Yolanda R. Davila

MEXICAN AND MEXICAN AMERICAN WOMEN IN A BATTERED WOMEN'S SHELTER: BARRIERS TO CONDOM NEGOTIATION FOR HIV/AIDS PREVENTION

Anecdotal information suggests that, for Hispanic women who are involved with abusive partners, condom use request as an HIV/AIDS sexual risk-reduction behavior may expose the women to risk of both abuse and HIV/AIDS. A qualitative study explored barriers to condom negotiation for HIV/AIDS prevention among Mexican and Mexican American women in abusive relationships. A convenience sample of 14 Mexican and Mexican American women was recruited from a battered womens shelter. A demographic form, a domestic violence assessment form, and audiotaped responses to a semistructured interview guide were used to collect data. Descriptive statistics were used to describe the sample. Audiotaped interviews were transcribed verbatim and submitted to content analysis, which revealed past and present themes of physical, psychological, and sexual abuse of Mexican and Mexican American women who requested condom use by their male sexual partners. Also identified by content analysis was the influence of mens power on womens public, private, and sexual interactions.

Reduced breastfeeding rates among obese mothers: a review of contributing factors, clinical considerations and future directions.

Maternal obesity is associated with significantly lower rates of breastfeeding initiation, duration and exclusivity. Increasing rates of obesity among reproductive-age women has prompted the need to carefully examine factors contributing to lower breastfeeding rates in this population. Recent research has demonstrated a significant impact of breastfeeding to reduce the risk of obesity in both mothers and their children. This article presents a review of research literature from three databases covering the years 1995 to 2014 using the search terms of breastfeeding and maternal obesity. We reviewed the existing research on contributing factors to lower breastfeeding rates among obese women, and our findings can guide the development of promising avenues to increase breastfeeding among a vulnerable population. The key findings concerned factors impacting initiation and early breastfeeding, factors impacting later breastfeeding and exclusivity, interventions to increase breastfeeding in obese women, and clinical considerations. The factors impacting early breastfeeding include mechanical factors and delayed onset of lactogenesis II and we have critically analyzed the potential contributors to these factors. The factors impacting later breastfeeding and exclusivity include hormonal imbalances, psychosocial factors, and mammary hypoplasia. Several recent interventions have sought to increase breastfeeding duration in obese women with varying levels of success and we have presented the strengths and weaknesses of these clinical trials. Clinical considerations include specific techniques that have been found to improve breastfeeding incidence and duration in obese women. Many obese women do not obtain the health benefits of exclusive breastfeeding and their children are more likely to also be overweight or obese if they are not breastfed. Further research is needed into the physiological basis for decreased breastfeeding among obese women along with effective interventions supported by rigorous clinical research to advance the care of obese reproductive age women and their children.

Community Readiness to Prevent Intimate Partner Violence in Bexar County, Texas

The purpose of this article is to describe the Community Readiness Model implemented by the San Antonio Safe Family Coalition in Bexar County, Texas, a coordinated community response to prevent intimate partner violence. The project used a participatory action process to (a) determine the citys and countys stage of readiness to prevent intimate partner violence; (b) identify differences in the city and county by dividing the area into sectors for the assessment; (c) engage the community in determining the accuracy and usefulness of the results of the assessment; (d) develop targeted strategies to move the city and county to a higher stage of readiness for prevention of intimate partner violence; and (e) evaluate the results of the project.

The social construction and conceptualization of sexual health among Mexican American women.

Research on the social construction and contextualization of sexual health among Latina women is sparse. This ethnographic study was aimed to bridge this gap by exploring sexual health experiences and behaviors of a Latina subgroup, Mexican American women. A series of individual semistructured, in-depth interviews were conducted with 20 Mexican American women from a sexual and reproductive health clinic in a large Southwestern city with a predominantly Mexican American population. Through thematic analysis, sacrificing of self, sexual silence, and taking control of self emerged as themes. These themes reflect the context within which construction of sexual health occurs and sexual health behaviors are influenced. Study findings are discussed within a socio-cultural framework for sexual health promotion intervention for both adolescent and adult Mexican American women.

Increasing Nurses’ Knowledge and Skills for Enhanced Response to Intimate Partner Violence

BACKGROUND A theoretically based intimate partner violence in-service program was developed, implemented, and evaluated among public health nurses. METHODS A two-phase, mixed-methods design was used. Phase 1 used qualitative methods for content development of the in-service program. Phase 2 used a one-group pretest-posttest design to evaluate the effectiveness of the program. RESULTS In Phase 1, nurses perceived a need for knowledge about community intimate partner violence prevention resources and enhancement of interviewing skills. In Phase 2, no significant difference was noted in level of intimate partner violence knowledge between pretest and posttest (p < .107). However, a significant difference in skill level was noted between pretest and posttest (p < .003). CONCLUSIONS Results support the use of an in-service program as an effective method of enhancing the intimate partner violence clinical skills of nurses.

HISPANIC WOMEN AND AIDS: GENDERED RISK FACTORS AND CLINICAL IMPLICATIONS

Current theory and research indicate that Hispanic women?s increased risk for AIDS is due to sociocultural and psychological factors that are influenced by gender. Hispanic women?s low social status limits their ability to negotiate safer sex behaviors for AIDS prevention. Female gender identity, based upon the desire for interpersonal attachment, places Hispanic women at risk for AIDS through a fear of abandonment by male sexual partners who perceive safer sex behaviors as unmasculine. Male sexual partners? beliefs, practices, and behaviors, such as bisexuality and the practice of anal intercourse, increase Hispanic women?s AIDS risk. The experience of involuntary sexual encounters and the lack of power to determine sexual behaviors and practices within these encounters also place Hispanic women at risk for AIDS.

Pilot Testing HIV and Intimate Partner Violence Prevention Modules Among Spanish-Speaking Latinas

The purpose of this study was to test two modules of a theoretically based, gender‐ and culturally specific HIV intimate partner violence risk reduction intervention for Spanish‐speaking Latinas. The themes of the modules were “¿Estás en una relación sana y segura?” (Are you in a healthy and safe relationship?) and “Mantenerse sana y segura” (Keeping yourself healthy and safe). An evaluative one‐group, repeated measure design with measures collected at preintervention (N = 31), immediate postintervention (n = 26), and 1‐month postintervention follow‐up (n = 20) design was used to evaluate the intervention. Study results represent a small but significant first step toward an integrative approach to the prevention of two major and interrelated public health issues among an at‐risk and underserved population.

Food security, maternal feeding practices and child weight-for-length

BACKGROUND Over consumption of energy-dense nutrient-poor foods may contribute to childhood obesity. We hypothesized that greater than recommended servings of sugar sweetened beverages and foods, indicators of food security, and a high maternal recumbent weight-for-length are positively associated with high percentages of child overweight/obesity. METHODS This secondary data analysis consisted of a sample of 240 mother-child dyads. The original studies were designed to examine the effect of a public health nursing intervention on optimal childhood growth for low-income, minority children. Eligibility to participate included: 1) mothers self-identified as Hispanic; 2) children were 12-24 months old; and 3) children were enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC); and 4) children were free of any major disease. Multivariate logistic regression examined the association between child weight, weight-for-length, maternal recumbent weight-for-length, childs eating schedule, maternal attitudes on feeding, food security, and consumption of sugar-sweetened beverages, desserts and fatty meats. RESULTS Receiving SNAP was positively associated with child weight-for-length (WL). Children whose mothers reported ever having received SNAP were 2.01 times more likely to be overweight compared to children whose mothers did not report ever having received SNAP (95% CI=1.04-3.90). Children who consumed desserts were 2.87 times more likely to be overweight compared to children who did not consume desserts (95% CI=1.19-6.88). Also, childs caloric intake was significantly associated with child WL. Children who consumed more calories were 1.00 times more likely to be overweight compared to children who consumed fewer calories (95% CI=1.00-1.00). DISCUSSION Research on food security and childrens weight has reported mixed findings. Methodological issues have been identified as contributory to the inconsistent findings. Of paramount importance to these studies is the measurement of low food security. CONCLUSION Children in this sample who were food insecure, as indicated by SNAP recipients, were more likely to have a higher WL measurement. Future studies should focus on the correlation between food security and hunger/satiety cues.

Contraception and the obese woman.

Purpose: Obesity has reached epidemic rates among U.S. women of reproductive age, many of whom want to use contraception. However, some forms of contraception can have adverse effects on an obese womans health. This article explores risks of contraception available in the United States and provides clinical recommendations for use by obese women. Data sources: Information was compiled by reviewing the scientific literature on contraception and female obesity using CINAHL, MEDLINE, PubMed search engines. Conclusions: The evidence is largely supportive of combined oral contraceptive (COC) use in carefully screened obese women without known risks factors for cardiovascular disease. The efficacy of COCs may be slightly reduced in obese women because of increased body mass. Other types of hormonal contraceptives have varying safety and efficacy reports when used by obese women. Intrauterine devices do not have reduced efficacy nor increased risks for obese women but insertion may be more difficult. Obesity has no effect on efficacy of barrier methods of contraception. Implications: Clinicians should conduct a careful history and physical exam with selected supporting laboratory tests when considering prescription of hormonal contraceptives for obese women. Obese women require health counseling to carefully follow directions for contraceptive use to avoid unintended pregnancy.

Group psychotherapy for abused women: A survivor-group prototype

Theoretical and research-based clinical psychiatric nursing interventions are prerequisites for the advancement of the psychiatric mental health nursing practice (Babich & Voit, 1991). Based on these prerequisites, the authors implemented a group psychotherapy intervention for battered women using Campbells adaptation (1986) of Littons survivor-group prototype (1976). This group prototype was chosen because it specifically recognizes the strengths of survivors of violent experiences. Major process and content themes were identified through analysis of group psychotherapy sessions, substantiating the efficacy of this group prototype as a basis for intervention with woman abuse.