Nicholas Powers

Background Sexual minority women (SMW) face barriers to cervical cancer screening adherence, being up to 10 times less likely than heterosexual women to undergo Pap testing. Sexual identity concealment and childhood abuse experiences may contribute to this disparity, as both engender avoidance of healthcare due to fear of discrimination and confronting trauma cues. Given that there is limited research on factors associated with cervical cancer screening among SMW, we sought to explore demographic differences in SMW’s screening behavior and rates of sexual identity concealment. Method We conducted secondary analyses of cross-sectional data from Wave 4 of the Chicago Health and Life Experiences of Women Study, a longitudinal study of adult SMW’s health. Measures captured demographics, degree of sexual identity concealment, childhood abuse, and healthcare utilization. Participants ages 21 to 65 were considered adherent to Pap testing guidelines if they received a Pap test in the past three years. Results Our sample included 383 SMW (M age = 46 years) of which 302 (78.9%) identified as gay/lesbian and 81 (21.1%) identified as bisexual. Regarding race, 167 (43.6%) participants were White, 132 (34.5%) were Black/African American, 53 (13.8%) were Hispanic/Latina, and 31 (8.1%) identified as other race. Approximately 45% of participants reported experiencing at least one type of childhood abuse, with sexual abuse as the most common. For Pap test adherence, 21.4% of the sample was non-adherent to testing guidelines. SMW over 50 were significantly more likely to be non-adherent compared to younger SMW, t(381) = 4.03, p <.001. SMW who saw their PCP annually were significantly more likely to be adherent (p = .03). Bisexual participants rated higher identity concealment than lesbian participants, t(381) = -6.02, p < .001, and Black/African American SMW reported significantly more sexual identity concealment than White SMW, F(3, 379) = 2.85, p = .027. Discussion Findings suggest that older SMW and those with reduced primary care access may have lower adherence to Pap testing guidelines. Public health efforts that improve healthcare access and support inclusion of sexuality data in medical record systems and cancer registries are needed to monitor screening disparities across the lifespan for SMW. SMW who are bisexual or Black/African American may benefit from providers facilitating identity disclosure in a sensitive manner.

Introduction Nurses in neonatal intensive care units (NICUs) are frequently faced with many stressors, including care for medically complex infants, infant suffering and death, exposure to parental trauma and grief, discordance between multiple disciplines regarding care decisions, and ethical and moral dilemmas. The COVID-19 pandemic has resulted in significant changes and restrictions to neonatal care that have also contributed to stress in both NICU families and care providers. Consequently, NICU nurses are at risk for experiencing secondary traumatic stress (STS), which has implications for their health, well-being, retention, and the quality of care provided. There is a gap in knowledge about the first-hand experiences of STS from the point of view of NICU nurses, particularly in the age of the COVID-19 pandemic. The current study provides an enhanced understanding of STS and coping strategies in NICU nurses through the qualitative analysis of rich narratives and first-hand accounts of their personal experiences, thoughts, and perceptions. Methods The study sample was comprised of 15 female registered nurses (RNs) working in a level-IV NICU in the United States. Self-report measures were used to collect sociodemographic information, key work-related information, STS symptoms and severity, and level of burnout and descriptive statistics were used to characterize and describe the study sample. Qualitative data collection occurred during individual semi-structured interviews with eligible NICU nurses. Interviews were transcribed and coded for thematic content using NVivo 14 qualitative data analysis software. Results Participants had high levels of STS (M = 45.07) and moderate levels of burnout (M = 3.70). Theoretical thematic analysis resulted in six main themes (e.g., coping strategies) and 17 subthemes (e.g., social and emotional support, compartmentalizing, emotional release), revealing the traumatic experiences NICU nurses witness while at work, the psychological and emotional impact of such exposure, and common coping strategies. In addition, nurses spoke about how the COVID-19 pandemic and related policy changes compounded stress and anxiety and increased feelings of loneliness. Participants offered their ideas for mitigating STS among nurses. This poster will use participant quotes to illustrate the main themes and subthemes derived from the thematic analysis. Discussion Caring for and supporting nurses is essential to sustaining an effective nursing workforce in the NICU and maintaining high-quality, compassionate care for infants and their families. An enhanced understanding of STS and coping strategies in NICU nurses is critical because STS has implications for provider health, well-being, retention, and the quality of care provided to vulnerable infants and families. There is the potential to prevent and offset the negative implications of STS for NICU nurses through education and intervention; however, more research needs to be conducted in this area. This formative research study provided key insight that can be used to inform intervention development, nurse training and education, and policy recommendations.

Background: Post-Traumatic Stress Disorder (PTSD) demonstrates high comorbidity with eating pathology. However, many individuals who are diagnosed with PTSD are not properly assessed for eating pathology and related functional impairment (e.g., clinicians underestimate the prevalence or hold stigmatizing attitudes towards eating disorders). Further, PTSD symptoms have been documented to interfere with eating disorder recovery, however the opposite relationship between these variables remains understudied. Undiagnosed eating pathology may exacerbate functional impairment from PTSD and weaken the effectiveness of evidence-based treatments. To further examine this issue, patients with an anxiety disorder diagnosis in a specialized CBT clinic were assessed for eating-disorder impairment (EDI). EDI is a construct that reflects the psychosocial consequences of eating-disorder pathology in a variety of contexts: mood, self-concept, interpersonal functioning, and work performance. The current study sought to examine whether there were differences in EDI based on principal anxiety and anxiety-related diagnoses as well as to determine whether this impairment was associated with treatment response. We first hypothesized that PTSD would be significantly associated with greater EDI relative to other diagnoses, and secondly, that this severity would be related to diminished improvement in symptoms following treatment. Methods: Patients (N = 748) completed self-report measures of EDI using the Clinical Impairment Assessment Questionnaire (CIA) as well as reported their anxiety disorder symptom severity at the beginning, middle, and end of treatment. Global CIA scores were calculated by adding each item and were used for the following analyses. Results: Using a logistic regression, with all principal anxiety diagnoses entered as predictors of CIA scores at baseline, PTSD had the strongest association with scores above the clinical threshold for eating-disorder impairment, supporting our first hypothesis. Controlling for all other anxiety disorders, patients with PTSD demonstrated an odds ratio of being three- times more likely to score above the clinical threshold on the CIA (OR 3.06, 95% CI [1.47, 6.37], p = .003). A mixed effects model was then conducted to evaluate the change in PTSD severity as a function of an interaction between Time and Baseline CIA. Consistent with our second hypothesis, higher baseline CIA scores predicted poorer PTSD treatment outcome (b = - 1.4, 95% CI [-1.67, -1.10], SE = .146, p = .000). PTSD symptoms at baseline did not predict reductions in EDI throughout treatment (p = .67, 95% CI [-.01, .01]), emphasizing that EDI poses unique challenges to evidence-based treatments for PTSD specifically. Conclusion: Compared to other anxiety disorders, PTSD was strongly associated with higher endorsement of EDI, and this higher impairment predicted poorer response to PTSD treatment. Recent research identifies perfectionistic cognitions to be associated with severe PTSD symptoms, which may resemble components of eating-disorder pathology (e.g., desiring to have a perfect diet or body type). Future research should explore whether assessing and targeting eating disorder features concurrent with PTSD treatment improves outcomes.