Engaging Former Drug Users as Key Research Staff to Design and Implement a Risk Reduction Program for Rural Cocaine Users

This manuscript describes lessons learned in the development and implementation of a clinical behavioral trial to reduce sexual risk among African-American cocaine users in rural Arkansas, from the perspectives of a multidisciplinary investigative team and community staff members with a history as local drug users who served as “translators.” Recommendations for investigators doing community-based research with active substance users are provided in the following domains: (a) engaging the community during formative research, (b) establishing bidirectional trust, (c) ensuring community voices are heard, and (d) managing conflict. The “translators” role is critical to the success of such projects.

Dimensions of Religion, Depression Symptomatology, and Substance Use Among Rural African American Cocaine Users

Research has shown a relationship between depression, substance use, and religiosity but, few have investigated this relationship in a community sample of African Americans who use drugs. This study examined the relationship between dimensions of religion (positive and negative religious coping; private and public religious participation; religious preference; and God-, clergy-, and congregation-based religious support), depression symptomatology, and substance use among 223 African American cocaine users. After controlling for gender, employment, and age, greater congregation-based support and greater clergy-based support were associated with fewer reported depressive symptoms. In addition, greater congregation-based support was associated with less alcohol use.

“We as Drug Addicts Need that Program”: Insight from Rural African American Cocaine Users on Designing a Sexual Risk Reduction Intervention for Their Community

This focused ethnographic study examines data collected in 2007 from four gender- and age-specific focus groups (FGs) (N = 31) to inform the development of a sexual risk reduction intervention for African American cocaine users in rural Arkansas. A semi-structured protocol was used to guide audio-recorded FGs. Data were entered into Ethnograph and analyzed using constant comparison and content analysis. Four codes with accompanying factors emerged from the data and revealed recommendations for sexual risk reduction interventions with similar populations. Intervention design implications and challenges, study limitations, and future research are discussed. The study was supported by funds from the National Institute of Nursing Research (P20 NR009006-01) and the National Institute on Drug Abuse (1R01DA024575-01 and F31 DA026286-01).

Chapter 5 Poverty, Personal Experiences of Violence, and Mental Health: Understanding Their Complex Intersections Among Low-Income Women

Low-income women face myriad challenges in maintaining good psychological well-being and receiving mental health treatment. Women living in poverty in the USA experience extremely high rates of mental illness, particularly depression, anxiety disorders, and post-traumatic stress disorder (PTSD) compared with the general population. The stress of having highly constrained financial resources, as well as increased exposure to personal and neighborhood violence, leads to anxiety, depression, and PTSD. Studies suggest that the negative effects of exposure to personal violence and poverty may synergistically impair low-income women’s mental health. Furthermore, women’s roles, both traditionally and often in actuality, add to the stressors that women face, as they carry the primary responsibility for parenting and, increasingly, as primary breadwinners. This chapter reviews the literature demonstrating the intersection between having a low income, exposure to personal violence, and maintenance of psychological well-being. We then present qualitative and quantitative data from the HPTN 064 study demonstrating women’s lived experiences of these factors. This chapter also explores the role of resiliency in these women’s lives and ends with recommendations for enhancing mental health of low-income women.

Presentation and Management of Venomous Snakebites: Should All Patients Be Transferred to a Tertiary Referral Hospital?

Venomous snakebites may be difficult to manage because of the varied clinical presentations that may lead to uncertainty regarding the most appropriate medical and surgical management. Frequently, snakebite victims are referred from smaller rural hospitals to larger tertiary centers offering more specialized services and care. A retrospective chart review was performed using medical records from both adult and pediatric hospitals in a rural state over a 7-year period (January 2004 to January 2011) to investigate the utility of intensive care and specialized medical services offered at tertiary referral centers. The results demonstrated that presentation of venomous snakebites is the same in adults and children as well as the management. The results also demonstrated that the use of supportive care and antivenin alone was successful in the management of the vast majority of snakebites. Most snakebite victims recovered with nonsurgical care; thus surgical intervention is rarely warranted. These findings demonstrate that snakebite victims may not need referral to a tertiary center, if the primary local hospital has supportive care capacity and familiarity with antivenin usage.

Stakeholder Identification of Barriers and Facilitators to Sexual Health Education for Female Survivors of Violence: A Mixed Methods Study.

ABSTRACT There is a strong relationship between experiencing violence and participating in behaviors that increase the risk of contracting sexually transmitted infections. Sexual health education (SHE) tailored to the unique needs of female survivors of violence is needed. This paper presents findings from 40 surveys and 33 accompanying interviews with stakeholders representing 31 agencies in the violence advocacy community in Arkansas to investigate the feasibility, acceptability, and perceived need of a SHE program for female survivors of violence. Data also explore the role and preferences of community agencies in the design and implementation of such a program. Interviews with stakeholders revealed three themes: intervention concerns, content, and structure.

Adaptation and Pilot Testing of a Sexual Health Intervention for Female Survivors of Violence

ABSTRACT Experiences of violence and behaviors that increase the risk of acquiring a sexually transmitted infection are high among women in the United States, and they often intersect (Meyer, Springer, & Altice, 2011; Montgomery et al., 2015; World Health Organization (WHO), 2010). However, there are few evidence-based HIV-prevention interventions that address the special needs and challenges faced by female survivors of violence (Centers for Disease Control and Prevention, (CDC), 2017a). To address this gap, we adapted and pilot-tested an existing evidence-based women-focused sexual risk-reduction intervention (The Future Is Ours) with 23 self-identified female survivors of violence. The intervention comprised eight-weekly, two-hour cognitive behavioral group sessions focusing on reducing sexual-risk and improving trauma-based coping skills. Using mixed-methods analyses, the adapted intervention was determined feasible and acceptable to participants, and preliminary results suggest that participation could reduce risk factors for sexually transmitted infections. Therefore, testing on a larger scale is warranted.

Reducing Risky Sex among Rural African American Cocaine Users: A Controlled Trial

Abstract:Rural African American cocaine users experience high rates of STIs/HIV. This NIDA-funded trial tested an adapted evidence-based risk reduction program versus an active control condition. Participants were 251 African American cocaine users in rural Arkansas recruited from 2009-2011. Outcomes included condom use skills and self-efficacy, sexual negotiation skills, peer norms, and self-reported risk behavior. The intervention group experienced greater increases in condom use skills and overall effectiveness in sexual negotiation skills. Both groups reported reductions in trading sex, improvements in condom use self-efficacy, and increased use of specific negotiation skills. Implications and limitations are discussed.