"If I Stay Silent, It Doesn't Help Anyone": Understanding How People Use TikTok to Talk About Sexual Violence.

TikTok is the second most popular social media platform among American teenagers, suggesting it may be a way to reach young people with sexual violence-related messages. This qualitative content analysis focused on what TikTok users share about sexual violence. The content of the videos fell into two primary types of information, people sharing experiences of sexual violence (i.e., what happened, how they responded, impacts of experiences) and people sharing other information related to sexual violence (i.e., education, raising awareness). The study results demonstrate that people use TikTok as a platform to share their messages about sexual violence-related topics, underscoring the potential of this platform for prevention and recovery messages targeted toward individuals who directly or indirectly experience sexual violence.

"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.

Adding COVID to cancer: does cancer status influence COVID-19 infection preventive behaviors?

Introduction: A better understanding of how to promote disease mitigation and prevention behaviors among vulnerable populations, such as cancer survivors, is needed. This study aimed to determine patterns of and factors associated with COVID-19-related preventive behaviors among cancer survivors and assess whether the COVID-19 preventive behaviors of cancer survivors differ from the general population. Methods: In June 2020, an online survey of adults (N = 897) assessed predictors of COVID-19-related preventive behaviors, including socio-demographics, COVID-19 beliefs and perceptions (Health Belief Model [HBM] variables), and cancer statuses (cancer survivors currently in treatment, cancer survivors not currently in treatment, and individuals with no history of cancer). An average score of respondent engagement in eight preventive behaviors was calculated. Differences in HBM variables and preventive behaviors by cancer status were assessed using ANCOVAs. Hierarchical multiple regression analyzed associations among socio-demographics, HBM constructs, cancer statuses, and engagement in COVID-19 preventive behaviors. Results: Participants reported engaging in 3.5 (SD = 0.6) preventive behaviors. Cancer survivors not in treatment engaged in preventive behaviors significantly less than the comparison group. In the final adjusted model, after adding COVID-19 beliefs and perceptions, cancer status was no longer significant. All HBM constructs except perceived susceptibility were significant predictors of preventive behaviors. Conclusions: COVID-19 beliefs and perceptions were more robust predictors preventive behaviors than cancer status. Nonetheless, public health organizations and practitioners should communicate the risk and severity of infection among cancer survivors and emphasize the need to engage in protective behaviors for COVID-19 and other infectious diseases with this vulnerable population.

Promotion of an Algorithm-Based Tool for Pregnancy Prevention by Instagram Influencers.

Objective: Despite growing concerns that some digital algorithm-reliant fertility awareness-based methods of pregnancy prevention are marketed in an inaccurate, opaque, and potentially harmful manner online, there has been limited systematic examination of such marketing practices. This article therefore provides an empirical examination of how social media influencers have promoted the fertility tracking tool Daysy on Instagram. We investigate: (1) how the tool is framed in relation to pregnancy prevention using Health Belief Model (HBM) constructs, and (2) the promotional and disclosure practices adopted by influencers. Materials and Methods: We collected Instagram posts mentioning Daysy made between June 2018 and May 2022 using the tool CrowdTangle. Using a qualitative content analysis approach, we coded a random sample of 400 Daysy posts. This yielded 122 Instagram influencer posts promoting Daysy for pregnancy prevention that we coded for promotional content and HBM constructs. Results: Posts originated primarily from Europe (n = 62, 50.82%) and the United States (n = 37, 30.33%). Findings indicate that barriers to use (n = 18, 15.57%) and the severity of risks from unplanned pregnancy (n = 8, 6.56%) were rarely conveyed, whereas benefits of use (n = 122, 100%) and the severity of risks of hormonal contraception (n = 31, 25.41%) were covered more extensively. Only about one third of posts disclosed any formal relationship to the brand Daysy. Conclusions: With many posts emphasizing benefits and obscuring potential limitations, we argue that accurate and transparent information about the effectiveness and limitations of fertility tracking technologies is critical for supporting informed decision-making and, as such, should remain a public health priority.

Working with Survivors of Sex Trafficking: Mental Health Implications.

Human trafficking is one of the largest criminal enterprises in the world, generating an estimated $150 billion in illegal profits annually. Sex trafficking is the most common form of human trafficking, and survivors experience significant physical, emotional, and sexual trauma that places them at increased risk of poor health outcomes. As sex trafficking continues to disproportionately impact the physical and mental health of individuals belonging to marginalized groups, a multidisciplinary approach to combat trafficking will require collaboration between health services, law enforcement, and social services. Therefore, medical professionals should be familiar with screening protocols for trafficking and evidence based, trauma-informed mental health treatment interventions.

Pandemic coping and COVID-19 preventive behaviors among cancer survivors.

BACKGROUND: Cancer survivors are at greater risk for COVID-19 complications, emphasizing the importance of adherence to COVID-19 prevention. Active coping mechanisms can help manage pandemic stress but disengaged coping practices can have adverse effects. OBJECTIVES: 1) Identify differences in COVID-19 coping styles and COVID-19 preventive behaviors among cancer survivors in active treatment, survivors not in treatment, and a comparison group without a cancer history. 2) Exploring variables that may predict adherence to COVID-19 preventative behaviors. PATIENT INVOLVEMENT & METHODS: This study used an online survey among two categories of cancer survivors - one group in active treatment and one group no longer in treatment - and one group without a cancer history (N = 897 total). RESULTS AND DISCUSSION: Cancer survivors in treatment were more likely to utilize both active and disengaged coping (p < .001). This could indicate that the additional COVID-19 strain is making survivors more likely to engage in coping in any way possible. Cancer survivors not in treatment were less likely to report intent to carry out COVID- 19 preventative behaviors compared to the comparison group (p = .009). Providers should understand how survivors may use both coping mechanism types because these coping strategies predict both depression and adherence to COVID-19 preventive behaviors.

Reading, sharing, creating Pinterest recipes: Parental engagement and feeding behaviors.

Pediatric overweight and obesity are associated with serious health concerns both during childhood and in adulthood. Visual social media platform Pinterest is often used to curate recipe content, but little is known about how, if at all, parents use the platform as a resource for meal planning for their families. This study focused on (1) describing how Pinterest using parents use the platform related to recipe searches and meal planning and (2) examining the association between parental feeding behaviors and frequency of Pinterest use related to recipes. Survey research firm Qualtrics was used to collect a nationwide sample of 659 Pinterest-using parents with children between ages 3-11 years of age. Data collection was initiated and completed in February of 2019. Measures included both parent and child demographics, Pinterest recipe use and engagement, and parental feeding practices using the Child Feeding Questionnaire (CFQ). Results showed that 26.9% of the respondents reported using Pinterest daily to read recipes, 17.9% to share recipes; 14.9% to comment on recipes on Pinterest; 10.3% reported creating and posting new recipes; and 13.8% mentioned making a recipe they find on Pinterest daily. Pinterest engagement was significantly negatively associated with parental age and with income insecurity, while positively associated with level of education. Hispanic participants showed higher levels of engagement as compared to White non-Hispanic participants. Among the CFQ subscales, Pressure and Perceived responsibility were significantly positively associated with Pinterest engagement while Monitoring and Restriction were not.

"Could Be Even Worse in College": Social Factors, Anxiety, and Depressive Symptoms Among Black Men on a College Campus.

Understanding mental health risks among Black men is a step forward in reducing health and educational disparities that are persistent in today's society. Semi-structured focus groups were conducted with 20 Black male undergraduate students from a college campus in the Southeast. The aim was to identify and understand the social and contextual factors impacting their risk of experiencing anxiety and depressive symptoms. A thematic analysis, theoretically grounded in the social-ecological model (SEM), was conducted, revealing three overarching themes: 1) what is known or felt about mental health 2) causes of stressors and 3) signs as symptoms. Discussions with men offered insight into their perspectives and personal experiences related to mental health issues and perceived risk factors. Themes suggest that the college transition, academic workload, perceived financial distress, and their desire and need to conform to ideals of masculinity were significant risk factors and stressors. Men offered descriptions of specific symptoms and health behaviors associated with such stress, including social isolation, anger, irritability, and changes in their own personal behaviors. Key findings paint a picture of college mental health experiences for some Black male college students. Moving forward, more research is needed to expand on this study's findings and improve mental health risk among this underserved population. Future directions are discussed alongside the results presented in this paper.

Mental health disorder symptom prevalence and rates of help-seeking among University-Enrolled, emerging adults.

Objective. Examine mental health symptom prevalence and rates of campus services utilization among Black male, White male and Black female college students. Participants. 2500 students from an ongoing, student survey at a public university; launched in 2011. Methods. Measures included data for anxiety and depressive symptoms and utilization of campus health services (counseling center, health services, etc.). Descriptive analyses determined prevalence and utilization rates. Mann Whitney U tests compared prevalence. Chi-squared tests compared utilization rates. Results. Anxiety prevalence: greater than 60% of students from each ethnic group reported symptoms; reporting rates decreased significantly for Black men (49.6%); p < 0.001. Depression prevalence: greater than 80% reported symptoms; there were significant differences in reporting between Black men and Black women (72.7% vs. 87.1%, p < 0.001). Utilization: Black men utilized counseling services less than White men (20.4% vs. 37.8%, p = 0.024). Conclusion. Black men report depressive and anxiety symptoms but underutilize campus health resources.

Tweeting a Pandemic: Communicating #COVID19 Across the Globe.

The COVID-19 pandemic brought about an urgent need for public health departments to clearly communicate their prevention, testing, and treatment recommendations. Previous research supports that Twitter is an important platform that public health departments use to communicate crisis information to stakeholders. This study aimed to shed light on how international health departments shared relevant information about COVID-19 on Twitter in 2020. We conducted a quantitative content analysis of N = 1,200 tweets from twelve countries, across six continents. COVID-19 prevention behaviors were consistently referenced far more than testing or treatment recommendations across countries. Disease severity and susceptibility were referenced more than recommendation benefits, barriers, and efficacy. Results provide support for how public health departments can better communicate recommendations related to COVID-19 behaviors. Based on these results, implications for public health organizations and public relations practitioners worldwide are discussed, and hands-on action guidelines are provided.

Between Healthcare Practitioners and Clergy: Evangelicals and COVID-19 Vaccine Hesitancy.

Evangelical Christians are among the most hesitant to get the COVID-19 vaccine. This study examined the extent to which COVID-19 vaccination uptake among Evangelicals is explained by demographic characteristics, Health Belief Model constructs, and faith-based support factors. Survey research firm Qualtrics recruited 531 U.S. adults and conducted a survey to explore predictors of COVID-19 vaccine uptake among people who self-identified as Evangelicals in September 2021. A logistic regression showed that those reporting high perceived benefits of the COVID-19 vaccine were more likely to be vaccinated, while those reporting high perceived barriers were less likely to be vaccinated. Those whose healthcare provider asked them about the vaccine were more likely to be vaccinated than those whose healthcare provider did not ask. Finally, while those who reported information seeking from religious leaders were less likely to be vaccinated, those who reported more faith-based support for vaccination were more likely to be vaccinated. In addition to beliefs about benefits and barriers to vaccination, the role of healthcare providers and clergy were important factors influencing vaccination status. Intervention efforts that capitalize on partnerships between health providers and clergy in supportive congregations may be able to reach undecided Evangelicals.

Examining Hashtag Use of #blackboyjoy and #theblackmancan and Related Content on Instagram: Descriptive Content Analysis.

BACKGROUND: Social media is widely accessible and increasingly utilized. Social media users develop hashtags and visual, text-based imagery to challenge misrepresentations, garner social support, and discuss a variety of mental health issues. Understanding how Black men are represented on social media and are using social media may be an avenue for promoting their engagement with and uptake of digital mental health interventions. OBJECTIVE: The aim of this study was to conduct a content analysis of posts containing visual and text-based components related to representations of Black men's race, gender, and behaviors. METHODS: An exploratory, descriptive content analysis was conducted for 500 Instagram posts to examine characteristics, content, and public engagement of posts containing the hashtags #theblackmancan and #blackboyjoy. Posts were selected randomly and extracted from Instagram using a social network mining tool during Fall 2018 and Spring 2019. A codebook was developed, and all posts were analyzed by 2 independent coders. Analyses included frequency counts and descriptive analysis to determine content and characteristics of posts. Mann-Whitney U tests and Kruskal-Wallis H tests were conducted to assess engagement associated with posts via likes, comments, and video views. RESULTS: Of the 500 posts extracted, most were image based (368/500, 73.6%), 272/500 (54.4%) were posted by an individual and 135/500 (27.0%) by a community organization, 269/500 (53.8%) were posted by individuals from Black populations, and 177/500 (35.4%) posts contained images of only males. Posts depicted images of Black men as fathers (100/500, 20.0%), Black men being celebrated (101/500, 20.2%), and Black men expressing joy (217/500, 43.4%). Posts (127/500, 25.4%) also depicted Black men in relation to gender atypical behavior, such as caring for children or styling their children's hair. Variables related to education and restrictive affection did not show up often in posts. Engagement via likes (median 1671, P<.001), comments (P<.001), and views (P<.001) for posts containing #theblackmancan was significantly higher compared with posts containing #blackboyjoy (median 140). Posts containing elements of celebrating Black men (P=.02) and gender atypical behavior (P<.001) also had significantly higher engagement. CONCLUSIONS: This is one of the first studies to look at hashtag use of #blackboyjoy and #theblackmancan. Posts containing #blackboyjoy and #theblackmancan promoted positive user-generated visual and text-based content on Instagram and promoted positive interactions among Black and diverse communities. With the popularity of social media and hashtag use increasing, researchers and future interventional research should investigate the potential for such imagery to serve as culturally relevant design components for digital mental health prevention efforts geared towards Black men and the communities they exist and engage with.

A Self-Guided Lifestyle Intervention for Young Men: Findings from the ACTIVATE Randomized Pilot Trial.

Background: Young men are at high risk for developing obesity-related health complications, yet are markedly underrepresented in lifestyle interventions. This pilot study examined the feasibility and preliminary efficacy of a lifestyle intervention (self-guided + health risk messaging) targeting young men. Methods: 35 young men (Age = 29.3 ± 4.27; BMI = 30.8 ± 4.26; 34% racial/ethnic minority) were randomly assigned to the intervention or delayed treatment control. The intervention (ACTIVATE) included 1 virtual group session, digital tools (wireless scale, self-monitoring app), access to self-paced content via a secure website, and 12 weekly texts to reinforce health risk messaging. Fasted objective weight was assessed remotely at baseline and 12-weeks. Perceived risk was assessed via survey at baseline, 2-week, and 12-week. T-tests were used to compare weight outcomes between arms. Linear regressions examined the association between percent weight change and perceived risk change. Results: Recruitment was successful as evidenced by 109% of target enrollment achieved in a 2-month period. Retention was 86% at 12 weeks, with no differences by arm (p = 0.17). Participants in the intervention arm experienced modest weight loss at 12 weeks, whereas slight gains were observed in the control arm (-1.6% ± 2.5 vs. +0.31% ± 2.8, p = 0.04). Change in perceived risk was not associated with change in percent weight (p > 0.05). Conclusions: A self-guided lifestyle intervention showed initial promise for weight management among young men, but these findings are limited by small sample size. More research is needed to bolster weight loss outcomes while retaining the scalable self-guided approach. Clinical Trial Registration: NCT04267263 (https://www.clinicaltrials.gov/ct2/show/NCT04267263).

Risk, Protective, and Associated Factors of Anxiety and Depressive Symptoms and Campus Health Services Utilization Among Black Men on a College Campus.

OBJECTIVE: The aim of this study is to analyze relationships among social and environmental determinants serving as risk, protective, and important covariate factors for mental health risk and help-seeking among Black men on a college campus. METHODS: A secondary data analysis was conducted utilizing an ongoing, campus-wide survey at a large, urban, public university. Measures included depressive and anxiety symptoms; campus service utilization; risk factors (e.g., financial status); protective factors (social support/religiosity); and additional covariates (substance use/GPA). Multiple linear regressions were conducted to examine relationships between these factors, symptoms and help-seeking. RESULTS: Data is included for 681 students. Findings indicated that stressful life events were associated with higher levels of anxiety symptoms (B = 0.39, p < 0.001) and depressive symptoms (B = 0.33, p = 0.013). Cannabis use (B = 1.14, p = .020) was also associated with higher levels of depressive symptoms. We found that financial status (B = 0.21, p = 0.041) was positively associated with higher levels of depressive symptoms and endorsement of religiosity was associated with lower levels anxiety (B = - 0.23, p = 0.019) and depressive symptoms (B = - 0.32, p = 0.035). Religiosity predicted lower utilization of campus health services. CONCLUSIONS: The key findings indicated that Black men's mental health is negatively influenced by stressful live events and cannabis use. As religiosity was associated with lower levels of symptoms and utilization, it may be beneficial to assess this in future work. Further research is needed to address and improve mental health and help-seeking among these men.

Social distancing during COVID-19: threat and efficacy among university students in seven nations.

COVID-19 has been spreading fast worldwide, and until effective and safe vaccines have been widely adopted, preventive measures such as social distancing are crucial to keep the pandemic under control. The study's research questions asked which psychosocial factors predict social distancing behavior and whether there are country-level differences in social distancing? Using the Extended Parallel Process Model (EPPM) as a theoretical lens, we examined the predictive effects of threat and efficacy and demographic variables on adherence to the COVID-19 preventive behavior of social distancing using a survey among an international sample of university students. Using path modeling and analysis of covariance, we confirmed the predictive effects of the EPPM on social distancing behavior. Our final model showed that perceived susceptibility to COVID-19 was both directly and indirectly (through response efficacy) associated with social distancing behavior; that perceived severity of COVID-19 yielded a significant indirect effect on social distancing behavior through both self-efficacy and response efficacy; that perceived susceptibility is indirectly and positively associated with social distancing behavior through response efficacy; and that self-efficacy and response efficacy were directly associated with social distancing behavior. Additionally, there were country-level differences in social distancing. Possible explanations for and implications of these findings are discussed.

Endorsement of COVID-19 related misinformation among cancer survivors.

OBJECTIVES: To determine whether cancer survivors currently in treatment are more or less likely to endorse COVID-19 related misinformation compared to their counterparts no longer in treatment and those without a cancer history. METHODS: We conducted a Qualtrics survey among 897 adults to determine differences in endorsement of COVID-19 misinformation among cancer survivors in active treatment, cancer survivors no longer in treatment, and a control group with no cancer history. RESULTS: Cancer survivors currently undergoing treatment were more likely to believe misinformation related to COVID-19 than those without a cancer history. Least likely to endorse COVID-19 misinformation were cancer survivor no longer in treatment. CONCLUSION: These results alert healthcare professionals to overall high levels of endorsement of COVID-19 misinformation among cancer survivors on active treatment. Oncologists and other providers working with patients undergoing treatment for cancer should be particularly mindful of the potential elevated beliefs in misinformation among this group. PRACTICAL IMPLICATIONS: Since patients undergoing cancer treatment seem to be particularly vulnerable to COVID-19 misinformation, oncologists and other healthcare providers working with this patient population should help address patients' concerns about the pandemic and how it relates to their course of treatment.

Development and evaluation of the red flag campaign for the primary prevention of sexual and dating violence on college campuses.

Objective Sexual and dating violence (SV/DV) on college campuses is a pervasive problem with far-reaching implications for public health. This paper describes the development and evaluation of a widely disseminated SV/DV primary prevention program, the Red Flag Campaign (RFC). Participants and Methods: An online survey was administered to 203 freshmen at a southeastern US university, of whom 82% reported exposure to the RFC in the previous month. Results: College students exposed to the RFC reported greater efficacy for intervening as a bystander compared to those students who were not exposed. These results held when looking at exposure to RFC messages specifically, but not RFC events. Conclusions: This evaluation offers preliminary evidence that the RFC is effective at increasing determinants of prosocial bystander behavior, the enactment of which could reduce SV/DV on college campuses. Implications and recommendations for college personnel implementing the RFC are discussed.

#WhyIDidntReport: Women Speak Out About Sexual Assault on Twitter.

BACKGROUND: In September 2018, Dr. Christine Blasey Ford accused then-nominee to the U.S. Supreme Court Brett Kavanaugh of sexual assault. When then-U.S. President Donald Trump questioned her credibility on Twitter, sexual assault survivors began tweeting their reasons for not reporting using the hashtag #WhyIDidntReport. This study examined how these posts were discussed on Twitter and to what extent the tweets fit within levels of the Social Ecological Model (SEM). METHOD: This study used quantitative content analysis to code 1,000 tweets with #WhyIDidntReport for violence type, reasons for not reporting, and SEM levels. RESULTS: Overall, 68.7% of posts mentioned a specific reason for not reporting; of these, 24.1% referred to the perpetrator being in a position of power, 36.3% feared not being believed, and 20.6% mentioned that others invalidated the assault. In addition, 47.6% mentioned a specific form of violence. Within the SEM, 47.6% referred to individual, 52.6% to relational, 43.2% to community, and 21.7% to societal reasons for not reporting. CONCLUSION: Reading social media content allows healthcare providers to directly discover how survivors talk about their experiences, priorities in the care environment, and how to support a patient-centered and trauma-informed approach. IMPLICATIONS: Understanding reasons people do not report sexual assault is critical for healthcare professionals to engage patients in open, honest screening and intervention efforts.

U.S. public support for COVID-19 vaccine donation to low- and middle-income countries during the COVID-19 pandemic.

As COVID-19 vaccines become available to the public, there will be a massive worldwide distribution effort. Vaccine distribution has historically been unequal primarily due to the inability of nations with developing economies to purchase enough vaccine to fully vaccinate their populations. Inequitable access to COVID-19 vaccines will not just cause humanitarian suffering, it will likely also be associated with increased economic suffering worldwide. This study focuses on the U.S. population and its beliefs about future COVID-19 vaccine donation by the U.S. to low- and middle-income countries. This study carried out a survey among 788 U.S. adults. Variables include demographics, COVID-19 vaccine priority status, COVID-19 vaccine donation beliefs, and Social Dominance Orientation. Analyses showed that older respondents were both less likely to endorse higher levels of COVID-19 vaccine donations and were more likely to want to wait until all in the U.S. who want the vaccine have received it; those who identified as Democrats were more likely to endorse higher levels of future COVID-19 vaccine donation than Republicans; and those scoring higher on SDO were both less likely to endorse higher levels of COVID-19 vaccine donations as well as more likely to want to wait until all in the U.S. who want the vaccine have received it. Policymakers, as well as healthcare providers and public health communication professionals, should give consideration to those messages most likely to engender support for global prevention efforts with each audience segment.