Peninnah M. Kako

Background: Nonfatal strangulation (NFS) is one of the most lethal forms of intimate partner violence (IPV) that is associated with increased risk of future homicide, yet it frequently goes unrecognized within healthcare settings. Black women experience disproportionately high rates of IPV while simultaneously facing structural barriers to healthcare access. Little research has examined how Black women survivors experience strangulation and navigate decisions about seeking care following NFS and other potentially lethal forms of IPV. Methods: This secondary qualitative analysis draws on interview data from 28 Black women survivors of IPV who participated in a larger community-engaged mixed-methods study conducted during the COVID-19 pandemic in an Upper Midwestern state. Of these, 17 (60.7%) both reported experiencing strangulation on the parent-study survey and described experiences consistent with nonfatal strangulation during their qualitative interviews and comprised the analytic sample for the present analysis. Guided by Black Feminist Thought, semi-structured interviews examined survivors’ experiences with violence, safety, help-seeking, and interactions with healthcare and social service systems. Data were analyzed using thematic analysis following Schensul and Schensul. Results: Three interconnected themes were identified. First, survivors described racism and anticipated discrimination as significant barriers to seeking healthcare following strangulation. Second, shame, stigma, and fear of judgment contributed to self-silencing and avoidance of formal services. Third, survivors described strangulation as a terrifying and potentially lethal form of violence occurring within broader histories of polyvictimization and cumulative trauma. Despite experiencing serious symptoms, many participants avoided healthcare because they feared retaliation from abusive partners, anticipated dismissive treatment, or believed healthcare systems would be unable to protect them. Together, these experiences illustrate how structural racism, institutional mistrust, and gendered violence intersect to shape healthcare decision-making. Conclusions: Findings suggest that barriers to care following strangulation extend beyond individual help-seeking behaviors and are deeply rooted in structural inequities. Improving outcomes for Black women survivors requires enhanced provider training on strangulation assessment, trauma- and violence-informed approaches, culturally responsive care, and healthcare system reforms that address racism, mistrust, and survivor safety. These findings have important implications for reducing disparities in IPV-related health outcomes and improving responses to high-lethality violence.

Background: Intimate partner homicide is one of the leading causes of death for women, disproportionately affecting Black women. Purpose: To investigate the severity of lethality risk and its relationship with individual characteristics, experiences of discrimination, and mental health among urban Black women in Wisconsin since the start of COVID-19. Methods: This analysis was part of a larger mixed-methods study. Women were recruited from community agencies in Wisconsin. Eligible participants could participate either in person, by phone call, or via Teams. Lethality was assessed using the Lethality Assessment Protocol (LAP). The experiences of discrimination were measured by the Experiences of Everyday Discrimination (EDS). Mental health and all other demographic variables were self-reported. The data collection was conducted between 2023 and 2025. Analyses were conducted using descriptive analysis, simple linear regression, and multiple regression. All analyses were conducted in SPSS version 29. Results: Data from 185 urban Black women were analyzed, with an overall mean weighted LAP score of 17.29. The overall regression was significant, accounting for approximately 5% of the variance in LAP scores. Experiencing discrimination at least once per year was significantly associated with LAP score ( p < 0.05) when controlling for all other variables. Conclusion: These findings highlighted that the experiences of discrimination are a significant predictor of lethality risk among Black women experiencing IPV, underscoring the contribution of structural and social factors to health inequities. The study underscored the need to appraise victims’ experiences of discrimination within IPV risk-assessment policies and to integrate these policies into routine care, and it calls for further research on pathways to IPV homicide in marginalized communities. Further research is needed to better understand the pathways of IPV homicide, particularly among highly marginalized communities.

Objective: Prenatal cannabis use has more than doubled in recent years, disproportionately affecting birthing people with lower incomes and mental health conditions. Despite this trend, research remains fragmented, and the voices of birthing people who use cannabis are largely absent. This study aimed to explore multidimensional influences on prenatal cannabis use, centering the lived experiences of those directly affected. Methods: Researchers conducted a reflective thematic analysis of secondary qualitative data from a community-based program in Wisconsin, where cannabis remains illegal. Nineteen pregnant cannabis users participated in interviews; most were Medicaid recipients, and nearly half reported household incomes below $10,000. Lifecourse theory guided study design and analysis. Synthesized Member Checking was used to enhance credibility. Results: Five central themes emerged: pregnancy as a turning point in cannabis use; cannabis as emotional regulation; complex ties between cannabis and mental health; relational influences on use; and contextual barriers to informed and supported decision-making. Emotional regulation and mental health were the most cited drivers of cannabis use. Discussion: Findings highlight the urgent need for holistic prenatal care that addresses both substance use and mental health, and for public health messaging that is unbiased and evidence-based. Addressing prenatal cannabis use requires community-engaged, cross-sector strategies and structural policy reform. Without tackling systemic barriers—such as racial bias in screening and care—efforts to support birthing people who use cannabis will remain insufficient.

Background: In sub-Saharan Africa, HIV/AIDS profoundly impacts women, intertwining with a range of socioeconomic, health, and environmental challenges that vary widely between regions. This study dives into the lives of women living with HIV in rural areas Malawi and Kenya. Method: For this cross-sectional study, employing quantitative methods and the Social Determinants of Health (SDOH) framework, we explored how different factors such as sociodemographic profiles, socioeconomic factors, housing conditions, food security, and economic crises shape their experiences to highlight key disparities and commonalities. Results: The analysis revealed that while age distributions and literacy rates were similar, reflecting global HIV trends, there were significant differences in educational attainment, income levels, and debt, necessitating targeted interventions. Housing conditions and appliance ownership varied, indicating different environmental health impacts across the regions. Notably, Kenya is facing a severe food security crisis that demands immediate action, and both countries are grappling with economic challenges spurred by environmental disasters and healthcare costs. Implications and Conclusion: This study contributes valuable insights into the unique and shared socioeconomic challenges faced by women living with HIV in Malawi and Kenya. It underscores the need for holistic, targeted public health strategies to enhance health outcomes, education, and economic stability for women living with HIV in resource limited areas. The findings advocate for collaborative efforts among policymakers, healthcare providers, and development practitioners to tailor interventions that address the specific needs of this vulnerable population, aiming to improve their quality of life and overall well-being.

Emerging male adults continue to be disproportionately affected by HIV compared to other age groups in Sub-Saharan Africa (SSA). Recent demographic data indicate that AIDS related illness is currently the leading cause of death among young people in SSA. Emerging adulthood is critical when it comes to sexuality because it is marked by the formation of identity and the establishment of more mature and intimate relationships which might increase vulnerability to sexually transmitted infections including HIV. Understanding HIV prevention and testing needs in emerging male adults in rural settings is essential to developing prevention efforts. This descriptive qualitative study was conducted to understand the HIV prevention and testing needs for emerging male adults in rural Kenyan setting. 30 in-depth interviews and 3 FGDs were conducted with emerging adults in rural Ainabkoi sub-county in Uasin Gishu county in Kenya. Findings pointed out that emerging adults in rural settings experience unique challenges in HIV testing and prevention influenced by socio-cultural, economic, political, and legal factors elevating their risk to HIV infection compared to other age groups. The study underscore that HIV is still the greatest threat among emerging adults in SSA and will require innovative approach to develop and implement youth and young adults’, especially males, sensitive interventions across multiple sectors that influence HIV prevention knowledge, service use, and treatment options for youths. Author Summary: In our study, we explored the challenges of preventing HIV among young adult men in rural Kenya, a region where traditional health services often struggle to reach effectively. I, along with my colleagues, conducted interviews and discussions to understand what these young men need and how they perceive existing HIV prevention efforts. We found that factors like limited healthcare access, societal norms, and economic conditions significantly influence their risk and ability to receive proper HIV education and services. The young men expressed a strong desire for more accessible and relevant HIV prevention strategies that respect their unique cultural and social settings. Our research underlines the importance of creating tailored HIV prevention programs that go beyond conventional methods. These programs should engage with the community’s specific needs and leverage local resources to enhance effectiveness. By focusing on these areas, our work contributes to a broader understanding of how to tackle HIV prevention in similar rural settings globally, suggesting that interventions need to be as diverse as the populations they aim to serve. This approach could inform future strategies not only for HIV but also for other health issues faced by isolated communities.

Gender-based violence (GBV) is an all-encompassing term that speaks to acts or threats that may lead to physical, sexual or emotional harm to an individual based on their gender. This paper provides a scoping review of research on gender-based violence among Somali refugee women in different parts of the world. Using the socio-ecological model as a framework, we reviewed 30 empirical studies focusing on some form of GBV among Somali refugee women. We identified societal, community and individual factors contributing to the experience of GBV. We also discuss how these factors influence women's willingness to access care, especially healthcare and social services. The review reveals that oftentimes, institutions that work closely with this population have a limited understanding of how closely culture affects the willingness and ability to seek help about GBV. Based on our analysis, we suggest ways in which social institutions and healthcare providers can provide culturally-safe support to Somali refugee women who have experienced some form of GBV.

Background: Child malnutrition persists globally with men and women playing distinct roles to support children’s nutrition. Women frequently carry the bulk of the workload related to food, care, and health, all of which are critical factors in child nutrition. For this reason, development efforts have emphasised women ignoring the potential role of men in supporting children’s nutrition. This study sought to understand the different roles that Malawian men and women play in children’s nutrition. Methods: This qualitative was conducted in rural Central Malawi as part of a baseline study in 2017 for the CARE Southern Africa Nutrition Initiative. Seventy-six participants were interviewed, including 19 men and 57 women, using focus group discussions and in-depth interviews. We sought to understand the gender distribution of men’s and women’s roles and how these roles influence child nutrition. Results: We found that both men and women were involved in productive, reproductive, and community work. However, consistent with the literature, women carried a disproportionate workload in supporting child nutrition compared to men. Women’s heavier workloads often prevented them from being able to meet children’s food needs. Nevertheless, shifts in gender roles were observed in some of the sampled communities, with men taking up responsibilities that have been typically associated with women. These changes in gender roles, however, did not necessarily increase women’s power within the household. Conclusions: Traditional gender roles remain prevalent in the sampled communities. Women continue to be primarily responsible for the food, care, and health of the household. Women’s heavy workloads prevent them from providing optimal care and nutrition for children. While efforts to advance gender equality by encouraging men to participate in child care and other household responsibilities appear to have had marginal success, the extent to which these efforts have successfully encouraged men to share power remains unclear. Improving gender equality and child nutrition will require efforts to redistribute gendered work and encourage men to move towards shared power with women over household decision-making and control over income.

Objective: To understand communities’ perceptions, beliefs, and health‐related behavior choices related to COVID‐19 in order to guide public health nursing communication and interaction with patients and the community.Design: A qualitative study, guided by the Health Belief Model (HBM), strove to comprehend the perceptions and reactions to COVID‐19 among Wisconsinites.Sample: Twenty‐five diverse Wisconsin residents aged 18 or older.Measurements: Semi‐structured interviews provided information about individuals’ attitudes, perceptions, and reactions to COVID‐19. Interviews were audio‐recorded, transcribed, and thematic analysis was conducted to identify themes.Results: We identified three major themes: (1) “health care starts way before you ever enter the doors of a healthcare facility”; (2) “to live in a society is to help each other”; and (3) mental health as impacted by COVID‐19.Conclusions: This study demonstrated the need for greater public health support, as well as the role of Social Determinants of Health. Understanding perceptions and reactions to COVID‐19 can help public health nurses understand and better respond to future pandemics.

Objective: As HIV transitions to a chronic disease, measures that foster continued health are critical. Peer support groups can help in reducing stigma and ensuring wellbeing for those living with HIV. The purpose of our study was to gain an understanding of the ways in which women living with HIV in rural areas sustain peer support groups.Design and sample: For this descriptive qualitative study, 20 women living with HIV participated in the study. Women were randomly divided into two peer support groups of ten women each; the groups met over a 12‐month period. monthly for the first two months and then every three months for the remainder of the year.Results: Discussion themes indicated women found ways to sustain the groups by using them as a platform for engaging in income generation; starting and participating in table banking; addressing food security; and finding financial and moral support. Problem‐solving challenges of sustaining peer support groups was also a major theme.Conclusion: As people live longer with HIV, long‐term peer support will be needed to maintain wellbeing. Community‐based peer support groups can be sustained by engaging women in common income‐generation activities.