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1.
PLoS Med ; 19(3): e1003930, 2022 03.
Article in English | MEDLINE | ID: covidwho-1793652

ABSTRACT

BACKGROUND: Low syphilis testing uptake is a major public health issue among men who have sex with men (MSM) in many low- and middle-income countries. Syphilis self-testing (SST) may complement and extend facility-based testing. We aimed to evaluate the effectiveness and costs of providing SST on increasing syphilis testing uptake among MSM in China. METHODS AND FINDINGS: An open-label, parallel 3-arm randomized controlled trial (RCT) was conducted between January 7, 2020 and July 17, 2020. Men who were at least 18 years of age, had condomless anal sex with men in the past year, reported not testing for syphilis in the last 6 months, and had a stable residence with mailing addresses were recruited from 124 cities in 26 Chinese provinces. Using block randomization with blocks of size 12, enrolled participants were randomly assigned (1:1:1) into 3 arms: standard of care arm, standard SST arm, and lottery incentivized SST arm (1 in 10 chance to win US$15 if they had a syphilis test). The primary outcome was the proportion of participants who tested for syphilis during the trial period and confirmed with photo verification and between arm comparisons were estimated with risk differences (RDs). Analyses were performed on a modified intention-to-treat basis: Participants were included in the complete case analysis if they had initiated at least 1 follow-up survey. The Syphilis/HIV Duo rapid test kit was used. A total of 451 men were enrolled. In total, 136 (90·7%, 136/150) in the standard of care arm, 142 (94·0%, 142/151) in the standard of SST arm, and 137 (91·3%, 137/150) in the lottery incentivized SST arm were included in the final analysis. The proportion of men who had at least 1 syphilis test during the trial period was 63.4% (95% confidence interval [CI]: 55.5% to 71.3%, p = 0.001) in the standard SST arm, 65.7% (95% CI: 57.7% to 73.6%, p = 0.0002) in the lottery incentivized SST arm, and 14.7% (95% CI: 8.8% to 20.7%, p < 0.001) in the standard of care arm. The estimated RD between the standard SST and standard of care arm was 48.7% (95% CI: 37.8% to 58.4%, p < 0.001). The majority (78.5%, 95% CI: 72.7% to 84.4%, p < 0.001) of syphilis self-testers reported never testing for syphilis. The cost per person tested was US$26.55 for standard SST, US$28.09 for the lottery incentivized SST, and US$66.19 for the standard of care. No study-related adverse events were reported during the study duration. Limitation was that the impact of the Coronavirus Disease 2019 (COVID-19) restrictions may have accentuated demand for decentralized testing. CONCLUSIONS: Compared to standard of care, providing SST significantly increased the proportion of MSM testing for syphilis in China and was cheaper (per person tested). TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR1900022409.


Subject(s)
HIV Infections/diagnosis , Homosexuality, Male , Patient Participation/methods , Self-Testing , Syphilis/diagnosis , Adolescent , Adult , COVID-19/epidemiology , China/epidemiology , Follow-Up Studies , HIV Infections/prevention & control , Health Services Accessibility/organization & administration , Homosexuality, Male/statistics & numerical data , Humans , Immunoassay/methods , Male , Mass Screening/economics , Mass Screening/methods , Mass Screening/organization & administration , Middle Aged , Motivation , Pandemics , Reagent Kits, Diagnostic/economics , Reagent Kits, Diagnostic/supply & distribution , SARS-CoV-2 , Sexual and Gender Minorities/statistics & numerical data , Syphilis/epidemiology , Syphilis/prevention & control , Young Adult
3.
PLoS One ; 16(9): e0257693, 2021.
Article in English | MEDLINE | ID: covidwho-1430551

ABSTRACT

BACKGROUND: LGBTQ2S youth are overrepresented among youth experiencing homelessness and experience significantly higher rates of mental health issues compared to heterosexual and cisgender youth. COVID-19 related challenges for LGBTQ2S youth experiencing homelessness remain unknown. To address this gap, this study aimed to understand the impacts of the COVID-19 pandemic on LGBTQ2S youth at risk of, and experiencing, homelessness in the Greater Toronto Area, Ontario, Canada and surrounding areas. METHODS: Utilizing a mixed-methods convergent parallel design, LGBTQ2S youth experiencing homelessness were recruited to participate in virtual surveys and in-depth one-on-one interviews. Surveys included standardized measures and were administered to measure mental health outcomes and collect information on demographic characteristics, and health service use. Survey data were analyzed with descriptive statistics and statistical tests for difference of proportions. Interviews were analyzed using an iterative thematic content approach. RESULTS: Sixty-one youth completed surveys and 20 youth participated in one-on-one interviews. Quantitative and qualitative data showed that youth have been significantly impacted by the COVID-19 pandemic in various ways, including experiencing poor mental health, such as suicidality, depression, anxiety, and increased substance use, and lack of access to health and social support services. CONCLUSION: Our study highlights the need for LGBTQ2S inclusive and affirming health care and support services for precariously housed adolescents to address the pre-existing social and health issues that have been exacerbated by the pandemic.


Subject(s)
COVID-19/epidemiology , Homeless Persons/statistics & numerical data , Sexual and Gender Minorities/statistics & numerical data , Adolescent , Female , Housing/statistics & numerical data , Humans , Male , Pandemics
5.
JMIR Public Health Surveill ; 7(8): e29029, 2021 08 17.
Article in English | MEDLINE | ID: covidwho-1360690

ABSTRACT

BACKGROUND: Widespread fear surrounding COVID-19, coupled with physical and social distancing orders, has caused severe adverse mental health outcomes. Little is known, however, about how the COVID-19 crisis has impacted LGBTQ+ youth, who disproportionately experienced a high rate of adverse mental health outcomes before the COVID-19 pandemic. OBJECTIVE: We aimed to address this knowledge gap by harnessing natural language processing methodologies to investigate the evolution of conversation topics in the most popular subreddit for LGBTQ+ youth. METHODS: We generated a data set of all r/LGBTeens subreddit posts (n=39,389) between January 1, 2020 and February 1, 2021 and analyzed meaningful trends in anxiety, anger, and sadness in the posts. Because the distribution of anxiety before widespread social distancing orders was meaningfully different from the distribution after (P<.001), we employed latent Dirichlet allocation to examine topics that provoked this shift in anxiety. RESULTS: We did not find any differences in LGBTQ+ youth anger and sadness before and after government-mandated social distancing; however, anxiety increased significantly (P<.001). Further analysis revealed a list of 10 anxiety-provoking topics discussed during the pandemic: attraction to a friend, coming out, coming out to family, discrimination, education, exploring sexuality, gender pronouns, love and relationship advice, starting a new relationship, and struggling with mental health. CONCLUSIONS: During the COVID-19 pandemic, LGBTQ+ teens increased their reliance on anonymous discussion forums when discussing anxiety-provoking topics. LGBTQ+ teens likely perceived anonymous forums as safe spaces for discussing lifestyle stressors during COVID-19 disruptions (eg, school closures). The list of prevalent anxiety-provoking topics in LGBTQ+ teens' anonymous discussions can inform future mental health interventions in LGBTQ+ youth.


Subject(s)
Anxiety/epidemiology , COVID-19/psychology , Natural Language Processing , Pandemics , Sexual and Gender Minorities/psychology , Social Media/statistics & numerical data , Social Media/trends , Adolescent , COVID-19/epidemiology , Emotions , Female , Humans , Longitudinal Studies , Male , Sexual and Gender Minorities/statistics & numerical data
6.
Int J Infect Dis ; 106: 358-362, 2021 May.
Article in English | MEDLINE | ID: covidwho-1279603

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has resulted in the disruption of provision of human immunodeficiency virus (HIV) services. This study examined the factors associated with difficulties in accessing HIV services during the COVID-19 pandemic. METHODS: An online survey of 236 Chinese-speaking gay and bisexual men in Hong Kong conducted in 2020. RESULTS: Among those who expressed a need to access HIV services during the COVID-19 pandemic, 22.9%, 33.9% and 43.2% indicated moderate-to-high, mild and no difficulties in accessing these services, respectively. Difficulties in accessing HIV services were positively related to concerns about potential COVID-19 infection, experience of actual impact on health because of COVID-19, disruption in work/studies, and reduced connection to the LGBT+ community during the pandemic. It was also found that difficulties in accessing HIV services were positively associated with frequency of having sex with casual partners, but were not significantly associated with frequency of having sex with regular partners. CONCLUSIONS: This study provides novel empirical evidence for understanding difficulties in accessing HIV services during the COVID-19 pandemic. It found that disruption in work/studies and frequency of having sex with casual partners were associated with difficulties in accessing HIV services.


Subject(s)
COVID-19/complications , COVID-19/epidemiology , HIV Infections/complications , Health Services Accessibility/statistics & numerical data , Homosexuality, Male/statistics & numerical data , Sexual and Gender Minorities/statistics & numerical data , Adult , Hong Kong/epidemiology , Humans , Male , Middle Aged , Pandemics , Surveys and Questionnaires , Young Adult
7.
Public Health Rep ; 136(4): 493-507, 2021.
Article in English | MEDLINE | ID: covidwho-1273187

ABSTRACT

OBJECTIVES: Lesbian, gay, bisexual, transgender, or queer and questioning (LGBTQ+) people and populations face myriad health disparities that are likely to be evident during the COVID-19 pandemic. The objectives of our study were to describe patterns of COVID-19 testing among LGBTQ+ people and to differentiate rates of COVID-19 testing and test results by sociodemographic characteristics. METHODS: Participants residing in the United States and US territories (N = 1090) aged ≥18 completed an internet-based survey from May through July 2020 that assessed COVID-19 testing and test results and sociodemographic characteristics, including sexual orientation and gender identity (SOGI). We analyzed data on receipt and results of polymerase chain reaction (PCR) and antibody testing for SARS-CoV-2 and symptoms of COVID-19 in relation to sociodemographic characteristics. RESULTS: Of the 1090 participants, 182 (16.7%) received a PCR test; of these, 16 (8.8%) had a positive test result. Of the 124 (11.4%) who received an antibody test, 45 (36.3%) had antibodies. Rates of PCR testing were higher among participants who were non-US-born (25.4%) versus US-born (16.3%) and employed full-time or part-time (18.5%) versus unemployed (10.8%). Antibody testing rates were higher among gay cisgender men (17.2%) versus other SOGI groups, non-US-born (25.4%) versus US-born participants, employed (12.6%) versus unemployed participants, and participants residing in the Northeast (20.0%) versus other regions. Among SOGI groups with sufficient cell sizes (n > 10), positive PCR results were highest among cisgender gay men (16.1%). CONCLUSIONS: The differential patterns of testing and positivity, particularly among gay men in our sample, confirm the need to create COVID-19 public health messaging and programming that attend to the LGBTQ+ population.


Subject(s)
COVID-19 Testing/statistics & numerical data , COVID-19/epidemiology , Sexual and Gender Minorities/statistics & numerical data , Adolescent , Adult , COVID-19/diagnosis , Cross-Sectional Studies , Female , Gender Identity , Humans , Male , Middle Aged , Socioeconomic Factors , Surveys and Questionnaires , United States/epidemiology , Young Adult
8.
Psychiatry Res ; 302: 114042, 2021 08.
Article in English | MEDLINE | ID: covidwho-1253497

ABSTRACT

We assessed the effects of the COVID19 lockdown on the mental health of transgender and gender non-conforming (TGN) youth (n = 18) vs cisgender youth (29 males; 29 females). Coronavirus Health Impact Survey (CRISIS) and Emotion Regulation Questionnaire were used in an online study. No group differences were found in demographic variables and exposure to COVID19. Negative emotions/feeling increased for all groups. Cisgender youth reported using more adaptive emotion regulation strategies than TGN youth. While the lockdown similarly affected TGN and cisgender youth, the former showed elevated levels of symptomatology and fewer adaptive emotional regulation strategies.


Subject(s)
COVID-19/psychology , Mental Disorders/epidemiology , Pandemics , Quarantine/psychology , Sexual and Gender Minorities/psychology , Adolescent , COVID-19/epidemiology , Female , Health Surveys , Humans , Male , Pilot Projects , Sexual and Gender Minorities/statistics & numerical data , Transgender Persons/psychology , Transgender Persons/statistics & numerical data
9.
Psychiatry Res ; 302: 114034, 2021 08.
Article in English | MEDLINE | ID: covidwho-1244805

ABSTRACT

Given concerns of increased suicide risk among university students during the COVID-19 pandemic, this study examined rates of lifetime and past-year suicidal ideation (SI) among university students in Fall 2020 (vs. two earlier semesters), overall and across gender, racial/ethnic background, and sexual identity. Participants included 1700 university students enrolled in a general education psychology course in Fall 2020, Fall 2014, or Fall 2013. Rates of SI were not significantly higher in Fall 2020 versus the earlier semesters and did not differ across racial/ethnic background. However, rates of SI in Fall 2020 were significantly higher among sexual minority than heterosexual students.


Subject(s)
COVID-19/psychology , Pandemics , Students/psychology , Suicidal Ideation , Adolescent , COVID-19/epidemiology , /statistics & numerical data , Female , Humans , Male , Midwestern United States/epidemiology , /statistics & numerical data , Risk Factors , Sexual and Gender Minorities/psychology , Sexual and Gender Minorities/statistics & numerical data , Students/statistics & numerical data , Surveys and Questionnaires , Universities , Young Adult
11.
Int J Infect Dis ; 106: 358-362, 2021 May.
Article in English | MEDLINE | ID: covidwho-1179657

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has resulted in the disruption of provision of human immunodeficiency virus (HIV) services. This study examined the factors associated with difficulties in accessing HIV services during the COVID-19 pandemic. METHODS: An online survey of 236 Chinese-speaking gay and bisexual men in Hong Kong conducted in 2020. RESULTS: Among those who expressed a need to access HIV services during the COVID-19 pandemic, 22.9%, 33.9% and 43.2% indicated moderate-to-high, mild and no difficulties in accessing these services, respectively. Difficulties in accessing HIV services were positively related to concerns about potential COVID-19 infection, experience of actual impact on health because of COVID-19, disruption in work/studies, and reduced connection to the LGBT+ community during the pandemic. It was also found that difficulties in accessing HIV services were positively associated with frequency of having sex with casual partners, but were not significantly associated with frequency of having sex with regular partners. CONCLUSIONS: This study provides novel empirical evidence for understanding difficulties in accessing HIV services during the COVID-19 pandemic. It found that disruption in work/studies and frequency of having sex with casual partners were associated with difficulties in accessing HIV services.


Subject(s)
COVID-19/complications , COVID-19/epidemiology , HIV Infections/complications , Health Services Accessibility/statistics & numerical data , Homosexuality, Male/statistics & numerical data , Sexual and Gender Minorities/statistics & numerical data , Adult , Hong Kong/epidemiology , Humans , Male , Middle Aged , Pandemics , Surveys and Questionnaires , Young Adult
12.
J Agromedicine ; 25(4): 370-373, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-1174761

ABSTRACT

The limited data on LGBTQ+ farmers demonstrate that this population lacks adequate healthcare access and faces stigma in agricultural communities. Given that COVID-19 disproportionately impacts LGBTQ+ populations, we investigate how working conditions and healthcare bias may expose LGBTQ+ farmers - essential employees - to high risk of transmitting the virus. During COVID-19, LGBTQ+ farmers may experience worse mental health outcomes as they face occupational and identity-based stressors. Conversely, LGBTQ+ farmers may also demonstrate mental health resilience during COVID-19 due to pre-existing socially distant networks they created in light of agricultural heterosexism. What is unique about COVID-19 is that healthcare inequities of a relatively small percentage of the agriculture workforce has amplifying implications for the entire agrifood system. We call for research on LGBTQ+ farmers to understand how sexuality impacts agricultural health, to uncover health risks and protective factors that may increase the health of farming communities, and to support essential food production during a pandemic.


Subject(s)
COVID-19/psychology , Farmers/psychology , Sexual and Gender Minorities/psychology , COVID-19/epidemiology , Farmers/statistics & numerical data , Female , Health Services Accessibility , Humans , Male , Mental Health , Pandemics , Sexual and Gender Minorities/statistics & numerical data
13.
J Acquir Immune Defic Syndr ; 87(1): 639-643, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1169725

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has had unforeseen consequences on the delivery of HIV and sexually transmitted disease (STD) prevention services. However, little is known about how the pandemic has impacted pre-exposure prophylaxis (PrEP)-using men who have sex with men (MSM). METHODS: Data come from an online cohort of PrEP-using MSM in the Southern United States from October 2019 to July 2020. Participants were administered 10 surveys in total, including 1 ad hoc survey specifically on COVID-19. We conducted a cross-sectional analysis of this ad hoc survey (n = 56) and present changes in sexual behaviors and utilization of and access to sexual health services. Using linear mixed-effect regression models, we also analyzed data from the larger cohort and document how sexual behaviors and PrEP use varied longitudinally across several months. RESULTS: A fifth of participants discontinued or changed how often they take PrEP because of COVID-19. A quarter of the cohort documented challenges when attempting to access PrEP, HIV testing, or STD testing. For all sexual behaviors examined longitudinally-number of male sexual partners, anal sex acts, condomless anal sex, and oral sex (all measured in the past 2 weeks)-there was a decrease from February to April followed by an increase from April to June. DISCUSSION: Our findings suggest reduced access to and utilization of STD and HIV services coupled with a continuation of behaviors which confer STD/HIV risk. Ensuring appropriate delivery of STD/HIV prevention services during this pandemic is imperative.


Subject(s)
COVID-19/epidemiology , Homosexuality, Male/statistics & numerical data , Pre-Exposure Prophylaxis/statistics & numerical data , Sexual Behavior/statistics & numerical data , Adolescent , Adult , Anti-HIV Agents/therapeutic use , Cohort Studies , Cross-Sectional Studies , HIV Infections/drug therapy , Humans , Longitudinal Studies , Male , Medication Adherence , Pandemics , SARS-CoV-2/isolation & purification , Safe Sex , Sexual and Gender Minorities/statistics & numerical data , Surveys and Questionnaires , United States/epidemiology , Young Adult
14.
Drug Alcohol Depend ; 221: 108594, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1124841

ABSTRACT

BACKGROUND: Sexual and gender minority (SGM) young persons are experiencing compounding effects of COVID-19 due to unique social inequalities and existent mental health and substance use challenges. Given that 41% of all young persons are enrolled in universities, and the increased vulnerabilities faced by SGM young persons during the pandemic, it is imperative to understand the effects of alcohol use on mental health among SGM university students amid COVID-19. This study aims to examine the associations between changes in alcohol use since the start of COVID-19 and mental distress among SGM university students in the U.S., and to explore sex-stratified differences. METHODS: A nonprobability cross-sectional sample of 509 SGM university students (Mage = 22.04 years, SD = 3.99) were retrospectively surveyed online between May-August 2020 and asked if their alcohol use had changed since the start of COVID-19. Statistical analyses explored the association between changes in alcohol use since the start of COVID-19 and mental distress. RESULTS: Average psychological distress (M = 27.79, SD = 7.82) was relatively high as per existing research and established clinical cutoff scores. Roughly 32% had increased alcohol use since the start of COVID-19. Subsequently, greater alcohol use (p < .05) since the start of COVID-19 was associated with higher psychological distress among SGM university students, and among females but not males assigned at birth. CONCLUSIONS: Higher education, medical, and behavioral health professionals should consider how to adapt their practice to address alcohol use and psychological burdens among SGM university students (especially females) who are facing health inequities during and beyond COVID-19, requiring SGM-affirmative care.


Subject(s)
Alcohol Drinking/psychology , COVID-19/psychology , Mental Health , Psychological Distress , Sexual and Gender Minorities/psychology , Students/psychology , Adolescent , Adult , Alcohol Drinking/trends , Cross-Sectional Studies , Female , Humans , Male , Retrospective Studies , Sexual and Gender Minorities/statistics & numerical data , Students/statistics & numerical data , Universities , Young Adult
16.
Lancet ; 397(10279): 1151-1156, 2021 03 20.
Article in English | MEDLINE | ID: covidwho-1087331

ABSTRACT

With more than 1·2 million people living with HIV in the USA, a complex epidemic across the large and diverse country, and a fragmented health-care system marked by widening health disparities, the US HIV epidemic requires sustained scientific and public health attention. The epidemic has been stubbornly persistent; high incidence densities have been sustained over decades and the epidemic is increasingly concentrated among racial, ethnic, and sexual and gender minority communities. This fact remains true despite extraordinary scientific advances in prevention, treatment, and care-advances that have been led, to a substantial degree, by US-supported science and researchers. In this watershed year of 2021 and in the face of the COVID-19 pandemic, it is clear that the USA will not meet the stated goals of the National HIV/AIDS Strategy, particularly those goals relating to reductions in new infections, decreases in morbidity, and reductions in HIV stigma. The six papers in the Lancet Series on HIV in the USA have each examined the underlying causes of these challenges and laid out paths forward for an invigorated, sustained, and more equitable response to the US HIV epidemic than has been seen to date. The sciences of HIV surveillance, prevention, treatment, and implementation all suggest that the visionary goals of the Ending the HIV Epidemic initiative in the USA might be achievable. However, fundamental barriers and challenges need to be addressed and the research effort sustained if we are to succeed.


Subject(s)
Epidemics/prevention & control , HIV Infections/epidemiology , Health Plan Implementation/organization & administration , Public Health Administration , Epidemiological Monitoring , HIV Infections/therapy , Health Status Disparities , Humans , Minority Groups/statistics & numerical data , Sexual and Gender Minorities/statistics & numerical data , Social Stigma
17.
JAMA Netw Open ; 3(12): e2027572, 2020 12 01.
Article in English | MEDLINE | ID: covidwho-1064282

ABSTRACT

Importance: Understanding patterns of e-cigarette use and access during the coronavirus disease 2019 (COVID-19) pandemic is important because e-cigarettes may put users at risk for more severe respiratory effects and other health problems. Objective: To examine whether underage youth and young adults who ever used e-cigarettes self-reported changes in access and use of e-cigarettes since the COVID-19 pandemic began. Design, Setting, and Participants: A national, cross-sectional online survey study was conducted from May 6 to May 14, 2020. This sample of 4351 participants aged 13 to 24 years across the US included 2167 e-cigarette ever-users. Quota sampling was used to balance for age, sex, race/ethnicity, and 50% having ever used e-cigarettes. Main Outcomes and Measures: Change in e-cigarette use (increase, decrease, quit, no change, and switch to another product) and access to e-cigarettes (easier or harder, and change in point-of-purchase) before and after the COVID-19 pandemic began, reasons for change, number of times e-cigarettes were used, nicotine dependence, and sociodemographic data. Results: This study focused on 2167 e-cigarette ever-users among 4351 participants who completed the survey. Among 2167 e-cigarette users, a total of 1442 were younger than 21 years and 725 were aged 21 years or older; 1397 were female (64.5%) and 438 identified as lesbian, gay, bisexual, transgender, queer (20.2%). The survey completion rate was 40%. Since the COVID-19 pandemic began, 1198 of 2125 e-cigarette users (56.4%) changed their use: 388 individuals (32.4%) quit, 422 individuals (35.3%) reduced the amount of nicotine, 211 individuals (17.6%) increased nicotine use, 94 individuals (7.8%) increased cannabis use, and 82 individuals (6.9%) switched to other products. Participants reported that not being able to go to vape shops and product unavailability were the reasons accessing e-cigarettes was difficult after the pandemic began. Since the COVID-19 pandemic began, individuals reported purchasing from alternative retail stores (disposables, 150 of 632 [23.7%]; pod-based, 144 of 797 [18.1%]; and other e-cigarette, 125 of 560 [22.3%], ie, between 18.1% and 23.7%), purchasing online instead of retail (disposables, 115 of 632 [18.2%]; pod-based, 156 of 797 [19.6%]; and other e-cigarette, 111 of 560 [19.8%], ie, between 18.2% to 19.8%), and shifted to retail instead of online (disposables, 11 of 632 [1.7%]; pod-based, 17 of 797 [2.0%]; and other e-cigarette, 13 of 560 [2.3%], ie, between 1.7%-2.3%). Other individuals reported no change: from retail stores (disposables 262 of 632 [41.5%]; pod-based 344 of 797 [43.2%]; and other e-cigarette, 223 of 560 [39.8%], ie, between 39.8% and 43.2%) and online (disposables 94 of 632 [14.9%]; pod-based 136 of 797 [17.1%]; and other e-cigarette, 88 of 560 [15.8%], ie, between 14.9% and 17.1%). Underage youth reported e-cigarette deliveries from vape shops and/or dealers or friends who received such deliveries, and 63 of 229 (27.5%) self-reported accessing e-cigarettes without age verification. e-Cigarette users were 52% less likely to quit or reduce their use if they previously used e-cigarettes between 11 and 99 times (adjusted odds ratio, 0.48; 95% CI, 0.30-0.78), 68% less likely to quit if they previously used e-cigarettes more than 100 times (adjusted odds ratio, 0.32; 95% CI, 0.20-0.51), and 51% were less likely to quit if they were nicotine dependent (adjusted odds ratio, 0.49; 95% CI, 0.35-0.70). Conclusions and Relevance: During the COVID-19 pandemic, youth e-cigarette users reported changes in e-cigarette use, point-of-purchase, and ability to purchase e-cigarettes without age verification. The US Food and Drug Administration and local policy makers may find these data useful to inform policies to prevent e-cigarette sales to underage youth.


Subject(s)
COVID-19 , Electronic Nicotine Delivery Systems/statistics & numerical data , Quarantine/statistics & numerical data , Tobacco Use Disorder/epidemiology , Vaping/epidemiology , Adolescent , Consumer Behavior/statistics & numerical data , Cross-Sectional Studies , Female , Humans , Male , SARS-CoV-2 , Sexual and Gender Minorities/statistics & numerical data , Surveys and Questionnaires , United States/epidemiology , Young Adult
18.
J Adolesc Health ; 68(2): 270-276, 2021 02.
Article in English | MEDLINE | ID: covidwho-1065260

ABSTRACT

PURPOSE: The purpose of this study is to document young adults' perceived stress and anxiety in a diverse sample of college students across the U.S. during the COVID-19 pandemic. METHODS: We recruited, via Instagram, a sample of full-time college students aged 18-22 from across the U.S. We surveyed them in April (baseline; N = 707; mean age = 20.0, SD = 1.3) and July (follow-up) 2020. This study presents overall levels of perceived stress and general anxiety symptoms and inequalities across each of these outcomes by gender, sexual orientation, race/ethnicity, and household income. We also explore potential explanations for these health issues by analyzing baseline qualitative data. RESULTS: All students, on average, were suffering from perceived stress and anxiety, with especially high levels in April. We also identified inequalities in college student mental well-being, particularly by gender identity and sexual orientation. Women reported worse well-being compared with men; transgender and gender diverse and sexual minority youths reported worse outcomes than their cisgender, heterosexual peers at both time points. Qualitative data illustrate how the COVID-19 pandemic has generated educational, economic, and environmental stressors that are affecting college students' well-being. CONCLUSIONS: As colleges and universities think about how to manage and mitigate the infectious disease dimensions of COVID-19 among their student populations, they must also consider who is most at risk for increased stress and anxiety during the pandemic.


Subject(s)
Anxiety/psychology , COVID-19/psychology , Depression/psychology , Heterosexuality/statistics & numerical data , Sexual and Gender Minorities/statistics & numerical data , Adult , Female , Heterosexuality/psychology , Humans , Income/statistics & numerical data , Male , Qualitative Research , Sex Factors , Sexual and Gender Minorities/psychology , Surveys and Questionnaires , United States , Universities , Young Adult
19.
MMWR Morb Mortal Wkly Rep ; 70(5): 149-154, 2021 Feb 05.
Article in English | MEDLINE | ID: covidwho-1063527

ABSTRACT

Sexual minority persons experience health disparities associated with sexual stigma and discrimination and have a high prevalence of several health conditions that have been associated with severe coronavirus disease 2019 (COVID-19) (1,2). Current COVID-19 surveillance systems do not capture information about sexual orientation. To begin bridging the gap in knowledge about COVID-19 risk among sexual minority adults, CDC examined disparities between sexual minority and heterosexual adults in the prevalence of underlying conditions with strong or mixed evidence of associations with severe COVID-19-related illness (3), by using data from the 2017-2019 Behavioral Risk Factor Surveillance System (BRFSS).* When age, sex, and survey year are adjusted, sexual minority persons have higher prevalences than do heterosexual persons of self-reported cancer, kidney disease, chronic obstructive pulmonary disease (COPD), heart disease (including myocardial infarction, angina, or coronary heart disease), obesity, smoking, diabetes, asthma, hypertension, and stroke. Sexual minority adults who are members of racial/ethnic minority groups disproportionately affected by the pandemic also have higher prevalences of several of these health conditions than do racial/ethnic minority adults who are heterosexual. Collecting data on sexual orientation in COVID-19 surveillance and other studies would improve knowledge about disparities in infection and adverse outcomes by sexual orientation, thereby informing more equitable responses to the pandemic.


Subject(s)
COVID-19/ethnology , Health Status Disparities , Sexual and Gender Minorities/statistics & numerical data , Adult , Behavioral Risk Factor Surveillance System , Comorbidity , Female , Humans , Male , Risk Factors , United States/epidemiology
20.
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