COVID-19 vaccine hesitancy among rural Oklahomans.

INTRODUCTION: COVID-19 vaccination is widely recommended as a prevention strategy; however, vaccine uptake is disproportionately lower among rural Americans compared to their urban counterparts. Development of public health activities to address the rural-urban vaccine gap requires an understanding of determinants of vaccine hesitation. The present study explores perceptions of and barriers to COVID-19 vaccination among rural Oklahomans. METHODS: Between March and May 2021, 222 residents, unvaccinated for COVID-19, within rural Oklahoma counties completed a cross-sectional, online questionnaire to qualitatively assess perceptions, benefits, and concerns regarding getting vaccinated for COVID-19. RESULTS: Approximately two-fifths of rural respondents in the present study were hesitant to get vaccinated, even when a vaccine was made available to them. Major factors included limited knowledge and understanding about the vaccine, including potential side-effects and long-term complications, as well as skepticism surrounding COVID-19 vaccine development and efficacy. Among the potential perceived benefits of vaccination were protecting the health of vulnerable individuals and the ability to return to normal day-to-day activities. CONCLUSION: Increases in COVID-19 cases and deaths in rural areas are expected to continue as new variants are introduced within communities. The present findings highlight the need for the development of culturally tailored vaccine information, to be disseminated by local leaders within rural communities.

Rural College Students' Amenability Toward Using At-Home Human Immunodeficiency Virus and Sexually Transmitted Infection Testing Kits.

BACKGROUND: College students residing in rural areas of the United States have limited access to human immunodeficiency virus (HIV) and sexually transmitted infection (STI) screening programs; yet, have increased rates of infection. METHODS: Students (N = 326), attending a state university located within a rural community, completed an online survey containing open-ended questions that gauged their perceptions and experiences with HIV/STI testing, amenability to at-home testing technology, and preferences for obtaining at-home testing kits. Inductive coding was used to create themes for each open-ended question. RESULTS: Students encounter a number of perceived barriers to accessing clinical HIV/STI testing venues including cost, utilization of parents' medical insurance, and stigma. Students desired screening paradigms that allow for a greater sense of privacy and the ability to be empowered through self-sampling methods. This includes the use of at-home testing kits, which could be accessed via mail, campus, or the local community. Although students were overwhelmingly amenable to using at-home testing, students discussed concerns with potential user error that could impact testing accuracy. CONCLUSIONS: Study findings suggest the importance of developing less clinically oriented systems of HIV/STI screening, which allow students to choose from an array of screening options. Removing perceived barriers, notably access and privacy concerns, to HIV/STI testing by leveraging at-home testing is one potential method to increase screening uptake among this at-risk population.

Navigating Barriers and Opportunities: Perceptions of the Non-Occupational Post-Exposure Prophylaxis Care Continuum Among Young Sexual Minority Men, Aged 17-24, in the United States.

Human immunodeficiency virus (HIV) is a public health concern among young sexual minority men (YSMM), ages 17 to 24, in the United States. Biomedical prevention methods, such as pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP), can help reduce the risk of HIV transmission among this population. However, there is limited awareness and use of nPEP by YSMM. This study aims to explore the perceptions of YSMM regarding the nPEP care continuum, which consists of three areas of focus: awareness, uptake, and linkage to other HIV prevention services. This study draws on synchronous online focus groups with a sample of 41 YSMM in the United States. Transcripts from the focus groups were analyzed using reflexive thematic analysis. Participants reported limited nPEP awareness and prior use, a process of personal appraisal of nPEP need based on HIV risk and costs, and a preference for PrEP over PEP for long-term HIV prevention. Interventions should be tailored to increase awareness of nPEP among YSMM and reduce addressable barriers to nPEP use for YSMM, including cost and confidentiality concerns, in situations where nPEP is warranted. Finally, more research is needed on how nPEP use can act as a bridge to PrEP initiation for this population.

Sexual and Gender Minority Men's Bystander Behaviors and Barriers in Response to Witnessing Minor Sexual Aggression.

Objective: Sexual and gender minority (SGM) men experience sexual assault victimization. Encouraging people to become involved when they witness high-risk sexual situations as a prosocial bystander is one preventative mechanism to address sexual assault victimization. However, research assessing the extent that SGM men will intervene when they witness a concerning male-to-male sexual situation and barriers that prevent intervention is lacking. We sought to address these gaps. Method: SGM men (n = 323, Mage = 39.4, range 18-77) completed a web-administered survey. Participants were asked if they had witnessed a high-risk sexual situation and, if so, to describe how they intervened; if they did not intervene, they were asked to explain why not. Data were analyzed using thematic analysis. Results: Nearly 50% (n = 157) of participants reported witnessing a situation that may require intervention, of those men 40% reported involvement. When SGM men intervened, their behaviors included direct and indirect verbal and nonverbal strategies. Reasons for not intervening included not appraising the situation as risky, not viewing it as their responsibility to intervene, or lacking the self-efficacy to act. Conclusion: SGM men reported similar barriers to intervention that heterosexual young adults encounter. Participants also provided a variety of intervention tactics that could be included in bystander intervention initiatives to increase their effectiveness and inclusivity. Additional efforts are needed to modify intervention initiatives at both the individual and community level.

Examining Profiles of Latinx Sexual Minority Adolescents Associated with Suicide Risk.

Few studies have focused on within-group heterogeneity about specific factors that make lesbian, gay, or bisexual (LGB) Latinx adolescents at greater odds than other LGB adolescents for suicide We take a unique mixture-modeling approach by creating profiles of Latinx LGB adolescents based on suicide risk factors used in previous investigations (bullying, alcohol, sleep, social media, and poor grades). We use these profiles in a logistic regression to investigate suicidality A sample of 686 LGB, Latinx adolescents were used in a latent profile analysis yielding four distinct profiles. Class 4 represented the highest risk, with high rates of bullying, alcohol, poor grades, and use of electronics, while class 3 represented the lowest risk with low rates of bullying and alcohol Results speak to the need to address suicidal ideation through multiple factors, noting the strong association that both bullying and alcohol have with suicidal ideation.

ACE domains and depression: Investigating which specific domains are associated with depression in adulthood.

BACKGROUND: The study of adverse childhood experiences (ACEs) has shown deleterious effects throughout adulthood. Little attention, however, is given to specific ACE domains as they relate to mental health outcomes, as most studies use cumulative ACE score models. OBJECTIVE: The current study disaggregates ACEs domains to investigate their independent effect (while controlling for each other and other demographic covariates) on receiving a depression diagnosis as an adult. PARTICIPANTS AND SETTING: Data were obtained from the Behavioral Risk Factor Surveillance Survey (BRFSS; N = 52,971). METHODS: To control and account for the numerical number of ACEs, separate models were run among each ACE score (e.g., those with an ACE score of exactly two, three, etc.). An aggregate model with all participants is also included. RESULTS: Across all ACE scores, those with a history of family mental illness had the highest likelihood of receiving a depression diagnosis. The second strongest association were those with sexual abuse. No other trends were found among the six other domains. Further, those with a combination of family mental illness and sexual abuse had the highest odds of depression. CONCLUSIONS: Mental health providers should consider the numerical number of ACEs as well as the specific ACE domains (specifically, family mental illness and sexual abuse). Additionally, this provides evidence for a possible weighting schema for the ACEs scale.

Client perspectives on the accessibility and quality of substance use treatment during the COVID-19 pandemic.

BACKGROUND: People who use drugs have been particularly vulnerable during the COVID-19 pandemic because of their unique social, harm reduction, and treatment needs. These unique needs and challenges have significant influence on the severity of their substance use, mental health symptomatology, willingness to engage in treatment, and adherence to treatment options. This has included immense challenges related to the dissemination of COVID-19 messaging and the need for harm reduction and treatment service entities to adopt new formats to continue operation. METHODS: In-depth interview data were collected people who use drugs (N=24) residing in Oklahoma from November 2020 through February 2021 to assess perspectives on (1) their access to harm reduction, substance use prevention, and treatment programs during the COVID-19 pandemic, (2) the perceived quality of such services and programs during this time, and (3) the perceived availability of tailored COVID-19 information. RESULTS: Several factors emerged related to accessing and quality of substance use services during COVID-19, including poor accessibility (e.g., internet access), diminished quality (i.e., lack of social support), and lack of tailored COVID-19 prevention and treatment messaging. CONCLUSIONS: Upticks in COVID-19 cases and deaths are expected to continue as new SARS-CoV-2 variants are introduced. The present findings highlight the need for tailored COVID-19 messaging (e.g., minimizing the sharing of substance use supplies that can spread COVID-19, mask wearing, COVID-19 vaccination), which is responsive to unique needs of substance using populations. Similarly, as prevention and treatment programs are delivered online, efforts are necessary to ensure equitable access and enhanced quality of services.

Education, Perceptions, and Delivery: Factors Shaping the Perceived Role in the Pre-Exposure Prophylaxis (PrEP) Care Continuum Among a Sample of Osteopathic Medical Students.

Pre-exposure prophylaxis (PrEP) uptake has been suboptimal despite its demonstrated efficacy in reducing the risk of HIV acquisition. Medical education is one distal determinant that shapes medical providers' perceived role in the PrEP care continuum. However, there is limited understanding of how osteopathic medical students and those wanting to practice in rural areas perceive their role in the PrEP care continuum in the domains of PrEP awareness, uptake, and adherence and retention. Twenty-one semistructured interviews were conducted (March 2019-April 2020) to assess what shapes osteopathic medical students' perceived role in the PrEP care continuum. Participants noted a lack of adequate sexual health training, personal perceptions concerning PrEP use, and ambiguity concerning which of the medical specialties should deliver PrEP. Osteopathic medical schools can incorporate more inclusive and holistic sexual health and PrEP curricula to address these barriers and better prepare osteopathic medical students for their future role in the PrEP care continuum.

Preferred Methods of HIV and Sexually Transmissible Infection Screening Delivery Among a Rural Sample of Men Who Have Sex with Men.

Despite the national HIV and sexually transmissible infection (STI) rates growing in rural areas, rural populations-particularly men who have sex with men (MSM), have limited access to secondary (i.e., HIV/STI screening) prevention activities compared with their urban counterparts. We conducted semistructured in-depth interviews with 23 rural MSM residing in Oklahoma and Arkansas to assess their (1) experiences with HIV and STI testing; (2) perceptions of at-home testing; and (3) preferences for receiving results and care. Barriers to accessing HIV/STI screening included lack of medical providers within rural communities, privacy and confidentiality concerns, and perceived stigma from providers and community members. To overcome these barriers, all participants recognized the importance of screening paradigms that facilitated at-home screening, medical consultation, and care. This included the ability to request a testing kit and receive results online, to access affirming and competent providers utilizing telemedicine technology, as well as prompt linkage to treatment. These narratives highlight the need for systems of care that facilitate HIV and STI screening within rural communities, which do not require participants to access services at traditional physical venues.