Documenting a Decade of Exponential Growth in Employer Demand for Peer Support Providers.

The past decade has seen peer support providers increasingly incorporated as part of a recovery-oriented approach to behavioral health (BH) services for mental illness and substance use disorder. Despite this, there are few data sources to track this sector of the BH workforce, and understanding of peer support provider supply, demand, distribution, and associated factors is limited. In this retrospective, observational study, the authors analyzed job postings from 2010 to 2020 to assess employer demand for peer support providers and the factors associated with its growth, using a labor market data set from Emsi Burning Glass. The authors identified peer support job postings using a three-pronged, stepwise approach. Then, bivariate regression analyses using robust standard errors were conducted to examine state-level relationships between the number of peer support job postings per 100,000 population and Medicaid policies and indicators of states' BH infrastructure. The authors identified approximately 35,000 unique postings, finding the number increased 17-fold between 2010 and 2020. Bivariate analysis found significant state-level associations between peer support job postings and Medicaid expansion, as well as states' mean number of mental health facilities. This analysis represents the first to quantify employer demand for peer support providers, clearly demonstrating robust growth over time. Findings underscore the importance of continuing to develop data on this workforce to better understand factors driving its growth.

Stop Asian hate: The mental health impact of racial discrimination among Asian Pacific Islander young and emerging adults during COVID-19.

BACKGROUND: The rapid surge in anti-API discrimination and assault during the COVID-19 pandemic has the potential to exacerbate mental health disparities already pervasive among API populations. The primary of this study was to understand the impact of the pandemic and COVID-related discrimination on API college and university student mental health. METHODS: Secondary data was used from three administrations (Fall 2019, Spring 2020, and Fall 2020) of the Healthy Minds Study (HMS). We conducted Chi-square analyses to analyze differences in mental health symptoms across the three academic semesters. Cross-sectional multivariable logistic regression models were utilized to examine the association between COVID-related discrimination and mental health symptoms and help-seeking behavior during Spring 2020 and Fall 2020. RESULTS: Comparing Fall 2019 to Fall 2020, we found that API students reported a 17 % increase in severe depression and a 30 % increase in severe anxiety. Mental health treatment utilization among those experiencing clinically-significant mental health problems decreased by 26 % between Fall 2019 and Spring 2020. COVID-related discrimination was associated with greater odds of severe depression in both Spring 2020. LIMITATIONS: HMS does not include a random sample of campuses as schools themselves elect to participate. Analyses rely on self-report data. CONCLUSIONS: Throughout the COVID-19 pandemic, API students reported significant increases in clinically-significant mental health symptoms and decreases in treatment utilization. Our analyses also suggest that COVID-related discrimination is correlated with greater odds of clinically-significant mental health symptoms, including severe depression and severe anxiety, as well as lower odds of treatment utilization.

Measuring Asian hate: Discordant reporting of race-based hate incidents and unfair treatment and association with measures of wellbeing.

Background: During COVID-19, anti-Asian discrimination increased in attention. Hate and unfair treatment are related but do not completely overlap. We expect those who report a hate incident would also report race-based unfair treatment, yet feelings of social desirability or self-blame may lead to under-reporting of unfair treatment. Objectives: To describe reporting of an experience of race-based hate but not an experience of race-based unfair treatment among Asians in California and explore the association between this reporting discordance with (1) serious psychological distress, (2) forgoing needed medical care, (3) increased household interpersonal conflict, and (4) feeling unsafe in their neighborhood. Methods: We used the 2020 California Health Interview Survey's AANHPI COVID Module, conducted weighted descriptive and multivariate analyses, and computed adjusted relative risks (RR). The multivariate models controlled for Asian subgroup, age, gender, immigrant status, education level, poverty, and English proficiency. Results: Among Asians who reported race-based hate (6.9% overall), 62.4% reported not experiencing race-based unfair treatment. Compared to Asians not reporting a hate incident, this "discordant" group was more likely to experience serious psychological distress (RR = 6.9), forgo necessary medical care (RR = 2.4), increased household interpersonal conflicts (RR = 2.7), and feel unsafe in their neighborhoods (RR = 3.0). The "concordant" group did not post significant effects for severe psychological distress nor forgoing necessary medical care. Discussion: Most Asians reporting hate did not report race-based unfair treatment, and this group is most affected by the consequences of a hate incident. We indicate future directions for research and policy.

Learning to love ourselves again: Organizing Filipinx/a/o scholar-activists as antiracist public health praxis.

A critical component for health equity lies in the inclusion of structurally excluded voices, such as Filipina/x/o Americans (FilAms). Because filam invisibility is normalized, denaturalizing these conditions requires reimagining power relations regarding whose experiences are documented, whose perspectives are legitimized, and whose strategies are supported. in this community case study, we describe our efforts to organize a multidisciplinary, multigenerational, community-driven collaboration for FilAm community wellness. Catalyzed by the disproportionate burden of deaths among FilAm healthcare workers at the onset of the COVID-19 pandemic and the accompanying silence from mainstream public health leaders, we formed the Filipinx/a/o Community Health Association (FilCHA). FilCHA is a counterspace where students, faculty, clinicians, and community leaders across the nation could collectively organize to resist our erasure. By building a virtual, intellectual community that centers our voices, FilCHA shifts power through partnerships in which people who directly experience the conditions that cause inequities have leadership roles and avenues to share their perspectives. We used Pinayism to guide our study of FilCHA, not just for the current crisis State-side, but through a multigenerational, transnational understanding of what knowledges have been taken from us and our ancestors. By naming our collective pain, building a counterspace for love of the community, and generating reflections for our communities, we work toward shared liberation. Harnessing the collective power of researchers as truth seekers and organizers as community builders in affirming spaces for holistic community wellbeing is love in action. This moment demands that we explicitly name love as essential to antiracist public health praxis.

The mental and physical health correlates of psychotic experiences among US college students: Findings from the Healthy Mind Study 2020.

BACKGROUND: Psychotic experiences have been framed as a marker of mental and physical health status; however, more research is needed to confirm these associations in university populations. METHODS: We analyzed data from the Healthy Minds Survey (Fall Semester Cohort 2020), which is a non-probability sample of students attending one of 28 universities in the United States, who completed an online survey (September 2020-December 2020). We used multivariable logistic regression to examine the associations between several mental and physical health conditions and psychotic experiences, adjusting for age, gender, sexual orientation race/ethnicity, and international student status. RESULTS: In terms of mental health, all conditions were associated with greater odds of having lifetime psychotic experiences. Having at least one mental health condition was associated with 2.18 times greater odds of having lifetime psychotic experiences (aOR: 2.18; 95% CI: 1.96-2.42). In terms of physical health, having at least one physical health condition was associated with 1.37 times greater odds of having lifetime psychotic experiences (aOR: 1.37; 95% CI: 1.22-1.53), but only four conditions were associated with greater odds of lifetime psychotic experiences, which were: asthma, gastrointestinal disease, HIV/AIDS, and other chronic disease. The counts of mental and physical health conditions were associated with greater odds of lifetime psychotic experiences in a dose-dependent fashion. CONCLUSION: Psychotic experiences appear to be an indicator for mental health problems and some physical health problems. More research is needed to determine whether assessing for psychotic experiences broadly can help identify at-risk individuals in university settings who may benefit from targeted preventive interventions.

Loneliness and psychotic experiences among US university students: Findings from the Healthy Minds Study 2020.

Loneliness and psychotic experiences (PEs) are common in university students. Despite this, little information is available on the association between loneliness and PEs in this population. In the present study, we studied 30,529 individuals from the Fall semester cohort of the 2020 Healthy Minds Study, a cross-sectional, web-based survey examining mental health and related factors in undergraduate and graduate students aged 18 years or older. Multivariable logistic regression analyses were used to evaluate associations between loneliness (exposure) and PEs (outcome). Loneliness was significantly associated with increased odds of any PEs (odds ratio, 1.32; 95% CI, 1.29-1.36), adjusting for age, gender identity, race/ethnicity, sexual orientation, and international student status. This relationship was consistent across the subtypes of PEs, i.e., delusions (odds ratio, 1.32; 95% CI, 1.29-1.36) and hallucinations (odds ratio, 1.27; 95% CI, 1.21-1.34), adjusting for the same covariates. We found that loneliness is consistently associated with PEs across different subtypes in a university population sample. Future studies may consider testing whether interventions to reduce loneliness among young adults and university students can have an impact on PEs.

Who is providing contraception care in the United States? An observational study of the contraception workforce.

BACKGROUND: Contraception care is essential to providing comprehensive healthcare; however, little is known nationally about the contraception workforce. Previous research has examined the supply, distribution, and adequacy of the health workforce providing contraception services, but this research has faced a series of data limitations, relying on surveys or focusing on a subset of practitioners and resulting in an incomplete picture of contraception practitioners in the United States. OBJECTIVE: This study aimed to construct a comprehensive database of the contraceptive workforce in the United States that provides the following 6 types of highly effective contraception: intrauterine device, implant, shot (depot medroxyprogesterone acetate), oral contraception, hormonal patch, and vaginal ring. In addition, we aimed to examine the difference in supply, distribution, the types of contraception services offered, and Medicaid participation. STUDY DESIGN: We constructed a national database of contraceptive service providers using multiple data sets: IQVIA prescription claims, preadjudicated medical claims, and the OneKey healthcare provider data set; the National Plan and Provider Enumeration System data set; and the Census Bureau's American Community Survey data on population demographics. All statistical analyses were descriptive, including chi-squared tests for groupwise differences and pairwise post hoc tests with Bonferroni corrections for multiple comparisons. RESULTS: Although 73.1% of obstetrician-gynecologists and 72.6% of nurse-midwives prescribed the pill, patch, or ring, only 51.4% of family medicine physicians, 32.4% of pediatricians, and 19.8% of internal medicine physicians do so. The ratio of all primary care providers prescribing contraception to the female population of reproductive age (ages, 15-44 years) varied substantially across states, with a range of 27.9 providers per 10,000 population in New Jersey to 74.2 providers per 10,000 population in Maine. In addition, there are substantial differences across states for Medicaid acceptance. Of the obstetrician-gynecologists providing contraception, the percentage of providers who prescribe contraception to Medicaid patients ranged from 83.9% (District of Columbia) to 100% (North Dakota); for family medicine physicians, it ranged from 49.7% (Florida) to 91.1% (Massachusetts); and for internal medicine physicians, it ranged from 25.0% (Texas) to 75.9% (Delaware). For in-person contraception, there were large differences in the proportion of providers offering the 3 different contraceptive method types (intrauterine device, implant, and shot) by provider specialty. CONCLUSION: This study found a significant difference in the distribution, types of contraception, and Medicaid participation of the contraception workforce. In addition to obstetrician-gynecologists and nurse-midwives, family medicine physicians, internal medicine physicians, pediatricians, advanced practice nurses, and physician assistants are important contraception providers. However, large gaps remain in the provision of highly effective services such as intrauterine devices and implants. Future research should examine provider characteristics, programs, and policies associated with the provision of different contraception services.

The Mental Health Impact of COVID-19 Racial and Ethnic Discrimination Against Asian American and Pacific Islanders.

Hate crimes against Asian American/Pacific Islanders (AAPIs) have surged in the United States during the COVID-19 pandemic to alarming new levels. We analyzed data from the Healthy Minds Study, and found that COVID-19 related racial/ethnic discrimination was associated with greater odds of having depression, anxiety, non-suicidal self-injury, binge drinking, and suicidal ideation among AAPI university students (N = 1,697). Findings suggest that the COVID-19 pandemic precipitated discrimination, which has been linked to mental health problems, calling for more preventive interventions to address the AAPI population, especially given their low rates of formal treatment utilization.

Vaping and psychotic experiences among college students in the United States.

AIM: While cigarette and marijuana use has been linked to psychotic experiences, few empirical studies have examined the relation between vaping and psychotic experiences. METHODS: We analyzed data from the Healthy Minds Survey (September 2020 - December 2020; N = 29,232 students from 36 universities), and used multiple logistic regression models to examine the associations between vaping over the past 30 days and psychotic experiences over the past 12 months, adjusting for age, gender, and race/ethnicity. We then additionally adjusted for cigarette and marijuana use, as well as depression and anxiety. RESULTS: Roughly 14 % of students in the sample reported psychotic experiences over the past year, and around 14-15 % of students reported vaping over the past month. In multiple logistic regression models, vaping was significantly associated with psychotic experiences (aOR 1.88; 95 % CI: 1.63-2.18). This association attenuated but remained statistically significant even after adjusting for any cigarette use and marijuana use, and after adjusting for depression and anxiety. CONCLUSIONS: Among college students, vaping was significantly associated with psychotic experiences, even after accounting for simple measures of cigarette and marijuana use, and mental health problems, calling for more prospective studies to examine the association.