Prostitution was common among a sample of individuals entering substance use treatment in the United States and was associated with higher risk of physical and mental health problems. Increased efforts toward understanding prostitution among patients in substance use treatment are warranted. Screening for prostitution in substance use treatment could allow for more comprehensive care to this population.

Concern for personal safety is a pervasive stressor for many women. Developing competencies in physical self-defense may empower women to engage more freely in daily activities with less fear. This study assessed the effects of physical self-defense training on multiple aspects of women's perceived self-efficacy and other self-reported personality characteristics. Training powerfully increased task-specific (self-defense) efficacy beliefs as well as physical and global efficacy beliefs. Training increased self-reported assertiveness, and posttraining decreases in hostility and aggression were found on several of the subscales of The Aggression Questionnaire (A. H. Buss & M. Perry, 1992), indicating that training did not have an aggression-disinhibiting effect. In the experimental condition, most of the effects were maintained (and some delayed effects appeared at follow-up.

Purpose Distress and reduced quality of life (QOL) are common among people with cancer. No study has compared these variables after breast cancer diagnosis to pre-cancer diagnosis levels. Methods Data on women with breast cancer 50 years of age or older (n=6949) were analyzed from the Women's Health Initiative (1993-2013). Health-related QOL (physical function, mental health) was measured using Rand-36. Depressive symptoms were measured with the 6-item Center for Epidemiologic Studies Depression. Assessments occurred before and after the cancer diagnosis. Hierarchical linear modeling compared pre-cancer QOL and depressive symptoms to levels post-diagnosis and tested whether pre-cancer physical activity, stressful life events, sleep disturbance, and pain predicted post-diagnosis outcomes. Results Compared with pre-cancer levels, depressive symptoms increased (20.0% increase at 0-6 months, 12.9% increase at 6-12 months), while physical function (−3.882 points at 0-6 months, −3.545 at 6-12 months) and mental health decreased (−2.899 points at 0-6 months, −1.672 at 6-12 months) in the first year after diagnosis (p's<.01). Depressive symptoms returned to pre-cancer levels after 10 years but QOL remained significantly lower. At more than 10 years post-diagnosis, physical function was 2.379 points lower than pre-cancer levels (p<0.01) while mental health was 1.922 points lower (p<0.01). All pre-cancer predictors were associated with all outcomes. Pain predicted uniquely greater decreases in physical function post-diagnosis. Conclusions Depressive symptoms increased and QOL decreased following breast cancer diagnosis compared with pre-cancer levels, particularly in the first year. Implications for Cancer Survivors QOL may remain lower for years after breast cancer diagnosis, though decreases are small.

The authors assessed the impact of self-defense training for women on multifaceted aspects of perceived self-efficacy. As compared to a waiting list control condition, training increased selfefficacy perceptions not only for self-defense skills but also across a variety of domains, including self-defense abilities, sports competencies, and coping skills. Trained participants also experienced a significant increase in more global aspects of personality, including perceptions of physical self-efficacy and assertiveness. No changes were detected on a trait measure of global self-efficacy; however, there was a significant change on a composite score of a multidomain self-efficacy questionnaire and on several domain-specific subscales, indicating that trained participants experienced a boost in multiple domains of self-efficacy not directly tapped by the intervention. Implications for constructing more sensitive measures of coping skills generalization effects are discussed.

IMPORTANCE Social isolation and loneliness are increasing public health concerns and have been associated with increased risk of cardiovascular disease (CVD) among older adults. OBJECTIVE To examine the associations of social isolation and loneliness with incident CVD in a large cohort of postmenopausal women and whether social support moderated these associations. DESIGN, SETTING, AND PARTICIPANTSThis prospective cohort study, conducted from March 2011 through March 2019, included community-living US women aged 65 to 99 years from the Women's Health Initiative Extension Study II who had no history of myocardial infarction, stroke, or coronary heart disease.EXPOSURES Social isolation and loneliness were ascertained using validated questionnaires. MAIN OUTCOMES AND MEASURESThe main outcome was major CVD, which was physician adjudicated using medical records and included coronary heart disease, stroke, and death from CVD.Continuous scores of social isolation and loneliness were analyzed. Hazard ratios (HRs) and 95% CIs for CVD were calculated for women with high social isolation and loneliness scores (midpoint of the upper half of the distribution) vs those with low scores (midpoint of the lower half of the distribution) using multivariable Cox proportional hazards regression models adjusting for age, race and ethnicity, educational level, and depression and then adding relevant health behavior and health status variables. Questionnaire-assessed social support was tested as a potential effect modifier. RESULTS Among 57 825 women (mean [SD] age, 79.0 [6.1] years; 89.1% White), 1599 major CVD events occurred over 186 762 person-years. The HR for the association of high vs low social isolation scores with CVD was 1.18 (95% CI, 1.13-1.23), and the HR for the association of high vs low loneliness scores with CVD was 1.14 (95% CI, 1.10-1.18). The HRs after additional adjustment for health behaviors and health status were 1.08 (95% CI, 1.03-1.12; 8.0% higher risk) for social isolation and 1.05 (95% CI, 1.01-1.09; 5.0% higher risk) for loneliness. Women with both high social isolation and high loneliness scores had a 13.0% to 27.0% higher risk of incident CVD than did women with low social isolation and low loneliness scores. Social support was not a significant effect modifier of the associations (social isolation × social support: r, -0.18; P = .86; loneliness × social support: r, 0.78; P = .48). CONCLUSIONS AND RELEVANCEIn this cohort study, social isolation and loneliness were independently associated with modestly higher risk of CVD among postmenopausal women in the US, and women with both social isolation and loneliness had greater CVD risk than did those with either exposure alone. The findings suggest that these prevalent psychosocial processes merit increased attention for prevention of CVD in older women, particularly in the era of COVID-19.