JMIR Publications

ABSTRACT

Background:

Emerging evidence supports that women with histories of abuse have heightened levels of stress and immune dysregulation. Few studies have examined the biological plausibility of this association in U.S. Black women– a population disproportionately affected by gender-based violence, health disparities, and generally under-represented in research. Biomarkers of stress and immune health can be difficult to study due to issues in participant recruitment, retention, and protocol adherence. This study documents the process of an at-home, self-collected and minimally invasive salivary cortisol collection protocol among a sample of Black women with histories of abuse in Baltimore City, Maryland, U.S.

Objective:

The paper's aims are two-fold. First, we describe the at-home, self-collection protocol that we developed for use among a large sample of under-represented racial and ethnic minority women with histories of abuse. Secondly, we share the best practices for our experimental, minimally invasive salivary CAR self-collection procedure that spanned three consecutive days for the ESSENCE project participants. Our paper addresses several issues and gaps in salivary CAR research, including the following: study sample sizes have been limited and lack statistical power, study samples have lacked racial and ethnic diversity, factors that could improve saliva self-collection protocol adherence are unknown, use of phone technology in facilitating protocol adherence is unknown, the feasibility and acceptability of saliva self-collection protocol among vulnerable populations (including women with experiences of violence) and the supports needed for protocol adherence is unknown. The establishment of this protocol and the markers gathered are foundational to understanding the effect of violence and toxic stress on women’s health.

Methods:

Black women (n=310) were recruited from November 2015 to May 2018 from Baltimore City STD clinics. Participants received in-person instruction and demonstration of how to self-collect saliva samples at home via the passive drool method and were given study-issued cell phones for reminders and to document protocol adherence. At home, participants collected saliva samples upon waking and 30 minutes post-waking on three consecutive weekdays (cortisol awakening response – 2 samples/day for 3 days). Study staff then retrieved saliva samples from participants’ residences, administered a short survey assessing their understanding and adherence to the saliva collection protocol, and documented the retrieval process.

Results:

Overall, the results report on our saliva collection protocol results, and demonstrate the feasibility of saliva cortisol awakening response among Black women with histories of abuse. Of the 305 women who completed the survey, 224 completed the saliva specimen collection protocol. Of the women who completed the saliva specimen collection protocol, 92 (41%) had a history of forced sex since age 18 (exposed women) and 132 (59%) had no history of forced sex in adulthood (non-exposed women). Women who completed the saliva protocol were similar in demographic characteristics to those of the full study sample (n=305) in terms of age, level of education, employment status, annual individual income, currently in a relationship, and having at least one child living in the household. The high adherence rate and successful collection of salivary cortisol samples support the feasibility of at-home self-collection protocols in this population.

Conclusions:

This study demonstrates the feasibility and acceptability of self-collection of salivary cortisol for cortisol awakening response among a hard-to-reach sample of U.S. Black women with experiences of trauma and abuse. Research implications include the facilitation of the collection of salivary biomarkers (including stress and inflammation measures) to promote research that examines the physiological and health repercussions of gender-based violence within the context of women’s everyday lives. Clinical Trial: N/A