Public Attitudes, Inequities, and Polarization in the Launch of the 988 Lifeline.

CONTEXT: To address the considerable burden of mental health need in the United States, Congress passed the National Suicide Hotline Designation Act in 2020. The Act rebranded the national suicide prevention lifeline as 988 - a 3-digit number akin to 911 for individuals to call in the case of a mental health emergency. Surprisingly little is known about American attitudes towards this new lifeline. METHODS: We rely on a demographically representative sample of 5,482 US adults conducted from June 24-28, 2022. We examine the influence of mental health status, partisan identification, and demographic characteristics on public awareness, public support, and intended use of the new 988 lifeline. FINDINGS: We find that while only a quarter of Americans are aware of the lifeline, support for the 988 lifeline is widespread, with over 75% of Americans indicating they would be likely to use the new number if needed. We identify key disparities in awareness, support, and intended use, with Republicans, individuals with low socio-economic status, and Blacks less supportive and in some cases less likely to use the 988 lifeline. CONCLUSIONS: Our results point to the need for additional interventions that increase public awareness of 988 and reduce disparities in program knowledge, support, and intended use.

Primary care physicians' strategies for addressing COVID-19 vaccine hesitancy.

OBJECTIVE: To explore the strategies that primary care physicians use to address patient COVID-19 vaccine hesitancy. METHOD: We administered an online survey to 625 primary care physicians from May 14 to May 25, 2021, to assess the messages that primary care physicians use to encourage hesitant patients to get vaccinated against COVID-19.589 physicians from the total pool of 625 provided open-ended responses. We conducted thematic content analysis on the responses based on previous research and themes identified within the data. SETTING: The survey was administered online using the survey research firm Dynata. RESULTS: Eleven primary themes emerged from our analysis, which included, physicians addressing specific concerns about vaccine safety (including costs versus benefits), physicians helping patients understand what it means to remain unvaccinated, or whether physicians try to connect emotionally through the use of guilt, or personal experience, whether physicians use derisive language to communicate with unvaccinated patients. In addition, a small number of physicians indicated they would not attempt to persuade someone who is vaccine hesitant. CONCLUSIONS: Our study shows that while some of the physicians used different strategies to address vaccine hesitancy, some of the physicians used harsh language or did not make any effort to reduce COVID-19 related vaccine hesitancy among their patients. Focused advocacy and training are needed to increase physician engagement in vaccine-related dialogues with their patients. Such efforts will ensure that critical opportunities for patient education and awareness-building are not missed and ensure high levels of vaccination uptake.

COVID-19: Academic, Financial, and Mental Health Challenges Faced by International Students in the United States Due to the Pandemic.

Background and objective Many international students often face challenges regarding their mental health, finances, and academics. The coronavirus disease 2019 (COVID-19) outbreak may have presented unprecedented challenges to many foreign students in these aspects. Our study examined the academic, financial, and mental health challenges encountered by international students residing in the United States due to the COVID-19 pandemic. It also examined the association between the mental health of the respondents and the academic and financial challenges they encountered. Method The study involved international students enrolled at Texas A&M University, who identified themselves as non-US citizens or non-permanent residents. We conducted a cross-sectional study by using Qualtrics® to explore the three domains of the study. Questions included in previous studies were modified to assess the academic and financial status while the Patient Health Questionnaire-4 (PHQ-4) score was used to assess the mental health of the respondents. We presented descriptive statistics for all domains and used an ordered logistic regression to further analyze the effect of the other domains on the mental health of the respondents. Results Of the 281 respondents, the majority (79%) experienced challenges with online classes; 91% reported having negative emotions and some students (24%) lost funding due to the pandemic. The inability to pay bills resulted in a three-fold increase in the likelihood of reporting higher mental distress [adjusted odds ratios (aOR): 3.051, 95% CI: 1.665-5.591; p<0.001], and experiencing academic challenges led to a seven-fold increase in the likelihood of reporting higher mental distress (aOR: 7.236, 95% CI: 3.168-12.530; p<0.001). Conclusion The COVID-19 pandemic posed a major challenge to international students and its impact on the mental health of the participants was aggravated by concurrent academic and financial hardships.

"The CDC Won't Let Me Be": The Opinion Dynamics of Support for CDC Regulatory Authority.

CONTEXT: The CDC's ability to respond to communicable disease threats has recently met significant political and legal opposition. The authors unpack the influence of political ideology on support for CDC authority, and they experimentally assess whether highlighting ideology's role in responding to health threats might bolster CDC support. METHODS: The authors fielded a demographically representative online survey experiment to 5,483 US adults. They assessed the sociopolitical correlates of CDC attitudes via multivariate regression analyses limited to a study-wide treatment group. Additionally, they tested the effectiveness of their experimental treatments via multivariate models that interact indicators of stimulus exposure with political ideology. FINDINGS: Although most Americans support the CDC's role in responding to health crises, self-identified conservatives are significantly less likely to do so. This effect holds when accounting for respondents' limited government and anti-expert attitudes, which the authors replicated in nationally representative data. Encouragingly, though, emphasizing the CDC's role in combating the spread of COVID-19 is associated with significantly stronger levels of support on the ideological right. CONCLUSIONS: Efforts to communicate the CDC's importance in responding to health threats can help bridge existing ideological divides and might create an incentive for policy makers to codify the agency's regulatory powers.

Factors associated with hospitalizations for co-occurring HIV and opioid-related diagnoses: Evidence from the national inpatient sample, 2009-2017.

There has been evidence of rising HIV incidence attributable to opioid misuse within some areas of the U.S. The purpose of our study was to explore national trends in co-occurring HIV and opioid-related hospitalizations and to identify their risk factors. We used the 2009-2017 National Inpatient Sample to indicate hospitalizations with co-occurring HIV and opioid misuse diagnoses. We estimated the frequency of such hospitalizations per year. We fitted a linear regression to the annual HIV-opioid co-occurrences with year as a predictor. The resulting regression did not reveal any significant temporal changes. We used multivariable logistic regression to determine the adjusted odds (AOR) of hospitalization for co-occurring HIV and opioid-related diagnoses. The odds of hospitalization were lower for rural residents (AOR = 0.28; CI = 0.24-0.32) than urban. Females (AOR = 0.95, CI = 0.89-0.99) had lower odds of hospitalization than males. Patients identifying as White (AOR = 1.23, CI = 1.00-1.50) and Black (AOR = 1.27, CI = 1.02-1.57) had higher odds of hospitalization than other races. When compared to co-occuring hospitalizations in the Midwest, the odds were higher in the Northeast. (AOR = 2.56, CI = 2.07-3.17) Future research should explore the extent to which similar findings occur in the context of mortality and targeted interventions should intesify for subpopulations at highest risk of co-occuring HIV and opioid misuse diagnoses.

Rural healthy people 2030: New decade, new challenges.

Rural Healthy People is a companion piece to the federal Healthy People initiative released once a decade to identify the most important Healthy People priorities for rural America, as identified by rural stakeholders, for the current decade. This study reports on the findings of Rural Healthy People 2030. The study relied on a survey of rural health stakeholders collected from July 12, 2021, to February 14, 2022, and: 1) identified the 20 Healthy People priorities most frequently selected as priorities for rural America, 2) studied the priorities that were most frequently selected as a "top 3" priority within each Healthy People 2030 category, and 3) investigated Healthy People 2030 priorities in terms of ranked importance for rural Americans. The analysis finds that for the first time across 3 decades of Rural Healthy People, a greater proportion of respondents selected "Mental Health and Mental Disorders" and "Addiction" as Healthy People priorities for rural America, than did "Health Care Access and Quality". Even still, respondents ranked "Health Care Access and Quality" as the single-most important rural priority. "Economic Stability," a new priority within the Social Determinant of Health category, debuted within the 10 most frequently selected priorities for rural America for the coming decade. As public health practitioners, researchers, and policymakers work toward closing the urban-rural divide, the most important rural priorities to address in the coming decade are mental health and substance use disorders, access to high quality health care services, and social determinants of health, such as economic stability.

More Than Words? How Highlighting Target Populations Affects Public Opinion about the Medicaid Program.

CONTEXT: The Medicaid program provides health insurance coverage to a diverse set of demographics. We know little about how the policy community describes these populations (e.g., on Medicaid-related websites or in public opinion polls and policy writings) or whether and how these descriptions may affect perceptions of the program, its beneficiaries, and potential policy changes. METHODS: To investigate this issue, we developed and fielded a nationally representative survey of 2,680 Americans that included an experiment for priming respondents by highlighting different combinations of target populations of the Medicaid program as found in the Medicaid policy discourse. FINDINGS: Overall, we find that Americans view Medicaid and its beneficiaries rather favorably. However, there are marked differences based on partisanship and racial animosity. Emphasizing citizenship and residency requirements at times improved these perceptions. CONCLUSIONS: Racial perceptions and partisanship are important correlates in Americans' views about Medicaid and its beneficiaries. However, perceptions are not immutable. In general, the policy community should shift toward using more comprehensive descriptions of the Medicaid population that go beyond the focus on low income and that include citizenship and residency requirements. Future research should expand this work by studying descriptions in the broader public discourse.

Erroneous Consonance. How inaccurate beliefs about physician opinion influence COVID-19 vaccine hesitancy.

Throughout the COVID-19 pandemic, researchers have studied how Americans' attitudes toward health experts influence their health behaviors and policy opinions. Fewer, however, consider the potential gap between individual and expert opinion about COVID-19, and how that might shape health attitudes and behavior. This omission is notable, as discrepancies between individual and expert opinion could help explain why some Americans fail to take action to protect themselves and others from the virus. In novel demographically representative surveys of the US adult population (N = 5,482) and primary care physician subpopulations (PCPs; N = 625), we contrast the relationship between: (1) Americans' and (2) PCPs' preferences regarding who ought to be responsible for taking action to combat the spread of COVID-19, as well as (3) Americans' perceptions of PCP preferences ("PCP meta-opinion"). In the aggregate, we find that Americans are far less likely than PCPs to see a role for both private and state actors in taking action to combat COVID-19. Interestingly, though, this disjuncture is not reflected in individual-level PCP meta-opinion; as most Americans think that PCPs share their views on state and private intervention (τb = 0.44-0.49). However, this consonance is often erroneous, which we show can have problematic health consequences. Multivariate models suggest that Americans who both see little place for individual responsibility in taking action to stop viral spread and who think that PCPs share those views are significantly less likely to vaccinate against COVID-19. We conclude by discussing the public health benefits of efforts to bring public opinion in line with expert opinion.

Suicide and non-fatal self-injury-related emergency department visits among individuals with autism spectrum disorder.

LAY ABSTRACT: This study used data for 14.4 million individuals with 43.5 million emergency department visits from all hospitals in the state of New York to explore the association between suicide and non-fatal self-injury-related (self-injury) emergency department visits and autism spectrum disorder. Overall, we found that individuals with autism spectrum disorder had more emergency department visits and admissions through the emergency department, more years of emergency department utilization, and higher prevalence of mental health-related comorbidities. Individuals with autism spectrum disorder were also significantly more likely to have at least one self-injury-related emergency department visit compared to those without autism spectrum disorder. These results emphasize the need to raise awareness across both family caregivers and healthcare providers on the increased suicide and self-injury risks that individuals with autism spectrum disorder face and to improve care delivery practices. In addition, effort to promote and increase timely access to mental health care is an urgent priority for individuals with autism spectrum disorder.

Vaccinating across the aisle: using co-partisan source cues to encourage COVID-19 vaccine uptake in the ideological right.

Overcoming the COVID-19 pandemic in the United States will require most Americans to vaccinate against the disease. However, considerable research suggests that a significant proportion of Americans intend to forego vaccination, putting pandemic recovery at risk. Republicans are one of the largest groups of COVID-19 vaccine hesitant individuals. Therefore, identifying strategies to reduce vaccine hesitancy within this group is vital to ending the pandemic. In this study, we investigate the effectiveness of messages from co-partisan sources in reducing vaccine hesitancy. In a large (N = 3000) and demographically representative survey, we find that exposing "Middle-of-the-Road" partisans to pro-vaccine messages from co-partisan source cues reduces vaccine hesitancy. However, for those who identify as "Strong" or "Weak" partisans, we find no statistically significant differences in vaccination intentions when exposed to pro-vaccine messages from co-partisan sources. We conclude by discussing how our findings are helpful for vaccine communication efforts.

Disparities in Prenatal Immunization Rates in Rural and Urban US Areas by Indicators of Access to Care.

PURPOSE: To evaluate disparities in urban-rural immunization rates among pregnant women by indicators of access to health care. METHODS: We analyzed Phase 8 (2016-2018) Pregnant Risk Assessment Monitoring System data for 82,603 respondents who recently gave birth to a live infant. Uptake of influenza (33 states) or Tdap (19 states) vaccines was compared for rural versus urban areas of participating states. We compared the prevalence of immunization for rural versus urban areas by indicators of health care access using average marginal predictive values from multivariable regression models. FINDINGS: Although nearly half (48.2%) of pregnant women in rural areas relied on Medicaid to fund prenatal care, rural-residing women were less likely to live in a state offering full coverage under Medicaid to pregnant women than urban-residing women (93.9% vs 98.0%, respectively). Among states with Medicaid programs not offering full access for pregnant women, influenza immunization coverage was 12% lower (aPR 0.88; 95% CI 0.82, 0.94) and Tdap immunization coverage was 20% lower (aPR 0.80; 95% CI 0.68, 0.95) for rural versus urban areas. Uninsured women in rural areas were less likely to receive influenza or Tdap vaccine compared to uninsured women in urban areas (aPR 0.65; 95% CI 0.50, 0.85 and aPR 0.73; 95% CI 0.57, 0.95, respectively). CONCLUSIONS: Pregnant women residing in rural areas more commonly rely on Medicaid to financially support prenatal care but are less likely to have expanded or full access to Medicaid coverage, potentially contributing to disparities vaccine uptake during pregnancy and increased rates of vaccine-preventable disease.

Physician Trust in the News Media and Attitudes toward COVID-19.

CONTEXT: Previous research has established the importance of primary care physicians in communicating public health directives. The implicit assumption is that, because of their expertise, doctors provide accurate and up-to-date information to their patients independent of partisan affiliation or media trust. METHODS: The authors conducted an online survey of 625 primary care physicians and used the results to test (1) whether physician trust in media outlets is consistent with their political partisanship, and (2) whether trust in media outlets influences (a) personal concern that someone in their family will get sick, (b) perceptions about the seriousness of the pandemic as portrayed in the media, and (c) trust in federal government agencies and scientists. FINDINGS: Physicians are better positioned to critically evaluate health-related news, but they are subject to the same biases that influence public opinion. Physicians' partisan commitments influence media trust, and media trust influences concern that a family member will get sick, perceptions regarding the seriousness of the pandemic, and trust in federal government agencies and scientists. CONCLUSIONS: Physician trust in specific media outlets shapes their understanding of the pandemic, and-to the extent that they trust conservative media outlets-it may limit their effectiveness as health policy messengers.

Exploring the role of discretionary income as a social determinant of health.

OBJECTIVE: The object of this study is to explore the impact of discretionary income on the overall well-being of Americans. DATA SOURCE: The data source used for this study was 2017 Behavioral Risk Factor Surveillance System data comprising 12 states that used the Social Determinants of Health (SDOH) module. STUDY DESIGN: Multivariable logistic regression models were used to analyze the relationship between discretionary income and self-reported health status after adjusting for common SDOH measures, sociodemographic factors, chronic conditions, and perspectives and experiences of respondents regarding specific aspects of their health. Average marginal effects (AME) were reported. DATA COLLECTION/EXTRACTION METHODS: Not applicable. PRINCIPAL FINDINGS: At all income levels, those with discretionary income at the end of the month were 6-7 percentage points more likely to report better than average health than those with none, controlling for other factors (AME: 0.07, 95% CI: 0.02-0.12). CONCLUSION: Our study suggests that discretionary income has a role to play in overall health and well-being that goes beyond that of disposable income and may be an important resource for diverse communities.

The Changing Nature of Telehealth Use by Primary Care Physicians in the United States.

INTRODUCTION: Prior to the COVID-19 pandemic, telehealth utilization was growing slowly and steadily, although differentially across medical specialties in the United States. The pandemic dramatically expanded physician use of telehealth, but our understanding of how much telehealth use has changed in primary care in the United States, the correlates of physician telehealth uptake, and the frequency with which primary care physicians intend to use telehealth after the pandemic are unknown. This paper is designed to assess these important questions. METHODS: Using data from an original national survey of 625 primary care physicians conducted from May 14 to May 25, 2021, we investigate the frequency of physician telehealth use before and during the pandemic and intended use after the pandemic. We also assess the correlates of changes in telehealth use by physicians, comparing telehealth use before the pandemic to use during and after the pandemic. RESULTS: The proportion of primary care physicians using telehealth often, jumped from 5.3% (95% CI 3.5, 7.0) before the pandemic to 46.2% (95% CI 42.3, 50.2) during the pandemic. More importantly, over 70% of physicians intended to use telehealth at least occasionally after the pandemic compared to just 18.7% before, with younger physicians, physicians without telehealth training in medical school, and Asian physicians most likely to increase their telehealth use long-term. DISCUSSION: The COVID-19 pandemic has spurred expansion in telehealth use by primary care physicians that will continue to shape care delivery well beyond the pandemic. Policy change could be needed to facilitate this growth of telehealth long-term.