Nihaya Daoud

Prevalence of abuse and violence before, during, and after pregnancy in a national sample of Canadian women

OBJECTIVES We describe the prevalence of abuse before, during, and after pregnancy among a national population-based sample of Canadian new mothers. METHODS We estimated prevalence, frequency, and timing of physical and sexual abuse, identified category of perpetrator, and examined the distribution of abuse by social and demographic characteristics in a weighted sample of 76,500 (unweighted sample = 6421) Canadian mothers interviewed postpartum for the Maternity Experiences Survey (2006-2007). RESULTS Prevalence of any abuse in the 2 years before the interviews was 10.9% (6% before pregnancy only, 1.4% during pregnancy only, 1% postpartum only, and 2.5% in any combination of these times). The prevalence of any abuse was higher among low-income mothers (21.2%), lone mothers (35.3%), and Aboriginal mothers (30.6%). In 52% of the cases, abuse was perpetrated by an intimate partner. Receiving information on what to do was reported by 61% of the abused mothers. CONCLUSIONS Large population-based studies on abuse around pregnancy can facilitate the identification of patterns of abuse and women at high risk for abuse. Before and after pregnancy may be particularly important times to monitor risk of abuse.

Lifestyle Intervention in Obese Arab Women: A Randomized Controlled Trial

BACKGROUND Few randomized controlled trials on lifestyle interventions have been reported in non-Western populations; none have been reported in Arab populations. METHODS From 2 Muslim Arab communities in Israel, obese, nondiabetic women aged 35 to 54 years with 1 or more components of the metabolic syndrome were randomized to either an intensive (n = 100) or a moderate (control) (n = 101) 12-month lifestyle intervention. Women in the intensive intervention had 11 individual and 11 group counseling sessions per year with a dietitian and 22 physical activity group sessions per year. Women in the moderate intervention had 3 individual and 2 group dietary counseling sessions per year and no guided physical activity. Cultural issues were addressed in the design and conduct of both interventions. The primary outcome measure was change in the metabolic syndrome and its components. RESULTS At 12 months, the intensive intervention group had median declines of 3.0 mg/dL (to convert to millimoles per liter, multiply by 0.0555) in fasting plasma glucose and 4.5 mg/dL (to convert to millimoles per liter, multiply by 0.0113) in triglyceride levels compared with median increases of 1 mg/dL in fasting plasma glucose and 5.8 mg/dL in triglyceride levels in the moderate intervention group (P = .01 and P = .02, respectively). The median waist circumference decreased by 5.4 cm in the intensive intervention group and by 3.1 cm in the moderate intervention group (P = .10). The prevalence of the metabolic syndrome decreased by 4.0% in the intensive intervention group and increased by 5.2% in the moderate intervention group (P = .12). CONCLUSION The 12-month culturally sensitive intensive lifestyle intervention was effective in improving some of the metabolic syndrome components in obese Arab women. Trial Registration clinicaltrials.gov Identifier: NCT00273572.

The contribution of socio-economic position to the excesses of violence and intimate partner violence among aboriginal versus non-Aboriginal Women in Canada.

OBJECTIVE: To examine the contribution of socio-economic position (SEP) in explaining the excess of any abuse and intimate partner violence (IPV) among Aboriginal versus non-Aboriginal women in Canada. This comparison has not been studied before.METHODS: We conducted logistic regression analysis, using nationwide data from a weighted sample of 57,318 Canadian-born mothers of singletons who participated in the Canadian Maternity Experiences Survey 2006-7.RESULTS: The unadjusted odds of any abuse and IPV were almost four times higher among Aboriginal compared to non-Aboriginal mothers; OR 3.91 (95% CI 3.12-4.89) and OR 3.78 (2.87-4.97), respectively. Adjustment for SEP reduced the unadjusted OR of any abuse and IPV by almost 40%. However, even with this adjustment, the odds of any abuse and IPV for Aboriginal mothers remained twice that of non-Aboriginal mothers; OR 2.34 (1.82-2.99) and OR 2.19 (1.60-3.00), respectively.CONCLUSIONS: SEP is a predominant contributor to the excess of abuse against Aboriginal vs. non-Aboriginal women in Canada. Reducing violence against Aboriginal women can be achieved mostly by improving their SEP, and simultaneously be informed by social processes and services that can mitigate abuse. The fact that SEP did not fully explain the excess of abuse among the Aboriginal women might lend support to “colonization or postcolonial theories,” and related contextual factors such as differences in community social resources (e.g., social capital) and services. The effect of these factors on the excess of abuse warrants future research.RésuméOBJECTIF: Examiner le rôle de la situation socioéconomique (SSE) pour expliquer le surcroît d’abus et de violence entre partenaires intimes (VPI) chez les femmes autochtones au Canada par rapport aux femmes non autochtones. Notre étude est la toute première à effectuer une telle comparaison.MÉTHODE: Nous avons analysé par régression logistique des données pancanadiennes tirées d’un échantillon pondéré de 57 318 femmes nées au Canada ayant accouché d’un enfant unique et ayant participé à l’Enquête canadienne sur l’expérience de la maternité de 2006-2007.RÉSULTATS: Les probabilités non ajustées d’abus et de VPI étaient près de quatre fois plus élevées chez les mères autochtones que chez les mères non autochtones: RC 3,91 (IC de 95 % 3,12–4,89) et RC 3,78 (2,87–4,97), respectivement. L’ajustement pour tenir compte de la SSE a réduit de près de 40 % le rapport de cotes non ajusté pour les cas d’abus et de VPI. Cependant, même avec cet ajustement, les probabilités d’abus et de VPI chez les mères autochtones demeurent deux fois plus élevées que chez les mères non autochtones: RC 2,34 (1,82-2,99) et RC 2,19 (1,60- 3,00), respectivement.CONCLUSIONS: La SSE est l’un des principaux facteurs contribuant au surcroît d’abus chez les femmes autochtones au Canada par rapport aux femmes non autochtones. Réduire la violence envers les femmes autochtones pourrait se faire principalement en améliorant leur SSE, tout en informant ces femmes des processus et des services sociaux qui peuvent atténuer les abus. Le fait que la SSE n’explique pas entièrement le surcroît d’abus que vivent les femmes autochtones pourrait accréditer les « théories » coloniales ou postcoloniales et les facteurs contextuels connexes, comme les différences dans les services et les ressources sociales communautaires (p. ex., le capital social). L’effet de ces facteurs sur le surcroît d’abus mérite d’être étudié plus avant.

Where Did She Go? The Transformation of Self-Esteem, Self-Identity, and Mental Well-Being among Women Who Have Experienced Intimate Partner Violence

BACKGROUND Discussions on intimate partner violence (IPV) often focus on physical abuse, ignoring psychological and sexual abuse and controlling behaviors. The damage of varied forms of IPV on mental well-being in its broader form have been far less explored, especially among low-income women. Our aim was to improve our understanding of self-perceptions of mental well-being among low-income women who have experienced IPV by considering a broader definition of mental well-being that includes self-esteem and self-identity as core components. METHODS Using qualitative methods, we present findings from in-depth interviews with 41 low-income women currently or recently experiencing abuse and housing instability. RESULTS Women experienced varied types of violence (physical, sexual, emotional, psychological, social isolation, and controlling behaviors). Injuries resulting from physical abuse were viewed differently from those arising from emotional and psychological control. Physical injuries healed faster, whereas damage to self-esteem and identity lingered. The journey through and out of IPV is often marked by an initial erosion of sense of self (identity deconstruction) followed by the identity reconstruction through an extended process of change aimed at rebuilding self-esteem, mental well-being, self-efficacy, and ultimately self-identity. CONCLUSIONS IPV-related training for physicians and allied health professionals should emphasize the varied nature of IPV and its impact on identity, self-esteem, and self-efficacy. Treatment should be holistic to address comorbid needs, including physical injury, mental health, and addiction problems. Consider supportive programs that integrate those living with or leaving IPV with women with past lived experience who can help women to understand the process of change and support this change in a nurturing setting.

Challenges Facing Minority Women in Achieving Good Health: Voices of Arab Women in Israel

ABSTRACT Arab women citizens of Israel bear a heavier burden of health problems compared with Jewish women. These inequalities were examined by conducting 6 focus groups that explored obstacles to achieving good health and strategies for maintaining good health as articulated by 86 Arab-Moslem women from the Triangle area in central Israel. Perceived obstacles ranged from personal to socio-political: unhealthy lifestyles, obedience to patriarchal norms, rapid lifestyle transitions, the political situation, poverty and lower socioeconomic status, and limited access to specific health care services. These multi-layered obstacles appeared to operate synergistically to limit womens access to social support and health care systems, intensify feelings of powerlessness, and further promote unhealthy behaviors. Moreover, these perceptions differed by the socioeconomic status of the group. The relatively more advantaged groups did not address issues related to poverty or access to health care services. Most health maintenance strategies discussed were personal and conservative, and ‘considerate’ of traditional Arab cultural norms. The findings provide a basis for developing more culturally competent and adequate health care services for Arab women in Israel and for further research concerning Arab womens health in the region.

Explanatory factors for health inequalities across different ethnic and gender groups: data from a national survey in England

Background The objective of this study was to examine the relative contribution of factors explaining ethnic health inequalities (EHI) in poor self-reported health (pSRH) and limiting long-standing illness (LLI) between Health Survey for England (HSE) participants. Method Using HSE 2003–2006 data, the odds of reporting pSRH or of LLI in 8573 Bangladeshi, Black African, Black Caribbean, Chinese, Indian, Irish and Pakistani participants was compared with 28 470 White British participants. The effects of demographics, socioeconomic position (SEP), psychosocial variables, community characteristics and health behaviours were assessed using separate regression models. Results Compared with White British men, age-adjusted odds (OR, 95% CI) of pSRH were higher among Bangladeshi (2.05, 1.34 to 3.14), Pakistani (1.77, 1.34 to 2.33) and Black Caribbean (1.60, 1.18 to 2.18) men, but these became non-significant following adjustment for SEP and health behaviours. Unlike Black Caribbean men, Black African men exhibited a lower risk of age-adjusted pSRH (0.66, 0.43 to 1.00 (p=0.048)) and LLI (0.45, 0.28 to 0.72), which were significant in every model. Likewise, Chinese men had a lower risk of age-adjusted pSRH (0.51, 0.26 to 1.00 (p=0.048)) and LLI (0.22, 0.10 to 0.48). Except in Black Caribbean women, adjustment for SEP rendered raised age-adjusted associations for pSRH among Pakistani (2.51, 1.99 to 3.17), Bangladeshi (1.85, 1.08 to 3.16), Black Caribbean (1.78, 1.44 to 2.21) and Indian women (1.37, 1.13 to 1.66) insignificant. Adjustment for health behaviours had the largest effect for South Asian women. By contrast, Irish women reported better age-adjusted SRH (0.70, 1.51 to 0.96). Conclusions SEP and health behaviours were major contributors explaining EHI. Policies to improve health equity need to monitor these pathways and be informed by them.

Conceptualizing Housing Instability: Experiences with Material and Psychological Instability Among Women Living with Partner Violence

Abstract Although recent research has documented that partner violence places women at risk of homelessness and material housing instability, sparse evidence yet documents the existence or importance of psychological housing instability for this group. We draw from 45 women’s reports of their experiences of housing instability across three periods: while living with their abusive partner, immediately after leaving the partner, and long after leaving. Housing instability—material and especially psychological—was a major concern for women across all periods, along with co-occurring social, familial, financial, mental health, and violence related problems. In the absence of coordinated services models, access to and navigation of available services to address these simultaneous problems posed important challenges for these women. The concept of housing instability should be expanded to include psychological instability, and, for women who are experiencing abuse, should be considered alongside numerous social and health problems that exacerbate housing precarity.

Social characteristics associated with disparities in smoking rates in Israel

Background Cigarette smoking is a major cause of health disparities. We aimed to determine social characteristics associated with smoking status and age at smoking initiation in the ethnically-diverse population of Israel. Methods This is a cross-sectional survey, based on data collected during 2010 by the Israel Bureau of Statistics, in a representative nationwide sample of 7,524 adults (≥20 years). Information collected by personal interviews included a broad set of demographic and socio-economic characteristics and detailed information on smoking habits. Associations between social characteristics and smoking habits were tested in multivariable regression models. Results Current smoking was more frequent among men than among women (30.9 % vs. 16.8 %; p < 0.0001). In multivariable regression analysis, the association of some social characteristics with smoking status differed by gender. Lower socioeconomic status (reflected by higher rate of unemployment, lower income, possession of fewer material assets, difficulty to meet living expenses) and lower educational level were significantly associated with current smoking among men but not among women. Family status other than being married was associated with higher likelihood of being a current smoker, while being traditional or observant was associated with a lower likelihood of ever smoking among both gender groups. Arab minority men and male immigrants from the former Soviet Union countries were more frequently current smokers than Israeli-born Jewish men [adjusted odds ratio (95 % confidence interval): 1.53 (1.22, 1.93) and 1.37 (1.01-1.87), respectively]. Compared to Israeli-born men, the age at smoking initiation was younger among male immigrants, and older among Arab minority men [adjusted hazard ratio (95 % confidence interval): 1.360 (1.165-1.586), and 0.849 (0.749-0.962), respectively]. While the prevalence of current smoking was lower in younger birth cohorts, the age at smoking initiation among ever-smokers declined as well. Conclusions Among several subgroups within the Israeli population the smoking uptake is high, e.g. Arab men, men who are less affluent, who have lower educational level, and male immigrants. These subgroups should be prioritized for intervention to reduce the burden of smoking. To be effective, gender, cultural background and socioeconomic characteristics should be considered in the design and implementation of culturally-congruent tobacco control and smoking prevention and cessation interventions. Electronic supplementary material The online version of this article (doi:10.1186/s13584-016-0095-2) contains supplementary material, which is available to authorized users.

Strategizing Safety: Theoretical Frameworks to Understand Women’s Decision Making in the Face of Partner Violence and Social Inequities:

Women in physically and psychologically abusive relationships face numerous decisions related to their safety: decisions that historically have been viewed by researchers and human service practitioners as related to individual or interpersonal factors, such as how they feel about their partner, what they (or those they are close to) think is best for their children, or whether they have a safe place to go to. Social and structural factors, such as poverty, sexism, and barriers related to disability, are either left out or viewed at their individual-level consequence, such as a woman’s employment status. Using interview data and case studies from a larger study on housing instability, partner violence, and health, the authors apply ecological and macro-level theoretical models that go beyond the individual level to the stories of women who struggled with partner violence, arguing that it is critical to examine the large social and structural forces that impact women’s lives if we are to understand the decisions women make when facing a violent partner.

Ethnic Discrimination and Smoking-Related Outcomes among Former and Current Arab Male Smokers in Israel: The Buffering Effects of Social Support

We examined the relationship between two forms of ethnic discrimination—interpersonal and institutional—and smoking outcomes among Arab men in Israel, and whether social support buffered these associations. We used cross-sectional data of adult Arab men, current or former smokers (n = 954). Mixed-effects regression models estimated the association between discrimination and smoking status, and nicotine dependence among current smokers. Interpersonal discrimination was associated with higher likelihood of being a current smoker compared to a former smoker, whereas institutional group discrimination was not. Social support moderated the ethnic discrimination-nicotine dependence link. Among men with low social support, greater interpersonal discrimination was associated with greater nicotine dependence. Similarly, among smokers with high institutional group discrimination, those with high social support reported lower nicotine dependence compared to those with low social support. Ethnic discrimination should be considered in efforts to improve smoking outcomes among Arab male smokers in Israel.