Economic Inequality during Covid-19 as a Pathway to Food Insecurity for People who are Disabled and Racialized as Non-White

Covid-19 heightened economic inequality across the U.S., especially for people who are disabled and non-white. These intersecting economic vulnerabilities open pathways to hunger. Using a survey from July 2020 (n = 2,043) in the Intermountain West, we find that economic inequality explained a substantial portion of food insecurity for people with disabilities. Racially stratified models show that people who were also non-white were more likely to be food insecure and receive differential protection from economic resources. Stronger social support will help mitigate food insecurity, yet such programs must grapple with the ways that ableism and racism intersect, especially during economic shock.Copyright © 2022 Taylor & Francis Group, LLC.

The mediating effects of socio-behavioral factors on the needs for help among Asian American breast cancer survivors

Background: Breast cancer survivors often report their high needs for help during the transition to cancer survivorship. During the COVID-19 pandemic, technology-based programs are increasingly popular because of their high flexibility and accessibility in delivering information and coaching/support to address the current needs for help among cancer survivors. Yet, little is known about how socio-behavioral factors influence the effects of a technology-based intervention on the needs for help of racial/ethnic minority breast cancer survivors, especially Asian American breast cancer survivors. Purpose(s): The purpose of this secondary analysis was to examine the multiple socio-behavioral factors (including attitudes, self-efficacy, perceived barriers, and social influences related to breast cancer survivorship) mediated the effects of a technology-based intervention on the needs for help among Asian American breast cancer survivors. Method(s): This analysis was conducted with the data from 199 Asian American breast cancer survivor women who were recruited from January 2017 to June 2020 through online and offline communities/groups. The needs for help were measured using the Support Care Needs Survey-34 Short Form (SCNS) with five domains on psychological, information, physical, support, and communication needs. Mediation analysis was conducted using the PROCESS macro within SPSS. The analysis determined the mediating effects of four socio-behavioral mediators on the needs for help at pre-test [T0 ], post 1-month [T1 ], and post 3-months [T2 ] of a technology-based intervention. Result(s): Overall, all the mediators had statistically significant mediation effects on all types of needs for help (p < .05) at different points. Attitudes and social influence presented statistically significant mediation effects on the total needs for help score over 3 months (T0 , T1 , and T2 ). Perceived Barriers had mediation effects on all types of needs for help over 1 month (T0 , T1 ). Self-efficacy mediated the effects on all types of needs for help only at post 1 month (T1 ). Conclusion(s): The findings supported that all the socio-behavioral factors (attitudes, self-efficacy, perceived barriers, and social influences) mediated the effects of a technology-based intervention on the needs for help of Asian American breast cancer survivors. Future research and practice should consider socio-behavioral factors to reduce their needs for help during their survivorship process.

The mediating role of learner empowerment in the relationship between the community of inquiry and online learning outcomes

The COVID-19 pandemic has necessitated a rapid shift to online learning, making the Community of Inquiry (CoI) framework increasingly relevant for creating meaningful and effective online learning experiences. However, the impact of CoI presences (i.e., teaching, social, and cognitive presence) on students' learning outcomes has been inconsistent in the literature, and a recent meta-analysis has identified a publication bias in this relationship, suggesting the need for a further investigation. This study aimed to enhance our understanding of how the CoI presences influence students' actual learning outcomes by incorporating learner empowerment as an essential learner characteristic. This study was conducted in two undergraduate courses that were abruptly shifted online due to the COVID-19 lockdown. Structural equation modeling was used to examine the relationship between the CoI presences, learner empowerment, and actual learning outcomes. The results show that learner empowerment has a direct and positive impact on students' actual learning outcomes, and partially mediates the relationship between CoI presences and learning outcomes. The findings highlight the significant mediating role of learner empowerment within the CoI framework and offer valuable insights into the design of productive online learning communities.

Vaccination, human mobility, and COVID-19 health outcomes: Empirical comparison before and during the outbreak of SARS-Cov-2 B.1.1.529 (Omicron) variant.

The B.1.1.529 (Omicron) variant surge has raised concerns about the effectiveness of vaccines and the impact of imprudent reopening. Leveraging over two years of county-level COVID-19 data in the US, this study aims to investigate relationships among vaccination, human mobility, and COVID-19 health outcomes (assessed via case rate and case-fatality rate), controlling for socioeconomic, demographic, racial/ethnic, and partisan factors. A set of cross-sectional models was first fitted to empirically compare disparities in COVID-19 health outcomes before and during the Omicron surge. Then, time-varying mediation analyses were employed to delineate how the effects of vaccine and mobility on COVID-19 health outcomes vary over time. Results showed that vaccine effectiveness against case rate lost significance during the Omicron surge, while its effectiveness against case-fatality rate remained significant throughout the pandemic. We also documented salient structural inequalities in COVID-19-related outcomes, with disadvantaged populations consistently bearing a larger brunt of case and death tolls, regardless of high vaccination rates. Last, findings revealed that mobility presented a significantly positive relationship with case rates during each wave of variant outbreak. Mobility substantially mediated the direct effect from vaccination to case rate, leading to a 10.276 % (95 % CI: 6.257, 14.294) decrease in vaccine effectiveness on average. Altogether, our study implies that sole reliance on vaccination to halt COVID-19 needs to be re-examined. Well-resourced and coordinated efforts to enhance vaccine effectiveness, mitigate health disparity and selectively loosen non-pharmaceutical interventions are essential to bringing the pandemic to an end.

Resilience and academic motivation's mediation effects in nursing students' academic stress and self-directed learning: A multicenter cross-sectional study.

AIMS: To investigate the mediating role of resilience and academic motivation between academic stress and self-directed learning. BACKGROUND: Academic stress in nursing students is a well-reported concept that affects resilience, academic motivation and self-directed learning. However, there is a dearth of studies investigating the mediating role of resilience and academic motivation between academic stress and self-directed learning. DESIGN: Cross-sectional study and mediation analysis. METHODS: Nursing students (n = 718) were recruited from five nursing schools via convenience sampling. Four self-report scales (Perception of Academic Stress Scale, Connor and Davidson Resilience Scale, Short Academic Motivation Scale and Self-directed Learning Instrument) were used to collect data from August to December 2022. Pearson's r, bivariate analysis and multistage regression analyses were employed to analyze the data. RESULTS: Academic stress negatively influences nursing students' resilience, academic motivation and self-directed learning. Resilience and academic motivation have a positive impact on self-directed learning. Resilience and academic motivation mediate the relationship between academic stress and self-directed learning, as evidenced by a reduction in the negative impacts of academic stress on nursing students. CONCLUSION: Resilience and academic motivation, as mediators, reduce the effects of academic stress on self-directed learning. Nursing educators and administrators should promote programs that strengthen resilience and academic motivation. Thus, improving educational and clinical performance.

Effect of Physical Activity on Association between COVID-19 and Personal Life in Community-Dwelling Older Adults.

Our study investigated whether changes in physical activity due to COVID-19 mediate the association between quarantine or hospitalization due to COVID-19 and COVID-19 life impact score. A total of 154 participants (0.23%) were quarantined or hospitalized due to COVID-19. There were mediating effects of changes in physical activity due to COVID-19 (ß = -1.63, 95% confidence interval = -0.77 to -2.42). This study suggests that measures to minimize lifestyle changes during the pandemic are required to reduce negative consequences.

Anxiety, insomnia and family support in nurses, two years after the onset of the pandemic crisis.

Introduction: The Covid-19 pandemic continues to cause serious physical and mental problems for health professionals, particularly nurses. Aim: To estimate the prevalence of anxiety and insomnia and to evaluate their possible association with family support received by nurses two years after the onset of the pandemic. Materials and methods: In total, the study participants were 404 nurses (335 females and 69 males) with a mean age of 42.88 (SD = 10.9) years and a mean of 17.96 (SD = 12) years working as nurses. Nurses from five tertiary hospitals in Athens constituted the study population who completed the questionnaires State-Trait Anxiety Inventory (STAI), Athens Insomnia Scale (AIS) and Family Support Scale (FSS), in the months of November and December 2021. Regarding demographic and occupational characteristics, gender, age and years of experience as nurses were recorded. Results: 60.1% of the nurses showed abnormal scores in state anxiety, with 46.8% in trait anxiety, and 61.4% showed insomnia. Women showed higher scores on the two subscales of anxiety and the insomnia scale compared to men (p < 0.01 and p < 0.05 respectively), while they showed a lower score on the FSS without statistical significance (p > 0.05). Positive correlations (p < 0.01) were found between the State Anxiety Inventory, Trait Anxiety Inventory and AIS, while all of them showed a high negative correlation with FSS (p < 0.01). Age showed a negative correlation with Trait Anxiety Inventory (p < 0.05). As shown by the mediation analysis, the relationship between state anxiety and insomnia was mediated by trait anxiety, whereas state anxiety appeared to be dependent on family support. Conclusions: Nurses continue to experience high levels of anxiety and insomnia and feel less supported by their families than in the first year of the pandemic. Insomnia appears to be dependent on state anxiety, with a significant indirect effect of trait anxiety, while family support seems to affect state anxiety.

A multiple mediation analysis to untangle the impacts of COVID-19 on nationwide bus ridership in the United States.

The COVID-19 pandemic has resulted in major consequences for many aspects of human life and the broader economy. Many transportation modes were severely impacted, including public transportation. During the early months of the pandemic in 2020, transit ridership dropped to unprecedented levels. Even by the end of 2022, bus ridership in the United States had not recovered to pre-pandemic levels. Despite the longstanding effects on public transportation, the direct and indirect impacts of the COVID-19 pandemic on bus ridership are largely unknown. In the context of this study, the direct impact refers to a change in travel behavior (i.e., due to the increased spread of COVID-19), while the indirect impact refers to reduced ridership due to factors such as lower employment or increased teleworking. This study proposes a framework to explore the drivers of transit ridership declines during COVID-19. The method is a multiple mediation analysis to estimate the monthly direct and indirect impacts of COVID-19 on bus ridership from March 2020 to December 2021. The results of this study revealed that three mediators (employment, telework, and people relocating) mediated about 13% to 38% of the total decline in bus ridership during the analysis period. The multiple mediation approach used in this study could be applied in many other transportation applications.

The mediating role of time attitude in the relationship between self-esteem and resilience in high school students

The aim of this research was to investigate the mediating role of time attitudes in the relationship between self-esteem and resilience in high school students. High school students' self-esteem, time attitude, and resilience have been researched comparatively. The research was carried out with a quantitative research design and survey method. Participants, who were selected using a convenience sampling method, were high school students. The 1,932 participants consisted of students in the following grade distribution: 793 ninth grade (248 male, 545 female);365 tenth grade (78 male, 257 female);350 eleventh grade (90 male, 260 female);and 434 twelfth grade (130 male, 324 female). Participants were selected from secondary education institutions in Sakarya and Kocaeli during COVID-19 from January to May 2021. Data were collected using tools such as the Two Factored Self-Esteem Scale, Adolescent Time Attitude Scale, and Ego Resilience Scale. The data was analyzed with correlation analysis and regression-based mediation analysis to investigate the relationship between self-esteem, time attitude and resilience. The SPSS 22 package program was used to analyze the data. After analyzing the data, it has been concluded that the time attitude in adolescents indeed has a mediating role in the relationship between self-esteem and resilience. The results of the research will make important contributions to the related literature.Copyright © 2023, Pharmaceutical Association of Serbia. All rights reserved.

Circulating neutrophil extracellular trap (NET)-forming 'rogue' neutrophil subset, immunotype [DEspR + CD11b +], mediate multi-organ failure in COVID-19-an observational study.

Background: Cumulative research show association of neutrophils and neutrophil extracellular traps (NETs) with poor outcomes in severe COVID-19. However, to date, there is no curative intent therapy able to block neutrophil/NETs-mediated progression of multi-organ dysfunction. Because of emerging neutrophil heterogeneity, the study of subsets of circulating NET-forming neutrophils [NET + Ns] as mediators of multi-organ failure progression among patients with COVID-19 is critical to identification of therapeutic targets. Methods: We conducted a prospective observational study of circulating levels of CD11b + [NET + N] immunotyped for dual endothelin-1/signal peptide receptor (DEspR ±) expression by quantitative immunofluorescence-cytology and causal mediation analysis. In 36 consented adults hospitalized with mod-severe COVID-19, May to September 2020, we measured acute multi-organ failure via SOFA-scores and respiratory failure via SaO2/FiO2 (SF)-ratio at time points t1 (average 5.5 days from ICU/hospital admission) and t2 (the day before ICU-discharge or death), and ICU-free days at day28 (ICUFD). Circulating absolute neutrophil counts (ANC) and [NET + N] subset-specific counts were measured at t1. Spearman correlation and causal mediation analyses were conducted. Results: Spearman correlation analyses showed correlations of t1-SOFA with t2-SOFA (rho r S = 0.80) and ICUFD (r S = -0.76); circulating DEspR + [NET + Ns] with t1-SOFA (r S = 0.71), t2-SOFA (r S = 0.62), and ICUFD (r S = -0.63), and ANC with t1-SOFA (r S = 0.71), and t2-SOFA (r S = 0.61).Causal mediation analysis identified DEspR + [NET + Ns] as mediator of 44.1% [95% CI:16.5,110.6] of the causal path between t1-SOFA (exposure) and t2-SOFA (outcome), with 46.9% [15.8,124.6] eliminated when DEspR + [NET + Ns] were theoretically reduced to zero. Concordantly, DEspR + [NET + Ns] mediated 47.1% [22.0,72.3%] of the t1-SOFA to ICUFD causal path, with 51.1% [22.8,80.4%] eliminated if DEspR + [NET + Ns] were reduced to zero. In patients with t1-SOFA > 1, the indirect effect of a hypothetical treatment eliminating DEspR + [NET + Ns] projected a reduction of t2-SOFA by 0.98 [0.29,2.06] points and ICUFD by 3.0 [0.85,7.09] days. In contrast, there was no significant mediation of SF-ratio through DEspR + [NET + Ns], and no significant mediation of SOFA-score through ANC. Conclusions: Despite equivalent correlations, DEspR + [NET + Ns], but not ANC, mediated progression of multi-organ failure in acute COVID-19, and its hypothetical reduction is projected to improve ICUFD. These translational findings warrant further studies of DEspR + [NET + Ns] as potential patient-stratifier and actionable therapeutic target for multi-organ failure in COVID-19. Supplementary Information: The online version contains supplementary material available at 10.1186/s41231-023-00143-x.

Statistical inference for linear mediation models with high-dimensional mediators and application to studying stock reaction to COVID-19 pandemic.

Mediation analysis draws increasing attention in many research areas such as economics, finance and social sciences. In this paper, we propose new statistical inference procedures for high dimensional mediation models, in which both the outcome model and the mediator model are linear with high dimensional mediators. Traditional procedures for mediation analysis cannot be used to make statistical inference for high dimensional linear mediation models due to high-dimensionality of the mediators. We propose an estimation procedure for the indirect effects of the models via a partially penalized least squares method, and further establish its theoretical properties. We further develop a partially penalized Wald test on the indirect effects, and prove that the proposed test has a χ 2 limiting null distribution. We also propose an F -type test for direct effects and show that the proposed test asymptotically follows a χ 2 -distribution under null hypothesis and a noncentral χ 2 -distribution under local alternatives. Monte Carlo simulations are conducted to examine the finite sample performance of the proposed tests and compare their performance with existing ones. We further apply the newly proposed statistical inference procedures to study stock reaction to COVID-19 pandemic via an empirical analysis of studying the mediation effects of financial metrics that bridge company's sector and stock return.

Age, COVID-19-related fear, insomnia symptoms and cyberchondria: a mediation model

Introduction: The subject of our study was the role of age, fear of COVID-19 infection and insomnia as predictors of cyberchondria in a Polish sample. We were also interested in whether insomnia mediated the relationship between fear of COVID-19 infection and cyberchondria in the entire sample. Material(s) and Method(s): The study sample consisted of 504 people, including 420 women and 84 men, aged 18 to 76 years (M +/-SD 30.49 +/-10.28), who were recruited through an online platform. Cyberchondria was assessed using the Polish version of the Cyberchondria Severity Scale. An 11-point numerical rating scale was used to measure the intensity of fear of COVID-19 infection for oneself. Insomnia symptoms were measured using the Polish version of the Athenian Insomnia Scale. Result(s): The correlation coefficients indicated positive relationships between the fear of COVID-19 infection and insomnia and cyberchondria, while age correlated negatively with cyberchondria. The hierarchical multivariate linear regression analysis revealed that COVID-19-related fear was the best predictor of cyberchondria. Insomnia and age were also cyberchondria predictors, but to a lesser extent. The mediation analysis revealed a significant indirect relationship between COVID-19-related fear and cyberchondria through insomnia symptoms. Conclusion(s): We observed that COVID-19-related fear and, to a lesser extent, age and insomnia were cyberchondria predictors. We also found both direct and indirect relationships between COVID-19-related fear and cyberchondria through insomnia.Copyright © 2022 Termedia Publishing House Ltd.. All rights reserved.

Estimations and Tests for Generalized Mediation Models with High-Dimensional Potential Mediators

Motivated by an empirical analysis of stock reaction to COVID-19 pandemic, we propose a generalized mediation model with high-dimensional potential mediators to study the mediation effects of financial metrics that bridge company's sector and stock value. We propose an estimation procedure for the direct effect via a partial penalized maximum likelihood method and establish its theoretical properties. We develop a Wald test for the indirect effect and show that the proposed test has a (Formula presented.) limiting null distribution. We also develop a partial penalized likelihood ratio test for the direct effect and show that the proposed test asymptotically follows a (Formula presented.) -distribution under null hypothesis. A more efficient estimator of indirect effect under complete mediation model is also developed. Simulation studies are conducted to examine the finite sample performance of the proposed procedures and compare with some existing methods. We further illustrate the proposed methodology with an empirical analysis of stock reaction to COVID-19 pandemic via exploring the underlying mechanism of the relationship between companies' sectors and their stock values. © 2023 American Statistical Association.

The strategic role of firm agility in the relationship between IT capability and firm performance under the COVID-19 outbreak

PurposeLeveraging theory from the dynamic capability literature, this study aims to explore how information technology (IT) capability influences firm agility and subsequently translates into firm performance.Design/methodology/approachThis study examines the proposed relationships by using survey data from a sample of 296 Chinese retail firms. Structural equation modeling is used to test this study's hypotheses.FindingsThe following results are produced: the direct effect of IT capability on firm agility is confirmed;firm agility has a direct impact on firm performance;and the indirect effect of IT capability on firm performance via firm agility is demonstrated (i.e. partial mediation).Originality/valueThe catastrophic outbreak of the COVID-19 pandemic has heightened the importance of firm agility more than ever. Although the traumatic event is painful, however, there is nothing like a crisis to offer a tremendous business opportunity. In response to the pandemic circumstance, firms are required to operate their business by reacting to unpredictable and dynamic market changes quickly and efficiently. This study sheds light on why firms should develop their IT capability and how it affects firm performance via firm agility during the COVID-19 outbreak.

Pulse of Asia 2021

The proceedings contain 67 papers. The topics discussed include: cardiovascular system and COVID-19;long term sequale on COVID-19;fighting vascular disease: thoughts about 2022 Taiwan hypertension guidelines;quantification of hemodynamic parameters using 4D flow MRI;nanomedicine for the treatment of atherosclerosis;direct thrombus imaging;clinical outcome in patients with deep vein thrombosis;cardiovascular benefits of SGLT-2 inhibitor;central blood pressure and pressure wave reflection in cardiovascular abnormalities: do not put them in shade;association between excess pressure and cognitive function among elderly population;visceral adipose tissue, coronary artery calcification and heart failure: a moderated mediation analysis;and the cardio-ankle vascular index was associated with CHADS2 score in patients with atrial fibrillation: a coupling registry study.

Job Stress during the COVID-19 Pandemic amongst Social Workers: A Comparison between Chinese Mainland and Macao

The COVID-19 pandemic may have resulted in front line social workers experiencing job stress, burnout and other psychological distress. Little is known about the work-related stress experienced by Chinese social workers during the pandemic. This study focused on the job stress of social workers from Mainland and Macao. The research aims of this study included: (1) testing whether there is a difference in job stress between social workers from Mainland and Macao during the pandemic and (2) identifying mediating factors that helped explain such regional differences. An online survey collected data from 292 social workers in Mainland China and 108 from Macao in 2020. Mainland participants reported significantly higher job stress than Macao participants. Regional differences in job stress amongst Mainland and Macao social workers were partially attributed to their age and professional role identity. More attention needs to be paid to social workers in Mainland China as they experience higher job stress than their counterparts from Macao. Future research is needed to examine other factors (e.g. job demand and financial compensation) that may contribute to such regional differences.

Telepresence Robot for Isolated Patients in the COVID-19 Pandemic: Effects of Socio-relationship and Telecommunication Device Types on Patients' Acceptance of Robots

Telecommunication devices can help mitigate the spread of the COVID-19 virus among the patients quarantined in hospitals. In contrast to the conventional telecommunication devices, a telepresence robot can deliver tangible communication cues from a remote sender to a receiver that vary according to level of interaction modalities. In the context of the COVID-19 pandemic, telecommunication interactants can be divided into two categories based on their socio-relationships. The types include those engaged in social-oriented relationships such as that between patients and families or acquaintances, and task-oriented relationships such as those between patients and doctors or nurses. We hypothesize that the types of telecommunication device used and socio-relationship would be factors affecting the COVID-19 patients' telecommunication experiences and acceptance of telepresence robots. We conducted a user study comparing three types of telecommunication devices namely floor-based robot versus desk-based robot versus tablet with the aforementioned two types of socio-relationships. The results indicated that the participants preferred telecommunication service in a social-oriented relationship to a task-oriented relationship. A mediation analysis revealed that social presence, competency, and familiarity mediates the effects of socio-relationship type on the satisfaction of the telecommunication service. Based on the socio-relationship type, different tendencies on the effect of telecommunication device types on service evaluation were observed. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

"Emotional drinking" during quarantine by COVID-19 in Chile: the role of depressive symptoms on problematic alcohol consumption

Aim: To assess the pattern of alcohol consumption in the Chilean adult population in association with depressive symptoms in the context of the COVID-19 quarantine. Method(s): A correlational and transversal study was conducted. Alcohol consumption and depressive symptoms were measured through an online survey, including the PHQ-9 Chilean version and the item banks for alcohol use of the Patient-Reported Outcomes Measurement Information System (PROMIS). Mediational analysis models were conducted to assess whether the relationship between depressive symptoms and problematic drinking was mediated by drinking to cope with negative emotions. Result(s): 32% of the sample reported depression, 84% acknowledge having been drunk during the previous 30 days and 18% acknowledge an increase in the amount of alcohol use. The presence of depressive symptomatology positively predicts problematic alcohol consumption during the quarantine;however, when it includes analyzing the reasons for drinking alcohol, this relationship becomes negative and shows a significant mediation effect in the relationship between depressive symptomatology and problematic drinking through increased drinking to control negative emotions. Conclusion(s): The findings suggest that during quarantine, the increase in problematic drinking is related to depressive symptoms associated with an increased urge to drink to cope with negative emotions.Copyright © 2022 Taylor & Francis Group, LLC.

[Effect of Family Environment on Non-Suicidal Self-Injury Among Middle School Students During the COVID-19 Epidemic: The Mediating Role of Depression].

Objective: To study the current status of non-suicidal self-injury (NSSI) incidents among middle school students in Chengdu during the COVID-19 epidemic and to explore the mechanism of action of depression on the relationship between family environment and NSSI. Methods: Data were obtained from the Chengdu Positive Child Development (CDPD) cohort. In June and July 2020, after primary and secondary schools were reopened after the closure due to the COVID-19 epidemic, on-site questionnaire surveys were conducted with the Deliberate Self-Harm Inventory (DSHI), the Chinese Family Assessment Instrument (C-FAI), and Center for Epidemiologic Studies Depression Scale for Children (CES-DC), thereby obtaining the data of 3595 middle school students. Two-sample t-test and χ 2 test were used to compare the incidence of NSSI among middle school students of different grades and genders, and the Model 58 test of the SPSS PROCESS component was used to analyze the mediating effect of gender-mediated depression. Results: 1) The incidence of NSSI among middle school students in Chengdu during the COVID-19 epidemic was 49.67%. The incidence of NSSI among ninth-graders (80.70%) was significantly higher than those of the eighth graders (33.82%) and seventh graders (32.32%), and the incidence of NSSI among female middle school students (54.75%) was significantly higher than that of male students (44.52%). 2) Family environment ( r=0.34, P<0.001) and depression ( r=0.50, P<0.001) were positively correlated with NSSI. 3) Depression partially mediated the effect of family environment on NSSI, with the mediating effect accounting for 64.64% of the total effect. Compared with that of male students, the positive predictive effect between family environment and depression and that between depression and NSSI in female middle school students were more significant. Conclusion: During the COVID-19 pandemic, middle school students in Chengdu had a high incidence of NSSI, which indicates that the family environment should be improved, more attention should be given to gender differences, and early screening and intervention for depression should be strengthened to reduce the incidence of NSSI.

Social Determinants of COVID-19 Vaccination Rates: A Time-Constrained Multiple Mediation Analysis.

Objective To estimate the multiple direct/indirect effects of social, environmental, and economic factors on COVID-19 vaccination rates (series complete) in the 3109 continental counties in the United States (U.S.). Study design  The dependent variable was the COVID-19 vaccination rates in the U.S. (April 15, 2022). Independent variables were collected from reliable secondary data sources, including the Census and CDC. Independent variables measured at two different time frames were utilized to predict vaccination rates. The number of vaccination sites in a given county was calculated using the geographic information system (GIS) packages as of April 9, 2022. The Internet Archive (Way Back Machine) was used to look up data for historical dates. Methods  A chain of temporally-constrained least absolute shrinkage and selection operator (LASSO) regressions was used to identify direct and indirect effects on vaccination rates. The first regression identified direct predictors of vaccination rates. Next, the direct predictors were set as response variables in subsequent regressions and regressed on variables that occurred before them. These regressions identified additional indirect predictors of vaccination. Finally, both direct and indirect variables were included in a network model. Results  Fifteen variables directly predicted vaccination rates and explained 43% of the variation in vaccination rates in April 2022. In addition, 11 variables indirectly affected vaccination rates, and their influence on vaccination was mediated by direct factors. For example, children in poverty rate mediated the effect of (a) median household income, (b) children in single-parent homes, and (c) income inequality. For another example, median household income mediated the effect of (a) the percentage of residents under the age of 18, (b) the percentage of residents who are Asian, (c) home ownership, and (d) traffic volume in the prior year. Our findings describe not only the direct but also the indirect effect of variables. Conclusions  A diverse set of demographics, social determinants, public health status, and provider characteristics predicted vaccination rates. Vaccination rates change systematically and are affected by the demographic composition and social determinants of illness within the county. One of the merits of our study is that it shows how the direct predictors of vaccination rates could be mediators of the effects of other variables.