Sheela Raja

The co-occurrence of childhood sexual abuse, adult sexual assault, intimate partner violence, and sexual harassment: a mediational model of posttraumatic stress disorder and physical health outcomes.

This study examined the co-occurrence of childhood sexual abuse, adult sexual assault, intimate partner violence, and sexual harassment in a predominantly African American sample of 268 female veterans, randomly sampled from an urban Veterans Affairs hospital womens clinic. A combination of hierarchical and iterative cluster analysis was used to identify 4 patterns of womens lifetime experiences of violence co-occurrence. The 1st cluster experienced relatively low levels of all 4 forms of violence; the 2nd group, high levels of all 4 forms; the 3rd, sexual revictimization across the lifespan with adult sexual harassment; and the 4th, high intimate partner violence with sexual harassment. This cluster solution was validated in a theoretically driven model that examined the role of posttraumatic stress disorder (PTSD) as a mediator of physical health symptomatology. Structural equation modeling analyses revealed that PTSD fully mediated the relationship between violence and physical health symptomatology. Consistent with a bio-psycho-immunologic theoretical model, PTSD levels more strongly predicted pain-related physical health symptoms compared to nonpain health problems. Implications for clinical interventions to prevent PTSD and to screen women for histories of violence in health care settings are discussed.

Assessing Attitudes Toward Lesbians and Gay Men: The Modern Homophobia Scale

The authors developed the Modern Homophobia Scale (MHS), a scale that includes measures of attitudes toward lesbians (MHS-L) and attitudes toward gay men (MHS-G). An initial pool of 97 items was generated by the authors based on a review of the literature on homophobia and feedback from several focus groups. Responses to the initial pool of items were factor analyzed. The final versions of the MHS-L and the MHS-G included items reflecting the following factors: Personal Discomfort with lesbians/gay men, Institutional Homophobia toward lesbians/gay men, and the Deviance/Changeability of female/male homosexuality. Although the Personal Discomfort, Institutional, and Deviance/Changeability factors were separable, they were highly correlated and showed little evidence of divergent validity. Reactions to gay, lesbian, and heterosexual characters in written vignettes provided initial support for the validity of the MHS. Both the MHS-L and MHS-G were significantly correlated with the Index of Homophobia and the Attitudes Toward Women Scale. A greater degree of homophobia on the MHS-L and MHS-G was associated with a greater degree of socially desirable responding as measured by the Balanced Inventory of Desirable Responding. Lower levels of homophobia on the MHS-L and MHS-G were associated with having lesbian and gay acquaintances and friends. On the MHS-L, men and women did not differ in their overall level of homophobia toward lesbians, but significant gender differences on MHS-L factor scores were present. Compared to men, women were more supportive of gay men on all three factors of the MHS-G.

The Radiating Impact of Intimate Partner Violence

Many studies of violence against women focus on the impact of abuse on the victims emotional and physical well-being. Here the authors expand the conceptualization of the impact of violence to include other aspects of the victims life as well as the lives of those in her social world. Analyses of life narrative interviews with women 1 year after their stay in battered womens shelters indicates that violence affects not only women who are abused but also those who are not directly victimized yet who nonetheless suffer consequences of violence. The authors discuss the implications of this conceptualization of violence for both research and policy

The Treatment Advocacy Program-Sinai: A Peer-Based HIV Prevention Intervention for Working with African American HIV-Infected Persons

As HIV/AIDS continues to disproportionately affect African American communities, there is a growing need for empirically based, culturally appropriate, tailored interventions for this clientele. As part of a Health Resources and Services Administration (HRSA)/Special Projects of National Significance (SPNS) initiative to increase prevention amongst those living with HIV, we implemented the Treatment Advocacy Program Intervention at Mount Sinai Hospital in Chicago, IL, USA. The main goal of the intervention was to help patients increase their medication adherence and sexual safety skills. This paper describes the rationale for implementing this peer-based HIV-prevention intervention, discusses how the intervention was tailored to work within our low socio-economic status, urban patient population, and reviews the training and quality assurance activities needed to integrate the intervention into our primary care clinic. We review the intervention content in detail, including the structure of the multiple, one-on-one education sessions, and the core topics covered (medication adherence and sexual safety). Finally, we discuss the challenges in implementing this program, many of which arise from the chaotic social situations that our patients experience.

Identifying Elements of Patient-Centered Care in Underserved Populations: A Qualitative Study of Patient Perspectives

Patient-centered care is an important goal in the delivery of healthcare. However, many patients do not engage in preventive medical care. In this pilot study, we conducted twenty in depth, semi-structured qualitative interviews at the University of Illinois at Chicago Health Sciences campus in a four month time frame. Many patients were underserved and underinsured, and we wanted to understand their experiences in the healthcare system. Using content analysis, several themes emerged from the interview data. Participants discussed the need for empathy and rapport with their providers. They identified provider behaviors that fostered a positive clinical relationship, including step-by step explanations of procedures, attention to body language and clinic atmosphere, and appropriate time management. Participants identified cost as the most common barrier to engaging in preventive care and discussed children and social support as motivating factors. A long-term relationship with a provider was an important motivator for preventive care, suggesting that the therapeutic alliance was essential to many patients. Conversely, many participants discussed a sense of dehumanization in the healthcare system, reporting that their life circumstances were overlooked, or that they were judged based on insurance status or ethnicity. We discuss implications for provider training and healthcare delivery, including the importance of patient-centered medical homes.

Implementing peer-based interventions in clinic-based settings: Lessons from a multi-site HIV prevention with positives initiative

ABSTRACT Interventions for people with HIV/AIDS became a national priority in 2003. While the importance of involving HIV-positive people in the design, delivery, and evaluation of prevention programs is widely recognized, information about how to implement peer-based services in clinic settings is sparse. The four projects described in this article implemented peer-based interventions as part of larger, multi-site Special Projects of National Significance (SPNS) initiative. Common themes reported by Project Directors/Evaluators describe the challenges and benefits of peer-based interventions across these programs, including infrastructural, clinical and research-related issues. We also discuss the benefits to Peers, researchers, and the clinics sites.

History of Traumatic Events in HIV-Positive Individuals: Risk Behavior Implications in an Urban Clinic Setting

As HIV/AIDS continues to disproportionately affect African American communities, the need for culturally appropriate, tailored interventions for this clientele is growing. Although prevention efforts often include information about individual coping and mental health, not all programs address the role of traumatic events, including community violence in relation to HIV risk. The authors implemented the Treatment Advocacy Program-Sinai with HIV-positive individuals at a large urban hospital. After controlling for demographics and other psychosocial factors, they found that a history of traumatic events—domestic, sexual, and community violence—were associated with sexual risk behavior for men and women in our sample; however, community violence was overwhelming associated with sexual risk for women. Based on the prevalence of violence and the relationship with sexual risk, they discuss implications for prevention interventions in urban clinic settings.

Trauma Informed Care in Medical Settings: A Pilot Study of Female Patient Perspectives on Coping, Screening and Fostering Resilience

Preconception Care: Prevalence of Chronic Disease All women of childbearing age hope that their children will be born healthy when they become pregnant. To have a healthy baby and be a healthy mother are universally valued goals. If women want to give birth to a healthy baby, the health of the mother should be the initial priority; this idea forms the basis of preconception care.

Self-reported physical health associations of traumatic events in medical and dental outpatients: a cross-sectional study.

AbstractThe purpose of this cross-sectional study was to understand the prevalence and severity of health-related sequelae of traumatic exposure in a nonpsychiatric, outpatient sample.Self-report surveys were completed by patients seeking outpatient medical (n = 123) and dental care (n = 125) at a large, urban academic medical center.Results suggested that trauma exposure was associated with a decrease in perceptions of overall health and an increase in pain interference at work. Contrary to prediction, a history of interpersonal trauma was associated with less physical and emotional interference with social activities. A history of trauma exposure was associated with an increase in time elapsed since last medical visit. Depression and anxiety did not mediate the relationship between trauma history and medical care.Based on these results, clinical and research implications in relation to the health effects of trauma are discussed. The results suggest that routine screening for traumatic events may be important, particularly when providers have long-term relationships with patients.