Examining Disparities in Current E-Cigarette Use among U.S. Adults before and after the WHO Declaration of the COVID-19 Pandemic in March 2020.

This paper aims to estimate the prevalence of e-cigarette use before and after the COVID-19 pandemic declaration and to delineate disparities in use across subpopulations. Data were derived from the 2020 Health Information National Trends Survey (N = 3865) to conduct weighted multivariable logistic regression and marginal analyses. The overall prevalence of current e-cigarette use increased from 4.79% to 8.63% after the COVID-19 pandemic declaration. Furthermore, non-Hispanic Black people and Hispanic people had lower odds of current e-cigarette use than non-Hispanic White people, but no significant differences were observed between groups before the pandemic. Compared to heterosexual participants, sexual minority (SM) participants had higher odds of current e-cigarette use after the declaration, with insignificant differences before. People who had cardiovascular disease conditions, relative to those without, had higher odds of current e-cigarette use after the declaration, but no group differences were found before the declaration. The marginal analyses showed that before and after the pandemic declaration, SM individuals had a significantly higher probability of using e-cigarettes compared to heterosexual individuals. These findings suggest the importance of adopting a subpopulation approach to understand and develop initiatives to address substance use, such as e-cigarettes, during pandemics and other public health emergencies.

An Examination of Discrimination on Stress, Depression, and Oppression-Based Trauma During the COVID-19 Pandemic and the Racial Awakening of 2020.

Background: Discrimination is a pervasive societal issue that monumentally impacts people of color (POC). Many Black, Asian, and Hispanic/Latinx individuals report experiencing race-based discrimination in their lifetime. Discrimination has previously been linked to adverse health outcomes among POC, including stress, depressive, and posttraumatic stress disorder symptoms. These health disparities are posited to have become exacerbated by COVID-19 and the racial awakening of 2020. The current study examined the short- and long-term effects of discrimination on stress, depression, and oppression-based trauma among POC. Methods: Participants were (n = 398) who identified as Black, Indigenous, Hispanic/Latinx, and Asian completed an online self-report survey assessing discrimination, depression, stress, and oppression-based trauma collected at 3 time points: (T1) beginning of the COVID-19 pandemic (May 2020), (T2) 6 weeks later during the racial awakening of 2020 (June 2020), (T3) one year later (June 2021). Results: Significant positive paths were revealed from T1 discrimination to T2 depression, T2 stress, and T3 oppression-based trauma. The association between T1 discrimination and T3 oppression-based trauma was partially mediated by T2 depression, but not by stress; total and total indirect effects remained significant. The final model accounted for a significant proportion of the variance in T3 oppression-based trauma, T2 depression, and T2 stress. Conclusion: Findings are consistent with prior research linking discriminatory experiences with mental health symptomatology and provide evidence that race-based discrimination poses harmful short-and long-term mental health consequences. Further research is necessary to better understand oppression-based trauma to improve the accuracy of clinical diagnosis and treatment of POC.

Loneliness, Social Isolation, and All-Cause Mortality in a Large Sample of Older Adults.

OBJECTIVES: Using data from a large random sample of U.S. older adults (N = 7982), the effect of loneliness and social isolation on all-cause mortality was examined considering their separate and combined effects. METHODS: The UCLA-3 Loneliness Scale and the Social Network Index (SNI) were used to define loneliness and social isolation. Cox proportional hazards regression models were performed. RESULTS: Among study participants, there were 548 deaths. In separate, adjusted models, loneliness (severe and moderate) and social isolation (limited and moderate social network) were both associated with all-cause mortality. When modeled together, social isolation (limited and moderate social network) along with severe loneliness remained significantly associated with mortality. DISCUSSION: Results demonstrate that both loneliness and social isolation contribute to greater risk of mortality within our population of older adults. As the COVID-19 pandemic continues, loneliness and social isolation should be targeted safely in efforts to reduce mortality risk among older adults.

Loneliness, Social Isolation and All-Cause Mortality in Older Adults

As distinct constructs, loneliness and social isolation have both been associated with mortality in older adults. Many studies have examined each construct separately;however, few have examined their impact together, especially within the U.S. Using data from a large sample of U.S. adults age 65+ (N=7,982), the effect of loneliness and social isolation on all-cause mortality was examined considering their separate and joint effects. Measures were based on the UCLA-3 Loneliness Scale and the Social Network Index (SNI). Loneliness was categorized as: Severe, moderate, or no loneliness. Social isolation (defined by the SNI) was categorized as: Limited, medium, or diverse social networks (SN). Cox proportional hazards regression models were performed. Among participants, there were 328 deaths after data collection (4.1%). In separate, adjusted models, loneliness (severe, HR=1.86, 95% CI: 1.43-2.41 and moderate, HR=1.51, 95% CI: 1.16-1.98) and social isolation (limited SN, HR=2.37, 95% CI: 1.72-3.27 and moderate SN, HR=1.55, 95% CI: 1.12-2.14) were both associated with mortality. Modeled together, loneliness (severe, HR=1.55, 95% CI: 1.18-2.04 and moderate, HR=1.40, 95% CI: 1.07-1.83) and social isolation (limited SN, HR=2.08, 95% CI: 1.49-2.89 and moderate SN, HR=1.46, 95% CI: 1.05-2.02) both remained significantly associated with all-cause mortality with limited SN as the stronger indicator. Results demonstrate that both loneliness and social isolation contribute to greater risk of mortality among older adults. Furthermore, individuals with limited SN are at greatest risk. As the COVID-19 pandemic continues, loneliness and social isolation should be targeted safely in efforts to reduce mortality risk among older adults.

Cumulative Effect of Loneliness and Social Isolation on Health Outcomes among Older Adults

Loneliness and social isolation are described similarly yet are distinct constructs. Numerous studies examine each construct separately;however, less research has been dedicated to exploring their impacts together. Using survey and claims data among adults age 65+ (N=6,994), the cumulative effects of loneliness and social isolation on late-life health outcomes were examined using Chi-square and multivariate regression models. Loneliness and social isolation were measured using the UCLA-3 Loneliness Scale and the Social Network Index. Participants were grouped into four categories of loneliness and social isolation based on overlap, including: lonely only (L), socially isolated only (SI), both lonely and socially isolated (LSI), or neither (N). Outcomes included quality of life and healthcare utilization and costs. Among participants, 9.8% were considered L, 20.6% SI, 9.1% LSI, and 60.5% N. Respondents were primarily female (55.0%) and 70-74 years of age (27.1%). Those considered LSI were more likely to be older, female, less healthy, depressed, with lower quality of life and greater healthcare utilization patterns. Participants who were L or LSI had higher rates of emergency room visits compared to the N group;LSI had the highest medical costs. Results demonstrate the cumulative effects of loneliness and social isolation among older adults. Findings not only fill a gap in research exploring the impacts of these constructs later in life, but also confirm the need for approaches targeting older adults who are both lonely and socially isolated. As the COVID-19 pandemic continues, this priority will continue to be urgent for older adults.

Correction: Perceptions of risk for COVID-19 among individuals with chronic diseases and stakeholders in Central Appalachia.

[This corrects the article DOI: 10.1057/s41599-021-00906-7.].

Perceptions of risk for COVID-19 among individuals with chronic diseases and stakeholders in Central Appalachia

Coronavirus disease 2019 (COVID-19) pandemic is rapidly evolving and is a serious public health threat worldwide. Timely and effective control of the pandemic is highly dependent on preventive approaches. Perception of risk is a major determinant of health behavior. The current study explores the association between actual risk and perceived risk for one’s self, family/friends and friends, and community. A questionnaire was administered to participants in Central Appalachia (n = 102). The actual risk was based on the number of chronic conditions of the following conditions: hypertension, heart disease, cancer, diabetes, and chronic obstructive pulmonary disease. Participants were also queried about their perception of risk for COVID-19. Generalized Linear Models were used to independently evaluate the likelihood of perceived risk for one’s: self, family/friends, and community, based on actual risk. Actual risk for COVID-19 was significantly associated with higher likelihood of higher perception of risk for one’s self (b = 0.24;p = 0.04), but not with one’s family/friends (b = 0.05;p = 0.68), or one’s community (b = 0.14;p = 0.16). No health insurance was negatively associated with perception of risk for self (b = −0.59;p = 0.04) and family/friends (b = −0.92;p < 0.001). Male gender (b = −0.47;p = 0.01) was also negatively associated with perception of risk for family/friends. In conclusion, individuals’ actual risk for COVID-19 is associated with their own perception of risk. This indicates that one’s perception of risk for COVID-19 is greater for their own health compared to their family/friends or the community. Therefore, monitoring and following up with chronic disease patients and addressing their lack of awareness of risk to others is needed to prevent and curtail the spread of COVID-19.

Barriers to Dissemination of Local Health Data Faced by US State Agencies: Survey Study of Behavioral Risk Factor Surveillance System Coordinators.

BACKGROUND: Advances in information technology have paved the way to facilitate accessibility to population-level health data through web-based data query systems (WDQSs). Despite these advances in technology, US state agencies face many challenges related to the dissemination of their local health data. It is essential for the public to have access to high-quality data that are easy to interpret, reliable, and trusted. These challenges have been at the forefront throughout the COVID-19 pandemic. OBJECTIVE: The purpose of this study is to identify the most significant challenges faced by state agencies, from the perspective of the Behavioral Risk Factor Surveillance System (BRFSS) coordinator from each state, and to assess if the coordinators from states with a WDQS perceive these challenges differently. METHODS: We surveyed BRFSS coordinators (N=43) across all 50 US states and the District of Columbia. We surveyed the participants about contextual factors and asked them to rate system aspects and challenges they faced with their health data system on a Likert scale. We used two-sample t tests to compare the means of the ratings by participants from states with and without a WDQS. RESULTS: Overall, 41/43 states (95%) make health data available over the internet, while 65% (28/43) employ a WDQS. States with a WDQS reported greater challenges (P=.01) related to the cost of hardware and software (mean score 3.44/4, 95% CI 3.09-3.78) than states without a WDQS (mean score 2.63/4, 95% CI 2.25-3.00). The system aspect of standardization of vocabulary scored more favorably (P=.01) in states with a WDQS (mean score 3.32/5, 95% CI 2.94-3.69) than in states without a WDQS (mean score 2.85/5, 95% CI 2.47-3.22). CONCLUSIONS: Securing of adequate resources and commitment to standardization are vital in the dissemination of local-level health data. Factors such as receiving data in a timely manner, privacy, and political opposition are less significant barriers than anticipated.

Cumulative effect of loneliness and social isolation on health outcomes among older adults.

OBJECTIVES: Loneliness and social isolation are described similarly yet are distinct constructs. Numerous studies have examined each construct separately; however, less effort has been dedicated to exploring the impacts in combination. This study sought to describe the cumulative effects on late-life health outcomes. METHOD: Survey data collected in 2018-2019 of a randomly sampled population of US older adults, age 65+, were utilized (N = 6,994). Survey measures included loneliness and social isolation using the UCLA-3 Loneliness Scale and Social Network Index. Participants were grouped into four categories based on overlap. Groups were lonely only, socially isolated only, both lonely and socially isolated, or neither. Bivariate and adjusted associations were examined. RESULTS: Among participants (mean age = 76.5 years), 9.8% (n = 684) were considered lonely only, 20.6% (n = 1,439) socially isolated only, 9.1% (n = 639) both lonely and socially isolated, and 60.5% (n = 4,232) neither. Those considered both lonely and socially isolated were more likely to be older, female, less healthy, depressed, with lower quality of life and greater medical costs in bivariate analyses. In adjusted results, participants who were both lonely and socially isolated had significantly higher rates of ER visits and marginally higher medical costs. CONCLUSION: Results demonstrate cumulative effects of these constructs among older adults. Findings not only fill a gap in research exploring the impacts of loneliness and social isolation later in life, but also confirm the need for approaches targeting older adults who are both lonely and socially isolated. As the COVID-19 pandemic continues, this priority will continue to be urgent for older adults.