Linda Halcon

Somali and Oromo Refugees: Correlates of Torture and Trauma History

OBJECTIVES This cross-sectional, community-based, epidemiological study characterized Somali and Ethiopian (Oromo) refugees in Minnesota to determine torture prevalence and associated problems. METHODS A comprehensive questionnaire was developed, then administered by trained ethnic interviewers to a nonprobability sample of 1134. Measures assessed torture techniques; traumatic events; and social, physical, and psychological problems, including posttraumatic stress symptoms. RESULTS Torture prevalence ranged from 25% to 69% by ethnicity and gender, higher than usually reported. Unexpectedly, women were tortured as often as men. Torture survivors had more health problems, including posttraumatic stress. CONCLUSIONS This study highlights the need to recognize torture in African refugees, especially women, identify indicators of posttraumatic stress in torture survivors, and provide additional resources to care for tortured refugees.

Prevalence and predictors of sexual risks among homeless youth.

This study examined prevalence of sexual risks among homeless adolescents and described factors associated with those risks. Community-based outreach methods were used successfully to access this difficult-to-reach population. The sample included 203 homeless youth aged 15–22 recruited from community sites. Questionnaire items addressed demographics, sexual behaviors, alcohol/drug use, STI history and testing, and pregnancy history. In cross-sectional analysis, 58.7% of males and 75.6% of females reported recent sexual intercourse. Of those, one third of males and half of the females used no barrier method with at least one partner. Both gender (female) and race/ethnicity (non-Black) were associated with having intercourse without a barrier contraceptive method. Over one fifth reported a history of “survival sex” or receiving money, drugs, clothing, shelter, or food for sex. These results show disturbingly high rates of a number of sexual risks, reinforcing the need for targeted interventions with this highly vulnerable population.

Adolescent Health in the Caribbean: Risk and Protective Factors

OBJECTIVES This study sought to identify, among youths, factors associated with characteristics such as poor health status, substance use, and suicide risk and to explore the extent to which the risk and protective factors identified cut across health-compromising behaviors. METHODS A survey was administered to representative samples of young people from 9 Caribbean countries. RESULTS Physical/sexual abuse and having a friend or relative who had attempted suicide were associated with an increased prevalence of health-compromising behaviors. Connectedness with parents and school and attendance at religious services were associated with fewer health risk behaviors. CONCLUSIONS When the identified risk and protective factors were compared with those seen among young people in the United States, similarities as well as important differences were found.

Sampling in difficult to access refugee and immigrant communities

We evaluated sampling strategies and trust-building activities in a large multiphase epidemiologic study of torture prevalence in populations that were difficult to locate and enroll. Refugee groups under study were Somalis from Somalia and Oromos from Ethiopia who were living in Minneapolis and St. Paul, Minnesota, in 1999–2002. Without a complete sampling frame from which to randomly recruit participants, we employed purposive sampling methods. Through comparative and statistical analyses, we found no apparent differences between our sample and the underlying population and discovered no effects of recruiting methods on study outcomes, suggesting that the sample could be analyzed with confidence. Ethnographic trust and rapport-building activities among investigators, field staff, and immigrant communities made it possible to obtain the sample and gather sensitive data. Maintaining a culture of trust was crucial in recovering from damaging environmental events that threatened data collection.

Complementary therapies and healing practices: faculty/student beliefs and attitudes and the implications for nursing education

The purpose of this study was to describe the knowledge and attitudes of nursing faculty and students (BSN and MS) regarding complementary/alternative therapies (C/AT) and their integration into nursing practice. Implications for curricular and faculty development were also identified. A cross-sectional survey (n = 170) of graduating BSN students (n = 73) and MS and PhD students (n = 47) and faculty (n = 50) was conducted in a university-based nursing program. The self-administered questionnaire contained 134 forced choice items. Questions assessed attitudes and knowledge about training in, personal use of, perceived barriers to, and intent to integrate C/AT into clinical practice. Over 95 percent of the students and faculty agreed that clinical care should integrate the best of conventional and C/AT practices. Few had received formal C/AT education; the highest number had received some education about massage, music, prayer/spiritual healing, and therapeutic/healing touch. They desired more education but not necessarily the skills to perform these therapies themselves. Faculty and students expressed positive attitudes about incorporating C/AT into curricula and nursing practice. Current knowledge lags behind interest, however, suggesting a situation ripe for change. The most important perceived barrier to incorporation was lack of evidence. Curricular change is needed to fully integrate C/AT in nursing programs at all levels; faculty development and nursing research is needed to facilitate these changes.

Adolescent Health in the Caribbean: A Regional Portrait

OBJECTIVES This study assessed youth health in the Caribbean Community and Common Market countries and describes the prevalence of health-related factors. METHODS We used a self-administered classroom questionnaire; questions addressed general health, health care, nutrition, sexual history, drug use, mental health, violence, family characteristics, and relationships with others. RESULTS Most youths reported good health; however, 1 in 10 reported a limiting disability or significant health problems. Violence was a pervasive concern. Of those who reported history of sexual intercourse, many reported that their first intercourse was forced, and nearly half reported that they were aged 10 years or younger when they first had intercourse. CONCLUSIONS Although most young people are healthy, problems indicate the importance of monitoring trends and designing effective youth health programs.

Sexual Abuse History, Risk Behavior, and Sexually Transmitted Diseases: The Impact of Age at Abuse

Objective: The objective of this study was to examine the relationship between age at onset of sexual abuse, risk behaviors, and a diagnosis of sexually transmitted disease (STD) in a clinic-attending adolescent population. Methods: Bivariate analyses were used to test association among age at onset of sexual abuse, risk behaviors, and STD diagnosis (n = 2175). Relationship between sexual abuse and STD acquisition was assessed by regression analysis. Results: More females than males reported sexual abuse, 26.75% and 5.4%, respectively. Abuse at or before 10 years of age was associated with more lifetime and recent partners. History of abuse was associated with higher rates of STD tests. In regression analysis, for males and females, the odds of having an STD were 2.5 times greater if abuse occurred at 10 years or younger. Conclusion: Sexual abuse at a younger age is associated with more sexual risk behaviors and is a risk factor for STDs.

Substance abuse and high-risk needle-related behaviors among homeless youth in minneapolis: Implications for prevention

Homeless and runaway youth face a variety of health, risks, including those related to substance abuse and use of unsterile needles. During 1998–1999, we recruited 201 Minneapolis homeless youths aged 15–22 years; these youths were interviewed by experienced street outreach workers from settings where street youth were known to congregate. Respondents spent a median of 6 months in the previous year living on the streets or “couch hopping.” There were 37% who reported having 15 or more alcoholic drinks per week, 41% smoked 1 pack or more of cigarettes per day, and 37% used marijuana 3 or more times a week; 15% reported lifetime injection drug use, including 6% who used injection drugs within the previous month. Twenty percent had received a tattoo, and 18% body piercing with a needle that had not been sterilized or had been used by someone else. There were 68% who had been tested for human immunodeficiency virus (HIV), 52% for hepatitis B, and 25% for hepatitis C. There were 44% who said they did not have enough information about hepatitis B and C. Less than half (43%) received hepatitis B vaccine; however, 51% of unvaccinated youths indicated that they would receive vaccination if offered. These Midwestern homeless youths face multiple health risks, including those related to substance use and exposure to unsterile needles. Despite unsafe behaviors, many of these youths were interested in methods to protect their health, including education, knowing their HIV or viral hepatitis serostatus, and obtaining hepatitis B immunization.

Screening for sexually transmitted infections among economically disadvantaged youth in a national job training program

PURPOSE To evaluate results of screening for syphilis, gonorrhea, and chlamydia among youth in a federally funded job training program. METHODS Data were evaluated from medical records of 12,881 randomly selected students in 54 U.S. job training centers during 1996. The intake medical evaluation includes serologic testing for syphilis. The policy was for females to receive a pelvic examination with gonorrhea and chlamydia testing and for males to be first screened with a urine leukocyte esterase (LE) assay, with follow-up gonorrhea and chlamydia testing for those with positive LE results. RESULTS Adjusting for our sampling strategy, among females, an estimated 9.2% had a positive chlamydia test, 2.7% a positive gonorrhea test, and 0.4% had a positive syphilis test. Gonorrhea and chlamydia rates among females were highest in African-American followed by Native American students. Chlamydia infection was most common in younger women < or = 17 years of age. An estimated 0.1% of males had a positive syphilis test, and 4.8% of males a positive urine LE test. Of 103 LE-positive males tested for gonorrhea and chlamydia, only 27 (26%) had a positive test for one of these STDs. CONCLUSIONS Our study supports routine screening of adolescents for gonorrhea and chlamydia, including those youth from socioeconomically disadvantaged backgrounds. Because individuals from such backgrounds may not regularly interact with traditional clinical health care systems, screening and treatment should be offered in alternative settings, such as the job training program described in this study.

Evaluating Health Realization for Coping Among Refugee Women

Many East African refugee women have experienced torture and trauma while fleeing from their home countries. Many also experience high rates of isolation, depression, and symptoms of posttraumatic stress disorder after resettlement. Effective methods are needed for improving the mental well-being of this population. This pilot study (N = 19) tested the feasibility, accessibility, and acceptability of a strengths-based, community-delivered intervention with Somali and Ethiopian women refugees. Feasibility was established through recruitment, retention, participation, and participant response. Accessibility was established through providing meals, transportation, and child-care assistance. Acceptability was established through evaluating translated materials, cultural congruence, and perceived relevance. Results support testing in a full-scale controlled study.