School modality, race and ethnicity, and mental health of U.S. adolescents during the COVID-19 pandemic.

BACKGROUND: While minoritized ethnoracial groups were most likely to be in online learning during the COVID-19 pandemic, the impact of these ethnoracial disparities on adolescent mental health is unclear. Since past studies do not directly examine whether the association between school modality and self-reported mental health outcomes varied by race and ethnicity among U.S. adolescents during the COVID-19 pandemic, this study addresses the gap. METHODS: Adolescents aged 13 to 17 years old (n = 510) were surveyed for self-reports of anxiety and depression symptoms using the 4-item Patient Health Questionnaire during Spring 2021. Seemingly unrelated regressions were used to estimate the differential association between school modality and mental health by respondents' race and ethnicity. RESULTS: Estimates without interaction between school modality and race and ethnicity suggested that Latino respondents reported a significantly higher frequency of depressive symptoms than their White counterparts (b = 0.459; p < 0.05). Similarly, the estimates without the interaction suggested respondents reporting hybrid learning had a higher frequency of depressive symptoms than in-person learning (b = 0.504; p < 0.05). Estimates with interaction between school modality and race and ethnicity suggested fully online learning was associated with poorer mental health only among White respondents and better mental health among Black respondents. Among adolescents attending school fully online, Black adolescents reported fewer mental health symptoms than their White counterparts (anxiety, b =- 1.364; p < 0.05, and depression, b =- 1.647; p < 0.05). CONCLUSIONS: Fully online learning may have benefitted the mental health of Black adolescents during the COVID-19 pandemic, perhaps because it buffered racial discrimination and social anxiety in schools. Additional interventions should be explored to promote in-person school environments that better support the mental health of Black adolescents. Moreover, prioritizing equitable access to broadband internet will provide better access to online learning and ensure positive mental health, particularly for adolescents from minoritized ethnoracial groups during instances of future pandemics. Future research should continue to consider the race and ethnicity of adolescents to promote mental well-being in schools across learning modalities.

"The dream is that there's one place you go": a qualitative study of women's experiences seeking care from Long COVID clinics in the USA.

BACKGROUND: Seeking and obtaining effective health care for Long COVID remains a challenge in the USA. Women have particularly been impacted, as they are both at higher risk of developing Long COVID and of facing gendered barriers to having symptoms acknowledged. Long COVID clinics, which provide multidisciplinary and coordinated care, have emerged as a potential solution. To date, however, there has been little examination of U.S. patient experiences with Long COVID clinics and how patients may or may not have come to access care at a Long COVID clinic. METHODS: We conducted semi-structured interviews with 30 U.S. women aged 18 or older who had experienced Long COVID symptoms for at least 3 months, who had not been hospitalized for acute COVID-19, and who had seen at least one medical provider about their symptoms. Participants were asked about experiences seeking medical care for Long COVID. Long COVID clinic-related responses were analyzed using qualitative framework analysis to identify key themes in experiences with Long COVID clinics. RESULTS: Of the 30 women, 43.3% (n = 13) had been seen at a Long COVID clinic or by a provider affiliated with a Long COVID clinic and 30.0% (n = 9) had explored or attempted to see a Long COVID clinic but had not been seen at time of interview. Participants expressed five key themes concerning their experiences with seeking care from Long COVID clinics: (1) Access to clinics remains an issue, (2) Clinics are not a one stop shop, (3) Not all clinic providers have sufficient Long COVID knowledge, (4) Clinics can offer validation and care, and (5) Treatment options are critical and urgent. CONCLUSIONS: While the potential for Long COVID clinics is significant, findings indicate that ongoing barriers to care and challenges related to quality and coordination of care hamper that potential and contribute to distress among women seeking Long COVID care. Since Long COVID clinics are uniquely positioned and framed as being the place to go to manage complex symptoms, it is critical to patient wellbeing that they be properly resourced to provide a level of care that complies with emerging best practices.

Who supports Bernie? Analyzing identity and ideological variation on Twitter during the 2020 democratic primaries.

Using a novel dataset of 590M messages by 21M users, we present the first large-scale examination of the behavior of likely Bernie supporters on Twitter during the 2020 U.S. Democratic primaries and presidential election. We use these data to dispel empirically the notion of a unified, stereotypical Bernie supporter (e.g., the "Bernie Bro"). Instead, our work uncovers significant variation in the identities and ideologies of Bernie supporters who were active on Twitter. Our work makes three contributions to the literature on social media and social movements. Methodologically, we present a novel mixed methods approach to surface identity and ideological variation within a movement via use of patterns in who retweets whom (i.e. who retweets which other users) and who retweets what (i.e. who retweets which specific tweets). Substantively, documentation of these variations challenges a trend in the social movement literature to assume actors within a particular movement are unified in their ideology, identity, and values.

Leveraging Artificial Intelligence to Predict Health Belief Model and COVID-19 Vaccine Uptake Using Survey Text from US Nurses.

We investigated how artificial intelligence (AI) reveals factors shaping COVID-19 vaccine hesitancy among healthcare providers by examining their open-text comments. We conducted a longitudinal survey starting in Spring of 2020 with 38,788 current and former female nurses in three national cohorts to assess how the pandemic has affected their livelihood. In January and March-April 2021 surveys, participants were invited to contribute open-text comments and answer specific questions about COVID-19 vaccine uptake. A closed-ended question in the survey identified vaccine-hesitant (VH) participants who either had no intention or were unsure of receiving a COVID-19 vaccine. We collected 1970 comments from VH participants and trained two machine learning (ML) algorithms to identify behavioral factors related to VH. The first predictive model classified each comment into one of three health belief model (HBM) constructs (barriers, severity, and susceptibility) related to adopting disease prevention activities. The second predictive model used the words in January comments to predict the vaccine status of VH in March-April 2021; vaccine status was correctly predicted 89% of the time. Our results showed that 35% of VH participants cited barriers, 17% severity, and 7% susceptibility to receiving a COVID-19 vaccine. Out of the HBM constructs, the VH participants citing a barrier, such as allergic reactions and side effects, had the most associated change in vaccine status from VH to later receiving a vaccine.

Telehealth use in 2022 among US adults by sexual orientation.

OBJECTIVES: To address a lack of research documenting telehealth use and experiences among sexual minority individuals during the COVID-19 pandemic and inform health care policies beyond the pandemic. STUDY DESIGN: Secondary analysis of the 2022 Health Information National Trends Survey (HINTS), a cross-sectional survey representative of US adults. METHODS: We estimated multivariable probit regressions to understand how sexual orientation was associated with reporting telehealth use, modality (video only, telephone only, both), and experiences, including the reason for, subject of most recent, and quality of the telehealth visit. We adjusted estimates based on respondents' self-reported demographics and health status. Analyses were weighted to represent the US adult population and used full information maximum likelihood to account for missing data. RESULTS: Among all HINTS respondents, having a telehealth visit within the past year was more common among sexual minority respondents than heterosexual respondents. Among telehealth users, sexual minority respondents were more likely than heterosexual respondents to say that they used telehealth because it was convenient and minimized their exposure to illnesses and that the subject of the most recent telehealth visit was mental health. They were less likely to say the subject was minor/acute care. Modality use and quality were comparable between sexual minority respondents and heterosexual respondents. CONCLUSIONS: The findings show greater demand for telehealth, especially for mental health care, among sexual minority adults. Knowledge of factors driving patterns in health care utilization within minoritized communities and the implications for both telehealth access and quality are necessary to create policies that have a broad positive impact.

Patient-centered communication, disparities, and patient portals in the US, 2017-2022.

OBJECTIVES: To identify the relationship between patient-centered communication and portal offers and use among insured adult patients and to understand the role of patient-centered communication in equitable access to portals. STUDY DESIGN: Using data from 4 cycles of the Health Information National Trends Survey across 2017-2022, we determined how patient-centered communication and sociodemographic characteristics of adult insured patients in the US are associated with offers of and access to online patient portals. METHODS: We conducted multivariable logistic regression analysis to examine associations of patient-centered communication and sociodemographic characteristics of adult insured patients in the US with offers of and access to online patient portals. RESULTS: Across the period of 2017-2022, approximately two-thirds of insured adult patients on average reported being offered a patient portal, and approximately half reported accessing a portal. Patients with lower-than-average patient-centered communication and those who are men, are Hispanic, have less than a college degree, and have no internet are less likely than their counterparts to report being offered or accessing a portal. CONCLUSIONS: Although patient-centered communication is an important factor in facilitating patient portal offers and access, it does not appear to be a driver of demographic divides in portal use.

Impact of Beliefs About Local Physician Supply and Self-Rated Health on Willingness to See a Nurse Practitioner During the COVID-19 Pandemic: Web-Based Survey and Experiment.

BACKGROUND: The COVID-19 pandemic overburdened primary care clinicians. For nurse practitioners (NPs) to alleviate the burden, the public must be willing to see an NP over a physician. Those with poor health tended to continue seeking care during the pandemic, suggesting that they may be willing to see an NP. OBJECTIVE: The aim of this study is to evaluate the public's willingness to see an NP for primary care and how this may be associated with their beliefs about the local supply of physicians and self-rated health. Two studies were conducted: (1) a survey to identify correlations and (2) an experiment to assess how willingness is dependent on information about the local supply of physicians. METHODS: The survey and experiment were conducted digitally in April and December 2020, respectively. Participants were US adults recruited from Amazon's Mechanical Turk platform. The key independent variables were self-rated health, which was a dichotomized 5-point scale (excellent, very good, good vs fair, and poor), and beliefs about local physician supply. The survey measured beliefs about local physician supply, while the experiment manipulated beliefs by altering information the participants read about the local supply of physicians. Willingness to see an NP was assessed in 2 ways. First as an overall preference over a physician and the second as a preference given 2 clinically significant scenarios in which participants imagined they were experiencing either coughing or a headache (presentation order randomized). Multiple regressions and ANOVAs were used to assess how beliefs about the local physician supply and self-rated health were associated with overall willingness to see an NP. Bivariate probits simultaneously estimated willingness to see an NP in the 2 clinically significant scenarios. RESULTS: The survey showed that concerns about physician supply were associated with lower willingness to see an NP among respondents with comparatively better health but a greater willingness among respondents with comparatively worse health. The experiment suggests that only the latter is causal. For the 2 clinically significant scenarios, these patterns appeared for the coughing scenario in the survey and the headache scenario in the experiment. CONCLUSIONS: US adults with comparatively worse self-rated health become more willing to see an NP for primary care when they hear information that raises their concerns about the local physician supply. The differences between the survey and experiment results may be useful for interpreting findings from future studies. Findings may aid in managing finite health care resources during public health crises and crafting successful messaging by NP advocacy groups. Efforts to address nursing shortages will also be needed.

Predicting Patient Satisfaction With Medications for Treating Opioid Use Disorder: Case Study Applying Natural Language Processing to Reviews of Methadone and Buprenorphine/Naloxone on Health-Related Social Media.

Background: Medication-assisted treatment (MAT) is an effective method for treating opioid use disorder (OUD), which combines behavioral therapies with one of three Food and Drug Administration-approved medications: methadone, buprenorphine, and naloxone. While MAT has been shown to be effective initially, there is a need for more information from the patient perspective about the satisfaction with medications. Existing research focuses on patient satisfaction with the entirety of the treatment, making it difficult to determine the unique role of medication and overlooking the views of those who may lack access to treatment due to being uninsured or concerns over stigma. Studies focusing on patients' perspectives are also limited by the lack of scales that can efficiently collect self-reports across domains of concerns. Objective: A broad survey of patients' viewpoints can be obtained through social media and drug review forums, which are then assessed using automated methods to discover factors associated with medication satisfaction. Because the text is unstructured, it may contain a mix of formal and informal language. The primary aim of this study was to use natural language processing methods on text posted on health-related social media to detect patients' satisfaction with two well-studied OUD medications: methadone and buprenorphine/naloxone. Methods: We collected 4353 patient reviews of methadone and buprenorphine/naloxone from 2008 to 2021 posted on WebMD and Drugs.com. To build our predictive models for detecting patient satisfaction, we first employed different analyses to build four input feature sets using the vectorized text, topic models, duration of treatment, and biomedical concepts by applying MetaMap. We then developed six prediction models: logistic regression, Elastic Net, least absolute shrinkage and selection operator, random forest classifier, Ridge classifier, and extreme gradient boosting to predict patients' satisfaction. Lastly, we compared the prediction models' performance over different feature sets. Results: Topics discovered included oral sensation, side effects, insurance, and doctor visits. Biomedical concepts included symptoms, drugs, and illnesses. The F-score of the predictive models across all methods ranged from 89.9% to 90.8%. The Ridge classifier model, a regression-based method, outperformed the other models. Conclusions: Assessment of patients' satisfaction with opioid dependency treatment medication can be predicted using automated text analysis. Adding biomedical concepts such as symptoms, drug name, and illness, along with the duration of treatment and topic models, had the most benefits for improving the prediction performance of the Elastic Net model compared to other models. Some of the factors associated with patient satisfaction overlap with domains covered in medication satisfaction scales (eg, side effects) and qualitative patient reports (eg, doctors' visits), while others (insurance) are overlooked, thereby underscoring the value added from processing text on online health forums to better understand patient adherence.

Resident Willingness to Participate in Digital Contact Tracing in a COVID-19 Hotspot: Findings From a Detroit Panel Study.

BACKGROUND: Digital surveillance tools and health informatics show promise in counteracting diseases but have limited uptake. A notable illustration of the limits of such tools is the general failure of digital contact tracing in the United States in response to COVID-19. OBJECTIVE: We investigated the associations between individual characteristics and the willingness to use app-based contact tracing in Detroit, a majority-minority city that experienced multiple waves of COVID-19 outbreaks and deaths since the start of the pandemic. The aim of this study was to examine variations among residents in the willingness to download a contact tracing app on their phones to provide public health officials with information about close COVID-19 contact during summer 2020. METHODS: To examine residents' willingness to participate in digital contact tracing, we analyzed data from 2 waves of the Detroit Metro Area Communities Study, a population-based survey of Detroit, Michigan residents. The data captured 1873 responses from 991 Detroit residents collected in June and July 2020. We estimated a series of multilevel logit models to gain insights into differences in the willingness to participate in digital contact tracing across a variety of individual attributes, including race/ethnicity, degree of trust in the government, and level of education, as well as interactions among these variables. RESULTS: Our results reflected widespread reluctance to participate in digital contact tracing in response to COVID-19, as less than half (826/1873, 44.1%) of the respondents said they would be willing to participate in app-based contact tracing. Compared to White respondents, Black (odds ratio [OR] 0.45, 95% CI 0.23-0.86) and Latino (OR 0.32, 95% CI 0.11-0.99) respondents were significantly less willing to participate in digital contact tracing. Trust in the government was positively associated with the willingness to participate in digital contact tracing (OR 1.17, 95% CI 1.07-1.27), but this effect was the strongest for White residents (OR 2.14, 95% CI 1.55-2.93). We found similarly divergent patterns of the effects of education by race. While there were no significant differences among noncollege-educated residents, White college-educated residents showed greater willingness to use app-based contact tracing (OR 6.12, 95% CI 1.86-20.15) and Black college-educated residents showed less willingness (OR 0.46, 95% CI 0.26-0.81). CONCLUSIONS: Trust in the government and education contribute to Detroit residents' wariness of digital contact tracing, reflecting concerns about surveillance that cut across race but likely arise from different sources. These findings point to the importance of a culturally informed understanding of health hesitancy for future efforts hoping to leverage digital contact tracing. Though contact tracing technologies have the potential to advance public health, unequal uptake may exacerbate disparate impacts of health crises.

Disparities in patient portal access by US adults before and during the COVID-19 pandemic.

Objective: Online patient portals become important during disruptions to in-person health care, like when cases of coronavirus disease 2019 (COVID-19) and other respiratory viruses rise, yet underlying structural inequalities associated with race, socio-economic status, and other socio-demographic characteristics may affect their use. We analyzed a population-based survey to identify disparities within the United States in access to online portals during the early period of COVID-19 in 2020. Materials and Methods: The National Cancer Institute fielded the 2020 Health and Information National Trends Survey from February to June 2020. We conducted multivariable analysis to identify socio-demographic characteristics of US patients who were offered and accessed online portals, and reasons for nonuse. Results: Less than half of insured adult patients reported accessing an online portal in the prior 12 months, and this was less common among patients who are male, are Hispanic, have less than a college degree, have Medicaid insurance, have no regular provider, or have no internet. Reasons for nonuse include: wanting to speak directly to a provider, not having an online record, concerns about privacy, and discomfort with technology. Discussion: Despite the rapid expansion of digital health technologies due to COVID-19, we found persistent socio-demographic disparities in access to patient portals. Ensuring that digital health tools are secure, private, and trustworthy would address some patient concerns that are barriers to portal access. Conclusion: Expanding the use of online portals requires explicitly addressing fundamental inequities to prevent exacerbating existing disparities, particularly during surges in cases of COVID-19 and other respiratory viruses that tax health care resources.

Mental Healthcare Utilization, Modalities, and Disruptions During Spring 2021 of the COVID-19 Pandemic Among U.S. Adolescents.

PURPOSE: The COVID-19 pandemic fomented a mental health crisis among adolescents. The present study contributes a national snapshot of mental healthcare utilization, including disruptions, barriers, and modalities, among U.S. adolescents. METHODS: Logistic regressions analyzing self-reports from a representative sample (N = 532) of 13-17-year-olds recruited from the AmeriSpeak Teen Panel during Spring 2021. RESULTS: Few demographic characteristics were associated with disruptions. Text-based communication/chat was most prevalent among minoritized racial and ethnic groups. Parental support was positively associated with finding private space for telehealth visits. Black adolescents were less likely to report in-person visits. Among those unable to receive care, Black adolescents preferred in-person visits. DISCUSSION: Policies enacted to facilitate access to text-based communication/chat should continue to limit disruptions and promote racial equity. Additional efforts should target improving access to in-person visits among Black adolescents. Clinicians should encourage parent/guardian collaboration to facilitate access to private space for telehealth visits.

State Health Department Communication about Long COVID in the United States on Facebook: Risks, Prevention, and Support.

Greater public awareness of long COVID severity and susceptibility is needed to support those with long COVID and encourage preventive behaviors. It is not yet known to what extent health departments have informed the public about long COVID risks or offered guidance and support for those with long COVID. The objective of this research was to determine how and to what extent US state health departments have communicated with the public about long COVID via Facebook. Facebook posts with COVID-19 and long COVID terms made by 50 US state health departments plus Washington, DC, from 1 January 2020 to 31 January 2022, were collected using CrowdTangle. The first long COVID post appeared on 15 July 2020. From 15 July 2020 to 31 January 2022, state health departments made 49,310 COVID-19 posts and 137 long COVID posts. Using quantitative content analysis methods, long COVID posts were coded for health belief model constructs. Among long COVID posts, 75.18% included language about susceptibility, 64.96% severity, and 64.23% benefits of prevention. Cues to preventive action appeared in 54.01% of posts. 19.71% of posts provided guidance for those with long COVID. While health departments posted extensively about COVID-19, posts about long COVID were rare. This represents a missed opportunity to bolster arguments for preventive behaviors and support those experiencing long COVID.

Factors Affecting Physicians' Credibility on Twitter When Sharing Health Information: Online Experimental Study.

Background: Largely absent from research on how users appraise the credibility of professionals as sources for the information they find on social media is work investigating factors shaping credibility within a specific profession, such as physicians. Objective: We address debates about how physicians can show their credibility on social media depending on whether they employ a formal or casual appearance in their profile picture. Using prominence-interpretation theory, we posit that formal appearance will affect perceived credibility based on users' social context-specifically, whether they have a regular health care provider. Methods: For this experiment, we recruited 205 social media users using Amazon Mechanical Turk. We asked participants if they had a regular health care provider and then randomly assigned them to read 1 of 3 Twitter posts that varied only in the profile picture of the physician offering health advice. Next, we tasked participants with assessing the credibility of the physician and their likelihood of engaging with the tweet and the physician on Twitter. We used path analysis to assess whether participants having a regular health care provider impacted how the profile picture affected their ratings of the physician's credibility and their likelihood to engage with the tweet and physician on Twitter. Results: We found that the profile picture of a physician posting health advice in either formal or casual attire did not elicit significant differences in credibility, with ratings comparable to those having no profile image. Among participants assigned the formal appearance condition, those with a regular provider rated the physician higher on a credibility than those without, which led to stronger intentions to engage with the tweet and physician. Conclusions: The findings add to existing research by showing how the social context of information seeking on social media shapes the credibility of a given professional. Practical implications for professionals engaging with the public on social media and combating false information include moving past debates about casual versus formal appearances and toward identifying ways to segment audiences based on factors like their backgrounds (eg, experiences with health care providers).

Seeking Help From Trusted Adults in Response to Peers' Social Media Posts About Mental Health Struggles: Qualitative Interview Study Among Latinx Adolescents.

BACKGROUND: Rather than confiding in adults about their mental health struggles, adolescents may use social media to disclose them to peers. Disclosure recipients are tasked with deciding whether to alert an adult and, if so, whom to alert. Few studies have examined how adolescents decide on a trusted adult to help a friend who posts on social media about his/her mental health struggles. Moreover, Latinx adolescents are underrepresented in research on social media use, which creates gaps in understanding how social media may influence their well-being. OBJECTIVE: This qualitative study presents findings from semistructured interviews with Latinx adolescents to investigate how they seek out trusted adults when a friend posts on social media about their mental health struggles. Specifically, we sought to determine which adult ties they activated, the resources they believed the adult could provide, and the support they expected the adult to provide. METHODS: We recruited participants through a nonprofit organization serving the Latinx community (primarily of Mexican origin) located in Milwaukee, Wisconsin. We conducted 43 semistructured interviews, each lasting 60-90 minutes, with Latinx adolescents (25 females, 18 males) aged 13-17 years. All interviews were conducted in English, at the adolescents' request. Using a grounded theory approach, we identified the nature of the relationship between the trusted adult and either the disclosure recipient or distressed friend, and the resources and support the trusted adult is expected to provide. RESULTS: Participants nominated adults who were emotionally or physically proximate to either the disclosure recipient or distressed friend, particularly parents (of the recipient and friend) and school staff. However, some felt that not all parents and school staff were emotionally proximate. Adolescents sought trusted adults with access to two resources: experiential knowledge and authority. Some, particularly males, avoided adults with authority because of the risk of punishment and others thought their immigrant parents did not have relevant experiential knowledge to assist them. Interviewees felt that trusted adults with either resource could provide emotional and instrumental support either directly or indirectly, while those with experiential knowledge could provide informational support. Notably, interviews did not problematize the fact that the disclosure occurred on social media when deliberating about adults. CONCLUSIONS: To assist a distressed friend posting on social media, Latinx adolescents look not only for trusted adults who are emotionally and physically proximate but also those who have key resources that facilitate support. Efforts should focus on connecting adolescents with trusted adults and training adults who hold positions of authority or experiential knowledge to offer both direct and indirect support. Additionally, efforts should consider how immigrant experiences shape parent-child relations and address the potential long-term consequences of oversurveillance of Latinx youth, particularly males, by school staff for their access to social support.

Perceptions of Alerts Issued by Social Media Platforms in Response to Self-injury Posts Among Latinx Adolescents: Qualitative Analysis.

BACKGROUND: There is growing interest in using social media data to detect and address nonsuicidal self-injury (NSSI) among adolescents. Adolescents often do not seek clinical help for NSSI and may adopt strategies to obscure detection; therefore, social media platforms may be able to facilitate early detection and treatment by using machine learning models to screen posts for harmful content and subsequently alert adults. However, such efforts have raised privacy and ethical concerns among health researchers. Little is currently known about how adolescents perceive these efforts. OBJECTIVE: The aim of this study is to examine perceptions of automated alerts for NSSI posts on social media among Latinx adolescents, who are at risk for NSSI yet are underrepresented in both NSSI and health informatics research. In addition, we considered their perspectives on preferred recipients of automated alerts. METHODS: We conducted semistructured, qualitative interviews with 42 Latinx adolescents between the ages of 13 and 17 years who were recruited from a nonprofit organization serving the Latinx community in Milwaukee, Wisconsin. The Latinx population in Milwaukee is largely of Mexican descent. All interviews were conducted between June and July 2019. Transcripts were analyzed using framework analysis to discern their perceptions of automated alerts sent by social media platforms and potential alert recipients. RESULTS: Participants felt that automated alerts would make adolescents safer and expedite aid before the situation escalated. However, some worried that hyperbolic statements would generate false alerts and instigate conflicts. Interviews revealed strong opinions about ideal alert recipients. Parents were most commonly endorsed, but support was conditional on perceptions that the parent would respond appropriately. Emergency services were judged as safer but inappropriate for situations considered lower risk. Alerts sent to school staff generated the strongest privacy concerns. Altogether, the preferred alert recipients varied by individual adolescents and perceived risks in the situation. None raised ethical concerns about the collection, analysis, or storage of personal information regarding their mental health status. CONCLUSIONS: Overall, Latinx adolescents expressed broad support for automated alerts for NSSI on social media, which indicates opportunities to address NSSI. However, these efforts should be co-constructed with adolescents to ensure that preferences and needs are met, as well as embedded within broader approaches for addressing structural and cultural barriers to care.

Gender Divides in Engagement With COVID-19 Information on the Internet Among U.S. Older Adults.

OBJECTIVE: Gender and age disparities in older adults' exposure to pandemic stressors may create different needs for engaging with COVID-19 information, yet mitigation strategies to curb spreading COVID-19 inhibit their access to preferred in-person information networks. To inform the design of Internet-based interventions for older adults, the current study of U.S. older adults examines gender and age divides in searching for and sharing COVID-19 information on the Internet. METHOD: A secondary analysis of survey data from the Pew Research Center fielded March 19-24, 2020. Bivariate probit regressions jointly estimated how searching for and sharing information on the Internet about COVID-19 were associated with the age and gender of U.S. older adults (50 or older), adjusting for sociodemographic characteristics. RESULTS: Consistent with previous research, younger older adults (50-64) were more likely than their older counterparts (65 or older) to search for and share information about COVID-19 and men, regardless of age, were less likely than women to share information. While men are usually more likely than women to search for information, women who are younger older adults were most likely to search for COVID-19 information. DISCUSSION: Internet-based interventions for older adults should consider how gender shapes their exposure to pandemic stressors. Men, who were already at risk of social isolation before the pandemic, may be candidates for interventions encouraging social uses of the Internet. Women between 50 and 64 were most likely among adults to provide care for another adult before the pandemic, which may be shaping their online information needs.

Racial and ethnic differences in self-reported telehealth use during the COVID-19 pandemic: a secondary analysis of a US survey of internet users from late March.

OBJECTIVE: Widespread technological changes, like the rapid uptake of telehealth in the US during the COVID-19 pandemic, risk creating or widening racial/ethnic disparities. We conducted a secondary analysis of a cross-sectional, nationally representative survey of internet users to evaluate whether there were racial/ethnic disparities in self-reported telehealth use early in the pandemic. MATERIALS AND METHODS: The Pew Research Center fielded the survey March 19-24, 2020. Telehealth use because of the pandemic was measured by asking whether respondents (N = 10 624) "used the internet or e-mail to connect with doctors or other medical professionals as a result of the coronavirus outbreak." We conducted survey-weighted logistic regressions, adjusting for respondents' socioeconomic characteristics and perceived threat of the pandemic to their own health (eg, no threat, minor, major). RESULTS: Approximately 17% of respondents reported using telehealth because of the pandemic, with significantly higher unadjusted odds among Blacks, Latinos, and those identified with other race compared to White respondents. The multivariable logistic regressions and sensitivity analyses show Black respondents were more likely than Whites to report using telehealth because of the pandemic, particularly when perceiving the pandemic as a minor threat to their own health. DISCUSSION: Black respondents are most likely to report using telehealth because of the COVID-19 pandemic, particularly when they perceive the pandemic as a minor health threat. CONCLUSION: The systemic racism creating health and health care disparities has likely raised the need for telehealth among Black patients during the pandemic. Findings suggest opportunities to leverage a broadly defined set of telehealth tools to reduce health care disparities postpandemic.

Racial and Ethnic Digital Divides in Posting COVID-19 Content on Social Media Among US Adults: Secondary Survey Analysis.

BACKGROUND: Public health surveillance experts are leveraging user-generated content on social media to track the spread and effects of COVID-19. However, racial and ethnic digital divides, which are disparities among people who have internet access and post on social media, can bias inferences. This bias is particularly problematic in the context of the COVID-19 pandemic because due to structural inequalities, members of racial and ethnic minority groups are disproportionately vulnerable to contracting the virus and to the deleterious economic and social effects from mitigation efforts. Further, important demographic intersections with race and ethnicity, such as gender and age, are rarely investigated in work characterizing social media users; however, they reflect additional axes of inequality shaping differential exposure to COVID-19 and its effects. OBJECTIVE: The aim of this study was to characterize how the race and ethnicity of US adults are associated with their odds of posting COVID-19 content on social media and how gender and age modify these odds. METHODS: We performed a secondary analysis of a survey conducted by the Pew Research Center from March 19 to 24, 2020, using a national probability sample (N=10,510). Respondents were recruited from an online panel, where panelists without an internet-enabled device were given one to keep at no cost. The binary dependent variable was responses to an item asking whether respondents "used social media to share or post information about the coronavirus." We used survey-weighted logistic regressions to estimate the odds of responding in the affirmative based on the race and ethnicity of respondents (white, black, Latino, other race/ethnicity), adjusted for covariates measuring sociodemographic background and COVID-19 experiences. We examined how gender (female, male) and age (18 to 30 years, 31 to 50 years, 51 to 64 years, and 65 years and older) intersected with race and ethnicity by estimating interactions. RESULTS: Respondents who identified as black (odds ratio [OR] 1.29, 95% CI 1.02-1.64; P=.03), Latino (OR 1.66, 95% CI 1.36-2.04; P<.001), or other races/ethnicities (OR 1.33, 95% CI 1.02-1.72; P=.03) had higher odds than respondents who identified as white of reporting that they posted COVID-19 content on social media. Women had higher odds of posting than men regardless of race and ethnicity (OR 1.58, 95% CI 1.39-1.80; P<.001). Among men, respondents who identified as black, Latino, or members of other races/ethnicities were significantly more likely to post than respondents who identified as white. Older adults (65 years or older) had significantly lower odds (OR 0.73, 95% CI 0.57-0.94; P=.01) of posting compared to younger adults (18-29 years), particularly among those identifying as other races/ethnicities. Latino respondents were the most likely to report posting across all age groups. CONCLUSIONS: In the United States, members of racial and ethnic minority groups are most likely to contribute to COVID-19 content on social media, particularly among groups traditionally less likely to use social media (older adults and men). The next step is to ensure that data collection procedures capture this diversity by encompassing a breadth of search criteria and social media platforms.

Why Most of Your Patients Aren't Using an Online Portal, and What You Can Do About It.

Online portals that provide patients with secure access to their medical records and provider communication can improve health care. Yet new technologies can also exacerbate existing health disparities. We analyzed information about 2,325 insured respondents to the nationally representative 2017 Health Information National Trends Survey to examine characteristics of portal nonusers and reasons for nonuse. Sixty-three percent reported not using a portal during the prior year. In multivariable analysis, we found that nonusers were more likely to be male, be on Medicaid, lack a regular provider, and have less than a college education, compared to users. Similar disparities existed in who reported being offered access to a portal, with nonwhites also less likely to report being offered access. Reasons for nonuse included privacy concerns and the desire to speak directly to providers, both of which indicate the important role of the doctor-patient relationship.