Vulnerable Young Women Research Articles

HIV-sensitive social protection for unemployed and out-of-school young women in Botswana: An exploratory study of barriers and solutions.

Promotive social protection programs aim to increase income and capabilities and could help address structural drivers of HIV-vulnerability like poverty, lack of education and gender inequality. Unemployed and out-of-school young women bear the brunt of HIV infection in Botswana, but rarely benefit from such economic empowerment programs. Using a qualitative exploratory study design and a participatory research approach, we explored factors affecting perceived program benefit and potential solutions to barriers. Direct stakeholders (n = 146) included 87 unemployed and out-of-school young women and 59 program and technical officers in five intervention districts. Perceived barriers were identified in 20 semi-structured interviews (one intervention district) and 11 fuzzy cognitive maps. Co-constructed improvement recommendations were generated in deliberative dialogues. Analysis relied on Framework and the socioecological model. Overall, participants viewed existing programs in Botswana as ineffective and inadequate to empower vulnerable young women socially or economically. Factors affecting perceived program benefit related to programs, program officers, the young women, and their social and structural environment. Participants perceived barriers at every socioecological level. Young women's lack of life and job skills, unhelpful attitudes, and irresponsible behaviors were personal-level barriers. At an interpersonal level, competing care responsibilities, lack of support from boyfriends and family, and negative peer influence impeded program benefit. Traditional venues for information dissemination, poverty, inequitable gender norms, and lack of coordination were community- and structural-level barriers. Improvement recommendations focused on improved outreach and peer approaches to implement potential solutions. Unemployed and out-of-school young women face multidimensional, interacting barriers that prevent benefit from available promotive social protection programs in Botswana. To become HIV-sensitive, these socioeconomic empowerment programs would need to accommodate or preferentially attract this key population. This requires more generous and comprehensive programs, a more client-centered program delivery, and improved coordination. Such structural changes require a holistic, intersectoral approach to HIV-sensitive social protection.

Utilizing User Preferences in Designing the AGILE (Accelerating Access to Gender-Based Violence Information and Services Leveraging on Technology Enhanced) Chatbot.

Technology advancements have enhanced artificial intelligence, leading to a user shift towards virtual assistants, but a human-centered approach is needed to assess for acceptability and effectiveness. The AGILE chatbot is designed in Kenya with features to redefine the response towards gender-based violence (GBV) among vulnerable populations, including adolescents, young women and men, and sexual and gender minorities, to offer accurate and reliable information among users. We conducted an exploratory qualitative study through focus group discussions (FGDs) targeting 150 participants sampled from vulnerable categories; adolescent girls and boys, young women, young men, and sexual and gender minorities. The FGDs included multiple inquiries to assess knowledge and prior interaction with intelligent conversational assistants to inform the user-centric development of a decision-supportive chatbot and a pilot of the chatbot prototype. Each focus group comprised 9-10 members, and the discussions lasted about two hours to gain qualitative user insights and experiences. We used thematic analysis and drew on grounded theory to analyze the data. The analysis resulted in 14 salient themes composed of sexual violence, physical violence, emotional violence, intimate partner violence, female genital mutilation, sexual reproductive health, mental health, help-seeking behaviors/where to seek support, who to talk to, and what information they would like, features of the chatbot, access of chatbot, abuse and HIV, family and community conflicts, and information for self-care. Adopting a human-centered approach in designing an effective chatbot with as many human features as possible is crucial in increasing utilization, addressing the gaps presented by marginalized/vulnerable populations, and reducing the current GBV epidemic by moving prevention and response services closer to people in need.

Increasing self‐esteem for vulnerable young women: A case study of entrepreneurship training for vulnerable young women in Thailand

AbstractDisadvantaged young people who have experienced violence often have low self‐esteem due to the difficult circumstances to which they are exposed. Abuse, bullying and other forms of mistreatment have a permanent impact on their sense of self‐worth, generating negative emotions and self‐protective behaviour in order to shield themselves from further harm. As a result, these young people may struggle to maintain their self‐esteem in the context of the challenges they face. This article aims to explore how training can be used to combat this issue to build self‐esteem among vulnerable young people, through a case study of a training entrepreneurship programme for vulnerable Thai young people residing in a home for girls. Through conducting a 16‐week training programme and follow‐up interviews, the study finds that entrepreneurship training has a positive effect on building self‐esteem. Findings indicate that the young women who participated reported feeling more confident, with better self‐reliance, and more capable of pursuing future endeavours, especially since the training enhances their understanding of long‐term effects and outcomes, including employment and the impact of job creation and sustainable development. Ultimately, the study underlines the importance of entrepreneurship training to build self‐esteem and confidence in young people who are vulnerable and in need of such an opportunity.

Prevalence and predictors of premarital sexual intercourse among young women in sub-Saharan Africa

IntroductionPremarital sexual intercourse (PSI) without adequate information and/or appropriate application of the relevant knowledge about sex before marriage, potentially has adverse effects on the sexual and reproductive health outcomes of vulnerable young women in sub-Saharan Africa (SSA). This study sought to examine the prevalence and predictors of PSI among young women aged 15–24 in SSA.MethodsNationally representative cross-sectional data from 29 countries in SSA were extracted for the study. A weighted sample size of 87,924 never married young women was used to estimate the prevalence of PSI in each country. A multilevel binary logistic regression modelling approach was used to examine the predictors of PSI at p < 0.05.ResultsThe prevalence of PSI among young women in SSA was 39.4%. Young women aged 20–24 (aOR = 4.49, 95% CI = 4.34, 4.65) and those who had secondary/higher educational level (aOR = 1.63, 95% CI = 1.54, 1.72) were more likely to engage in PSI compared to those aged 15–19 and those with no formal education. However, young women who belonged to the Islamic religion (aOR = 0.66, 95% CI = 0.56, 0.78); those who were working (aOR = 0.75, 95% CI = 0.73, 0.78); belonged to the richest wealth index (aOR = 0.55, 95% CI = 0.52, 0.58); were not exposed to radio at all (aOR = 0.90, 95% CI = 0.81, 0.99); were not exposed to television at all (aOR = 0.50, 95% CI = 0.46, 0.53); resided in rural areas (aOR = 0.73, 95% CI = 0.70, 0.76); and those who were living in the East African sub-region (aOR = 0.32, 95% CI = 0.29, 0.35) were less likely to engage in PSI compared to those who were traditionalist, unemployed, belonged to the poorest wealth index, exposed to radio frequently, exposed to television frequently, resided in urban areas, and lived in the Southern Africa sub-region, respectively.ConclusionSub-regional variations in the prevalence of PSI exist amidst multiple risk factors among young women in SSA. Concerted efforts are required to empower young women financially, including education on sexual and reproductive health behaviors such as the detrimental effects of sexual experimentation and encouraging abstinence and/or condom use through regular youth-risk communication advocacy.

Facilitators and barriers to engaging with the DREAMS initiative among young women who sell sex aged 18–24 in Zimbabwe: a qualitative study

BackgroundAdolescent girls and young women (AGYW) are at high risk of contracting HIV and exchanging sex for financial or material support heightens their risk. In Zimbabwe, the DREAMS initiative integrated education and employment opportunities within HIV health promotion and clinical services for vulnerable young women, including those who sell sex. While most participants accessed health services, fewer than 10% participated in any social programmes.MethodsWe conducted semi-structured qualitative interviews with 43 young women aged 18–24 to understand their experiences of engaging with the DREAMS programme. We purposively sampled participants for diversity in level of education, type and location of selling sex. We analysed the data by applying the Theoretical Domains Framework to explore facilitators and barriers to engaging with DREAMS.ResultsEligible women were motivated by hopes of escaping poverty, and their longer-term engagement was sustained through exposure to new social networks, including friendships with less vulnerable peers. Barriers included opportunity costs and expenses such as transport or equipment required for job placements. Participants also described pervasive stigma and discrimination related to their involvement in selling sex. Interviews highlighted the young women’s struggles in a context of entrenched social and material deprivation and structural discrimination that hindered their ability to take up most of the social services offered.ConclusionsThis study demonstrates that while poverty was a key driver of participation in an integrated package of support, it also constrained the ability of highly vulnerable young women to benefit fully from the DREAMS initiative. Multi-layered HIV prevention approaches such as DREAMS that seek to alter complex and longstanding social and economic deprivation address many of the challenges faced by YWSS but will only succeed if the underlying drivers of HIV risk among YWSS are also addressed.

“I had a shitty past; I want a great future.”: Hopes and fears of vulnerable adolescent girls aging out of care

Past studies of adolescent girls aging out of care have shown that being able to imagine themselves in a positive future may make them more resilient now and motivate them to take steps to achieve their goals. In the present study, to learn more about how such girls picture their futures, we conducted interviews and analyses guided by possible-selves theory. Our sample consisted of 15 girls aged 16–18 who were living in foster families or in residential-care settings. We conducted semi-structured interviews with these girls, using an adaptation of the Possible Selves Mapping Interview (Sheppard et Marshall, 1999). Many of the hopes that these girls expressed in their interviews were similar to those of most girls their age, but some of these hopes were influenced by adverse experiences in the girls’ pasts and darkened by their fears for the future. Three of the participants stood out for talking much more about their hopes than about their fears. The differences that we observed in these girls’ possible selves may help to improve programs supporting vulnerable young women after they leave care. To be helpful, these programs not only must be based on what the girls themselves want to achieve, but also must help them to develop detailed action plans and provide them with positive role models, sources of motivation and the belief that if they experience failures, they will always get another chance.

A Realist Interpretation of Chika Unigwe's On Black Sisters' Street

This paper is a realist interpretation of Chika Unigwe’s On Black Sisters’ Street. The text is considered for study here because it dwells on the popular, the modern and social issues that define realist works. The paper involves realism of subject-matter and social realism as its theoretical tools for the evaluation of the research subject. Realism of subject-matter deals with themes that are common to society while social realism looks at the poor social conditions of the middle and lower classes. The paper is a qualitative research and it is based on a content analysis of the select text for study. The paper probes the ugly life of four young girls in Nigeria who are trafficked into Antwerp, Belgium, to work as prostitutes and earn income for their traffickers. The girls suffer from sexual abuse and deceit from their parents and older men. They undergo hardship as a result of lack of proper parental care, unemployment, insecurity and poor social services which make them frustrated. All of these make their lives vulnerable. Therefore, the study concludes that, well placed individuals, parents, civil society organizations and the government should make efforts to improve and secure the lives of vulnerable young women in Nigeria in order to help them escape from their vulnerabilities. Also, the novel’s authentic representation of life and society and its focus on character more than plot, including its attention to the lower class, the social and the contemporary issues fits it into the realist agenda.

The Association of Recurrent and Multiple Types of Abuse with Adverse Mental Health, Substance Use, and Sexual Health Outcomes among Out-of-School Adolescent Girls and Young Women in Cape Town, South Africa.

Although physical and sexual abuse exposure is a well-established risk for poor health, the dimensions of abuse associated with health among socially vulnerable adolescent girls and young women (AGYW) remain underexamined. This article describes associations between combinations of abuse type and timing with mental health, substance use, and sexual risk outcomes among a sample of 499 AGYW (aged 16 to 19) who had left school early and were recruited for a cluster randomized trial in Cape Town, South Africa. Approximately one-third (33.5%; 95% CI: 28.7, 38.6) of participants reported lifetime abuse. Exposure to more than one type of abuse was associated with increased risk of depression (β = 3.92; 95% CI: 2.25, 5.59) and anxiety (β = 3.70; 95% CI: 2.11, 5.28), and greater odds of polydrug use (OR = 2.10; 95% CI: 1.02, 4.34) and substance-impaired sex (OR = 2.17; 95% CI: 1.31, 3.86). Exposure to multiple types of abuse during childhood/early adolescence and again in late adolescence was associated with increased risk of depression (β = 4.65; 95% CI: 3.15, 6.14), anxiety (β = 4.35; 95% CI: 2.70, 6.02), and polydrug use (OR = 2.37; 95% CI: 1.03, 5.73). Findings underscore the need for trauma-informed interventions that reduce mental health, substance use, and sexual risks among AGYW who have experienced multiple forms of abuse and recurrent abuse.

HIV-sensitive social protection for vulnerable young women in East and Southern Africa: a systematic review.

IntroductionSocial protection programmes are considered HIV‐sensitive when addressing risk, vulnerability or impact of HIV infection. Socio‐economic interventions, like livelihood and employability programmes, address HIV vulnerabilities like poverty and gender inequality. We explored the HIV‐sensitivity of socio‐economic interventions for unemployed and out‐of‐school young women aged 15 to 30 years, in East and Southern Africa, a key population for HIV infection.MethodsWe conducted a systematic review using a narrative synthesis method and the Mixed Methods Appraisal Tool for quality appraisal. Interventions of interest were work skills training, microfinance, and employment support. Outcomes of interest were socio‐economic outcomes (income, assets, savings, skills, (self‐) employment) and HIV‐related outcomes (behavioural and biological). We searched published and grey literature (January 2005 to November 2019; English/French) in MEDLINE, Scopus, Web of Science and websites of relevant international organizations.ResultsWe screened 3870 titles and abstracts and 188 full‐text papers to retain 18 papers, representing 12 projects. Projects offered different combinations of HIV‐sensitive social protection programmes, complemented with mentors, safe space and training (HIV, reproductive health and gender training). All 12 projects offered work skills training to improve life and business skills. Six offered formal (n = 2) or informal (n = 5) livelihood training. Eleven projects offered microfinance, including microgrants (n = 7), microcredit (n = 6) and savings (n = 4). One project offered employment support in the form of apprenticeships. In general, microgrants, savings, business and life skills contributed improved socio‐economic and HIV‐related outcomes. Most livelihood training contributed positive socio‐economic outcomes, but only two projects showed improved HIV‐related outcomes. Microcredit contributed little to either outcome. Programmes were effective when (i) sensitive to beneficiaries' age, needs, interests and economic vulnerability; (ii) adapted to local implementation contexts; and (iii) included life skills. Programme delivery through mentorship and safe space increased social capital and may be critical to improve the HIV‐sensitivity of socio‐economic programmes.ConclusionsA wide variety of livelihood and employability programmes were leveraged to achieve improved socio‐economic and HIV‐related outcomes among unemployed and out‐of‐school young women. To be HIV‐sensitive, programmes should be designed around their interests, needs and vulnerability, adapted to local implementation contexts, and include life skills. Employment support received little attention in this literature.

Effectiveness of the Sista2Sista programme in improving HIV and other sexual and reproductive health outcomes among vulnerable adolescent girls and young women in Zimbabwe

Background: In Zimbabwe, adolescent girls and young women (AGYW) experience high rates of HIV and other sexual and reproductive health challenges. In 2013, the Zimbabwe Ministry of Health and Child Care partnered with the United Nations Population Fund to implement the Sista2Sista programme, a structured peer group intervention aimed at improving health outcomes among vulnerable in- and out-of-school AGYW. Methods: Programme data was analysed for 91 612 AGYW aged 10–24 years old who participated in Sista2Sista from 2013 to 2019. Logistic regression was used to determine odds ratios (OR) and evaluate programme exposure as a factor in a set of defined variables. Results: 58 471 AGYW (63.82%) graduated from the Sista2Sista programme by completing at least 30 of 40 exercises. Graduates were more likely to take an HIV test (2.78 OR 95% CI 2.52–3.10), less likely to get married (0.63 OR 95% CI 0.55–0.73) and less likely to drop out of school (0.60 OR 95% CI 0.53–0.69). At higher thresholds of programme completion, additional positive outcomes were observed. Participants who completed all 40 exercises were more likely to return to school (1.41 OR 95% CI 1.18–1.69), more likely to use contraception (1.38 OR 95% CI 1.21–1.56), more likely to report sexual abuse (1.76 OR 95% CI 1.17–2.66), and less likely to become pregnant as adolescents (0.41 OR 95% CI 0.24–0.72). Individual counselling improved the likelihood of programme graduation. Conclusions: The Sista2Sista programme had a positive effect on HIV and other sexual health outcomes among vulnerable AGYW in Zimbabwe. Strategies to improve graduation rates should be explored.

Conceptualizing a Low Resource-Low Intensity Psychosocial-SRH Integrated Intervention to Improve Sexual and Reproductive Health Care Seeking among Young Women in Humanitarian Settings

Despite the availability of sexual and reproductive health (SRH) services in some humanitarian contexts, most young women have limited access to these services. Furthermore, many young women in humanitarian settings suffer from distress and cannot access care. In response to this double burden, WHO is conceptualizing a potentially scalable psychosocial (PSS) and SRH integrated intervention package to improve the use of selected SRH services and wellbeing among young women (aged 15-24 years) in humanitarian settings. Informed by two systematic reviews exploring the efficacy of PSS and SRH educational interventions on selected SRH outcomes (coupled with expert consultations, reviewing existing WHO PSS interventions for common mental disorders, and active community engagement), a three-tiered PSS and SRH integrated intervention package is being designed to, 1) engage young women and their social circles through community education and advocacy activities, and 2) enhance women’s socio-emotional capabilities and SRH-related knowledge and behaviours. This intervention will consist of a women groups ‘component (a package of eight-modules), a community component, and up to three sessions of focused support through home visits for vulnerable young women. This article describes the process of conceptualising the intervention package and provides an overview of the content of this PSS-SRH integrated intervention.

Age Matters: Determinants of sexual and reproductive health vulnerabilities amongst young women who sell sex (16–24 years) in Zimbabwe

Female sex workers bear a disproportionate burden of HIV and other poor sexual and reproductive health (SRH) outcomes which has led to the tailoring of SRH interventions to mitigate risk. Understanding of the SRH vulnerabilities of young women who sell sex (YWSS) (16–24 years) in Southern Africa is under-represented in research which may result in a mismatch in current SRH interventions and service design. This paper is based on a sub-analysis of a qualitative study investigating the SRH of young women who sell sex (16–24 years) in Zimbabwe. We explored the differences in dynamics of SRH vulnerability amongst YWSS within the 16–24 year age band. In-depth interviews (IDIs) were conducted amongst key informants (n = 4), health care providers (n = 5), and peer educators (n = 16). Amongst YWSS, we conducted IDIs (n = 42) and focus group discussions (n = 30). Transcripts were inductively coded for emergent themes and categories. Age and life stage determinants led to key differences in SRH vulnerabilities between younger (16–19 years) and older YWSS (20–24 years). These determinants emerged in the following ways: 1) distancing of younger participants from a “sex worker” identity leading to difficulties in identification and limiting intervention reach, 2) inexperience in dealing with clients and immature cognitive development leading to greater exposure to risk, and 3) the subordinate social position and exploitation of young participants within sex worker hierarchies or networks and lack of protective networks. We highlight the presence of a diverse group of vulnerable young women who may be missed by sex worker programme responses. In future intervention planning, there is need to consider the age-related needs and vulnerabilities within a spectrum of young women involved in a wide range of transactional relationships to ensure that services reach those most vulnerable to poor SRH outcomes. • Young women who sell sex have unique sexual and reproductive health needs. • Elusive identities within the economies of sex pose a challenge to related interventions. • Substance use as a coping mechanism amongst young women who sell sex. • Subordinate social status of young women who sell sex in sex worker hierarchies. • Younger and older sex workers differ in characteristics and vulnerability.

The Lives of Girls and Young Women in the Time of COVID-19

As with Zika, Ebola, HIV and AIDS, and other pandemics in recent history, girls and young women are particularly vulnerable to COVID-19 socially and emotionally if not medically. Some observers have referred to the current crisis as a tale of two pandemics in reference to both the obvious health issues and the pervasive gender inequalities that have become exacerbated, and others have referred to it as “the shadow pandemic” (UN Women 2020: n.p.) in highlighting the negative impact that physical distancing and social isolation are having on already vulnerable girls and young women experiencing sex- and gender-based violence. All over the world girls and young women are facing increasing levels of precariousness as a direct result of the health measures being taken to curb the global transmission of COVID-19. The increasing lack of privacy in the home furthers the practice of cultural forms of patriarchy that lead to violence.

Lessons for the COVID-19 response from a multidrugresistant tuberculosis study in South Africa: How public health promotion can reach vulnerable young women

Background. As the world grapples with the COVID-19 pandemic, lessons from responding to diseases that are endemic to Africa, such as HIV/AIDS, malaria, yellow fever, Lassa fever and Ebola, can inform responses to the new challenge. Gaps in and successes of South Africa (SA)’s established tuberculosis (TB) management programme have potential to inform COVID-19 responses. Objectives. To present the findings of a 2019 study that assessed how communication can contribute to improving health outcomes among young women with multidrug-resistant TB (MDR-TB) in SA. Methods. Primary qualitative data were collected from 20 purposefully selected participants in eThekwini Metro, KwaZulu-Natal Province. Data were collected through focus group discussions with women with MDR-TB, and key informant interviews with their family members, health workers and KwaZulu-Natal health department personnel. Results. The study assessed how age, gender, socioeconomic status, geographic location and comorbidity converge to influence susceptibility to communicable diseases and risk of mortality, and proposes that vulnerabilty factors be incorporated into both MDR-TB and COVID-19 responses. Conclusion. In the early stages of the COVID-19 pandemic, much is unknown about the incubation period and infection transmission modes, and there have been suggestions that asymptomatic people may be infectious. In highly populated urban areas, television and radio (local soap operas, dramas and hard news programmes), social media (Facebook and WhatsApp) and information from children are the best mediums for reaching young women to provide integrated public health education about both MDR-TB and COVID-19.

Re-writing Stories of Child Early and Forced Marriages through Vocational and Entrepreneurship Skills: Experience from the “Girls Inspire Project” in Tanzania

This paper highlights experiences of young mothers, victims of child, early and forced marriages (CEFM) as pertaining to their basic rights, social wellbeing and sustainable livelihood four years after their participation in the Girls Inspire project. CEFM is still a critical issue in Tanzania and one of the obstacles toward girls’ and women’s empowerment. Data was collected from six districts in the regions of Dodoma, Rukwa and Lindi between 2016-2018 through the use of questionnaires for a random sample of 367 as well as in-depth interviews with 34 young mothers between 13 to 19 years old who were purposively selected. Other data was generated from the use of focus group discussions for a non-random sample of 137 young mothers. The findings show how the provision of alternative learning through ODL, coupled with skills development in areas of vocation and entrepreneurship can help vulnerable girls and young women be involved in shaping decisions that affect their lives as well as enhance their well-being, employability and sustainable livelihoods.&#x0D; Keywords: Child marriages, teenage pregnancies, gender equality and sustainable livelihood.

The merits of context: Unfolding mental vulnerability as category and experience

‘Mentally vulnerable’ young people are a strong focal point in public debate and policy in Denmark at present, and a variety of cultural activities are now being offered to them. Building on ethnographic fieldwork (April 2018-August 2019) with so-called mentally vulnerable young women (aged 18-36) who meet in literature reading groups, this article seeks to connect the reading group with the phenomenon of ‘mental vulnerability’, first through a review of the historical emergence and contemporary use of the term, and second by considering what (painful) experiences the term signifies for individuals belonging to this category. This contextualization involves a discussion of literature on the role of context in anthropological analyses. The article concludes with an empirical contradiction: the reading group provides a sanctuary from everyday demands for purposefulness and productivity, but it can also be used as a strategy for navigating such demands.

P-04-18 Sexual Education in Uruguay: Is "Damage Control” the Best Approach?

This paper aims to raise awareness on the importance of sex education and its benefits to children and adolescents that, rather than promote unsafe sexual practices, provides young people with accurate information about sexuality. We reviewed sexual education programs that were developed from different areas and introduced in public schools, generating debates and discussions. Private educational institutions have introduced sex education, with significant differences between them. This difference is mainly due to the religious background, reflected on the programs shared with the students.The role of family is transcendental, it is clear that important messages related to sex and sexuality is taught by families to their children, according to their convictions, beliefs and own experiences. Sexuality is addressed from the biological and psychological aspects, including emotional, developmental, maturational and social aspects, that are difficult to apply in the educational community. There is emphasis on the prevention of unintended pregnancy and prevention of sexually transmitted diseases.Few programs address also all phases of human sexuality, that imply understanding of self-respect and care, and the knowledge to make informed decisions allowing complete exercise of sexuality. As a result of avoiding sex education at schools and not teaching at home, many young people fell confused and have few qualified adult referents to ask for information. This leads to high risk situations, where alcohol, drugs and unsafe sex is the rule, not to forget also how vulnerable young women can be at this point, exposing them to physic and psychologic violence.

Intersectionality, special populations, needs and suggestions: the Flint Women\u2019s study

BackgroundEquitable access to services that promote health and wellbeing is an important component of social justice. A community-engaged participatory qualitative study was conducted in Flint, Michigan, USA, to understand the needs of special populations (young women, perinatal women and new mothers, older women, women with disabilities, and LGBTQIA women) and elicit their ideas about solutions.MethodsIn-depth interviews (n = 100) were conducted. Participants were either women living in the Flint area, human service providers in the area, or both. A team of community and academic coders analyzed the data using an a priori framework.ResultsParticipants identified needs of different groups of women and suggested ways to address them. Access to healthy food, reducing healthcare costs, and improving transportation, job opportunities and affordable quality housing were crosscutting themes across all groups of women. Mentoring support was said to protect vulnerable young women from the risk of human trafficking. Older women were said to gain a sense of purpose, build their social support and reduce their loneliness by engaging in mentoring younger women. Women with disabilities were reported to benefit from infrastructure accessibility and authentic inclusion in all areas of life. Providing help that considers their dignity, pride and self-worth were suggested. LGBTQIA women were reported to have housing needs due to discrimination; mostly turned down as renters and can be rejected from faith-based homeless shelters. LGBTQIA women would also benefit from increased sensitivity among healthcare providers. For all groups of women, streamlining access to social services and other resources, building social support networks and increasing awareness about existing resources were recommended.ConclusionEfforts directed towards improving women’s health and wellbeing should include perspectives and suggestions of diverse groups of women from the community. Acting on suggestions that emanate from the community’s lived experiences may reduce inequalities in health and wellbeing.

Body esteem, weight-control outcome expectancies, and e-cigarette use among young adults.

Evidence is still scarce regarding the use of e-cigarettes by young people for weight-control reasons. This study aimed to test a model in which the prospective association between negative body esteem and e-cigarette use is mediated by weight-control outcome expectancies for e-cigarette use. The model was tested across genders. Data were collected at three time points, 6 months apart, from 2327 young adults (mean age = 21.2; SD = 2.2; 54% women). Self-reported data were collected on demographics, body mass index, body esteem, weight-control outcome expectancies for e-cigarette use, and current e-cigarette use and cigarette smoking. Among women, we found a significant indirect effect of lower body esteem on higher likelihood of current e-cigarette use 1 year later, mediated by higher weight-control outcome expectancies at 6-month follow-up, adjusting for demographics, body mass index, and baseline e-cigarette use and cigarette smoking. Among men, body esteem was not found to have significant effect on either weight-control expectancies or e-cigarette use. Based on the current findings, young adult women who have higher negative body esteem are at increased risk for using e-cigarettes for weight-control motives. The current findings are some of the first to show prospective associations among weight-control motives and e-cigarette use among young adults. These findings suggest that a group of vulnerable young women may be using e-cigarettes to lose or control weight. More research is needed to understand their choice of flavors, nicotine concentration, and device type. In addition, research is needed to understand whether e-cigarettes are being marketed, directly or indirectly, as being useful for weight loss or control. There may be a need for health promotion strategies that provide healthier alternatives to young women struggling with low body esteem who use e-cigarettes for weight loss or control.

Reaching marginalized young women for HIV prevention in Botswana: a pilot social network analysis.

Almost one-fifth of Botswana's population is infected with HIV. The Inter-Ministerial National Structural Intervention Trial is a trial to test the impact on HIV rates of a structural intervention that refocuses government structural support programs in favor of young women. Ensuring that the intervention reaches all vulnerable young women in any given community is a challenge. Door-to-door recruitment was inefficient in previous work, so we explored innovative ways to reach this population. We sought to understand the support networks of marginalized young women, and to test the possibility of using social networks to support universal recruitment in this population. Ego-centric and sociometric analyses were used to describe the support networks of marginalized young women. Marginalized young women go to other women and relatives for support, and they communicate face to face rather than using social media. Network maps show how young women were connected to each other. Lessons from the pilot include a better understanding of how to use social networks as a recruitment method, such as the time required and the types of community members that can help. Social networks could help reach other hard-to-reach populations.