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Objectives: Breast reconstruction (BR) potentially can improve quality of life in postmastectomy breast cancer survivors (BCS); however, African-American women are less likely to undergo BR than Caucasian women. This qualitative study was undertaken to explore individual, sociocultural, and contextual factors influencing African-American women's BR decision-making processes and preferences. Methods: Postmastectomy African-American BCS with and without BR participated in semi-structured interviews. We adopted a grounded theory approach using the constant comparison method to understand the contexts and processes informing participants' BR decision-making. Results: Twenty-three women participated, of whom 17 elected BR and 6 did not. Whereas women's primary reasons for deciding for or against BR differed, our core category, "empowered choices ," describes both groups' decision-making as a process focused on empowering themselves physically and/or psychologically, through self-advocacy, informed and shared decision-making, and giving back/receiving communal and spiritual support from church and African-American survivor groups. Socioeconomic factors influenced women's access to BR. Women preferred autologous BR and expressed the need for greater culturally-matched resources and support to inform treatment and shared BR decision-making. Conclusions: Understanding and supporting African-American women's BR preferences and empowerment is essential to ensuring equal access, and culturally-relevant, high-quality, and informed patient-centered care.

The purpose of this manuscript is to determine the prevalence of opioid misuse/opioid use disorder (OUD) among adults experiencing homelessness and describe characteristics that account for significant variance in relation to opioid misuse in those who misuse and do not misuse opioids. From six homeless shelters in Oklahoma City, adults participated in a survey about their demographics, substance use, mental health, and physical health from July to August of 2016 (n = 569). For assessing substance use, participants responded about their opioid misuse and diagnosis of OUD, current smoking status, arrests due to drug possession or driving while intoxicated, and diagnosis with alcohol use disorder or another drug use disorder, excluding opiate use disorder. A cumulative score of mental health comorbidity was created based on affirmative responses for having been diagnosed with depression, post-traumatic stress disorder (PTSD), schizophrenia/schizoaffective disorder, bipolar disorder, or an anxiety disorder besides PTSD. For physical health, one item from the General Health Survey-Short Form assessed pain, one item from the Behavioral Risk Factor Surveillance Survey assessed health, and one item assessed history of concussion. Bivariate analyses and logistic regression models identified the association. Sixteen percent of participants reported having experienced opioid misuse/been diagnosed with OUD. Substance use behaviors and physical health accounted for significant variance among those who misuse compared to those that do not misuse opioids. The most robust positive association of opioid misuse included: being white, being a current smoker, being diagnosed with another drug disorder, and having a concussion history. Additional research among the homeless population with a focus on concussion history as it relates to substance use and mental health comorbidity is needed.