Concordance of Ethyl Glucuronide, Blood Alcohol Content, and Self-Reported Alcohol Use in Russian Women with HIV and Hepatitis C Virus Co-Infection.

Problematic alcohol use is prevalent in Russia and is deleterious for individuals with HIV and Hepatitis C Virus (HCV). Ethyl glucuronide (EtG) and blood alcohol content (BAC) provide objective biomarkers of drinking that can be compared to self-reported alcohol use. This paper describes patterns of alcohol use measured by biomarkers and self-report along with concordance across measures. Participants were Russian women with HIV and HCV co-infection (N = 200; Mean age = 34.9) from two Saint Petersburg comprehensive HIV care centers enrolled in an alcohol reduction intervention clinical trial. Measures were: (a) urine specimen analyzed for EtG; (b) breathalyzer reading of BAC; and (c) self-reported frequency of drinking, typical number of drinks consumed, and number of standard drinks consumed in the past month. At baseline, 64.0% (n = 128) had a positive EtG (> 500 ng/mL) and 76.5% (n = 153) had a positive breathalyzer reading (non-zero reading). There was agreement between EtG and BAC (kappa = 0.66, p < .001; Phi coefficient = 0.69, p < .001); self-reported alcohol measures were positively correlated with positive EtG and BAC (p's < 0.001). There was concordance between EtG and BAC measures, which have differing alcohol detection windows. Most participants endorsed frequent drinking at high quantities, with very few reporting no alcohol consumption in the past month. Concordance between biomarkers and self-reported alcohol use suggests that underreporting of alcohol use was minimal. Results highlight the need for alcohol screening within HIV care. Implications for alcohol assessment within research and clinical contexts are discussed.

Examining Changes in Sleep Duration Associated with the Onset of the COVID-19 Pandemic: Who is Sleeping and Who is Not?

The COVID-19 pandemic has resulted in social isolation and reports of insomnia. However, reports of changes in sleep duration and associated factors are few. To determine the impact of COVID-19 on changes in sleep behavior, data were analyzed from an online survey of adults recruited via social media that included questions asking whether the respondent slept less or more after the onset of the pandemic as well as self-reported sociodemographic and occupational information; beliefs about COVID-19; and responses pertaining to loneliness, anxiety, and depression. There were 5,175 respondents; 53.9% had a change in sleep duration.17.1% slept less and 36.7% slept more. Sleeping more was related to greater education, being single/divorced/separated, unemployed or a student. Being retired, divorced/separated or a homemaker, and living in the Mountain or Central time zones were associated with less sleep. Beliefs that COVID-19 would result in personal adverse consequences was associated with both more and less sleep. However, the strongest associations for both more and less sleep were seen with depression, anxiety, and loneliness. In summary, changes in sleep duration since the start of the COVID-19 pandemic were highly prevalent among social media users and were associated with several sociodemographic factors and beliefs that COVID-19 would have adverse personal impacts. However, the strongest associations occurred with worse mental health suggesting that improvements may occur with better sleep.Supplemental data for this article is available online at https://doi.org/10.1080/08964289.2021.2002800 .

Employment conditions as barriers to the adoption of COVID-19 mitigation measures: how the COVID-19 pandemic may be deepening health disparities among low-income earners and essential workers in the United States.

BACKGROUND: The COVID-19 pandemic has disproportionately impacted economically-disadvantaged populations in the United States (US). Precarious employment conditions may contribute to these disparities by impeding workers in such conditions from adopting COVID-19 mitigation measures to reduce infection risk. This study investigated the relationship between employment and economic conditions and the adoption of COVID-19 protective behaviors among US workers during the initial phase of the COVID-19 pandemic. METHODS: Employing a social media advertisement campaign, an online, self-administered survey was used to collect data from 2,845 working adults in April 2020. Hierarchical generalized linear models were performed to assess the differences in engagement with recommended protective behaviors based on employment and economic conditions, while controlling for knowledge and perceived threat of COVID-19, as would be predicted by the Health Belief Model (HBM). RESULTS: Essential workers had more precarious employment and economic conditions than non-essential workers: 67% had variable income; 30% did not have paid sick leave; 42% had lost income due to COVID-19, and 15% were food insecure. The adoption of protective behaviors was high in the sample: 77% of participants avoided leaving home, and 93% increased hand hygiene. Consistent with the HBM, COVID-19 knowledge scores and perceived threat were positively associated with engaging in all protective behaviors. However, after controlling for these, essential workers were 60% and 70% less likely than non-essential workers, who by the nature of their jobs cannot stay at home, to stay at home and increase hand hygiene, respectively. Similarly, participants who could not afford to quarantine were 50% less likely to avoid leaving home (AOR: 0.5; 95% CI: 0.4, 0.6) than those who could, whereas there were no significant differences concerning hand hygiene. CONCLUSIONS: Our findings are consistent with the accumulating evidence that the employment conditions of essential workers and other low-income earners are precarious, that they have experienced disproportionately higher rates of income loss during the initial phase of the COVID-19 pandemic and face significant barriers to adopting protective measures. Our findings underscore the importance and need of policy responses focusing on expanding social protection and benefits to prevent the further deepening of existing health disparities in the US.

What predicts people's belief in COVID-19 misinformation? A retrospective study using a nationwide online survey among adults residing in the United States.

BACKGROUND: Tackling infodemics with flooding misinformation is key to managing the COVID-19 pandemic. Yet only a few studies have attempted to understand the characteristics of the people who believe in misinformation. METHODS: Data was used from an online survey that was administered in April 2020 to 6518 English-speaking adult participants in the United States. We created binary variables to represent four misinformation categories related to COVID-19: general COVID-19-related, vaccine/anti-vaccine, COVID-19 as an act of bioterrorism, and mode of transmission. Using binary logistic regression and the LASSO regularization, we then identified the important predictors of belief in each type of misinformation. Nested vector bootstrapping approach was used to estimate the standard error of the LASSO coefficients. RESULTS: About 30% of our sample reported believing in at least one type of COVID-19-related misinformation. Belief in one type of misinformation was not strongly associated with belief in other types. We also identified 58 demographic and socioeconomic factors that predicted people's susceptibility to at least one type of COVID-19 misinformation. Different groups, characterized by distinct sets of predictors, were susceptible to different types of misinformation. There were 25 predictors for general COVID-19 misinformation, 42 for COVID-19 vaccine, 36 for COVID-19 as an act of bioterrorism, and 27 for mode of COVID-transmission. CONCLUSION: Our findings confirm the existence of groups with unique characteristics that believe in different types of COVID-19 misinformation. Findings are readily applicable by policymakers to inform careful targeting of misinformation mitigation strategies.

Increased alcohol use during the COVID-19 pandemic: The effect of mental health and age in a cross-sectional sample of social media users in the U.S.

The COVID-19 pandemic has triggered a public health crisis of unprecedented scale. Increased alcohol use has been extensively documented during other crises, particularly among persons with anxiety and depression. Despite COVID-19's differential impact by age, the association of age, mental health and alcohol use during the pandemic has not been explored. This study aimed to examine whether age modified the association of anxiety and depressive symptoms with alcohol use during the COVID-19 pandemic. Two online surveys were administered to U.S. adult social media users in March and April 2020. Generalized linear models were conducted in 2020 among 5850 respondents (52.9% female; 22.0% aged 18-39 years, 47.0% aged 40-59 years, and 31.0% aged ≥60 years) to examine if age modified the association of anxiety and depression symptomatology and alcohol use. Overall, 29% of respondents reported increased alcohol use. Adjusted odds ratios of reporting increased alcohol use were 1.41 (95% CI = 1.20-1.66) among respondents with anxiety symptoms and 1.64 (95% CI = 1.21-2.23) among those with depressive symptoms compared to those without such symptoms. Whereas respondents aged 18-39 years had the highest probability of reporting increased alcohol use, the probability of older persons (40-59 and ≥60 years) reporting increased drinking was much greater among those with symptoms of anxiety and depression, compared to those without symptoms. These findings warrant age-differentiated public health messaging on the risks of excessive alcohol use and scale-up of substance use services for middle-aged and older adults with symptoms of depression and anxiety.

Heavy Alcohol Use is Associated with Lower CD4 Counts among Russian Women Living with HIV: A Multilevel Analysis.

Alcohol use remains prevalent among Russian women with HIV infection. Multilevel mixed effects models were used to estimate the association of heavy drinking and HIV outcomes among women (N = 250 at baseline; N = 207 at follow-up), aged 18-35, engaged in HIV care in Saint Petersburg. Alcohol use was assessed at baseline and 3 months by self-report and by the biomarker phosphatidylethanol (PEth). Overall, 35% of women were heavy drinkers, defined as women reporting ≥ 1 past-30-day heavy drinking episode (≥ 4 standard drinks on one occasion) or with PEth blood levels ≥ 80 ng/mL. Women who engaged in heavy drinking had an average 41 CD4 cells/mm3 (95% CI = - 81, - 2; z = - 2.04; P = 0.042) fewer than those who did not. Heavy drinking was associated with higher HIV symptom burden (IRR = 1.20; 95% CI = 1.05, 1.36; z = 2.73; P = 0.006) and suboptimal antiretroviral adherence (OR = 3.04; 95% CI = 1.27, 7.28; χ2 = 2.50; P = 0.013), but not with viral load. Findings support the integration of alcohol treatment interventions as part of routine HIV care in Russia.

RESUMEN: El consumo de alcohol es común en las mujeres rusas con VIH. Utilizamos modelos multinivel de efectos mixtos para estimar la asociación entre el consumo de alcohol excesivo y los resultados adversos de VIH en un grupo de mujeres (N = 250 al inicio del estudio; N = 207 en el seguimiento), de 18 a 35 años de edad, que recibían atención médica para el VIH en San Petersburgo. El consumo de alcohol excesivo, definido como el consumo de ≥ 4 bebidas alcohólicas en una ocasión en base a autoinforme o a niveles de fosfatidiletanol ≥ 80 ng/mL, se evaluó al inicio del estudio y a los 3 meses. Las mujeres que bebían en exceso, el 35% de la muestra, tenían un promedio de 41 células CD4/mm3 (IC del 95% = − 81, − 2; z = − 2,04; P = 0,042) menos que las que no lo hacían. El consumo excesivo de alcohol se asoció con una mayor carga de síntomas de VIH (TIR = 1,20; IC del 95% = 1,05, 1,36; z = 2,73; P = 0,006) y una adherencia al tratamiento antirretroviral subóptima (OR = 3,04; IC del 95% = 1,27, 7,28; χ2 = 2,50; P = 0,013), pero no con carga viral. Los hallazgos respaldan la integración de la atención para el tratamiento del alcoholismo en los servicios de atención rutinaria del VIH en Rusia.

Food insecurity among households with children during the COVID-19 pandemic: results from a study among social media users across the United States.

BACKGROUND: In the United States, approximately 11% of households were food insecure prior to the COVID-19 pandemic. The present study aims to describe the prevalence of food insecurity among adults and households with children living in the United States during the pandemic. METHODS: This study utilized social media as a recruitment platform to administer an original online survey on demographics and COVID-related food insecurity. The survey was disseminated through an advertisement campaign on Facebook and affiliated platforms. Food insecurity was assessed with a validated six-item United States Department of Agriculture (USDA) Household Food Security Survey Module, which was used to create a six-point numerical food security score, where a higher score indicates lower food security. Individual-level participant demographic information was also collected. Logistic regressions (low/very-low compared with high/marginal food security) were performed to generate adjusted odds ratios (AOR) and 95%CIs for food insecurity and select demographic characteristics. RESULTS: Advertisements reached 250,701 individuals and resulted in 5,606 complete surveys. Overall, 14.7% of participants self-identified as having low or very low food security in their households, with higher prevalence (17.5%) among households with children. Unemployment (AOR:1.76, 95%CI:1.09-2.80), high school or lower education (AOR:2.25, 95%CI:1.29-3.90), and low income (AOR[$30,000-$50,000]:5.87, 95%CI:3.35-10.37; AOR[< $30,000]:10.61, 95%CI:5.50-20.80) were associated with higher odds of food insecurity in multivariable models among households with children (and the whole sample). CONCLUSIONS: These data indicate exacerbation of food insecurity during the pandemic. The study will be instrumental in guiding additional research and time-sensitive interventions targeted towards vulnerable food insecure subgroups.

Factors associated with experiencing sexual violence among female gender-based violence survivors in conflict-afflicted eastern Ukraine.

BACKGROUND: Since 2014, over 1.6 million people have been forcibly displaced by the conflict in eastern Ukraine. In 2014, 8% of reproductive-aged women in Ukraine had ever experienced sexual violence, compared to 5% in 2007. This increase was driven by non-domestic sexual violence. Our study examined characteristics of women in eastern Ukraine receiving psychosocial services following sexual violence compared to survivors of other forms of gender-based violence. METHODS: Intake data collected between February 2016 and June 2017 by psychosocial service providers in five conflict-affected areas of Ukraine from women, aged 15-49, (N = 8525), was analyzed. Descriptive analysis and covariate adjusted logistic and negative binomial regressions were used to identify socioeconomic, incident and access to services factors associated with having experienced sexual violence compared to other forms of violence. RESULTS: Among this sample of survivors receiving psychosocial services, 2.6% (n = 220) reported experiencing sexual violence. A majority of sexual violence acts reported were committed by non-domestic perpetrators (61.4%); followed by intimate partners (25.9%). Almost half of sexual violence cases occurred at home (49.1%). Experiencing sexual violence was positively associated with being younger, single and internally displaced, and negatively with engaging in unpaid labor, such as childcare. Women who experienced sexual violence delayed seeking care by 4 days compared to other gender-based violence survivors. Sexual violence survivors were less likely than physical violence survivors to have reported the incident prior to receiving care (adjusted odds ratio = 0.39; 95% confidence interval = 0.28-0.54). CONCLUSIONS: Non-domestic and intimate partner sexual violence were both prevalent in our sample. Compared to survivors disclosing other types of gender-based violence, sexual violence survivors appear to face unique barriers to reporting and accessing timely care. Prevention and outreach programs tailored to the specific vulnerabilities, such as displacement status, and needs of sexual violence survivors in conflict settings are urgently needed.

Longitudinal predictors of male sexual partner risk among Black and Latina women in their late thirties: ethnic/racial identity commitment as a protective factor.

This study aimed to investigate predictors of male sexual partner risk among Latinas and Black women in their late thirties. We used multiple regression analysis to examine factors associated with male sexual partner risk among 296 women who participated in two waves of the Harlem Longitudinal Development Study (New York, 2011-2013 and 2014-2016). Women who experienced childhood sexual abuse had higher risk partners than those who did not [b = 0.16, 95% confidence interval (CI) = 0.06, 0.28]. Earlier marijuana use was a risk factor for partner risk in the late thirties (b = 0.12, 95% CI = 0.04, 0.27). Higher levels of ethnic/racial identity commitment mitigated this risk (b = - 0.15, 95% CI = - 0.26, - 0.04). Ethnic/racial identity commitment can be protective against male sexual partner risk among Latina and Black women who use marijuana. Further research should explore the protective role of different dimensions of ethnic/racial identity against sexually transmitted infections, including HIV.

Social media as a recruitment platform for a nationwide online survey of COVID-19 knowledge, beliefs, and practices in the United States: methodology and feasibility analysis.

BACKGROUND: The COVID-19 pandemic has evolved into one of the most impactful health crises in modern history, compelling researchers to explore innovative ways to efficiently collect public health data in a timely manner. Social media platforms have been explored as a research recruitment tool in other settings; however, their feasibility for collecting representative survey data during infectious disease epidemics remain unexplored. OBJECTIVES: This study has two aims 1) describe the methodology used to recruit a nationwide sample of adults residing in the United States (U.S.) to participate in a survey on COVID-19 knowledge, beliefs, and practices, and 2) outline the preliminary findings related to recruitment, challenges using social media as a recruitment platform, and strategies used to address these challenges. METHODS: An original web-based survey informed by evidence from past literature and validated scales was developed. A Facebook advertisement campaign was used to disseminate the link to an online Qualtrics survey between March 20-30, 2020. Two supplementary male-only and racial minority- targeted advertisements were created on the sixth and tenth day of recruitment, respectively, to address issues of disproportionate female- and White-oriented gender- and ethnic-skewing observed in the advertisement's reach and response trends. RESULTS: In total, 6602 participant responses were recorded with representation from all U.S. 50 states, the District of Columbia, and Puerto Rico. The advertisements cumulatively reached 236,017 individuals and resulted in 9609 clicks (4.07% reach). Total cost of the advertisement was $906, resulting in costs of $0.09 per click and $0.18 per full response (completed surveys). Implementation of the male-only advertisement improved the cumulative percentage of male respondents from approximately 20 to 40%. CONCLUSIONS: The social media advertisement campaign was an effective and efficient strategy to collect large scale, nationwide data on COVID-19 within a short time period. Although the proportion of men who completed the survey was lower than those who didn't, interventions to increase male responses and enhance representativeness were successful. These findings can inform future research on the use of social media recruitment for the rapid collection of survey data related to rapidly evolving health crises, such as COVID-19.

Childhood Violence, High School Academic Environment, and Adult Alcohol Use Among Latinas and Black Women: A Structural Equation Modeling Study.

OBJECTIVE: Young Latinas and Black women drink less than women of other racial/ethnic groups but experience more alcohol-related problems in midlife. This study aims to identify modifiable factors to prevent adult onset of alcohol use disorder (AUD) in this population. METHODS: Data were collected at six time points as part of the Harlem Longitudinal Development Study from 365 Latinas (47%) and Black (53%) women (mean age at time 1 = 14, standard deviation 1.3). Structural equation modeling was used to test hypothesized pathways from childhood physical and sexual abuse to AUD via depressive mood, anxiety disorders, and somatic complaints in the 20s. We also tested the moderation effect of the high school academic environment by including in the structural equation model two latent variable interaction terms between the school environment and each of the abuse variables. RESULTS: Childhood physical and sexual abuse was positively associated with depressive mood, anxiety disorders, and somatic complaints when participants were in the 20s. Depressive mood mediated childhood abuse and AUD when women were in the 30s. The high school academic environment attenuated the effect of physical, but not sexual abuse, on depressive mood (ß = -0.59, B = -9.38, 95% CI [-14.00, -4.76]), anxiety symptoms (ß = -0.61, B = -14.19, 95% CI [-21.76, -6.61]), appetite loss (ß = -0.41, B = -10.52, 95% CI [-15.61, -5.42]), and sleeplessness (ß = -0.50, B = -9.56, 95% CI [-13.95, -5.17]) in the early 20s. CONCLUSIONS: Our findings underscore the need to invest in early violence prevention interventions and in education to ensure equitable access to quality, academically oriented, and safe schools.

Understanding Domestic Violence Among Older Women in Ukraine: A Secondary Analysis Using Gender-Based Violence Screening Data.

This secondary descriptive analysis sought to understand Gender-Based Violence (GBV), with a focus on Domestic Violence (DV), among older women in Ukraine's conflict setting. Analysis was conducted on a subsample of 150 women aged 60+ from GBV-Information Management System intake data of 12,480 GBV survivors. Fisher's exact tests were used to compare differences in GBV incidents among women who experienced DV compared to other types of GBV. Using United Nations humanitarian and aging frameworks, qualitative analysis was completed following two rounds of coding. Sixty percent of women aged ≥60 experienced DV. Local women were more likely to experience DV versus displaced women (85.6% vs. 48.3%, p < .001). Six core themes emerged: experiencing versus witnessing violence, intergenerational conflict, livelihoods, alcohol, humiliation, and neglect. Deeper understanding of DV among older women in humanitarian settings is needed, strengthening a call to action to prioritize protection against, and prevention of, GBV more broadly among this marginalized group.

Digital health and the promise of equity in maternity care: A mixed methods multi-country assessment on the use of information and communication technologies in healthcare facilities in Latin America and the Caribbean.

INTRODUCTION: Timely access to maternity care is critical to saving lives. Digital health may serve to bridge the care chasm and advance health equity. Conducted in the aftermath of the COVID-19 pandemic, this cross-sectional mixed-methods study assessed the use of information and communication technologies (ICTs) in healthcare facilities in nine Latin American and Caribbean countries to understand the landscape of ICT use in maternity care and the barriers and facilitators to its adoption. MATERIALS AND METHODS: Between April 2021 and September 2022, we disseminated an online survey in English and Spanish among, mainly public, healthcare institutions that provided maternity care in Argentina, Bolivia, Colombia, the Dominican Republic, Ecuador, Guyana, Honduras, Paraguay and Peru. We also interviewed 27 administrators and providers in ministries of health and healthcare institutions. RESULTS: Most of the 1877 institutions that answered the survey reported using ICTs in maternity care (N = 1536, 82%), ranging from 96% in Peru to 64% in the Dominican Republic. Of institutions that used ICTs, 59% reported using them more than before or for the first time since the pandemic began. ICTs were most commonly used to provide family planning (64%) and breastfeeding (58%) counseling, mainly by phone (82%). At the facility level, availability of equipment and internet coverage, coupled with skilled human resources, were the main factors associated with ICT use. At country level, government-led initiatives to develop digital health platforms, alongside national investments in the digital infrastructure, were the determining factors in the adoption of ICTs in healthcare provision. CONCLUSION: Digital health for maternity care provision relied on commonly available technology and did not necessitate highly sophisticated systems, making it a sustainable and replicable strategy. However, disparities in access to digital health remain and many facilities in rural and remote areas lacked connectivity. Use of ICTs in maternity care depended on countries' long-term commitments to achieving universal health and digital coverage.

Patient-Provider Health Communication Strategies: Enhancing HPV Vaccine Uptake among Adolescents of Color.

Cervical cancer remains a public health issue in the United States, particularly among stigmatized racial and ethnic populations. The human papillomavirus (HPV) vaccine has been clinically proven to prevent cervical cancers, and other HPV-associated cancers, among men and women. However, HPV vaccine uptake is suboptimal; only 55% of adolescents complete the two-dose series by age 15. Past research has shown that provider HPV vaccine communication for people of marginalized races/ethnicities is subpar. This article focuses on provider communication strategies to promote HPV vaccine uptake effectively and equitably. The authors reviewed the literature on evidence-based patient-provider HPV vaccine communication techniques to create a set of communication language providers could use and avoid using to enhance HPV vaccine acceptance and uptake among adolescents of marginalized racial and ethnic groups. Evidence has shown that information and the manner of dissemination are critical for influencing HPV vaccine uptake. These communication strategies must be suited to the context of the targeted population, and the message content can be broadly categorized into source, content, and modality. Strategies to improve patient-provider communication among adolescents of color using source, modality, and content include the following: (1) Source: increase provider self-efficacy to provide the recommendation, building rapport between providers and parents; (2) Content: persistent, forceful language with minimal acquiescence should be employed, reframing the conversation focus from sex to cancer; and (3) Modality: use multiple vaccine reminder modalities, and work with the community to culturally adapt the vaccination language. Utilizing effective behavior-change communication adapted for adolescents of color can reduce missed opportunities for HPV prevention, potentially decreasing racial and ethnic disparities in HPV-related morbidity and mortality.

A longitudinal pathway from ethnic-racial discrimination to sexual risk behaviors among Black women and Latinas: Ethnic-racial identity exploration as a protective factor.

BACKGROUND: Black women and Latinas in their thirties continue to be at risk for HIV transmission via heterosexual intercourse. METHODS: Informed by the Theory of Gender and Power, this study investigated a longitudinal path model linking experiences of ethnic-racial discrimination in late adolescence to sexual risk behaviors in adulthood among 492 Black women and Latinas. We also tested whether ethnic-racial identity exploration served as a resilience asset protecting women against the psychological impact of ethnic-racial discrimination. Survey data from female participants in the Harlem Longitudinal Development Study, which has followed a cohort of New York City Black and Latinx youth since 1990, were analyzed. Data for this analysis were collected at four time points when participants were on average 19, 24, 29, and 32 years of age. Structural equation modeling was used to examine a hypothesized pathway from earlier ethnic-racial discrimination to later sexual risk behaviors and the protective role of ethnic-racial identity exploration. RESULTS: Results confirmed that ethnic-racial discrimination in late adolescence was linked with sexual risk behaviors in the early thirties via increased levels of affective distress in emerging adulthood, experiences of victimization in young adulthood, and substance use in the early thirties among women low in ethnic-racial identity exploration. We also found that ethnic-racial identity served as a resilience asset, as the association between discrimination in late adolescence and affective distress in emerging adulthood was not significant among women with higher levels of ethnic-racial identity exploration. CONCLUSIONS: The results provide important preliminary evidence that ethnic-racial identity exploration may serve as a resilience asset among Black women and Latinas confronting racial discrimination. Further, we suggest that ethnic-racial identity exploration may constitute an important facet of critical consciousness.

Socioeconomic predictors of COVID-19-related health disparities among United States workers: A structural equation modeling study.

The COVID-19 pandemic has disproportionately impacted the physical and mental health, and the economic stability, of specific population subgroups in different ways, deepening existing disparities. Essential workers have faced the greatest risk of exposure to COVID-19; women have been burdened by caretaking responsibilities; and rural residents have experienced healthcare access barriers. Each of these factors did not occur on their own. While most research has so far focused on individual factors related to COVID-19 disparities, few have explored the complex relationships between the multiple components of COVID-19 vulnerabilities. Using structural equation modeling on a sample of United States (U.S.) workers (N = 2800), we aimed to 1) identify factor clusters that make up specific COVID-19 vulnerabilities, and 2) explore how these vulnerabilities affected specific subgroups, specifically essential workers, women and rural residents. We identified 3 COVID-19 vulnerabilities: financial, mental health, and healthcare access; 9 out of 10 respondents experienced one; 15% reported all three. Essential workers [standardized coefficient (ß) = 0.23; unstandardized coefficient (B) = 0.21, 95% CI = 0.17, 0.24] and rural residents (ß = 0.13; B = 0.12, 95% CI = 0.09, 0.16) experienced more financial vulnerability than non-essential workers and non-rural residents, respectively. Women (ß = 0.22; B = 0.65, 95% CI = 0.65, 0.74) experienced worse mental health than men; whereas essential workers reported better mental health (ß = -0.08; B = -0.25, 95% CI = -0.38, -0.13) than other workers. Rural residents (ß = 0.09; B = 0.15, 95% CI = 0.07, 0.24) experienced more healthcare access barriers than non-rural residents. Findings highlight how interrelated financial, mental health, and healthcare access vulnerabilities contribute to the disproportionate COVID-19-related burden among U.S. workers. Policies to secure employment conditions, including fixed income and paid sick leave, are urgently needed to mitigate pandemic-associated disparities.

Knowledge, beliefs, mental health, substance use, and behaviors related to the COVID-19 pandemic among US adults: a national online survey.

Aim: Given the need for data to inform public health messaging to mitigate the COVID-19 pandemic, this national survey sought to assess the state of COVID-19-related knowledge, beliefs, mental health, substance use changes, and behaviors among a sample of U.S. adults. Subject and methods: In the period March 20-30, 2020, we collected data on COVID-19-related knowledge, awareness and adoption of preventive practices, depression and anxiety (Patient Health Questionnaire-4), stress (Impact of Event Scale-6), pessimism, and tobacco and alcohol use. Differences between age groups (18-39 years, 40-59 years and ≥ 60 years) were tested using Pearson's chi-squared tests or ANOVAs; associations between drinking and smoking and depression, anxiety, and stress were tested using adjusted logistic regression models. Results: Approximately half of the sample (N Total = 6391) were 50-69 years old and 58% were female. COVID-19 knowledge (mean = 12.0; SD = 1.2) and protective practice awareness (mean = 9.1; SD = 0.8) were high. Among respondents, 44% had a score consistent with depression and anxiety (PHQ-4 score ≥ 6), and 52% reported high stress scores (≥ median of 1.33). COVID-19-related anxiety and depression were associated with increased drinking (AOR = 1.79; 95% CI = 1.49, 2.15) and smoking (AOR = 2.17; 95% CI = 1.64, 2.88). High stress scores were also associated with increased drinking (AOR = 1.80; 95% CI = 1.49, 2.17, p < 0.001) and smoking (AOR = 1.75; 95% CI = 1.31, 2.33). Conclusions: In spite of high knowledge levels, important gaps were identified. High prevalence of poor mental health outcomes and associated increases in drinking and smoking warrant ongoing risk communications tailoring to effectively disseminate information and expanding psychosocial services, particularly via telehealth, to mitigate the negative mental health impact of COVID-19. Supplementary Information: The online version contains supplementary material available at 10.1007/s10389-021-01564-4.

Patterns of Gender-Based Violence in Conflict-Affected Ukraine: A Descriptive Analysis of Internally Displaced and Local Women Receiving Psychosocial Services.

Since 2014, a protracted armed conflict has afflicted eastern Ukraine, resulting in the displacement of over 1.4 million residents. The resulting humanitarian crisis has placed women, particularly displaced women, at greater risk of gender-based violence (GBV). In Ukraine, reports of GBV were higher following the start of the conflict (22.4% in 2014 vs. 18.3% in 2007), with displaced women suffering from GBV nearly three times more than non-displaced residents (15.2% vs. 5.3%). Many GBV incidents in Ukraine have been reported along the "contact line," the border separating government from non-government-controlled areas. This study compares types of GBV experienced by displaced and local (non-displaced) women receiving psychosocial support in order to identify the gaps in services during a time of conflict. Data was collected by mental healthcare providers from 11,826 women (25.5% displaced; 74.5% local) aged 15 to 69 receiving psychosocial services in five conflict-affected regions from February 2016 to June 2017. Group differences were assessed using Pearson's chi-squared or Fisher's exact tests for categorical variables and Wilcoxon rank-sum tests for continuous variables. Overall, almost half of the women experienced intimate partner violence and psychological abuse. Compared to residents, displaced women were more likely to report non-domestic GBV incidents involving sexual and economic violence. Almost 8% of violent incidents against displaced women occurred at checkpoints or at reception centers for internally displaced persons (IDP) and 20% were perpetrated by armed men. Consistent with the literature, this study suggests that displaced women are more vulnerable to attacks by persons outside the home and by armed groups. Our findings underscore the need to expand violence prevention programs to address the unique vulnerabilities of displaced women before, during, and after displacement. Programs should be tailored to prevent violence within and outside the home. Increased prevention efforts are needed in areas with high concentrations of armed men, along the contact line, and at IDP reception centers to protect displaced women. This is particularly urgent in the context of increased GBV due to COVID-19.

Costing of a Multiple Family Group Strengthening Intervention (SMART-Africa) to Improve Child and Adolescent Behavioral Health in Uganda.

Reliable cost estimates are key to assessing the feasibility, affordability, and cost-effectiveness of interventions. We estimated the economic costs of a multiple family group (MFG) intervention-child and adolescent mental health evidence-based practices (CAMH-EBP) implemented under the SMART-Africa study, seeking to improve family functioning and reduce child and adolescent behavior problems-delivered through task-shifting by community health workers (CHWs) or parent peers (PPs) in school settings in Uganda. This prospective microcosting analysis was conducted from a provider perspective as part of a three-armed randomized controlled trial of the MFG intervention involving 2,391 participants aged 8-13 years and their caregivers in 26 primary schools. Activity-specific costs were estimated and summed, and divided by actual participant numbers in each study arm to conservatively calculate total per-child costs by arm. Total per-child costs of the MFG-PP and MFG-CHW arms were estimated at US$346 and US$328, respectively. The higher per-child cost of the MFG-PP arm was driven by lower than anticipated attendance by participants recruited to this arm. Personnel costs were the key cost driver, accounting for approximately 70% of total costs because of intensive supervision and support provided to MFG facilitators and intervention quality assurance efforts. This is the first study estimating the economic costs of an evidence-based MFG intervention provided through task-shifting strategies in a low-resource setting. Compared with the costs of other family-based interventions ranging between US$500 and US$900 in similar settings, the MFG intervention had a lower per-participant cost; however, few comparisons are available in the literature. More costing studies on CAMH-EBPs in low-resource settings are needed.

Regional and socioeconomic predictors of perceived ability to access coronavirus testing in the United States: results from a nationwide online COVID-19 survey.

PURPOSE: Access to COVID-19 testing remained a salient issue during the early months of the pandemic, therefore this study aimed to identify 1) regional and 2) socioeconomic predictors of perceived ability to access Coronavirus testing. METHODS: An online survey using social media-based advertising was conducted among U.S. adults in April 2020. Participants were asked whether they thought they could acquire a COVID-19 test, along with basic demographic, socioeconomic and geographic information. RESULTS: A total of 6,378 participants provided data on perceived access to COVID-19 testing. In adjusted analyses, we found higher income and possession of health insurance to be associated with perceived ability to access Coronavirus testing. Geographically, perceived access was highest (68%) in East South Central division and lowest (39%) in West North Central. Disparities in health insurance coverage did not directly correspond to disparities in perceived access to COVID-19 testing. CONCLUSIONS: Sex, geographic location, income, and insurance status were associated with perceived access to COVID-19 testing; interventions aimed at improving either access or awareness of measures taken to improve access are warranted. These findings from the pandemic's early months shed light on the importance of disaggregating perceived and true access to screening during such crises.