Jacquelyn C. Campbell’s research while affiliated with Johns Hopkins Bloomberg School of Public Health and other places

Black women are disproportionately impacted by mental health conditions, like depression, posttraumatic stress disorder (PTSD), and substance use harms. Experiences of discrimination may cause and exacerbate these conditions, but little is known about how distinct types of discrimination (overt vs. subtle) may be related to these outcomes. The current study sought to evaluate the associations between overt and subtle discrimination, mental health, and substance misuse outcomes among Black women. Data were drawn from ESSENCE, a retrospective cohort study (2013–2018) on sexual assault and HIV risk among Black women attending sexually transmitted disease (STD) clinics in Baltimore, Maryland (n = 199). Multivariable Poisson regression models tested the associations between overt and subtle discrimination, depressive and PTSD symptoms, and substance misuse while controlling for covariates. Nearly half (42.2%) of participants reported depressive symptoms, and over a third reported severe PTSD symptoms (35.2%). Higher levels of subtle discrimination were associated with increased risk of depressive symptoms (adjusted relative risk [aRR] = 1.32, 95% confidence interval [CI]: 1.16, 1.50, p < .0001), whereas higher levels of overt discrimination were associated with increased risk of severe PTSD symptoms (aRR = 1.22, 95% CI [1.02, 1.46], p = .0287). Neither overt nor subtle discrimination was significantly associated with hazardous alcohol use or daily marijuana use in adjusted models. We identified that subtle discrimination has a unique negative association with depressive symptoms, while overt discrimination is positively associated with PTSD symptoms. This information is critical for tailoring stigma reduction interventions and mental health supports for Black women.

Background Firearms are the leading cause of victimization of abused women by intimate partner homicide and intimate partner homicide-suicides in the US. This calls for evidence-based intervention strategies to prevent firearm-related injuries or mortality and address the firearms-related safety needs of women in abusive relationships. My Safety Steps (MySteps) was designed to comprehensively assess women's firearm-related risks, and current safety needs and to prevent women's harm from their abuser's access or ownership of a firearm through a digitally delivered firearm-focused safety planning intervention. This paper describes the development, feasibility, acceptability, and preliminary evaluation of the digital BSHAPE intervention among women survivors of intimate partner violence (IPV). Methods Using a pretest post-test control group design, the study was conducted with 103 participants with 55 women randomly assigned to the MySteps arm and 48 women to the standard of care control arm. The feasibility and acceptability outcomes assessed were enrollment, adherence, and perceptions of the intervention. Preliminary evaluation outcomes included the partner's access to a firearm, women's self-efficacy beliefs, and empowerment. Further, qualitative follow-up interviews were conducted with 30 survivors of IPV in the MySteps arm to follow up on the use and helpfulness of safety strategies provided in MySteps. Results and conclusion The intervention was found to be feasible, and acceptable and demonstrated improved outcomes for survivors of IPV at risk from their partner's firearm. Women provided feedback for further refinement. The findings of this study will be useful in further refining MySteps and testing it in a full-scale randomized controlled trial.

BACKGROUND Emerging evidence supports that women with histories of abuse have heightened levels of stress and immune dysregulation. Few studies have examined the biological plausibility of this association in U.S. Black women– a population disproportionately affected by gender-based violence, health disparities, and generally under-represented in research. Biomarkers of stress and immune health can be difficult to study due to issues in participant recruitment, retention, and protocol adherence. This study documents the process of an at-home, self-collected and minimally invasive salivary cortisol collection protocol among a sample of Black women with histories of abuse in Baltimore City, Maryland, U.S. OBJECTIVE The paper's aims are two-fold. First, we describe the at-home, self-collection protocol that we developed for use among a large sample of under-represented racial and ethnic minority women with histories of abuse. Secondly, we share the best practices for our experimental, minimally invasive salivary CAR self-collection procedure that spanned three consecutive days for the ESSENCE project participants. Our paper addresses several issues and gaps in salivary CAR research, including the following: study sample sizes have been limited and lack statistical power, study samples have lacked racial and ethnic diversity, factors that could improve saliva self-collection protocol adherence are unknown, use of phone technology in facilitating protocol adherence is unknown, the feasibility and acceptability of saliva self-collection protocol among vulnerable populations (including women with experiences of violence) and the supports needed for protocol adherence is unknown. The establishment of this protocol and the markers gathered are foundational to understanding the effect of violence and toxic stress on women’s health. METHODS Black women (n=310) were recruited from November 2015 to May 2018 from Baltimore City STD clinics. Participants received in-person instruction and demonstration of how to self-collect saliva samples at home via the passive drool method and were given study-issued cell phones for reminders and to document protocol adherence. At home, participants collected saliva samples upon waking and 30 minutes post-waking on three consecutive weekdays (cortisol awakening response – 2 samples/day for 3 days). Study staff then retrieved saliva samples from participants’ residences, administered a short survey assessing their understanding and adherence to the saliva collection protocol, and documented the retrieval process. RESULTS Overall, the results report on our saliva collection protocol results, and demonstrate the feasibility of saliva cortisol awakening response among Black women with histories of abuse. Of the 305 women who completed the survey, 224 completed the saliva specimen collection protocol. Of the women who completed the saliva specimen collection protocol, 92 (41%) had a history of forced sex since age 18 (exposed women) and 132 (59%) had no history of forced sex in adulthood (non-exposed women). Women who completed the saliva protocol were similar in demographic characteristics to those of the full study sample (n=305) in terms of age, level of education, employment status, annual individual income, currently in a relationship, and having at least one child living in the household. The high adherence rate and successful collection of salivary cortisol samples support the feasibility of at-home self-collection protocols in this population. CONCLUSIONS This study demonstrates the feasibility and acceptability of self-collection of salivary cortisol for cortisol awakening response among a hard-to-reach sample of U.S. Black women with experiences of trauma and abuse. Research implications include the facilitation of the collection of salivary biomarkers (including stress and inflammation measures) to promote research that examines the physiological and health repercussions of gender-based violence within the context of women’s everyday lives. CLINICALTRIAL N/A

Introduction Suicide is a leading cause of death among Native American youth and adolescents in the USA. A myriad of factors have been correlated with risk for suicide ideation (SI)/suicide attempt (SA), including historical trauma; however, accurate measurement of historical trauma has been inconsistent. Objective To examine the association of family history of a negative mandatory boarding school experience with SI and SAs. Methods An anonymous online survey was conducted with 288 Native youth aged 15–24 years from the Fort Peck Reservation in Montana. Multinomial regression was applied adjusting for other known risk and protective factors of SI and SAs. Results Thirty-five percent reported past SAs and 15% reported ideation without prior attempt. Of the 129 (45%) reporting a family history of mandatory boarding school experiences, 28% perceived the experience as positive while 22% as negative. After adjusting for risk and protective factors, both SI and SAs were associated with a family history of negative mandatory boarding school experiences (adjusted OR (AOR)=4.8 and 4.3, respectively) and polydrug use (AOR=3.6 and 2.3). SAs were also associated with post-traumatic stress disorder (AOR=2.6) and depressive symptoms (AOR=3.6). Conclusion The association between family history of negative mandatory boarding school experiences and SI and SAs implies that culturally responsive interventions are needed to reduce the intergenerational impacts of historical trauma.

Despite domestic violence and related homicides perpetrated by partners and/or in-laws being a significant public health problem in India, there are no reliable and valid instruments to identify and intervene with women in domestic violence relationships. Continued domestic violence can escalate to severe, near-lethal, or lethal violence or homicide. The Danger Assessment (DA) is a risk assessment instrument designed to assess the likelihood of severe, near-lethal, or lethal violence in abusive relationships. However, the DA is not designed to determine the risk of future severe, near-lethal, or lethal violence by in-laws. In-law abuse plays a significant role in domestic violence-related homicides in India and other countries with similar cultural norms. This study addressed this gap by developing the Danger Assessment for in-laws (DA-L) to assess risk from in-laws, alongside the Danger Assessment for Women in India (DA-WI) to assess risk from partners. The study also examined the psychometric properties of the DA-L and DA-WI. Longitudinal data from 150 women in India were used to measure the reliability and validity of the two versions of the DA. The original DA items and additional risk items were examined using relative risk ratios for their relationship with severe violence at three-month follow-ups. Predictive validity was tested with the receiver operating characteristic curve. The study resulted in reliable and valid measures (11 items DA-L and 26-items DA-WI) of risk. The versions of the DA can be useful for practitioners in India and those working with Indian women in the US and other countries. The DAs can be used for identifying women in domestic violence relationships who are at risk for future severe domestic violence and guide the provision of tailored safety plans.

The Lethality Assessment Program (LAP) assists police responding to intimate partner violence incidents by connecting victims identified as high risk with advocates while police are at the scene. The Lethality Screen is the risk assessment used with the LAP. This manuscript focuses on evaluating and refining changes to the Lethality Screen that prioritize strangulation as a risk item that automatically places a survivor in the high-danger category. Secondary data from the Oklahoma Lethality Assessment (OK-LA) Study (n=234) were utilized for analysis. Researchers and community partners collaborated to explore various options for revising the Lethality Screen given the goal of the community partner to prioritize strangulation on the risk assessment. The final adaptation of the Lethality Screen was examined for its ability to predict near fatal violence, severe violence, violence and abuse by an intimate partner at 7 months follow-up. The revised Lethality Screen has high sensitivity (84-93%), low specificity (14-16%), and broad ranges of negative predictive value (47-94%) and positive predictive value (12-63%). Revisions to the Lethality Screen are discussed in conjunction with additional adaptations that were made to the LAP, resulting in the LAP 2.0.

Purpose Research shows strong associations between intimate partner violence (IPV) among women and suicidal ideation but this topic is understudied among immigrant women in abusive relationships in the United States. Empowerment may play a significant role in protecting abused immigrant women from suicidal ideation but has not been studied with quantitative data. Method The current study used convenience sampling. Immigrant women who experienced IPV were asked about IPV severity, empowerment, and where they were born. Bivariate associations among variables were assessed; empowerment was tested as a moderator of the relationship between IPV and suicidal ideation. Results The sample comprised 293 immigrant women, with 62.8% reporting suicidal ideation with a significantly greater proportion of women from South America than elsewhere reporting suicidal ideation. Empowerment buffered the effect of IPV on suicidal ideation. Conclusion Prevalence of suicidal ideation among immigrant women experiencing IPV is concerning. Severity of IPV, region of the world where women were born, and empowerment were all related to suicidal ideation, showing directions for future research. Empowerment nursing interventions are needed to address IPV and resulting mental health problems among immigrant women. [ Journal of Psychosocial Nursing and Mental Health Services, xx (x), xx–xx.]

Introduction: Understanding the risk for severe intimate partner violence (IPV) can help women and providers assess danger. The validated, widely used Danger Assessment (DA) developed for this purpose has not been tested in a low- and middle-income country (LMIC). We tailored the DA to Nairobi, Kenya, and prospectively evaluated baseline danger against severe IPV at 3-month follow-up. Methods: We used data from the myPlan Kenya trial conducted in 3 informal settlements in Nairobi, Kenya, from 2017 to 2018. DA items were refined through formative and pilot phases, yielding minor wording modifications. Quantitative analyses prospectively evaluated baseline DA against severe IPV at 3-month follow-up to understand the predictive effect of the (1) original 20-item DA, (2) 16-item Kenya-DA (highest relative risk ratios [RRR] with severe IPV), and (3) 16-item Kenya-DA weighted (weighting based on strength of RRRs). Diagnostic criteria, including C-statistics, sensitivity, specificity, receiver operating characteristic curve, and area under the curve, were examined; logistic regressions quantified the odds of each metric predicting severe IPV at follow-up. Results: The original 20-item DA produced the highest specificity (75.41%) and lowest sensitivity (57.14%), resulting in the overall lowest C-statistic. Compared to the 16-item Kenya-DA, the Kenya-DA weighted produced slightly higher sensitivity (66.67% vs. 64.29%) and specificity (77.05% vs. 72.13%), resulting in the highest C-statistic (0.78 vs. 0.75). All versions successfully predicted severe IPV at 3-month follow-up (original DA: odds ratio [OR]=1.26, 95% confidence interval [CI]=1.12, 1.41, P<.001; Kenya-DA: OR=1.33, 95% CI=1.16, 1.53, P<.001; Kenya-DA weighted: OR=1.19, 95% CI=1.10, 1.28, P<.001). Several factors identified as homicide risk factors in other settings were not prospectively associated with severe IPV. Conclusion: Within a high-danger LMIC context, all 3 DA configurations performed well diagnostically. We recommend the 16-item Kenya-DA given the value for simplicity and field implementation, whereas the Kenya-DA weighted can add accuracy for research purposes.

Objective Screening for intimate partner violence in the home is often challenging due to the lack of privacy. The aim of this study was to compare two different screening methods (paper‐pencil vs. tablet) for identifying intimate partner violence during perinatal home visits. Design Randomized control trial. Sample Pregnant women ( N = 416) in perinatal home visiting programs were randomized to either paper‐pencil or computer assisted, intimate partner violence screening. Measurements The Abuse Assessment Screen was used to screen for physical and sexual IPV and Women's Experiences with Battering for emotional intimate partner violence. Results No significant differences in prevalence were found between the screening methods. Intimate partner violence prevalence rates for the year before and/or during pregnancy using paper‐pencil was 21.8% versus 24.5% using tablets ( p = .507). There were significant differences in prevalence among the three race/ethnic groups (Caucasian, 36.9%; African American, 26.7%; Hispanics, 10.6%; p < .001) and significant differences in rates across three geographical areas: urban 16.0%; rural 27.6%, suburban women 32.3% ( p < .001). Conclusions This study provides evidence that both methods are useful for identifying intimate partner violence during perinatal home visits.