Introduction: Student Experiences of COVID-19 Around the Globe: Insights from the Pandemic Journaling Project.

The COVID-19 crisis has taken a significant toll on the mental health of many students around the globe. In addition to the traumatic effects of loss of life and livelihood within students' families, students have faced other challenges, including disruptions to learning and work; decreased access to health care services; emotional struggles associated with loneliness and social isolation; and difficulties exercising essential rights, such as rights to civic engagement, housing, and protection from violence. Such disruptions negatively impact students' developmental, emotional, and behavioral health and wellbeing and also become overlaid upon existing inequities to generate intersectional effects. With these findings in mind, this special issue investigates how COVID-19 has affected the mental health and wellbeing of high school and college students in diverse locations around the world, including the United States, Mexico, Brazil, China, and South Africa. The contributions collected here analyze data collected through the Pandemic Journaling Project, a combined research study and online journaling platform that ran on a weekly basis from May 2020 through May 2022, along with complementary projects and using additional research methods, such as semi-structured interviews and autobiographical writing by students. The collection offers a nuanced, comparative window onto the diverse struggles that students and educators experienced at the height of the pandemic and considers potential solutions for addressing the long-term impacts of COVID-19. It also suggests a potential role for journaling in promoting mental wellbeing among youth, particularly in the Global South.

Thriving Despite the Odds: Digital Capital and Reimagined Life Projects Among Mexican College Students During COVID-19.

During the pandemic, Mexico experienced one of the longest periods of school closures in Latin America. After the first year of COVID-19, thousands of college students dropped out of school, which has been partially attributed to difficulties in adapting to online learning. This study examines how some college students in Mexico coped with and overcame these challenges. Our research draws on journals of and in-depth interviews with Mexican college students who participated in the Pandemic Journaling Project-a combined online journaling platform and research study. Participant accounts describe challenges students experienced navigating the rapid roll-out of online education. However, over time, many of the students in our study cultivated a renewed sense of purpose in their educational activities. They attributed this shift in perspective to their ability to carve out new approaches to social support, the development of professional capacities, and insight into the potential for technology to promote a more inclusive society. Our work shows how students' ability to integrate digital competencies into their broader life projects and aspirations for the future played an important role in college perseverance and reducing mental health distress. Findings have important implications for the potential role of increased access to technological resources in mitigating social inequity and improving mental health outcomes among young adults.

Mobility Imaginaries of Humanitarian Intervention: Gender, Migration, and Violence along Mexico's Southern Border.

Thousands of Central American women have been displaced from their countries of origin by violence. While the violence committed against them is often portrayed as isolated acts of aggression, women's suffering is also produced and perpetuated by humanitarian interventions that immobilize women in dangerous transit zones. Interventions are then justified by institutional logics that juxtapose women's vulnerability against the threat of their own mobility. This article draws on 14 months of ethnographic fieldwork along the southern Mexico border among migrant women who sought out humanitarian assistance following violent encounters. Central to my argument is the concept of mobility imaginaries, or widely shared social assumptions about how mobility should and can be accessed, by whom, and under what circumstances. Through this framework, I show how gendered mobility biases that underlie institutional logics compound other forms of institutional inequality, which often serves to reproduce, rather than mitigate, root causes of gender-based vulnerability.

The Complexity of Multiple Contraceptive Method Use and the Anxiety That Informs It: Implications for Theory and Practice.

Despite clinical guidelines and national data describing the use of one contraceptive method as the best and most common way to prevent unintended pregnancy, limited evidence indicates a more complex picture of actual contraceptive practice. Face-to-face in-depth interviews were conducted in November of 2013 with a sample of women from two cities in the United States (n = 52). The interviews explored the ways participants used contraception to protect themselves from unintended pregnancy over the past 12 months. Most respondents reported using multiple methods, many of which are considered to be less-effective, within this timeframe. The practice of combining methods in order to increase one's level of protection from pregnancy was prevalent, and was mainly enacted in two ways: by backing up inconsistent method use with other methods and by "buttressing" methods. These practices were found to be more common, and more complex, than previously described in the literature. These behaviors were mainly informed by a deep anxiety about both the efficacy of contraceptive methods, and about respondents' own perceived ability to prevent pregnancy. These findings challenge prevailing assumptions about women's contraceptive method use and have implications for clinical contraceptive counseling practice.

Responding to structural inequities: Coping strategies among immigrant women during COVID-19.

Examining coping strategies and resilience among immigrant communities reflects a commitment to working with immigrant communities to understand their needs while also identifying and building upon their strengths. In the United States, the physical, emotional, and economic impacts of the COVID-19 pandemic intersected with existing structural inequities to produce distinct challenges and stressors related to the pandemic, immigration, caregiving responsibilities, and structural xenophobia. Leveraging an understanding of the multilevel effects of stress, this qualitative study explores individual, interpersonal, and community-level coping strategies immigrant women used to respond to, alleviate, or reduce distress related to these compounding stressors. Using semi-structured in-depth interviews conducted in 2020 and 2021 with 44 first- and second-generation cisgender immigrant women from different national origins and 19 direct service providers serving immigrant communities in New York City, data were coded and analyzed using a constant comparative approach. Four central themes were identified: caregiving as a source of strength, leveraging resources, social connections, and community support. While women described a range of coping strategies they used to manage stressors and challenges, perspectives from direct service providers also connect these coping strategies to the harm-generating institutions, policies, and structures that produce and uphold structural oppression and inequities. Accounts from service providers point to the detrimental long-term effects of prolonged coping, underscoring a duality between resilience and vulnerability. Exploring the coping strategies cisgender immigrant women used to ease distress and promote resilience during a period of heightened structural vulnerability is critical to centering the experiences of immigrant women while simultaneously directing attention towards addressing the fundamental causes of cumulative disadvantage and the systems and structures through which it is transmitted.

Structural gendered racism as conceptualized by immigrant women in the United States.

RATIONALE: Immigrants represent a rapidly growing proportion of the population, yet the many ways in which structural inequities, including racism, xenophobia, and sexism, influence their health remains largely understudied. Perspectives from immigrant women can highlight intersectional dimensions of structural gendered racism and the ways in which racial and gender-based systems of structural oppression interact. OBJECTIVE: This study aims to show the multilevel manifestations of structural gendered racism in the health experiences of immigrant women living in New York City. METHOD: Semi-structured, in-depth interviews were conducted in 2020 and 2021 with 44 cisgender immigrant women from different national origins in New York City to explore how immigrant women experienced structural gendered racism and its pathways to their health. Interviews were thematically analyzed using a constant comparative approach. RESULTS: Participants expressed intersectional dimensions of structural gendered racism and the anti-immigrant climate through restrictive immigration policy and issues related to citizenship status, disproportionate immigration enforcement and criminalization, economic exploitation, and gendered interpersonal racism experienced across a range of systems and contexts. Participants weighed their concerns for safety and facing racism as part of their life course and health decisions for themselves and their families. CONCLUSIONS: The perspectives and experiences of immigrant women are key to identifying multilevel solutions for the burdens of structural gendered racism, particularly among individuals and communities of non-U.S. national origin. Understanding how racism, sexism, xenophobia, and intersecting systems of oppression impact immigrant women is critical for advancing health equity.

Perspectives from the pandemic epicenter: Sexual and reproductive health of immigrant women in New York City.

CONTEXT: The United States' response to COVID-19 created a policy, economic, and healthcare provision environment that had implications for the sexual and reproductive health (SRH) of racialized and minoritized communities. Perspectives from heterogenous immigrant communities in New York City, the pandemic epicenter in the United States (US), provides a glimpse into how restrictive social policy environments shape contraception, abortion, pregnancy preferences, and other aspects of SRH for marginalized immigrant communities. METHODS: We conducted in-depth interviews in 2020 and 2021 with 44 cisgender immigrant women from different national origins and 19 direct service providers for immigrant communities in New York City to explore how immigrants were forced to adapt their SRH preferences and behaviors to the structural barriers of the COVID-19 pandemic. We coded and analyzed the interviews using a constant comparative approach. RESULTS: Pandemic-related fears and structural barriers to healthcare access shaped shifts in contraceptive use and preferences among our participants. Immigrant women weighed their concerns for health and safety and the potential of facing discrimination as part of their contraceptive preferences. Immigrants also described shifts in their pregnancy preferences as rooted in concerns for their health and safety and economic constraints unique to immigrant communities. CONCLUSION: Understanding how immigrant women's SRH shifted in response to the structural and policy constraints of the COVID-19 pandemic can reveal how historically marginalized communities will be impacted by an increasingly restrictive reproductive health and immigration policy landscape.

Disruptions in Sexual and Reproductive Health Care Service Delivery for Immigrants During COVID-19.

Purpose: To provide perspectives from heterogenous cisgender immigrant women and service providers for immigrants in New York City (NYC) on how restrictive sexual and reproductive health (SRH) care delivery environments during COVID-19 shape immigrant's access to health care and health outcomes to generate insights for clinical practices and policies for immigrant women's health care needs. Methods: A qualitative study was conducted in 2020 and 2021, including in-depth interviews with 44 immigrant women from different national origins and 19 direct service providers for immigrant communities in NYC to explore how immigrants adapted to and were impacted by pandemic-related SRH care service delivery barriers. Interviews were coded and analyzed using a constant comparative approach. Results: Pandemic-related delays and interrupted health care, restrictive accompaniment policies, and the transition from in-person to virtual care compounded barriers to care for immigrant communities. Care delays and interruptions forced some participants to live with untreated health conditions, resulting in physical pain and emotional distress. Participants also experienced challenges within the health care system because of changes to visitor policies that restricted the accompaniment of family members or support persons. Some participants experienced difficulties accessing telehealth and technology, while others welcomed the flexibility given the demands of frontline work and childcare. Conclusions: To mitigate the health and social implications of increasingly restrictive immigration, reproductive, and social policies, clinical practices like expanding access to care for all immigrants, engaging immigrant communities in health care institutions policies and practices, and integrating immigrant's support networks into care play an important role.

How social policies shape the health and well-being of sexual- and gender-minority youth: Pathways of influence, social side effects and implications for life course trajectories.

Recent research has documented the harmful health consequences of structural-level stigma that targets sexual and gender minority (SGM) individuals. In the case of sexual and gender minority youth (SGMY), life trajectories are shaped not only by targeted, SGM-focused policies, but also by social policies more broadly which may have unique impacts on SGMY given their social position. However, little work has explored the pathways that connect both targeted and universal social policies and the health and well-being of SGMY. In this study, we conducted 68 qualitative interviews with SGMY in New York City (n = 30) and community stakeholders across the US (n = 38) and used the constant comparative method to identify the pathways through which social policies affect SGMY health and well-being. We propose three pathways that are shaped by specific inter-related social policies in ways that contribute to health inequities among SGMY: 1) access to social inclusion in educational settings; 2) housing-related regulations and subsequent (in)stability; and 3) access to material resources through labor market participation. We also highlight ways that SGMY, and organizations that support them, engage in agency and resistance to promote inclusion and wellbeing. Drawing on ecosocial theory, we demonstrate how policies work across multiple domains and levels to influence cycles of vulnerability and risk for SGMY. We close by discussing the implications of our findings for future research and policy.

A national qualitative study of Hospital-at-Home implementation under the CMS Acute Hospital Care at Home waiver.

BACKGROUND: The Centers for Medicare & Medicaid Services (CMS) announced the Acute Hospital Care at Home (AHCaH) waiver program in November 2020 to help expand hospital capacity to cope with the COVID-19 pandemic. The AHCaH waived the 24/7 on-site nursing requirement and enabled hospitals to obtain full hospital-level diagnosis-related group (DRG) reimbursement for providing Hospital-at-Home (HaH) care. This study sought to describe AHCaH implementation processes and strategies at the national level and identify challenges and facilitators to launching or adapting a HaH to meet waiver requirements. METHODS: We conducted semi-structured interviews to explore barriers and facilitators of HaH implementation. The analysis was informed by the Exploration, Preparation, Implementation, and Sustainment (EPIS) implementation framework. Interviews were audio recorded for transcription and thematic coding. PRINCIPAL FINDINGS: We interviewed a sample of clinical leaders (N = 18; clinical/medical directors, operational and program managers) from 14 new and pre-existing U.S. HaH programs diverse by size, urbanicity, and geography. Participants were enthusiastic about the AHCaH waiver. Participants described barriers and facilitators at planning and implementation stages within three overarching themes influencing waiver program implementation: 1) institutional value and assets; 2) program components, such as electronic health records, vendors, pharmacy, and patient monitoring; and 3) patient enrollment, including eligibility and geographic limits. CONCLUSIONS: Implementation of AHCaH waiver is a complex process that requires building components in compliance with the requirements to extend the hospital into the home, in coordination with internal and external partners. The study identified barriers that potential adopters and proponents should consider alongside the strategies that some organizations have found useful. Clarity regarding the waiver's future may expedite HaH model dissemination and ensure longevity of this valuable model of care delivery.

Racism and health care: Experiences of Latinx immigrant women in NYC during COVID-19.

The COVID-19 pandemic has disproportionately affected minoritized racial groups, especially Latinx immigrants, evidenced by the high rates of COVID-19 infections, hospitalizations, and deaths among this population. With increasing xenophobia and anti-immigrant sentiment in parallel to the pandemic, it is critical to understand the perspectives of Latinx populations. This study explores Latinx immigrant women's perceptions of racism and xenophobia in their health care experiences in New York City (NYC) during the COVID-19 pandemic and, further, seeks to understand the role of perceived discrimination in health care settings and on health care access. Data were analyzed using a constant comparative method of analysis from twenty-one in-depth interviews conducted with foreign-born women in the five boroughs of New York City from diverse countries across Latin America. Four central themes emerged including: structural inequalities, discriminatory health care experiences, victimization in public institutions, and overcoming discrimination in health care settings. Latinx immigrant women described the ways in which perceptions and experiences of discrimination shaped their capacity to address health-related needs during the COVID-19 pandemic. This study provides evidence to a growing body of literature suggesting that structural racism and xenophobia and perceptions of anti-immigrant discrimination, including resulting structural inequalities, may have a negative effect on individuals' ability to access and engage the health care system, resulting in avoidance of health care services - a critical need during a global pandemic. Scholars, policymakers, and practitioners alike should be mindful of how racism and xenophobia shape Latinx immigrant communities' engagement with the health care system.

Shouldering the load yet again: Black women's experiences of stress during COVID-19.

Black women in the United States experience considerable amounts of stress, which has been exacerbated by the COVID-19 pandemic. Prior studies have linked stress to adverse mental and physical outcomes for Black women and, moreover, shown that Black women are more susceptible to maladaptive coping, which compounds these risks. Research on the Superwoman Schema and Sojourner's Syndrome, for instance, shows how Black women are compelled to portray strength and resilience while suffering internally and experiencing poor health outcomes. These phenomena can be attributed to the historical expectations of Black women to be pillars of their families and sources of strength despite adversity and persistent institutional discrimination. During the COVID-19 pandemic, Black women's greater likelihood of holding "essential worker" roles has further increased their risk of both COVID-19 exposure and heightened stress. Additionally, the COVID-19 pandemic has aggravated long standing structural inequities and disparities between Black women and other racial/ethnic groups. Drawing on journal entries submitted by Black women participating in the Pandemic Journaling Project (PJP), a combined online journaling platform and interdisciplinary research study, this paper illuminates the voices of Black women during the COVID-19 pandemic. Seventy-two Black women created journal entries using the PJP platform. We analyze the stories, idioms, and feelings they recorded during a global pandemic. We identify three prominent domains of stress: work and school, caregiving, and social (dis)connectedness. In addition to exploring manifestations of stress across these domains, we, discuss some of the mental health implications of COVID-19 and explore the potential for regular journaling as a possible mode of stress management among Black women.

Introduction: Journaling and Mental Health during COVID-19: Insights from the Pandemic Journaling Project.

In this article, we introduce the SSM-MH Special Issue "Journaling and Mental Health during COVID-19: Insights from the Pandemic Journaling Project," which presents findings from the Pandemic Journaling Project (PJP). PJP is an online journaling platform and mixed-methods research study created in May 2020 to provide ordinary people around the world an opportunity to chronicle the impact of the COVID-19 pandemic in their lives-for themselves and for posterity. The essays in this collection demonstrate how journaling via an online platform can help illuminate experiences of mental wellbeing and distress, with important implications for both research and clinical practice. We begin by introducing the Pandemic Journaling Project and describing our procedures for generating the data subsets analyzed in the papers collected here. We then outline the principal interventions of the special issue as a whole, introduce the papers, and identify a number of cross-cutting themes and broader contributions. Finally, we point toward key questions for future research and therapeutic practice by highlighting the three-fold value of online journaling as a research method, a therapeutic strategy, and a tool for advancing social justice. We focus in particular on how this innovative methodological approach holds promise as both a modality for psychotherapeutic intervention and a form of grassroots collaborative ethnography. We suggest that our methods create new opportunities for confronting the impact of pandemics and other large-scale events that generate radical social change and affect population-level mental health.

How Black and Latino young men who have sex with men in the United States experience and engage with eligibility criteria and recruitment practices: implications for the sustainability of community-based research.

Research recruitment, eligibility, and who chooses to participate shape the resulting data and knowledge, which together inform interventions, treatment, and programming. Patterns of research participation are particularly salient at this moment given emerging biomedical prevention paradigms. This paper explores the perspectives of Black and Latino young men who have sex with men (BL-YMSM) regarding research recruitment and eligibility criteria, how their experiences influence willingness to enroll in a given study, and implications for the veracity and representativeness of resulting data. We examine inclusion and recruitment as a complex assemblage, which should not be reduced to its parts. From April-July 2018, we conducted in-depth interviews with 30 BL-YMSM, ages 18-29, in New York City. Interviews were recorded, transcribed, and analyzed using the constant comparative method. Black and Latino YMSM's responses unveiled tensions between researchers', recruiters', and participants' expectations, particularly regarding eligibility criteria (e.g., age, sex frequency), assumptions about 'risky behaviors,' and the 'target' community. Men preferred peer-to-peer recruitment, noting that most approaches miss key population segments. Findings highlight the need to critically examine the selected 'target' community, who sees themselves as participants, and implications for data comprehensiveness and veracity. Study eligibility criteria and recruitment approaches are methodological issues that shape knowledge production and the policies and programs deployed into communities. These findings can inform how future research studies frame recruitment and eligibility in order to better meet the needs of participants and ensure future engagement.

A movement in motion: collective mobility and embodied practice in the central American migrant caravan.

In this article, I examine the psychosocial and phenomenological implications for the lived experiences of collective mobility among Central American asylum seekers and irregular migrants bound for the United States. I argue that attentiveness to migrants' embodied practices and encounters with the material world engender novel insight into the generative and productive potential of collective journeying. I focus on migrant caravans through Mexico that have surged in recent years in response to escalating rates of gang violence, extreme poverty, and environmental devastation in Central American countries. The analysis reveals that the transformative power of the caravan lies in its capacity to disrupt patterns of collective trauma by bearing witness to the atrocities migrants have suffered and giving meaning to their collective struggle. Close examination of how these processes unfold en route may help explain how and why collective mobility promotes resilience among participants and their ability to resist the effects of long-term collective trauma.

Local Faith Actors and the Global Compact on Refugees.

Power dynamics of global decision-making have meant that local faith actors have not been frequently heard in the context of refugee response. The development of new global refugee and humanitarian frameworks gives hope that there will be greater inclusion of Southern-led, faith-based responses. A closer look, however, demonstrates discrepancies between the frameworks used in global policy processes and the realities of local faith actors in providing refugee assistance. We present primary research from distinct case studies in Mexico and Honduras, which counters much of what is assumed about local faith actors in refugee services and aid. Interventions that are considered to be examples of good practice in the global South are not always congruent with those conceptualized as good practices by the international community. Failure to recognize and integrate approaches and practices from the global South, including those led by actors inspired by faith, will ultimately continue to replicate dominant global power structures.

Exclusive Breastfeeding Experiences among Mexican American Women.

BACKGROUND: According to the Centers for Disease Control and Prevention, Hispanic breastfeeding mothers begin early formula supplementation at higher rates than other ethnic groups, which can lead to shorter breastfeeding duration and decreased exclusive breastfeeding. Acculturation, the process of adopting beliefs and behaviors of another culture, appears to influence breastfeeding practices of Hispanic women in the United States. Little is known about Mexican American mothers' formula use and exclusive breastfeeding within the context of acculturation. OBJECTIVE: Our study identified perceived benefits and barriers to exclusive breastfeeding and levels of acculturation among Mexican American women living in a Midwestern city. METHODS: We used a qualitative descriptive design integrating Pender's Health Promotion Model concepts. Individual interviews were conducted in English or Spanish (N = 21). The revised Acculturation Rating Scale for Mexican Americans was used to examine acculturation levels. RESULTS: Acculturation scores indicated that the majority (66%) of the sample was "very Mexican oriented." Most women exclusively breastfed, with a few using early supplementation for "insufficient milk production." Three themes emerged: (1) It is natural that a woman give life and also provide the best food for her baby; (2) Breastfeeding is ultimately a woman's decision but is influenced by tradition, guidance, and encouragement; and (3) Breast milk is superior but life circumstances can challenge one's ability to breastfeed. CONCLUSION: Strong familial/cultural traditions supported and normalized breastfeeding. Barriers to exclusive breastfeeding were similar to breastfeeding women in general, in the United States. Findings support the need for culturally competent and individualized lactation care.

Indigenous Women of Latin America: Unintended Pregnancy, Unsafe Abortion, and Reproductive Health Outcomes.

Indigenous women in Latin America have poorer reproductive health outcomes than the general population and face considerable barriers in accessing adequate health services. Indigenous women have high rates of adolescent fertility and unintended pregnancy and may face increased risks for morbidity and mortality related to unsafe abortion. However, research among this population, particularly focusing on social and cultural implications of unwanted pregnancy and unsafe abortion, is significantly limited. This article reviews the literature on unsafe abortion in Latin America and describes successful interventions to ameliorate reproductive health outcomes within Indigenous communities. It also explores important implications for future research. Shedding light on the circumstances, perspectives, and lived realities of Indigenous women of childbearing age, could encourage further qualitative investigation and mitigate negative outcomes through improved understanding of the topic, targeted culturally appropriate interventions, and recommendations for future policy and programming reformations.