Sharing Culture and Management of Sex Work Information on Mobile Phones by Female Sex Workers in Nepal: Implications for mHealth Practice and Research.

Female sex workers (FSWs) in Nepal continue to be disproportionately at risk for Sexually Transmitted Infections (STIs), including HIV. Due to stigma related to sex work and HIV, FSWs keep their sex work information hidden, which poses a barrier to seeking health services. Emerging research indicates a high uptake of mobile phones among FSWs in Nepal. Mobile health (mHealth) interventions can provide health information and linkage to care. However, largely missing from the literature is FSWs' experience of managing the information about their involvement in sex work in a culture where sharing personal information and belongings is a part of the social norm, and maintaining privacy could have negative social repercussions. The current study aims to understand how FSWs perceive and manage privacy when they share their mobile phones. Using the Communication Privacy Management theory, we explore FSWs' perception of the threat to their privacy posed by mobile phones. We conducted 30 in-depth interviews among FSWs in Kathmandu, Nepal. Results showed that all participants owned mobile phones, and sharing devices was common. Mobile phones pose a considerable challenge in keeping sex work information private, and FSWs use various communication strategies to circumvent privacy threats. The findings highlight the mental and emotional burden FSWs face trying to conceal their private information in a sharing culture. The study discusses the importance of theorizing privacy in the cultural context of the Global South and the practical implications for developing mHealth interventions for this population.

A Latent Profile Analysis of COVID-19 and Influenza Vaccine Hesitancy among Economically Marginalized Hispanic Mothers of Children under Five Years of Age in the US.

Rates of COVID-19 and influenza vaccine coverage among Hispanic young children continue to be low in comparison to other racial and ethnic groups in the United States. This study utilized a person-centered approach to understand COVID-19 and influenza vaccination hesitancy for young children under the age of five among 309 economically marginalized Hispanic mothers. Drawing on the cultural health belief model, in 2022, following FDA approval of the COVID-19 vaccine for young children, a latent profile analysis was conducted from which three profiles emerged. The Low Acculturation group (Profile 1), was notable for lower acculturation, moderate cultural medical mistrust, lower access to vaccines, and higher financial security. Compared to Profile 1, the two remaining profiles had higher acculturation and lower levels of financial security, but differed in that the High Acculturation group (Profile 2) had higher vaccine accessibility and the Moderate Acculturation group (Profile 3) had higher cultural medical mistrust. Relative to other profiles, Low Acculturation mothers were more likely to plan to vaccinate their child against current and seasonal COVID-19 and seasonal influenza, report that their child's health provider recommended the COVID-19 shot and reported lower COVID-19 and influenza vaccine mistrust. However, they also reported lower vaccine accessibility and moderate levels of cultural medical mistrust. The study highlights the importance of developing person-centered public health strategies that draw on Hispanic cultural values and consider diversity within lower income Hispanic populations to increase future pediatric COVID-19 and flu vaccination coverage among young Hispanic children.

"It didn't hurt me": patients' and providers' perspectives on unsupervised take-home doses, drug diversion, and overdose risks in the provision of medication for opioid use disorder during COVID-19 in San Juan, Puerto Rico.

BACKGROUND: During the COVID-19 pandemic, clinics offering medication for opioid use disorder (MOUD) needed to rapidly introduce unsupervised take-home dosing, while relapsing patients and patients unable to enter treatment faced increased risks of fentanyl-related overdose deaths and other drug-related harms. Based on a qualitative study of people who inject drugs (PWID) receiving MOUD treatment and MOUD staff in Puerto Rico, this paper documents the lived experiences of patients and providers during this period and the risk perceptions and management strategies to address substance misuse and drug diversion attributable to unsupervised take-home-dose delivery. METHODS: In-depth qualitative interviews were conducted with patients (N = 25) and staff (N = 25) in two clinics providing MOUD in San Juan, Puerto Rico, during 2022. Patients and staff were receiving or providing treatment during the pandemic, and patients reported injection drug use during the past thirty days. RESULTS: Patients were overwhelmingly male (84%), unmarried (72%), and unemployed (52%), with almost half (44%) injecting one to three times a day. Mean time in treatment was 7 years. Staff had a mean age of 46 years with more than half of the sample (63%) female. The majority of patients believed that unsupervised take-home dosing had no significant effect on their treatment adherence or engagement. In contrast, providers expressed concerns over the potential for drug diversion and possible increased risks of patient attrition, overdose episodes, and poor treatment outcomes. CONCLUSION: This study underscores the importance of insider perspectives on harm-reduction changes in policy implemented during a health crisis. Of note is the finding that staff disagreed among themselves regarding the potential harms of diversion and changes in drug testing protocols. These different perspectives are important to address so that future pandemic policies are successfully designed and implemented. Our study also illuminates disagreement in risk assessments between patients and providers. This suggests that preparation for emergency treatment plans requires enhanced communication with patients to match treatments to the context of lived experience.

Acceptance of digital phenotyping linked to a digital pill system to measure PrEP adherence among men who have sex with men with substance use.

Once-daily oral HIV pre-exposure prophylaxis (PrEP) is an effective strategy to prevent HIV, but is highly dependent on adherence. Men who have sex with men (MSM) who use substances face unique challenges maintaining PrEP adherence. Digital pill systems (DPS) allow for real-time adherence measurement through ingestible sensors. Integration of DPS technology with other digital health tools, such as digital phenotyping, may improve understanding of nonadherence triggers and development of personalized adherence interventions based on ingestion behavior. This study explored the willingness of MSM with substance use to share digital phenotypic data and interact with ancillary systems in the context of DPS-measured PrEP adherence. Adult MSM on PrEP with substance use were recruited through a social networking app. Participants were introduced to DPS technology and completed an assessment to measure willingness to participate in DPS-based PrEP adherence research, contribute digital phenotyping data, and interact with ancillary systems in the context of DPS-based research. Medical mistrust, daily worry about PrEP adherence, and substance use were also assessed. Participants who identified as cisgender male and were willing to participate in DPS-based research (N = 131) were included in this subsample analysis. Most were White (76.3%) and non-Hispanic (77.9%). Participants who reported daily PrEP adherence worry had 3.7 times greater odds (95% CI: 1.03, 13.4) of willingness to share biometric data via a wearable device paired to the DPS. Participants with daily PrEP adherence worry were more likely to be willing to share smartphone data (p = 0.006) and receive text messages surrounding their daily activities (p = 0.003), compared to those with less worry. MSM with substance use disorder, who worried about PrEP adherence, were willing to use DPS technology and share data required for digital phenotyping in the context of PrEP adherence measurement. Efforts to address medical mistrust can increase advantages of this technology for HIV prevention.

An examination of the independent and intersectional effects of racial and heterosexist medical mistrust on timing of sexual/reproductive health care visits among Black sexual minority women in the USA.

Experiences of racism and heterosexism in medical settings are social and systemic barriers to 'on-time' receipt of sexual and reproductive health services among women with both racial and sexual minority identities. Medical mistrust based on experiences related to these dual identities is associated with avoidance and delays in care. However, investigators are just beginning to apply an intersectional lens to quantitatively understanding such barriers. The purpose of this study was to examine the independent and interaction effects of racial and heterosexist medical mistrust on timing of sexual/reproductive health care among Black sexual minority women who have sex with women and men. A total of 320 women participated in an online study of factors affecting sexual health in this population. Ordinal logistic regression was used to assess the independent and interaction effects of racial and heterosexist medical mistrust on self-reported time since last sexual/reproductive health visit. Results indicated an interaction between the two types of medical mistrust. Research on Black women who have sex with women and men's experiences of racism and heterosexism in the US healthcare system can lead to the development of the comprehensive training programmes needed to alleviate medical mistrust among women with racial and sexual minority identities.

Extended impact of the COVID-19 pandemic: Trajectories of mental health and substance use among U.S. adults, September 2020-August 2021.

Background: Americans reported significant increases in mental health and substance use problems after the COVID-19 pandemic outbreak. This can be a product of the pandemic disruptions in everyday life, with some populations being more impacted than others. Objectives: To assess the ongoing impact of the COVID-19 pandemic on mental health and substance use in U.S. adults from September 2020 to August 2021. Methods: Participants included 1056 adults (68.5% women) who participated in a national longitudinal online survey assessing the perceived impact of COVID-19 on daily life, stress, depression and anxiety symptoms, and alcohol and cannabis use at 3-time points from September 2020 to August 2021. Results: Individuals with lower self-reported social status reported the highest perceived impact. Participants' perceived impact of the COVID-19 pandemic on daily life, stress, anxiety, and alcohol use risk significantly decreased over time but remained high. However, there was no change in depressive symptoms and cannabis use. Higher levels of perceived impact of the pandemic significantly predicted both more baseline mental health concerns and lower decreases over time. Lower self-report social status predicted more baseline mental health concerns and smaller decreases in those concerns. Black adults reported significantly higher cannabis use rates than non-Hispanic White adults. Conclusion: The impact of COVID-19 on daily life continued to be a risk factor for mental health during the second wave of the pandemic. In addition to infection prevention, public health policies should focus on pandemic-related social factors such as economic concerns and caretaking that continue to affect mental health.

Associations Among Web-Based Civic Engagement and Discrimination, Web-Based Social Support, and Mental Health and Substance Use Risk Among LGBT Youth: Cross-Sectional Survey Study.

BACKGROUND: Social media use is ubiquitous among lesbian, gay, bisexual, and transgender or nonbinary (LGBT) adolescents. The time spent on LGBT sites and involvement in social justice-oriented web-based civic activities can increase exposure to heterosexist and transphobic posts, resulting in increases in depression, anxiety, and substance use. Collaborative social justice civic engagement may also increase LGBT adolescents' social support on the web, which may buffer the mental health and substance use risks associated with web-based discrimination. OBJECTIVE: Drawing on the minority stress and stress-buffering hypotheses, this study aimed to test time spent on LGBT sites, involvement in web-based social justice activities, the mediating effect of web-based discrimination, and the moderating effect of web-based social support on mental health and substance use. METHODS: An anonymous web-based survey conducted from October 20 to November 18, 2022, analyzed data from 571 respondents (mean age 16.4, SD 1.1 years): 125 cisgender lesbian girls, 186 cisgender gay boys, 111 cisgender bisexual adolescents, and 149 transgender or nonbinary adolescents. Measures included demographics, web-based LGBT identity disclosure, hours per week spent on LGBT social media sites, engagement in web-based social justice activities (Online Civic Engagement Behavior Construct), exposure to web-based discrimination (Online Victimization Scale), web-based social support (adapted from scales examining web-based interactions), depressive and anxiety symptoms, and substance use (the Patient Health Questionnaire modified for Adolescents; Generalized Anxiety Disorder 7-item; and Car, Relax, Alone, Forget, Friends, Trouble Screening Test). RESULTS: The time spent on LGBT social media sites was unrelated to web-based discrimination after civic engagement was accounted for (90% CI -0.007 to 0.004). Web-based social justice civic engagement was positively associated with social support (ß=.4, 90% CI 0.2-0.4), exposure to discrimination (ß=.6, 90% CI 0.5-0.7), and higher substance use risk (ß=.2, 90% CI 0.2-0.6). Consistent with minority stress theory, exposure to web-based discrimination fully mediated the positive association between LGBT justice civic engagement and depressive (ß=.3, 90% CI 0.2-0.4) and anxiety symptoms (ß=.3, 90% CI 0.2-0.4). Web-based social support did not moderate the association between exposure to discrimination with depressive (90% CI -0.07 to 0.1) and anxiety symptoms (90% CI -0.06 to 0.1) and substance use (90% CI -0.04 to 0.01). CONCLUSIONS: This study highlights the importance of examining LGBT youth's specific web-based activities and the need for future research to focus on the intersectional experiences of LGBT adolescents from racial and ethnic minoritized groups through culturally sensitive questions. This study also calls for social media platforms to implement policies that mitigate the effects of algorithms that expose youth to heterosexist and transphobic messaging, such as adopting machine learning algorithms that can efficiently recognize and remove harmful content.

Factors associated with HPV vaccine acceptability and hesitancy among Black mothers with young daughters in the United States.

Introduction: Compared to other-race peers, Black women are disproportionately impacted by human papillomavirus [HPV] infection, related health outcomes, and cervical cancer mortality as a result of suboptimal HPV vaccine uptake during adolescence. Few studies in the United States have examined psychosocial determinants of HPV vaccine acceptability and hesitancy among Black parents. The current study integrated the health belief model and the theory of planned behavior to evaluate the extent to which psychosocial factors are associated with pediatric HPV vaccination intentions among this population. Methods: Black mothers (N = 402; age range = 25 to 69 years, M = 37.45, SD = 7.88) of daughters ages 9 to 15 years completed an online survey assessing HPV infection and vaccine beliefs and attitudes across four domains: Mother's HPV Perceptions, Mother's Vaccine Attitudes, Cues to Action, and Perceived Barriers to HPV Vaccination. Participants indicated their willingness to vaccinate their daughter on a 5-level ordinal scale ("I will definitely not have my daughter get the vaccine" to "I will definitely have my daughter get the vaccine") which was dichotomously recoded for binomial logistic regressions. Results: Half of the sample (48%) intended to vaccinate their daughter. Number of daughters, mother's HPV vaccine status, perceived HPV vaccine benefits, HPV vaccine safety concerns, pediatric HPV vaccine peer norms, and doctor recommendations emerged as independent factors of Black mothers' intentions to vaccinate their daughters against HPV when controlling for all other factors. Discussion: In addition to medical training to increase doctor recommendation of the HPV vaccine for Black girls, population-tailored public health messaging aimed at promoting HPV vaccine acceptance among Black mothers is urgently needed. This messaging should engage community support and emphasize the benefits of vaccination for adolescent Black girls while also addressing parental concerns regarding the safety of pediatric HPV vaccination.

Differences in mental health and alcohol use across profiles of COVID-19 disruptions.

This study aimed to examine differences in mental health and alcohol use outcomes across distinct patterns of work, home, and social life disruptions associated with the COVID-19 pandemic. Data from 2093 adult participants were collected from September 2020 to April 2021 as a part of a larger study examining the impacts of the COVID-19 pandemic on substance use. Participants provided data on COVID-19 pandemic experiences, mental health outcomes, media consumption, and alcohol use at baseline. Alcohol use difficulties, including problems related to the use, desire to use alcohol, failure to cut down on alcohol use, and family/friend concern with alcohol use, were measured at 60-day follow-up. Factor mixture modeling followed by group comparisons, multiple linear regressions, and multiple logistic regressions was conducted. A four-profile model was selected. Results indicated that profile membership predicted differences in mental health and alcohol use outcomes above and beyond demographics. Individuals experiencing the most disruption reported the strongest daily impact of COVID-19 and significantly high levels of depression, anxiety, loneliness, overwhelm, alcohol use at baseline, and alcohol use difficulties measured at 60-day follow-up. The findings highlight the need for integrated mental health and/or alcohol services and social services targeting work, home, and social life during public health emergencies in order to respond effectively and comprehensively to the needs of those requiring different types of support.

COVID-19 Vaccine Hesitancy among Economically Marginalized Hispanic Parents of Children under Five Years in the United States.

Hispanic children in the US have high rates of COVID-19-related hospitalizations and deaths. Following FDA emergency approval, COVID-19 vaccination rates for young children under five years have been alarmingly low, especially in border states with significant Hispanic populations. This study identified social and cultural determinants of COVID-19 vaccine hesitancy among economically marginalized Hispanic parents of children under five. In 2022, following FDA approval, 309 Hispanic female guardians in US border states responded to an online survey assessing parental intent to vaccinate their child, demographic characteristics, COVID-19 health and vaccine beliefs, trust in traditional sources of health information, physician and community support, and acculturation to Anglo American norms. The majority (45.6%) did not intend to vaccinate their child or were unsure (22.0%). Kendall's tau-b indicated vaccine acceptance was negatively associated with COVID-19 specific and general vaccine distrust, belief the vaccine was unnecessary, time living in the U.S., and language acculturation (range tb = -0.13 to -0.44; p = 0.05-0.001) and positively related to trust in traditional resources, doctor's recommendation, child's age, household income and parent education (range tb = 0.11 to 0.37; p = 0.05-0.001). This research highlights the importance of COVID-19 vaccination public health strategies that draw on Hispanic cultural values, community partnerships and enhanced pediatrician communication regarding routine and COVID-19-specific vaccinations.

Attitudes towards participating in research involving digital pill systems to measure oral HIV pre-exposure chemoprophylaxis: a cross-sectional study among men who have sex with men with substance use in the USA.

OBJECTIVES: This quantitative survey sought to understand, among men who have sex with men (MSM) with potentially problematic substance use, the attitudes towards participation in research involving digital pill systems (DPS) for HIV pre-exposure prophylaxis (PrEP) adherence measurement, and the barriers and facilitators to research participation. DESIGN: One-time, cross-sectional, online sampling-based survey. SETTING: US social networking app predominantly focused on MSM. PARTICIPANTS: MSM without HIV who reported current use of oral PrEP, potentially problematic substance use and sexual activity in the past 3 months. A total of 157 participants were eligible, passed validity checks and enrolled. OUTCOME MEASURES: Perceptions of DPS usefulness, accuracy and usability (System Usability Scale (SUS)); willingness and motivations to participate in DPS research; preferences for access to and feedback on DPS adherence data; data sharing considerations; and medical mistrust (Group-Based Medical Mistrust Scale (GBMMS)). RESULTS: Most of the sample (N=157) was white (n=119, 75.8%), gay (n=124, 79.0%) and cisgender (n=150, 95.5%). The median age was 33 years (IQR: 14). The mean GBMMS score was 13.5 (SD=5.2), and the median SUS score was 70 (IQR: 27.5). In the past 3 months, 36.3% (n=57) reported frequent use of substances before or during sex, and 62.4% (n=98) engaged in condomless sex. While most were adherent to PrEP, approximately 34.4% (n=54) expressed significant worry about daily adherence. Participants wished to monitor their PrEP adherence daily (n=66, 42.0%) and 52% (n=82) were very willing to participate in DPS-based research. The majority were minimally concerned about sharing DPS-detected adherence data with research teams (n=126, 80.3%), and were extremely willing to share these data with healthcare providers (n=109, 69.4%). CONCLUSIONS: In this sample, MSM without HIV who use substances reported willingness to use DPS to measure PrEP adherence in a research context, and identified benefits to accessing real-time, DPS-detected adherence data.

Diversity in Digital Pill Systems: Differences in Perceptions and Attitudes Towards Use of a Digital Pill System for HIV Pre-Exposure Prophylaxis Among Men Who Have Sex with Men with Diverse Racial and Ethnic Identities.

Nonadherence, particularly among men who have sex with men (MSM) with substance use disorders, increases the risk of HIV acquisition. Measuring adherence to HIV pre-exposure chemoprophylaxis (PrEP), and responding to suboptimal adherence or changes in adherence behavior remains a challenging public health problem. Despite the importance of accurate adherence measurement, there is no gold standard for detecting medication ingestion events in HIV research. Current adherence measures indirectly infer ingestion events or measure medication concentrations over time, yet such approaches fail to provide direct confirmation of ingestions and contextual information surrounding adherence and nonadherence. A digital pill system (DPS) - a novel tool that leverages ingestible radiofrequency sensors to measure actual ingestion events - may advance adherence measurement in HIV research. We examined and compared the willingness of MSM across racial and ethnic identities to operate a DPS in the context of PrEP adherence measurement and suggest potential future applications of this technology.

The effects of COVID-19 victimization distress and racial bias on mental health among AIAN, Asian, Black, and Latinx young adults.

OBJECTIVE: U.S. young adult racial minorities have been disproportionately impacted by the coronavirus disease (COVID-19) pandemic in rates of infection and morbidity. Prepandemic racial discrimination has been associated with depression and general anxiety. However, the effect of coronavirus-specific forms of discrimination on mental health has not been examined. This study assessed the effect of social determinants of mental health and COVID-19-specific victimization and racial bias beliefs on depression and anxiety among young adults of color in the U.S. METHOD: A national online survey of 399 American Indian/Alaskan Natives, Asian, Black, and Latinx adults (18-25 years) included demographic variables, COVID-19-health risks, and standardized measures of depression, anxiety, coronavirus-related victimization distress and perceptions of coronavirus-related racial bias across a range of contexts. RESULTS: Employment, financial and prescription insecurity, COVID-19-health risks, coronavirus-victimization distress and coronavirus racial bias beliefs were positively correlated with depression and anxiety. Scores on the Coronavirus Racial Bias Scale were significantly higher among Asian and Black respondents. Structural equation modeling controlling for race/ethnicity and demographic variables indicated coronavirus racial bias mediated the effect of coronavirus victimization distress on both mental health indices. CONCLUSION: Results suggest the COVID-19 pandemic has created new pathways to mental health disparities among young adults of color by reversing formerly protective factors such as employment, and by exacerbating structural and societal inequities linked to race. Findings highlight the necessity of creating mental health services tailored to the specific needs of racial minorities during the current and future health crises. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

COVID-related social determinants of substance use disorder among diverse U.S. racial ethnic groups.

OBJECTIVE: Black, Asian, and Hispanic/Latino people are disproportionately impacted by the COVID-19 pandemic and were more likely to experience coronavirus-related racial discrimination. This study examined the association between pandemic-related stressors, including employment and housing disruptions, coronavirus-related victimization distress, and perceptions of pandemic-associated increase in societal racial biases, and substance use disorder (SUD) risk among Asian, Black, Hispanic/Latino, and non-Hispanic White adults in the U.S. METHODS: Data were collected as part of a larger national survey on substance use during the pandemic. Eligible participants for the current study were 1336 adults self-identified as Asian (8.53%), Black (10.55%), Hispanic/Latino (10.93%), and non-Hispanic White (69.99%). Measures included demographic and COVID-19-related employment, housing, and health items, the coronavirus victimization distress scale (CVD), the coronavirus racial bias scale (CRB), and measures of substance use risk. RESULTS: Across racial/ethnic groups, employment disruption distress and housing disruption due to the pandemic were associated with SUD risk. Binary logistic regression analyses controlling for demographic variables indicated CVD was associated with higher odds of tobacco use risk (AOR = 1.36, 95% CI [1.01, 1.81]) and polysubstance use risk (AOR = 1.87, 95% CI [1.14, 3.06]), yet CRB was unrelated to any SUDs. Logistic regressions for each racial/ethnic group found different patterns of relationships between stressors and risk for SUDs. CONCLUSIONS: Results highlight the significance of examining how the current pandemic has exacerbated racial/ethnic systemic inequalities through COVID-19 related victimization. The data also suggest that across all racial/ethnic groups employment and housing disruptions and perceptions of pandemic instigated increases in societal racial bias are risk factors for SUD. The study calls for further empirical research on substance use prevention and intervention practice sensitive to specific needs of diverse populations during the current and future health crises.

Sexual and Gender Minority Individuals' Interest in Sexual Health Services at Collective Sex Venues in New York City.

Sexual and gender minority individuals who attend collective sex venues (CSVs; establishments where people can have sex in groups or the presence of others) are at elevated risk for HIV and STIs. On-site sexual health interventions have been attempted at CSVs, but attendees' interest in receiving such services is under-investigated. This paper presents results from a 2020 online cross-sectional survey completed by 342 sexual and gender minority individuals who attended CSVs in New York City. Interest in services such as on-site testing for STIs, testing vans near CSVs, and informational referrals was overall high, particularly among younger participants. Among participants who reported being HIV negative, those of younger age and those who were not using PrEP reported being more likely to take an HIV test if it would be offered at CSVs. In open-text survey responses, participants expressed interest in CSVs providing free prevention services such as HIV/STI testing, PEP, PrEP, and STI medications or vaccination, as well as in ways to improve norms surrounding condom use and consent at these venues. Some participants expressed barriers to on-site services such as privacy concerns, preexisting access to health services, an emphasis on personal responsibility, and negative reactions to the presence of service providers. However, some participants also felt that these services could be delivered in a positive, acceptable, and non-judgmental way, especially by involving CSV organizers and attendees in their implementation. Findings from this study can inform future initiatives to develop sexual health interventions at CSVs.

Psychological Well-Being and Substance Use During the COVID-19 Pandemic: Ethnic/Racial Identity, Discrimination, and Vigilance.

OBJECTIVES: Emerging evidence indicates that the COVID-19 pandemic has exacerbated mental health disparities among Black, Indigenous, and People of Color (BIPOC) through increased exposure to racism. Although ethnic/racial identity (ERI) and mental health were associated among BIPOC young adults pre-pandemic, it is unclear how these associations may differ in the exacerbated hostile racial environment of the pandemic. The current study examined the associations between ERI exploration and commitment within the context of ethnic/racial discrimination (ERD) and race-related vigilance with psychological well-being and substance use as explained by rumination. METHODS: Data from a cross-sectional online survey of 450 AIAN, Asian, Black, and Latinx young adults (18-25 years) collected in April 2020 included demographic variables, standardized measures of ERI, ERD, race-related vigilance, rumination brooding and reflection, substance use, and psychological well-being. RESULTS: Black respondents reported more exposure to ERD than AIAN and Asian young adults. ERI exploration and commitment were positively associated with well-being. ERI exploration, ERD, and rumination were associated with higher levels of substance use. An association between ERI exploration and more substance use and lower well-being was partially accounted for by higher levels of rumination. An association between ERI commitment and more substance use was fully accounted for by higher levels of rumination. CONCLUSIONS: Although ERI exploration and commitment were associated with better psychological well-being among BIPOC young adults, a significant association was found between ERI commitment and more substance use as explained by rumination. Public health efforts should cultivate culturally sensitive mental health services to decrease rumination and its negative association with substance use and well-being.

COVID-19 Vaccine Hesitancy among Parents of Children under Five Years in the United States.

On 17 June 2022, the U.S. FDA authorized the Pfizer-BioNTech and Moderna COVID-19 (SARS-CoV-2) vaccines for emergency use (EUA) in children ages 6 months-4 years. Seroprevalence has increased during the current Omicron variant wave for children under 5 years, and the burden of hospitalization for this age group is similar or exceeds other pediatric vaccine-preventable diseases. Research following the October 2021 EUA for vaccines for children 5-11 indicates a high prevalence of parental vaccine hesitancy and low uptake, underscoring the urgency of understanding attitudes and beliefs driving parental COVID-19 vaccine rejection and acceptance for younger children. One month prior to FDA approval, in the present study 411 U.S. female guardians of children 1-4 years from diverse racial/ethnic, economic, and geographic backgrounds participated in a mixed method online survey assessing determinants of COVID-19 pediatric vaccine hesitancy. Only 31.3% of parents intended to vaccinate their child, 22.6% were unsure, and 46.2% intended not to vaccinate. Logistic regression indicated significant barriers to vaccination uptake including concerns about immediate and long-term vaccination side effects for young children, the rushed nature of FDA approval and distrust in government and pharmaceutical companies, lack of community and family support for pediatric vaccination, conflicting media messaging, and lower socioeconomic status. Vaccine-resistant and unsure parents were also more likely to believe that children were not susceptible to infection and that the vaccine no longer worked against new variants. Findings underscore the need for improved public health messaging and transparency regarding vaccine development and approval, the importance of community outreach, and increased pediatrician attention to parental concerns to better improve COVID-19 vaccine uptake for young children.

Employment, coronavirus victimization distress, and substance use disorders among black and non-Hispanic White young adults during the COVID-19 pandemic.

Substance abuse among young adults increased during the COVID-19 pandemic. Although pre-pandemic data indicate non-Hispanic White adults had higher levels of substance use disorder (SUD), Black adults suffered more serious consequences. The COVID-19 pandemic has introduced new stressors that may contribute to SUD, especially among Black young adults, including employment as essential workers, which may be related to victimization distress associated with the coronavirus (i.e., coronavirus victimization distress). The current study administered an anonymous, cross-sectional, online survey to a national sample of 132 Black and 141 non-Hispanic White adults 18 - 25 years to assess the relationship between health, economic disparities, employment, coronavirus victimization distress, and substance use during the first wave of the pandemic. Controlling for COVID-19 health risks and income, structural equation models indicated that coronavirus victimization distress fully accounted for the positive association between employment and SUD risk, and this association was more pronounced among Black young adults. Findings underscore the urgency of considering disease-related victimization in SUD interventions involving employed young adults during infectious disease pandemics.

Attitudes Toward Peer-Delivered Sexual-Health Services Among New York City Sexual and Gender Minority Individuals Who Have Sex with Men and Attend Collective Sex Venues.

Collective sex venues such as sex clubs are strategic sites to promote sexual health among sexual and gender minority individuals. We present qualitative findings from a multiple-method study on the acceptability of sexual-health services at collective sex venues in New York City (NYC) among attendees who identified as men, transgender, or gender non-conforming. In a survey used for sample selection (n = 342), most respondents (82.7%) agreed that "having outreach workers at sex venues is a good thing." Interviewees (n = 30) appreciated how on-site services could promote sexual health in their community. They felt peer workers should be familiar with collective sex venues and share demographic characteristics with attendees. Some participants felt workers should keep some boundaries from attendees, while others felt they could be fully integrated in the environment, suggesting that either peer outreach or popular-opinion leader types of interventions could be feasible.

Determinants of COVID-19 Vaccine Uptake in Adolescents 12-17 Years Old: Examining Pediatric Vaccine Hesitancy Among Racially Diverse Parents in the United States.

As of December 8, 2021, 9.9 million U.S. adolescents ages 12-17 years old remain unvaccinated against COVID-19 (SARS-CoV-2) despite FDA emergency approval of the Pfizer-BioNTech COVID-19 vaccine for use among this age group in May 2021. A slow-down in adolescent vaccine uptake and increased likelihood of hospitalization among unvaccinated youth highlight the importance of understanding parental hesitancy in vaccinating their adolescent children against COVID-19. Racial/ethnic disparities in pediatric COVID-19 infection and hospitalization further underscore the need to examine parental vaccine acceptance and hesitancy among diverse U.S. parent populations. In October 2021, 242 Hispanic and non-Hispanic Asian, Black, and White parents of adolescents ages 12-17 years participated in a national online survey assessing determinants of COVID-19 pediatric vaccine hesitancy. Compared to Asian, Black, and Hispanic parents, non-Hispanic White parents reported reduced odds of having vaccinated their adolescent. Bivariate analyses and a multivariable binomial logistic regression indicated that identification as non-Hispanic White, parental COVID-19 vaccine status and safety measures, COVID-19 misconceptions, general vaccine mistrust and COVID-19 related collectivist and individualist attitudes accounted for 45.5% of the variance in the vaccine status of their adolescent children. Our findings draw attention to the urgent need to consider the COVID-19 beliefs, attitudes, and behaviors of parents from diverse racial/ethnic groups in developing population tailored public health messaging to increase adolescent COVID-19 vaccine uptake.