Objective Studies suggest that American Muslim women underutilize mammography. While religion has a strong influence upon Muslim health behaviors scant research has examined how religion-related beliefs inform Muslim women’s intention for mammography. Our study identifies and examines such beliefs. Methods Muslim women aged 40 and older sampled from mosques participated in focus groups and individual interviews. Drawing upon the Theory of Planned Behavior, interviews elicited salient behavioral, normative, and control beliefs regarding mammography and the influence of Islam upon screening intention. Results Fifty women participated in 6 focus groups and 19 in semi-structured interviews, with near-equal numbers of African American, South Asian, and Arab Muslims. Forty-two percent of participants had not had a mammogram within the past two years. Across differences in race/ethnicity and mammography status women voiced four religion-related salient beliefs that inform mammography intention: (1) the perceived duty to care for one’s health, (2) religious practices as methods of disease prevention, (3) fatalistic notions about health, and (4) comfort with gender concordant healthcare. Conclusions Religious beliefs influence decisions to pursue mammography across the ethnic/racial diversity of Muslim women. Notions about duty to God and the stewardship of one’s body appear to enhance mammography intention. Theocentric notions of cure and illness and varied views regarding personal agency also inform decisional frames that impact mammography intention. Given the salience of religion among our participants, religiously-tailored messages in interventions have the potential to enhance cancer screening.

BackgroundIntersectionality theory focuses on how one’s human experiences are constituted by mutually reinforcing interactions between different aspects of one’s identities, such as race, class, gender, and sexual orientation. In this study, we asked: 1) Do associations between intersecting identities (race and sexual orientation) and mental health (depressive symptoms) and substance use (alcohol, tobacco, and marijuana) differ between men and women? and 2) How do single or intersecting self-reports of perceived racial and/or sexual orientation discrimination influence mental health and substance use outcomes for men and women? We compared results of assessing identities versus experiences of discrimination.MethodsMultivariable regressions were conducted on cross-sectional data from 2315 Black and White college students. Predictors included measures of sociodemographic characteristics and experiences of discrimination. Outcomes included past 2-week depressive symptoms (PHQ-9), past 30-day alcohol use, past 30-day tobacco use, and past 30-day marijuana use.ResultsIntersecting identities and experience of discrimination had different associations with outcomes. Among women, self-reporting both forms of discrimination was associated with higher depressive symptoms and substance use. For example, compared to women experiencing no discrimination, women experiencing both forms of discrimination had higher depressive symptoms (B = 3.63, CI = [2.22–5.03]), alcohol use (B = 1.65, CI = [0.56–2.73]), tobacco use (OR = 3.45, CI = [1.97–6.05]), and marijuana use (OR = 3.38, CI = [1.80–6.31]). However, compared to White heterosexual women, White sexual minority women had higher risks for all outcomes (B = 3.16 and CI = [2.03–4.29] for depressive symptoms, B = 1.45 and CI = [0.58–2.32] for alcohol use, OR = 2.21 and CI = [1.32–3.70] for tobacco use, and OR = 3.01 and CI = [1.77–5.12] for marijuana use); while Black sexual minority women had higher tobacco (OR = 2.64, CI = [1.39–5.02]) and marijuana use (OR = 2.81, CI = [1.33–5.92]) only. Compared to White heterosexual men, White sexual minority men had higher depressive symptoms (B = 1.90, CI = [0.52–3.28]) and marijuana use (OR = 2.37, CI = [1.24–4.49]).ConclusionsOur results highlight the deleterious impacts of racial discrimination and sexual orientation discrimination on health, in particular for women. Future studies should distinguish between and jointly assess intersecting social positions (e.g., identities) and processes (e.g., interpersonal experience of discrimination or forms of structural oppression).

Background: Depression is one of the most common illnesses in the United States, with increased prevalence among people with lower socioeconomic status and chronic mental illness who often seek care in the emergency department (ED). We sought to estimate the rate and severity of major depressive disorder (MDD) in a nonpsychiatric ED population and its association with subsequent ED visits and hospitalizations.Methods: This prospective cohort study enrolled a convenience sample of English-speaking adults presenting to an urban academic medical center ED without psychiatric complaints between January 1, 2015, and September 21, 2015.Patients completed a computerized adaptive depression diagnostic screen (CAD-MDD) and dimensional depression severity measurement test (CAT-DI) via tablet computer. Primary outcomes included number of ED visits and hospitalizations assessed from index visit until January 1, 2016. Negative binomial regression modeling was performed to assess associations between depression, depression severity, clinical covariates, and utilization outcomes.Results: Of 999 enrolled patients, 27% screened positive for MDD. The presence of MDD conveyed a 61% increase in the rate of ED visits (incidence rate ratio [IRR] = 1.61, 95% confidence interval [CI] = 1.27 to 2.03) and a 49% increase in the rate of hospitalizations (IRR = 1.49, 95% CI = 1.06-2.09). For each 10% increase in MDD severity, there was a 10% increase in the relative rate of subsequent ED visits (IRR = 1.10, 95% CI = 1.04 to 1.16) and hospitalizations (IRR = 1.10, 95% CI = 1.02 to 1.18). Across the range of the severity scale there was over a 2.5-fold increase in the rate of ED visits and hospitalization rates.Conclusions: Rates of depression were high among a convenience sample of English-speaking adult ED patients presenting with nonpsychiatric complaints and independently associated with increased risk of subsequent ED utilization and hospitalization. Standardized assessment tools that provide rapid, accurate, and precise classification of MDD severity have the potential to play an important role in identifying ED patients in need of urgent psychiatric resource referral.From the

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Many American Muslim women reported delays in care seeking due to a perceived lack of female clinicians. Women with higher levels of modesty and self-rated religiosity had higher odds of delaying care. Women who had lived in the United States for longer durations had lower odds of delaying care. Our research highlights the need for gender-concordant providers and culturally sensitive care for American Muslims.

BackgroundSexual minority young adults represent a high-risk population for tobacco use. This study examined cigarette and alternative tobacco product (ATP) use prevalence across sexual orientation (heterosexual, gay/lesbian, and bisexual) among college-attending young adult men and women, respectively.MethodsBaseline data from a two-year longitudinal study of 3386 young adult college students aged 18–25 in Georgia were analyzed. Correlates examined included sociodemographics (age, sex, sexual orientation, race/ethnicity, college type, and parental education). Outcomes included past 30-day use of tobacco (cigarette, little cigars/cigarillos [LCCs], e-cigarettes, hookah, any tobacco product used, and number of tobacco products used, respectively). Two-group, multivariate multiple regression models were used to examine predictors of tobacco use among men and women, respectively.ResultsAmong men (N = 1207), 34.7% used any tobacco product; 18.6% cigarettes; 12.3% LCCs; 16.8% e-cigarettes; and 14.7% hookah. Controlling for sociodemographics, gay sexual orientation (OR = 1.62, p = 0.012) was associated with higher odds of cigarette use; no other significant associations were found between sexual orientation and tobacco use. Among women (N = 2179), 25.3% used any tobacco product; 10.4% cigarettes; 10.6% LCCs; 7.6% e-cigarettes; and 10.8% hookah. Being bisexual was associated with cigarette (p < 0.001), LCC (p < 0.001), and e-cigarette use (p = 0.006). Lesbian sexual orientation was associated with cigarette (p = 0.032) and LCC use (p < 0.001). Being bisexual predicted any tobacco product used (p = 0.002), as well as number of tobacco products used (p = 0.004). Group comparisons showed that the effect of sexual minority status on LCC use was significantly different for men versus women.ConclusionSexual minority women, especially bisexual women, are at higher risk for using specific tobacco products compared to heterosexual women; homosexual men are at increased risk of cigarette use compared to heterosexual men. These nuances in tobacco use should inform interventions targeting sexual minorities.

Background: During a pandemic, women may be especially vulnerable to secondary health problems driven by its social and economic effects. We examined the relationship between changes in health-related socioeconomic risks (HRSRs) and mental health. Materials and Methods: A cross-sectional survey of 3,200 women aged 18-90 years was conducted in April 2020 using a quota-based sample from a national panel (88% cooperation rate). Patterns of change in HRSRs (food insecurity, housing instability, interpersonal violence, and difficulties with utilities and transportation) were described. Weighted, multivariate logistic regression was used to model the odds of depression, anxiety, and traumatic stress symptoms among those with and without incident or worsening HRSRs. Results: More than 40% of women had one or more prepandemic HRSRs. In the early pandemic phase, 49% of all women, including 29% with no prepandemic HRSRs, had experienced incident or worsening HRSRs. By April 2020, the rates of depression and anxiety were twice that of prepandemic benchmarks (29%); 17% of women had symptoms of traumatic stress. The odds of depression, anxiety, and posttraumatic stress symptoms were two to three times higher among women who reported at least one incident or worsening HRSR; this finding was similar for women with and without prepandemic HRSRs. Conclusions: Increased health-related socioeconomic vulnerability among U.S. women early in the coronavirus disease 2019 (COVID-19) pandemic was prevalent and associated with alarmingly high rates of mental health problems. Pandemic-related mental health needs are likely to be much greater than currently available resources, especially for vulnerable women.

Mosques could serve as a promising setting for health interventions. However, little empirical data are available to guide the development of mosque-based health interventions, especially for women. We aimed to assess Muslim women's views on effective strategies for mosque-based educational interventions to promote women's health. A sample of Muslim women of diverse ethnicity and race was recruited from mosques in Chicago to participate in semi-structured interviews. In interviews, nineteen participants (aged 41-67 years) discussed characteristics of the imam and peer educator, aspects of the intervention modality, and content of health messaging that would be effective in mosque-based health programs. Participants reported that imams should have health-related knowledge to deliver to be successful, while peer educators should be respected women, educated in both religion and health. Sermons and group education classes were believed to be modalities that could reach a large portion of the community for discussions of women's health issues. Participants also suggested that sermons should use scriptural sources to convey the importance of women's health. Participants supported imam-led sermons and peer-led educational classes as effective strategies to promote women's health. Our study results speak to strategies for leveraging religious concepts to promote health among Muslim women.