Delivering COVID-19 Vaccine via Trusted Social Services: Program Evaluation Results from the Chicagoland CEAL Program.

To describe the reach, implementation, and sustainability of COVID-19 vaccination programs delivered by social service community organizations. Five academic institutions in the Chicagoland CEAL (Community Engagement Alliance) program partnered with 17 community organizations from September 2021-April 2022. Interviews, community organizations program implementation tracking documents, and health department vaccination data were used to conduct the evaluation. A total of 269 events were held and 5,432 COVID-19 vaccines delivered from May 2021-April 2022. Strategies that worked best included offering vaccinations in community settings with flexible and reliable hours; pairing vaccinations with ongoing social services; giving community organizations flexibility to adjust programs; offering incentives; and vaccinating staff first. These strategies and partnership structures supported vaccine uptake, community organization alignment with their missions and communities' needs, and trust. Community organizations delivering social services are local community experts and trusted messengers. Pairing social service delivery with COVID-19 vaccination built individual and community agency. Giving COs creative control over program implementation enhanced trust and vaccine delivery. When given appropriate resources and control, community organizations can quickly deliver urgently needed health services in a public health crisis.

Racial and ethnic differences in physical activity among mothers of young children: 2011-2018 NHANES.

BACKGROUND: American women tend to reduce physical activity (PA) during the transition to motherhood. Their main barrier to participation in PA is lack of time due to new/increased parenting and housework responsibilities. Because there are known racial/ethnic variations in time spent on housework among American women, their PA changes during the transition to motherhood might also differ by racial/ ethnic background. This study aimed to compare PA between American mothers of young child(ren) under age 5 years (YC) and American women without children by their racial/ethnic background. METHODS: Secondary data analyses were conducted using 2011-2018 US National Health and Nutrition Survey data. The study sample included 4,892 women aged 20-45 years (Asian n = 760; Black n = 1,162; Hispanic n = 1,324; White n = 1,646). Participants completed a Physical Activity Questionnaire that asked about participation in transportation and leisure-time moderate- and vigorous-intensity PA (MVPA; minutes/week). Multivariable regression analyses were conducted to compare MVPA among women living without children and with YC (no older children) in each of the racial/ethnic groups. RESULTS: Overall, the prevalence of physical inactivity, defined as zero minutes of MVPA in a typical week, was 43% (95% CI = 38-49%) vs. 32% (95% CI = 29-35%) among women living with YC vs. without children. The adjusted odds of physical inactivity for women living with YC, compared to women living without children, was significantly higher among Asian (OR = 2.08 [95% CI = 1.37-3.17]) and White women (OR = 1.63 [95% CI = 1.11-2.38]), while it was statistically insignificant among Hispanic and Black women. Among women who reported participating in MVPA, Asian women living with YC had 35 fewer minutes/week of MVPA than their counterparts living without children (p = 0.06), while other racial and ethnic groups showed no significant differences. CONCLUSIONS: American mothers of YC were less likely to engage in transportation or leisure-time MVPA, compared to those living without children. This association was particularly strong among Asian women. The study results suggest that a PA reduction in the transition to motherhood may be particularly large among Asian American women, calling for targeted efforts for PA promotion among Asian American mothers of YC; e.g., culturally-tailored community-based physical activity programs for Asian American mothers.

U.S. Vietnamese parents' HPV vaccine decision-making for their adolescents: an exploration of practice-, provider-, and patient-level influences.

U.S. Vietnamese have high cervical cancer incidence and low human papillomavirus (HPV) vaccine initiation. Using the P3 model, we explored practice-, provider-, and patient-level determinants of U.S. Vietnamese parents' HPV vaccine decision-making for their adolescents. We conducted a cross-sectional, online survey (04/2020-12/2020) with U.S. Vietnamese parents who had ≥ 1 adolescent ages 9-18. We assessed HPV vaccination outcomes (initiation, willingness to initiate, completion) and provider recommendation. Modified Poisson regressions were used to identify practice-, provider- and patient-level correlates of outcomes. The sample (n = 408) was 44 years old on average; 83% were female and 85% had a Bachelor's degree. Around half of adolescents were female (51%) and 13-18 year old (54%). Only 41 and 23% of parents had initiated and completed the HPV vaccine series for their child, respectively. Initiation was associated with receiving provider recommendation (either low- or high-quality), while willingness to initiate was associated with receiving high-quality recommendation. Both initiation and willingness to initiate was negatively associated with parental perception that their child was too young for a "sexually transmitted infection (STI)-preventing vaccine." Provider recommendation was associated with higher parental U.S. acculturation and the child being older and female. Provider-facing interventions should promote high-quality, age-based, gender-neutral HPV vaccine recommendation. These and population- and individual-facing interventions should recognize the need for additional parental education, particularly related to misconceptions regarding STI prevention.

Use and Perceptions of Opioids Versus Marijuana among Cancer Survivors.

Public health concerns regarding opioids and marijuana have implications for their medical use. This study examined use motives and perceived barriers in relation to opioid and marijuana use and interest in use among US adult cancer survivors. Self-administered surveys were distributed using social media to assess use motives and perceived barriers among participants living with cancer. Overall, 40.9% of cancer survivors reported current (past 30-day) use of opioids, 42.5% used marijuana, and 39.7% used both. The most common use motives for either/both drugs were to cope with pain and stress/anxiety (>70%). Highest-rated barriers to using either/both drugs were missing symptoms of worsening illness and not wanting to talk about their symptoms. Controlling for sociodemographics, binary logistic regression indicated that current opioid use was associated with reporting greater barriers to use (OR = 1.17, p = .011; Nagelkerke R-square = .934) and that current marijuana use was associated with reporting greater barriers to use (OR = 1.37, p = .003; Nagelkerke R-square = .921). Cancer survivors report various use motives and barriers to use regarding opioids and marijuana. While use motives and barriers for both drugs were similar, these constructs were differentially associated with use and interest in use across drugs. Understanding patients' perceptions about opioids and marijuana is an essential component to effectively manage symptoms related to a cancer diagnosis and improve quality of life for cancer survivors.

Hepatitis B Testing Among Vietnamese in Metropolitan Atlanta: The Role of Healthcare-Related and Acculturation-Related Factors.

BACKGROUND: Compared to other racial/ethnic groups, U.S. Vietnamese have higher Hepatitis B infection prevalence, which is a major liver cancer risk factor. Increased testing could reduce this disparity. It is critical to understand subgroups of U.S. Vietnamese least likely to have been tested for Hepatitis B and design appropriate interventions. We examined healthcare- and acculturation-related factors influencing Hepatitis B testing among U.S. Vietnamese. METHODS: Survey data of 100 U.S. Vietnamese attending health fairs/programs hosted by community-based organizations (2017-2018) were analyzed. Healthcare-related predictors included insurance and past 2-year checkup. Acculturation-related predictors included Vancouver Acculturation Index, percentage of lifetime in the U.S., and Vietnamese and English fluency. We conducted a multiple logistic regression controlling for age, sex, education, and household income. RESULTS: The sample was an average 37.5 years old and 61.6% female. Insurance coverage was reported by 83.0%. Average percentage of lifetime in the U.S. was 56.8%. Seventy percent reported having received Hepatitis B testing. Hepatitis B testing was associated with health insurance (aOR = 2.61, 95% CI = [1.05-6.47], p = .04) but not any acculturation-related predictors CONCLUSION: Improving insurance coverage and options can be a strategy to increase Hepatitis B testing among U.S. Vietnamese. More education regarding Hepatitis B (e.g., via community-based, culturally-appropriate, lay health worker-led programs) is needed to ensure that individuals are aware of their testing status and pursue appropriate healthcare decisions.

Practice-, provider- and patient-level facilitators of and barriers to HPV vaccine promotion and uptake in Georgia: a qualitative study of healthcare providers' perspectives.

Georgia experiences higher human papillomavirus (HPV)-associated cancer burden and lower HPV vaccine uptake compared with national estimates. Using the P3 model that concomitantly assesses practice-, provider- and patient-level factors influencing health behaviors, we examined facilitators of and barriers to HPV vaccine promotion and uptake in Georgia. In 2018, we conducted six focus groups with 55 providers. Questions focused on multilevel facilitators of and barriers to HPV vaccine promotion and uptake. Our analysis was guided by the P3 model and a deductive coding approach. We found that practice-level influences included organizational priorities of vaccinations, appointment scheduling, immunization registries/records, vaccine availability and coordination with community resources. Provider-level influences included time constraints, role, vaccine knowledge, self-efficacy to discuss HPV vaccine and vaccine confidence. Patient-level influences included trust, experiences with vaccine-preventable diseases, perceived high costs, perceived side effects and concerns with sexual activity. Findings suggest that interventions include incentives to boost vaccine rates and incorporate appointment scheduling technology. An emphasis should be placed on the use of immunization registries, improving across-practice information exchange, and providing education for providers on HPV vaccine. Patient-provider communication and trust emerge as intervention targets. Providers should be trained in addressing patient concerns related to costs, side effects and sexual activity.

Motives for Alcohol and Marijuana Use as Predictors of Use and Problem Use Among Young Adult College Students.

This study examined (a) differences between alcohol-only users and alcohol-marijuana co-users and (b) motives for use in relation to alcohol and marijuana use and problem use. Spring 2016 data among 1,870 past 4-month alcohol users (63.6% female, 69.1% White) from seven Georgia colleges/universities were analyzed cross-sectionally and with regard to problem use measured 4 months later. Correlates of co-use (n = 345; vs. alcohol-only use, n = 1,525) included greater alcohol and marijuana use frequency, problem drinking and marijuana use, and alcohol use motives (p's < .05). Controlling for covariates, alcohol use frequency correlated with greater marijuana use frequency and Coping and Self-enhancement alcohol use motives, but lower Conformity alcohol use motives (p's < .001); greater Coping and Self-enhancement alcohol use motives (p's < .01) predicted problem alcohol use. Marijuana use frequency correlated with greater Coping and Expansion marijuana use motives (p's < .05); greater Expansion marijuana use motives (p = .005) predicted problem marijuana use. College-based substance use interventions should target Coping and Self-enhancement alcohol use motives and Expansion marijuana use motives.

Mental health and substance use among women and men at the intersections of identities and experiences of discrimination: insights from the intersectionality framework.

BACKGROUND: Intersectionality theory focuses on how one's human experiences are constituted by mutually reinforcing interactions between different aspects of one's identities, such as race, class, gender, and sexual orientation. In this study, we asked: 1) Do associations between intersecting identities (race and sexual orientation) and mental health (depressive symptoms) and substance use (alcohol, tobacco, and marijuana) differ between men and women? and 2) How do single or intersecting self-reports of perceived racial and/or sexual orientation discrimination influence mental health and substance use outcomes for men and women? We compared results of assessing identities versus experiences of discrimination. METHODS: Multivariable regressions were conducted on cross-sectional data from 2315 Black and White college students. Predictors included measures of sociodemographic characteristics and experiences of discrimination. Outcomes included past 2-week depressive symptoms (PHQ-9), past 30-day alcohol use, past 30-day tobacco use, and past 30-day marijuana use. RESULTS: Intersecting identities and experience of discrimination had different associations with outcomes. Among women, self-reporting both forms of discrimination was associated with higher depressive symptoms and substance use. For example, compared to women experiencing no discrimination, women experiencing both forms of discrimination had higher depressive symptoms (B = 3.63, CI = [2.22-5.03]), alcohol use (B = 1.65, CI = [0.56-2.73]), tobacco use (OR = 3.45, CI = [1.97-6.05]), and marijuana use (OR = 3.38, CI = [1.80-6.31]). However, compared to White heterosexual women, White sexual minority women had higher risks for all outcomes (B = 3.16 and CI = [2.03-4.29] for depressive symptoms, B = 1.45 and CI = [0.58-2.32] for alcohol use, OR = 2.21 and CI = [1.32-3.70] for tobacco use, and OR = 3.01 and CI = [1.77-5.12] for marijuana use); while Black sexual minority women had higher tobacco (OR = 2.64, CI = [1.39-5.02]) and marijuana use (OR = 2.81, CI = [1.33-5.92]) only. Compared to White heterosexual men, White sexual minority men had higher depressive symptoms (B = 1.90, CI = [0.52-3.28]) and marijuana use (OR = 2.37, CI = [1.24-4.49]). CONCLUSIONS: Our results highlight the deleterious impacts of racial discrimination and sexual orientation discrimination on health, in particular for women. Future studies should distinguish between and jointly assess intersecting social positions (e.g., identities) and processes (e.g., interpersonal experience of discrimination or forms of structural oppression).

Human papillomavirus vaccination among diverse college students in the state of Georgia: who receives recommendation, who initiates and what are the reasons?

Young adulthood is a critical time for catch-up HPV vaccination. We assessed predictors of vaccine recommendation and initiation among college students. We analysed cross-sectional surveys from 2397 students using multivariable logistic regressions. Guided by the Socio-ecological and Health Belief Models, measures included socio-demographic characteristics, intrapersonal measures (e.g. vaccine beliefs), interpersonal measures (e.g. doctor's recommendation) and institutional-level measures (e.g. college settings). The sample included students from private, public, technical and historically black colleges/universities. Of the sample, 64.5% were White; additionally, 48.3% of women (n = 750/1552) and 18.8% of men (n = 159/845) received a doctor's recommendation. Among women, predictors included older age, US-born, higher parental education and attending private schools. Among men, predictors included younger age, being homosexual and attending private schools. HPV vaccine series initiation was low-43.3% of women (n = 672) and 16.7% of men (n = 141). Doctor's recommendation predicted initiation for both sexes. Younger women, women attending technical colleges and men of 'multiple/other' race had lower odds of initiation. Common initiation barriers for both sexes included a lack of doctor recommendation and sexual inactivity. These barriers and the associations between nativity, race and socio-economic status with vaccine recommendation and initiation should be further investigated. Interventions should improve patient-provider communication around HPV vaccine.

The Development and Validation of a Modesty Measure for Diverse Muslim Populations.

This paper reports on the multi-phase development of an English-language modesty measure for use among Muslim populations. The process yielded a 10-item measure that has high levels of internal consistency reliability (Cronbach's α of 0.83), and has acceptable discriminant and predictive validity. Specifically although our modesty measure for Muslim women was found to be significantly correlated with measures of positive and negative religious (Islamic) coping, it was not significantly correlated with religious practice-based religiosity (discriminant validity). Further logistic modeling revealed higher modesty levels positively associated with forgoing mammography because of concerns about lack of same-sex providers (predictive validity).

Sex and sexual orientation in relation to tobacco use among young adult college students in the US: a cross-sectional study.

BACKGROUND: Sexual minority young adults represent a high-risk population for tobacco use. This study examined cigarette and alternative tobacco product (ATP) use prevalence across sexual orientation (heterosexual, gay/lesbian, and bisexual) among college-attending young adult men and women, respectively. METHODS: Baseline data from a two-year longitudinal study of 3386 young adult college students aged 18-25 in Georgia were analyzed. Correlates examined included sociodemographics (age, sex, sexual orientation, race/ethnicity, college type, and parental education). Outcomes included past 30-day use of tobacco (cigarette, little cigars/cigarillos [LCCs], e-cigarettes, hookah, any tobacco product used, and number of tobacco products used, respectively). Two-group, multivariate multiple regression models were used to examine predictors of tobacco use among men and women, respectively. RESULTS: Among men (N = 1207), 34.7% used any tobacco product; 18.6% cigarettes; 12.3% LCCs; 16.8% e-cigarettes; and 14.7% hookah. Controlling for sociodemographics, gay sexual orientation (OR = 1.62, p = 0.012) was associated with higher odds of cigarette use; no other significant associations were found between sexual orientation and tobacco use. Among women (N = 2179), 25.3% used any tobacco product; 10.4% cigarettes; 10.6% LCCs; 7.6% e-cigarettes; and 10.8% hookah. Being bisexual was associated with cigarette (p < 0.001), LCC (p < 0.001), and e-cigarette use (p = 0.006). Lesbian sexual orientation was associated with cigarette (p = 0.032) and LCC use (p < 0.001). Being bisexual predicted any tobacco product used (p = 0.002), as well as number of tobacco products used (p = 0.004). Group comparisons showed that the effect of sexual minority status on LCC use was significantly different for men versus women. CONCLUSION: Sexual minority women, especially bisexual women, are at higher risk for using specific tobacco products compared to heterosexual women; homosexual men are at increased risk of cigarette use compared to heterosexual men. These nuances in tobacco use should inform interventions targeting sexual minorities.

Marijuana Use and Driving Under the Influence among Young Adults: A Socioecological Perspective on Risk Factors.

BACKGROUND: Given increases in marijuana use and driving under the influence (DUI), it is critical to identify those at risk in order to inform intervention efforts. OBJECTIVES: We used a socioecological framework to examine correlates of level of marijuana use and DUI in the past month among young adult marijuana users. METHODS: We recruited 1567 participants aged 18-34 years via Facebook ads targeting tobacco and marijuana users in August 2014 to complete an online survey assessing marijuana use and DUI, as well as related multilevel factors. Analyses focused on 649 participants reporting past 30-day marijuana use. RESULTS: The sample was an average age of 24.48 (SD = 5.10), 43.9% female, and 76.4% White and used marijuana an average of 17.86 (SD = 11.29) days in the past month. Notably, 48.4% reported driving after marijuana use at least once in the past month, and 74.0% were passengers. Multivariable regression indicated that greater use was associated with: being older; being male; greater symptoms of dependence; residing in a state with recreational marijuana legalized; having a medical marijuana card; having parents and more friends who use; higher coping motives; lower perceived harm to health; and less concern about driving after marijuana use (adjusted R-squared = 0.294). Correlates of driving after using marijuana in the past month included: being younger; more frequent use; having more friends who use; higher enhancement motives; and less concern about driving after using (Nagelkerke R-squared = 0.442). Conclusions/Importance: Interventions and campaigns should address social norms and risk perceptions regarding marijuana use, particularly as it relates to DUI.

Muslim women's perspectives on designing mosque-based women's health interventions-An exploratory qualitative study.

Mosques could serve as a promising setting for health interventions. However, little empirical data are available to guide the development of mosque-based health interventions, especially for women. We aimed to assess Muslim women's views on effective strategies for mosque-based educational interventions to promote women's health. A sample of Muslim women of diverse ethnicity and race was recruited from mosques in Chicago to participate in semi-structured interviews. In interviews, nineteen participants (aged 41-67 years) discussed characteristics of the imam and peer educator, aspects of the intervention modality, and content of health messaging that would be effective in mosque-based health programs. Participants reported that imams should have health-related knowledge to deliver to be successful, while peer educators should be respected women, educated in both religion and health. Sermons and group education classes were believed to be modalities that could reach a large portion of the community for discussions of women's health issues. Participants also suggested that sermons should use scriptural sources to convey the importance of women's health. Participants supported imam-led sermons and peer-led educational classes as effective strategies to promote women's health. Our study results speak to strategies for leveraging religious concepts to promote health among Muslim women.

Religious beliefs and mammography intention: findings from a qualitative study of a diverse group of American Muslim women.

OBJECTIVE: Studies suggest that American Muslim women underutilize mammography. While religion has a strong influence upon Muslim health behaviors, scant research has examined how religion-related beliefs inform Muslim women's intention for mammography. Our study identifies and examines such beliefs. METHODS: Muslim women aged 40 years and older sampled from mosques participated in focus groups and individual interviews. Drawing upon the theory of planned behavior, interviews elicited salient behavioral, normative, and control beliefs regarding mammography and the influence of Islam upon screening intention. RESULTS: Fifty women participated in 6 focus groups and 19 in semistructured interviews, with near-equal numbers of African American, South Asian, and Arab Muslims. Forty-two percent of participants had not had a mammogram within the past 2 years. Across differences in race/ethnicity and mammography status, women voiced four religion-related salient beliefs that inform mammography intention: (1) the perceived duty to care for one's health, (2) religious practices as methods of disease prevention, (3) fatalistic notions about health, and (4) comfort with gender concordant health care. CONCLUSIONS: Religious beliefs influence decisions to pursue mammography across the ethnic/racial diversity of Muslim women. Notions about duty to God and the stewardship of one's body appear to enhance mammography intention. Theocentric notions of cure and illness and varied views regarding personal agency also inform decisional frames that impact mammography intention. Given the salience of religion among our participants, religiously tailored messages in interventions have the potential to enhance cancer screening.

"My culture doesn't 100% like these kinds of services, but you decide what to do": Female refugees' experiences with sexual and reproductive healthcare in the Southeastern U.S.

Objective: This study investigates female refugees' experiences accessing and utilizing sexual and reproductive (SRH) services in the state of Georgia. Methods: We conducted in-person, in-depth semi-structured interviews with 26 female refugee adolescents and adults from Burma, Bhutan or Nepal, and the Democratic Republic of Congo living in Georgia. Questions inquired about perceptions and experiences while accessing and utilizing SRH services. Data were analyzed using thematic analysis. Results: Participants discussed the importance but also varying influence of social and cultural norms on SRH service utilization. Challenges to accessing and utilizing SRH services included communication and cost barriers. Facilitators included accessible clinic locations, transportation, and positive interactions with clinic providers and staff. Conclusion: Understanding female refugees' experiences accessing and utilizing SRH services is critical to meet their SRH needs adequately. Through community engagement, practitioners and researchers can gain insights into cultural influences on SRH, address communication and cost barriers, and enhance existing facilitators to increase female refugees' access and use of services. Innovation: Our community-engaged study incorporated perspectives of diverse groups of refugee women and adolescents in the Southeastern U.S. Findings from this study highlight lived experiences with SRH services and identify barriers to and facilitators of SRH services access and utilization.

Low-Income Asian Americans: High Levels Of Food Insecurity And Low Participation In The CalFresh Nutrition Program.

Little is known about food insecurity and the extent of Supplemental Nutrition Assistance Program (SNAP) participation in the heterogeneous Asian American population. Using California Health Interview Survey data from the period 2011-20, we examined both issues among low-income Asian American adults from six origin groups: Chinese, Filipino, Japanese, Korean, South Asian, and Vietnamese. We found high and varied levels of overall food insecurity, with the highest burden among Filipino adults (40 percent). Food insecurity by severity was also heterogenous; very low food security affected 2 percent of Chinese adults but 9 percent and 10 percent of Filipino and Japanese adults, respectively. Participation in CalFresh (California-implemented SNAP) ranged from 11 percent and 12 percent among Korean and Chinese adults, respectively, to 20 percent among Vietnamese adults. Compared with English-proficient low-income Asian American adults, those with limited English proficiency were no less likely to participate in CalFresh, possibly reflecting language assistance required by California law and provided by community-based organizations. These results underscore the importance of collecting and reporting disaggregated data by Asian origin group that could inform targeted outreach and interventions.

Food insecurity among Asian Americans: A scoping review protocol.

INTRODUCTION: Food insecurity is prevalent in the U.S. and is associated with deleterious health, behavioral, and social consequences. Food insecurity is currently addressed largely through public and private food assistance programs (e.g., the Supplementary Nutrition Assistance Program, and food pantries). A body of research has explored racial and ethnic disparities and differences in food insecurity and coping strategies. However, limited literature has explored these experiences among Asian Americans and Asian origin groups in the United States. OBJECTIVE: The aim of this review is to establish what is known about the experience of food insecurity and nutrition program participation in the Asian American population and among Asian origin groups and to suggest further research and policy action to better address food insecurity in this population. METHODS: Our review is guided by the methodological framework proposed by Arksey and O'Malley and refined and outlined by Levac and colleagues and the Joanna Briggs Institute. We will search key terms related to food insecurity and Asian Americans in Medline (Ovid), the Cochrane Library (Wiley), CINAHL Plus with Full Text (Ebsco), PsycINFO (Ebsco), and Scopus (Elsevier). An article will be included if it was published in the English language; is a peer reviewed research manuscript and reports primary research findings from analyses; and describes food insecurity or strategies to cope with food insecurity among individuals of Asian origins living in the U.S. An article will be excluded if it is a book, conference proceedings, or grey literature (e.g., thesis or dissertation); is a commentary, editorial, or opinion piece without primary research data; contains only research conducted outside of the U.S.; includes Asians in the sample but does not provide separate data on food insecurity or strategies to cope with food insecurity among Asians; and describes only dietary changes or patterns but not food insecurity. Two or more reviewers will participate in the study screening and selection process. We will record information from the final articles chosen to be included in the review in a data table template and will also prepare a summary narrative with key findings. EXPECTED OUTPUTS: Results will be disseminated through peer-reviewed publications and conference presentations. The findings from this review will be of interest to researchers and practitioners and inform further research and policy to better address food insecurity among this population.

Social Risk and Smoking Among Women Smokers Early in the COVID-19 Pandemic: The Role of Mental Health.

Background: We examined patterns of smoking in relation to health-related socioeconomic vulnerability (HRSV) among U.S. women early in the pandemic and whether mental health symptoms mediated these relationships. Materials and Methods: Data were obtained from the April 2020 National U.S. Women's Health COVID-19 Study (N = 3200). Among current smokers, adjusted odds of increased smoking since the start of the pandemic (vs. same or less) by incident and worsening HRSVs were modeled. Structural equation modeling was used to assess anxiety, depression, and traumatic stress symptoms as mediators of the relationship between six HRSVs (food insecurity; housing, utilities, and transportation difficulties; interpersonal violence; financial strain) and increased smoking early in the pandemic. Results: Nearly half (48%) of current smokers reported increased smoking since the pandemic started. Odds of increased smoking were higher among women with incident financial strain (aOR = 2.0, 95% CI 1.2-3.3), incident food insecurity (aOR = 2.9, 95% CI 1.7-5.1), any worsening HRSV (aOR = 2.2, 95% CI 1.5-3.0), and worsening food insecurity (aOR = 1.9, 95% CI 1.3-3.0). Anxiety symptoms were a significant, partial mediator of the relationship between increased smoking and any worsening HRSVs (proportion mediated = 0.17, p = 0.001) and worsening food insecurity (0.19, p = 0.023), specifically. Depression symptoms were a significant, partial mediator of the relationship between increased smoking and any worsening HRSVs (0.15, p = 0.004) and incident financial strain (0.19, p = 0.034). Traumatic stress was not a significant mediator of any tested relationship. Conclusions: Anxiety and depression symptoms partially explain the relationship between rising socioeconomic vulnerability and increased smoking among women early in the pandemic. Addressing HRSVs and mental health may help reduce increased smoking during a public health crisis.