Theme: Some women reported that their faith in God was important and

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Table 1. Participants for Semi-structured Interviews 4 Demographic Information 3. Results 4Qualitative Study Examining the Role of Spirituality in the Lives of African-American Women who Use Crack through the Lens of Soul Theology Substance use, particularly cocaine and heroin use, contributes to a major vector of HIV infection in U.S.

urban cities, not only through sharing cdrug works d but also through risky sexual practice. Various prevention and intervention strategies have been implemented to address both drug use and sexual risk behavior. Research suggests that spirituality and religious faith may mediate as well as play a protective role in physical and mental health of the African Americans.

Studies have suggested an association between religiosity and avoidance of alcohol and drugs. Strength of religious faith and belief in a benevolent and meaningful world were shown to be independent predictors of sex-related HIV preventive behavior. Due to the importance of religion and spirituality in the lives of African Americans, especially those who are older and women and the possible impact they have on the reduction of risk behavior, it is imperative that we understand the role religion and spirituality plays in the lives and health of substance abusing women.

Purpose The purpose of the ... more. less.

present study was to explore the role of spirituality and religion in the lives of African American urban women who use crack generally and by using tenants from Soul Theology. More specifically this paper aims (a) to contribute to the existing literature that explains the impact, effects and role spirituality and religiosity the lives of urban African American substance abusing woman and (b) to conduct an initial investigation of whether there is support for Soul Theology, a culturally specific theological framework which posits that some spiritual beliefs empower and promote physical and mental healing as African Americans go through life challenges. Definitions Used for this Study Religiosity is a comprehensive sociologicalterm used to refer to the numerous aspects of religious activity, dedication, and belief. Spirituality is both the belief in and the personal relationship between humans and God or a Higher Power. Kyla Marie Sawyer, PhD*, Wendee M. Wechsberg, PhD, Rhonda Karg, PhD, Kara S. Riehman, PhD, and Wendy K. Lam, PhD " RTI International, Research Triangle Park, NC *Presenting author RTI International · 3040 Cornwallis Road Research Triangle Park, NC 27709 Phone 919-541-7364 · Fax 919-485-5555 Email kms@rti.org · Web www.rti.org Presented at the 134th Annual Meeting of the American Public Health Association, Boston, MA, November 4 38, 2006 RTI International is a trade name of Research Triangle Institute. cBut if I did, just take it in stride and just remember my goals [staying clean from crack], that sooner or later, and I put faith in God that sooner or later, when it 9s time, He 9s going to let me know it 9s time [to be clean from crack]. d 4Participant 16 c...June the 26th, so, you know, I know as long as I stay clean, something 9s going to happen. You know, if I do the footwork, God is going to help me through. d 4 Participant 17 1. Background As a follow-up of the Women 9s CoOp I 4a randomized control intervention trial 4the Women Focused HIV Prevention with African-Americans (Women 9s CoOp II), aimed to examine the long-term intervention effects of a longitudinal woman-focused HIV-prevention intervention as well as examine how African American crack using women work on recovery issues and develop personal power. (See Wechsberg, Lam, Zule & Bobashev, 2004). The participants, depending on when they first enrolled, were out of the Women 9s CoOp I study for two to five years. Women 9s CoOp II was conducted from July 2004 to July 2008 in Wake and Durham counties of North Carolina, specificallythe Raleigh- Durham area. The study had several components: Intake, semi-structured interviews, 6-, 12-, and 18-month follow-ups. For the purposes of this study, we focused on the semi-structured open-ended interviews, which addressed the unique economic hardships, social contexts, and struggles of women 9s lives that affect their alcohol and drug use, victimization and sexual risk. These interviews were conducted to explore in greater detail what happened in the past few years to the women since participating in the first HIV prevention intervention study (Women 9s CoOp I). Qualitative Analysis Deductive Category Application Inductive Category Development 2. Methods Study Participants Eligibility Criteria Participated in the original Women 9s CoOp, where they had to: a) be at least 18 years of age; b)report engaging in unprotected sex during the past 90 days; c) admit using crack on at least 13 of the past 90 days. Recruitment Women who participated in the original Women 9s CoOp were recruited using the locator forms and street outreach in Raleigh- Durham, NC starting April 2003. Method 4Qualitative Study Procedure Women consented to be taped and shared their stories of how they work on recovery issues and develop personal power. The following topics were covered in the interview: Analysis of Transcript Data Qualitative Component 4 Core Beliefs \x2 Deductive Category Application (DCA) is based on codes that have been determined prior to reading the data. These codes are typically generated from research questions and/or theory. \x2 We used tenets from Soul Theology to analyze the interview transcripts. Qualitative Component 4 Emerging Themes \x2 Inductive Category Development (ICD) involves formulation of codes, as the data are read and re-read. Codes are changed and redefined as various themes emerge and reoccur. \x2 We also used ICD to determine emerging themes in the transcriptions. 2. Methods (continued) 55 (11) % Trading Sex (n) 80 (16) % Expressed Spirituality/Religiosity in In-Depth Interview (n) 40 (8) % Stopped Using Crack (n) 25 (5) % Received more education (n) 50 (10) % Participated in Treatment Program since last study (n) 35 (7) % Homeless (n) 5 (1) % Widowed (n) 10 (2) % Living with sexual partner (n) 20 (4) % Divorced (n) 10 (2) % Separated (n) 10 (2) % Married (n) 45 (9) % Single (n) Marital Status 31 354 Age Range 44.2 (9.93) Mean age (sd) in years (n = 20) Women Subset of Participants Who Expressed Spirituality/Religiosity Even though interview questions did not cover spirituality or religiosity, 16 of the 20 women throughout the interview expressed these topics as they related to recovery and personal power. Of these 16 women: 6 (38%) women reported no longer using crack 8 (50%) women reported no longer trading sex 11 (69%) women reported having a place to live Women 9s CoOp Site 4. Core Beliefs 4 Soul Theology * (Deductive Category Application) Like other research, this study supports the importance of spirituality or religiosity for positive health outcomes. One of the most interesting points about the results of semi-structured interviews is how much spirituality and/or religiosity were intertwined in theresponses of the women, albeit we did not ask any spirituality or religiosity questions. This indicates that spirituality and/or religiosity is an important factor in the lives of African American women who use drugs. And according to them it has played a vital part in developing their personal power, sense of identity, coping with situations related to drug use, recovery and mental health. Based on the quotes from the women, Soul Theology is supported and provides an initial framework for understanding how African American women substance users cope through life 9s challenges. Additional themes indicated that involvement in church and/or with church members had positive impact (i.e., reduction/cessation of drug use) on the lives of African American substance using women. Also, women reported that prayer helped them cope with challenges that emerged in their lives and their faith in God helped them to get clean. More specifically our study findings of urban African American women, who use crack, were both consistent and different from the existing findings of research on rural African American women who use cocaine (Brown, 2006). In both studies women used their faith in God to address their addiction. Also, women believed that God kept them or was their caretaker during those times when they were using drugs and in times of major crisis. In our study however, women mentioned that God was not only was their caregiver, but 8He 9 provided strength for them so that they felt more empowered to take care of themselves rather than depend on a man for help. Both groups of women also reported that the church was integral in their lives, however the rural women spoke only in terms of church attendance, where the urban women spoke of both church attendance and relationships with Christians who helped them change their play things (crack), playmates (people who used drugs) and play places (place where participants got high). Bible reading and praying were also consistent for both rural and urban women in these studies. Unlike urban woman, rural women reported that they participated in spiritual/relig- ious enrichment by watching television or listening to radio. They also mentioned that they felt as though they were not living according to their religious upbringing. Although we derived important information from this study we also had limitations. First and foremost, we did not include questions with regard to women 9s spirituality or religiosity. Because it was not a focal area of investigation, the depth in which we explored these aforementioned topics was not as thorough as it could have been. Although much care was given by the four interviewers and two analysts to adhere to the protocol of the study without leading the participants or having bias during coding and interpretation, there is a possibility that occurred. Furthermore, although each one of the six tenets of Soul Theology that we examined was supported, some of the tenets were only supported by one to three participants. Had the study focused on understanding religiosity and spirituality directly, perhaps we would have had more support for each one of the tenets. Additionally, this study only had 20 participants; therefore we are not able to generalize these findings to all African American women who use crack cocaine. We recognize and respect that spirituality and religiosity are an integral part of African American crack using women 9s lives. We believe that a healthy balance of spirituality and religiosity, coupled with a comprehensive intervention, will assist women in reaching their goals to be free from crack cocaine and other life challenges that these women face. 6. Discussion Acknowledgements: The Woman-Focused HIV Preventions with African Americans (Women 9s CoOp II) Study was supported by the National Institute on Drug Abuse (NIDA; 2R01- DA11609). The interpretations and conclusions do not necessarily represent the position of NIDA. Thank you to all the participants, field staff, and RTI technical staff for making this presentation possible. Thank you to Drs. Wechsberg, Karg, and Lam for their continued support. For questions please contact Kyla Sawyer at kms@rti.org or 919.541.7364. The Women 9s CoOp has been shown to change African American women 9s drug use and sexual risk. However, intervention effects have not been sustained over time. Because the women in our study demonstrate that spirituality and religiosity are important to their lives and that strength of religious faith is related to reduction of drug use and increase in confidence in abstaining from drug use, integrating a spirituality and/or religiosity component into the Women 9s intervention may be among the next steps as we further develop the Women 9s CoOp study. Future research should explore what elements of spirituality and religiosity (e.g., core beliefs of Soul Theology ) to add to the intervention as well as how these factors should be implemented into an intervention. The spiritually enhanced intervention should then be piloted among African American substance using women and perhaps men as well. 7. Implications Soul Theology posits that some spiritual beliefs, thought to have been developed through years of slavery and oppression, empower African Americans through life challenges. Some of those beliefs are: The Providence of God The Goodness of God and creation The Grace of God The Providence of God c&God is in charge&It is the deep and sweeping assertion that the whole universe is friendly and benevolent, and that its Creator is able and willing to turn into good ends whatever may occur. d 4 Excerpt from Soul Theology cI, I stopped right there to let him, let them go past me. They pulls in front of me, snatch me. One grabs me from the front and the other one grabs me from the back and helphim in the back push me in the car at gun-point, took me on 147 and drug me in the bushes and raped me. I laid on my back. And the reason why, people said, cWhen you 9re telling that, you don 9t cry, dbecause you know what? God gave me the, He granted me the, how you say it? He, He granted me my serenity to be able to save another 9s life. And I got tired of crying over it. Now I, I learned to accept it, you know. If I hadn 9t have been out there, it wouldn 9t have happened to me, you know. If I hadn 9t have been out there trying to get money to get, to get high, it wouldn 9t have happened to me. d 4 Participant 12 The Justice of God cGod is just&God is also fair and impartial&[There is this] idea that there is only one true God, and this Deity requires ethical accountability. 8For what- soever a man soweth, that shall he also reap. 9 d 4 Excerpt from Soul Theology The Justice of God The Omnipotence of God The Omniscience of God Interviewer: Okay. Where do you see yourself in two years? Participant 15: I don 9t know. I try to live day to day because [you never know what might happen]. I pray every morning, pray every night. That 9s the best I can do. God is good to me. He is. The goodness of God and creation cIt is the belief that the experience of creation and life itselfmust be ultimately beneficial or good. d 4 Excerpt from Soul Theology cYeah, I 9d like for him to take [an AIDS test] right when we be there together&You know what I 9m saying? It 9s too late now. We 9re trying to make a baby&He should have thought about that. You was the one to say [inaudible] no more. You know. We are as one. Okay. We are as one. But if something come back, at least we 9ll be sitting up there being healthy together. It wasn 9t like it was intentionally&You know what I 9m saying? We should have did this beforehand&But I 9m not worried about it. God got me. I already know that&It 9s going to be all right. He got me. d 4 Participant 12 The Omnipotence of God cOmnipotence means all-powerful&Nothing can exist that is free of the ultimate control of the Creator and Lord of the universe. Human [choice], of course, amounts to a kind of exception, but it is ordained by God and constitutes a divine self-limitation. d 4 Excerpt from Soul Theology c We keep being honest, as they say we keep being honest, truly with ourselves, and it ain 9t about telling God and other human beings what God, God already knows, so it 9s to tell yourself, cYes, I am an addict. Yes, I have a disease that wants me dead. Yes, my disease take me to levels where I should not go. Yes, I risk my life, I risk my health. dDon 9t know if a man will turn around, strangle you and then cut yourthroat up. Cut your, I mean, you never know, you know, and then you, cOh, I was on drugs. I did a crazy thing. d No, you had a choice. You know, sometimes it don 9t seem like why I 9m in addiction that I got a choice, but I got a choice. d 4 Participant 1 The Omniscience of God c[Omniscience means] God knows everything. d 4 Excerpt from Soul Theology cA lot of stuff, I knew it, but I ain 9t never paid no mind to what I cared about, but to really give a damn about living, I never, some of the pains that I realize I 9ve done, and that I have let been done to me, for the sake of what? Sake of a drug. Or whatever you need money for, having to put up with people just to have somewhere to stay, and let them give me a meal. I ain 9t never thought I had to do that. When I could have felt like I couldn 9t go out there and sell myself, I had to deal with whatever. I felt that way. I felt stuck. Through the Grace of God I got up out of there. I ain 9t telling my man. He still think I 9m in Chapel Hill. [laughter]. d 4 Participant 1 The Grace of God c...God is gracious. The crowning and ultimate trait of the Eternal is understanding forgiveness or unconditional, unmerited acceptance. d 4 Excerpt from Soul Theology 5. Summary of Additional Emerging Themes (Inductive Category Development) In addition to the Soul Theology themes, additional themes emerged through ICD which further described how our sample of African American women crack users incorporates spirituality and/or religiosity into their lives. Those themes are: cI feel blessed to learn that I have goals that have been accomplished that were set some time ago. Plan and work on those plans and God will deliver. d 4 Participant 2 The following are 3 quotes that support some of these emerging themes: Theme: Some women reported that their faith in God was important and that their faith was part of changing their drug-using lifestyle. c 4because when you stop getting high, that 9s just starting to live because your spirit is dead when you 9re getting high. When a, when, when us people that use drugs get high, our whole spiritual life is dead. We 9re just walking, we 9re a walking shell with no spirit. Our spirit is dead. That 9s why I have spirit now. I pray every day, every day. Me and him pray together at night, you know. And I feel like I 9m alive. d 4 Participant 12 Interviewer: All right. We are getting though my questions here. Let 9s talk a little bit, we talked about cutting your current sources of stress and you mentioned someof those. How would you say you cope with your stresses these days? Participant 9: Pray. Meditate. Read . Theme: Prayer helps the women feel alive and cope with the stress of drug life. Theme: Church involvement and member support were also reported to contribute to the maintenance of abstinence from substance use. *There are 10 core beliefs. Six focus on beliefs that articulateunderstandings of God 9s attributes which have been experienced by the African American community. The remaining core beliefs extract anthropological insights into the culture and religion of African Americans. For the purposes of this study we used the first six for DCA. Participant 18: Okay, after the study, the first study, like I said, everybody said since I wasn 9t doing drugs and going to church and trying to help somebody else like I got help, my friends just scattered. You know? Interviewer: They scattered because you weren 9t doing drugs? Participant 18: Yes. Interviewer: Or because you weren 9t going to church? Participant 18: They scattered because I wasn 9t doing drugs and I was going to church. I was trying to __. Interviewer: This was a different group of friends. Participant 18: Yeah, I tried to get them to follow in my footsteps because I had a lot of experience with somebody else and I had been to church as a young kid-all of my life-but I slipped out of that and then I started doing drugs and I got off and I started back going to church and it seemed like my friends weren 9t my friends no more. 1. God 9s Grace (Something bad should have happened but it didn 9t because of God) 3 9 quotes 2. When situations got rough I called on God 3 5 quotes 3. Church involvement helped with reduction/cessation of substance use 3 5 quotes 4. Attending church and/or associating with Christians had a positive influence on me 3 5 quotes 5. God saved me from negative consequences of sexual risk/drug use 3 5 quotes 6. God/Faith is important to getting clean 3 5 quotes 7. Prayer, meditation and reading spiritual materials help me 3 5 quotes 8. Look to God for strength/help 3 4 quotes 9. God took care of me/God helped me 3 3 quotes 10. God blessed me (Something good happened to me because of God) 3 3 quotes 11. My faith is a big part of my life 3 2 quotes 7) HIV 8) Personal Power 9) Violence 10) Involvement with the Criminal Justice System 11) Use of Services 1) Remembering the Women 9s CoOp Study 2) Education and Training 3) Employment 4) Living Arrangements 5) Drug Use 6) Relationships/Partners

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