Alexa A. Lopez

There is a direct relationship between fatal drug overdose and individuals who have been involved with the United States criminal legal system. Fatal drug overdose in the United States has reached unprecedented levels in the last decade, disproportionately affecting individuals involved with the criminal legal system and those who experience intersecting social and structural determinants of health. In addition, evidence shows that the immediate post-release period after incarceration is characterized by elevated overdose mortality. However, current policy structures, including the federal Medicaid Inmate Exclusion Policy, fragmented reentry systems, and inconsistent access to medications for opioid use disorder (MOUD), leave justice-involved populations without essential supports during this high-risk transition. This commentary synthesizes national evidence and proposes 3 policy initiatives to reduce post-incarceration overdose deaths: (1) adoption of the Section 1115 Medicaid Reentry Demonstration Waiver to provide prerelease screening, treatment initiation, care coordination, and bridge medication; (2) implementation of statewide carceral-based recovery support programs that integrate peer recovery coaches, trauma-informed care principles, naloxone training, and warm handoffs to community services; and (3) development of low-threshold community harm reduction hubs offering naloxone distribution, same-day and telehealth-enabled MOUD access, housing navigation, and peer support. These initiatives strengthen care continuity and target the transition periods where risk is greatest. Implementing these evidence-informed strategies is both a public health imperative and a critical step toward advancing health equity for criminal legal system-involved populations.

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.

Background: Proper nutrition supports maternal and fetal health. Gaps in nutritional knowledge (NK) and nutritional literacy (NL) can affect maternal and fetal health. NK refers to knowing facts and processes about nutrition, while NL is a broader component that includes competencies and skills needed to obtain, understand, and apply nutrition information to make dietary decisions. NL and NK limitations may contribute to adverse maternal and neonatal outcomes. This scoping review aims to understand the relationship between NK, NL, and pregnancy outcomes, offering insights into areas for future nutrition-based interventions. Methods: Seven databases were searched for studies assessing NK and NL among pregnant women. A total of 5080 articles were identified, with 4249 retained after removing duplicates. Following title and abstract screening, 18 articles underwent full-text review, and 11 met the inclusion criteria. Data were extracted, analyzed, and categorized into nine key themes. Results: All eleven studies employed survey-based methods; ten focused on NK and one on NL. Overall, NK was generally low. The evidence for an association between NK or NL and pregnancy outcomes was limited. Education, income, occupation, and family influence were identified as key factors influencing the NK and NL of pregnant women. Education and income levels were identified as having the most significant impact on NK overall. Only one study accessed the relationship between NK and adverse birth and neonatal outcomes, and this only included HDP and preterm labor. Also, only one out of the eleven studies was conducted in the US. Conclusions: In this review, we found that NK and NL among pregnant women was generally low, with limited evidence linking it to pregnancy outcomes; education and income emerged as the most influential factors of NK and NL. Future studies in high-income countries are recommended to assess the association between NL and adverse maternal outcomes, especially GDM.

Black women are disproportionally impacted by intimate partner violence (IPV), which influences women's mental health. The COVID‐19 pandemic caused significant mental health strain on women experiencing IPV while also affecting their ability to seek mental health services. This study was conducted to qualitatively investigate the impact of IPV on urban Black women's mental health since the start of the COVID‐19 pandemic. This analysis is part of an ongoing mixed‐methods study in the Upper Midwest of the United States. We used purposive and snowball sampling to engage 28 women in in‐depth individual interviews. Using content analysis, four themes were identified, including (1) anxious feelings, (2) feeling depressed, (3) posttraumatic stress disorder feelings, and (4) substance use. There is an urgent need to consider mental health interventions in times of national or global crises. Mental health interventions are especially of consideration for populations experiencing deep vulnerability, like women who experience IPV. This is more so the case in crises where there is a need to enact restrictive policies to contain public health epidemics or pandemics.

Violent behaviour perpetrated against women has long‐lasting negative physical and mental health consequences for women, their children, their families, and their communities. Intimate partner violence (IPV) is associated with many adverse physical, psychological, and emotional consequences. Structural racism and historical trauma affect women's trust and further hinder the ability of Indigenous and Black women to seek help after experiencing IPV. The availability of IPV support services, which can include shelter, food, group therapy, legal assistance, and advocacy, can be inaccessible to women due to the inability to access often limited resources in urban environments and reasons compounded by potential geographic distance if living in rural areas or living in community. Understanding the unique reasons why Indigenous and Black women do not seek help, and the barriers they experience when seeking help after IPV, is critical. Pandemics have the potential to create further complexities on how IPV is experienced. Black and Indigenous women experiencing IPV were therefore at even greater risk for IPV‐related harm because of state and local “stay at home” measures put in place to minimise the spread COVID‐19. The purpose of this manuscript is to explicate the methods for a large R01 study in the Upper Midwest.

Traditional substance misuse treatments have not always taken women or marginalized populations into consideration. A holistic approach that addresses how drugs may be used to cope with trauma caused by violence, poverty, and neglect as well as employment of engagement strategies that connect populations with culturally relevant support systems are key, especially in treating African American women. As substance misuse rates rise among African American women, characterizing how this may influence or be influenced by relationships (such as with children, intimate partners, and social relations) is especially important in the context of effective treatment. The purpose of this qualitative study was to examine the themes surrounding substance misuse and close relationships among women previously enrolled in a transitional housing treatment program grounded in social support. Many women discussed how the program itself was an impetus in addressing not only their own substance use but also intergenerational substance use within their families. Women also noted how relationships with their children were vastly different pretreatment compared with during and after treatment, specifically emphasizing a positive improvement. Regarding intimate relationships, African American women learned to establish assertiveness and navigate healthier social relationships, all while sustaining drug abstinence. It is important to acknowledge the role of the healthcare professional in ensuring effective and culturally relevant treatment for African American women; nursing curricula should include evidence-based practice education and training on mental health and substance misuse specific to marginalized communities to more deeply understand the complex intersections of substance misuse, poverty, and social relationships in the lives of women.

Through the lens of Black Feminist Thought, the intersectionality of poverty, racism, and sexism in the lives of urban dwelling African American women was explored. Reflections on recovery among women previously enrolled in a transitional housing treatment program were gathered via semistructured interviews, using an instrumental case study design. Four major themes surrounding the context of recovery were identified and analyzed: Knowledge and awareness of addiction, importance of social support and support groups, peace of mind that resulted from a new lifestyle, and women's desire to maintain their recovery status. Many women did not realize that their drug use constituted an addiction prior to their enrollment in the program. Social support and support groups such as AA, NA, and AODA helped the women to maintain their recovery, and this newfound recovery resulted in additional stress relief. Finally, many women felt empowered to maintain their recovery, not only for themselves but also their children. Paradigm shifts in treatment and recovery processes are needed to better serve minority populations, specifically focusing on women and African Americans. Recovery services must shift from previously male centered, hegemonic, pathology-oriented treatment modalities to serve populations more efficiently and equitably. Furthermore, to create effective social change in recovery, programs must address the social determinants of substance misuse, addictive behaviors, and underlying structural inequalities resulting from the intersection of racism, sexism, and classism. Deeper understandings of complex social issues must be disseminated, particularly for women battling substance misuse who are homeless, racially discriminated against and marginalized. (PsycInfo Database Record (c) 2022 APA, all rights reserved).