Racial-ethnic disparities in psychological distress during the COVID-19 pandemic in the United States: the role of experienced discrimination and perceived racial bias.

BACKGROUND: Research on mental health disparities by race-ethnicity in the United States (US) during COVID-19 is limited and has generated mixed results. Few studies have included Asian Americans as a whole or by subgroups in the analysis. METHODS: Data came from the 2020 Health, Ethnicity, and Pandemic Study, based on a nationally representative sample of 2,709 community-dwelling adults in the US with minorities oversampled. The outcome was psychological distress. The exposure variable was race-ethnicity, including four major racial-ethnic groups and several Asian ethnic subgroups in the US. The mediators included experienced discrimination and perceived racial bias toward one's racial-ethnic group. Weighted linear regressions and mediation analyses were performed. RESULTS: Among the four major racial-ethnic groups, Hispanics (22%) had the highest prevalence of severe distress, followed by Asians (18%) and Blacks (16%), with Whites (14%) having the lowest prevalence. Hispanics' poorer mental health was largely due to their socioeconomic disadvantages. Within Asians, Southeast Asians (29%), Koreans (27%), and South Asians (22%) exhibited the highest prevalence of severe distress. Their worse mental health was mainly mediated by experienced discrimination and perceived racial bias. CONCLUSIONS: Purposefully tackling racial prejudice and discrimination is necessary to alleviate the disproportionate psychological distress burden in racial-ethnic minority groups.

Experience of Racial Discrimination was Associated with Psychological Distress and Worsening Sex Life Among Adult Americans During COVID-19.

The recent escalation of racism in the U.S. during the COVID-19 pandemic points to the importance of examining the association between experienced racism and sexual health. Based on data from a nationally representative survey conducted in the U.S. in October 2020 (n = 1,915), Chi-square tests and multivariable logistic regressions were estimated to examine the association between experience of racism and changes in sex life during the pandemic. We further performed a causal mediation analysis using the bootstrap technique to assess the mediating role of psychological distress in the observed association between the experience of racism and changes in sex life. Among the respondents, the proportions reporting better, worse, or no change in sex life were, respectively, 15%, 21%, and 64%. Experiencing racial discrimination during COVID-19 was significantly associated with worsening sex life (adjusted odd ratio [AOR] = 1.53; 95% confidence interval [CI] = 1.04, 2.25). Respondents with experienced racism were also more likely to report psychological distress (AOR = 1.68; 95% CI = 1.09, 2.59). About one-third (32.66%) of the observed association between experienced racism and worsening sex life was mediated through psychological distress. Addressing racism and its association with psychological distress has the potential to improve sexual health and reduce related racial and ethnic disparities.

Impact of the COVID-19 pandemic on cancer healthcare utilization in southwestern China on March 2021.

BACKGROUND: Oncological care has been disrupted worldwide during the COVID-19 pandemic. We aimed to quantify the long-term impact of the pandemic on cancer care utilization and to examine how this impact varied by sociodemographic and clinical factors in southwestern China, where the Dynamic Zero-COVID Strategy was implemented. This strategy mainly included lockdowns, stringent testing, and travel restrictions to prevent the spread of COVID-19. METHOD: We identified 859,497 episodes of the utilization of cancer care from electronic medical records between January 1, 2019, and March 31, 2021, from the cancer center of a tertiary hospital serving an estimated population of 8.4 million in southwestern China. Changes in weekly utilization were evaluated via segmented Poisson regression across service categories, stratified by cancer type and sociodemographic factors. RESULTS: A sharp reduction in utilization of in-person cancer services occurred during the first week of the pandemic outbreak in January 2020, followed by a quick rebound in February 2020. Although there were few COVID-19 cases from March 2020 until this analysis, the recovery of most in-person services was slow and remained incomplete as of March 31, 2021. The exceptions were outpatient radiation and surgery, which increased and exceeded pre-pandemic levels, particularly among lung cancer patients; meanwhile, telemedicine utilization increased substantially after the onset of the pandemic. Care disruptions were most prominent for women, rural residents, uninsured, and breast cancer patients. CONCLUSIONS: As of March 2021, despite few COVID-19 cases, the COVID-19 pandemic has had a strong and continuing impact on in-person oncology care utilization in southwestern China under the Dynamic Zero-COVID Strategy. Equitable and timely access to cancer care requires adjustment in strict policies for COVID-19 prevention and control, as well as targeted remedies for the most vulnerable populations during and beyond the pandemic. Future studies should monitor the long-term effects of the COVID-19 pandemic and response strategies on cancer care and outcomes.

Association of the COVID-19 Pandemic and Changes in Patterns of Cancer-Related Mortality in the United States.

PURPOSE: This study examined changes in patterns of cancer-related deaths during the first year of the coronavirus disease 2019 pandemic in the United States. METHODS: We identified cancer-related deaths, defined as deaths attributable to cancer as the primary cause (underlying cause) or deaths with cancer documented as one of the multiple contributing factors (contributing cause) from the Multiple Cause of Death database (2015-2020). We compared age-standardized cancer-related annual and monthly mortality rates for January-December 2020 (first pandemic year) to January-December 2015-2019 (prepandemic) overall and stratified by sex, race/ethnicity, urban rural residence, and place of death. RESULTS: We found that the death rate (per 100,000 person-years) with cancer as the underlying cause was lower in 2020 compared with 2019 (144.1 v 146.2), continuing the past trend observed in 2015-2019. By contrast, the death rate with cancer as a contributing cause was higher in 2020 than in 2019 (164.1 v 162.0), reversing the continuously decreasing trend from 2015 to 2019. We projected 19,703 more deaths with cancer as a contributing cause than expected on the basis of historical trends. Mirroring pandemic peaks, the monthly death rates with cancer as a contributing cause first increased in April 2020 (rate ratio [RR], 1.03; 95% CI, 1.02 to 1.04), subsequently declined in May and June 2020, and then increased again each month from July through December 2020 compared with 2019, with the highest RR in December (RR, 1.07; 95% CI, 1.06 to 1.08). CONCLUSION: Death rates with cancer as the underlying cause continued to decrease in 2020 despite the increase in death rates with cancer as a contributing cause in 2020. Ongoing monitoring of long-term cancer-related mortality trends is warranted to assess effects of delays in cancer diagnosis and receipt of care during the pandemic.

Cancer Screening in the United States During the Second Year of the COVID-19 Pandemic.

PURPOSE: To examine whether cancer screening prevalence in the United States during 2021 has returned to prepandemic levels using nationally representative data. METHODS: Information on receipt of age-eligible screening for breast (women age 50-74 years), cervical (women without a hysterectomy age 21-65 years), prostate (men age 55-69 years), and colorectal cancer (men and women age 50-75 years) according to the US Preventive Services Task Force recommendations was obtained from the 2019 and 2021 National Health Interview Survey. Past-year screening prevalence in 2019 and 2021 and adjusted prevalence ratios (aPRs), 2021 versus 2019, with their 95% CIs were calculated using complex survey logistic regression models. RESULTS: Between 2019 and 2021, past-year screening in the United States decreased from 59.9% to 57.1% (aPR, 0.94; 95% CI, 0.91 to 0.97) for breast cancer, from 45.3% to 39.0% (aPR, 0.85; 95% CI, 0.82 to 0.89) for cervical cancer, and from 39.5% to 36.3% (aPR, 0.9; 95% CI, 0.84 to 0.97) for prostate cancer. Declines were most notable for non-Hispanic Asian persons. Colorectal cancer screening prevalence remained unchanged because an increase in past-year stool testing (from 7.0% to 10.3%; aPR, 1.44; 95% CI, 1.31 to 1.58) offset a decline in colonoscopy (from 15.5% to 13.8%; aPR, 0.88; 95% CI, 0.83 to 0.95). The increase in stool testing was most pronounced in non-Hispanic Black and Hispanic populations and in persons with low socioeconomic status. CONCLUSION: Past-year screening prevalence for breast, cervical, and prostate cancer among age-eligible adults in the United States continued to be lower than prepandemic levels in the second year of the COVID-19 pandemic, reinforcing the importance of return to screening health system outreach and media campaigns. The large increase in stool testing emphasizes the role of home-based screening during health care system disruptions.[Media: see text].

The First Year of the COVID-19 Pandemic: Changes in Preventive Services in Community Health Centers.

INTRODUCTION: Community Health Centers provide comprehensive primary healthcare services to many underserved populations. It is unknown how routine preventive and chronic care services in Community Health Centers may have changed nationwide during the COVID-19 pandemic. METHODS: The 2014-2020 Health Resources and Services Administration Uniform Data System of Community Health Centers was used, and data analysis was conducted from November 2021 to May 2022. Data for clinical quality measures in 2020 were treated as during the pandemic, whereas receipt of care in 2019 and before were treated as before the pandemic. Outcomes included 6 clinical quality measures of being up to date for colorectal cancer screening, cervical cancer screening, tobacco screening and cessation counseling, BMI screening and follow-up, depression screening and follow-up, and aspirin use for ischemic vascular disease. A mixed effects regression model was used to estimate changes in measures by year. RESULTS: Between 2019 and 2020, receipt of preventive services declined for each of the 6 clinical quality measures: from 40.8% to 37.7% for colorectal cancer screening, from 48.8% to 44.9% for cervical cancer screening, from 85.8% to 83.4% for tobacco screening and cessation counseling, from 70.7% to 65.4% for BMI screening and follow-up, from 71.1% to 64.9% for depression screening and follow-up, and from 81.5% to 79.4% for aspirin use for ischemic vascular disease. CONCLUSIONS: Receipt of preventive services in Community Health Centers declined during the COVID-19 pandemic for each of the 6 clinical quality measures considered in the study. Immediate action is required to support ongoing high-quality, primary healthcare services in Community Health Centers across the nation.

Associations of racial and ethnic discrimination with adverse changes in exercise and screen time during the COVID-19 pandemic in the United States.

OBJECTIVES: During the coronavirus disease 2019 (COVID-19) pandemic, a growing prevalence of racial and ethnic discrimination occurred when many Americans struggled to maintain healthy lifestyles. This study investigated the associations of racial and ethnic discrimination with changes in exercise and screen time during the pandemic in the United States. METHODS: We included 2,613 adults who self-identified as non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, or Hispanic from the Health, Ethnicity, and Pandemic study, a cross-sectional survey conducted among a nationally representative sample of United States adults between October and November 2020. We assessed self-reported racial and ethnic discrimination by measuring COVID-19-related racial and ethnic bias and examined its associations with changes in exercise and screen time using multivariable logistic regression models. We analyzed data between September 2021 and March 2022. RESULTS: COVID-19-related racial and ethnic bias was associated with decreased exercise time among non-Hispanic Asian (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.13 to 1.89) and Hispanic people (OR, 1.91; 95% CI, 1.32 to 2.77), and with increased screen time among non-Hispanic Black people (OR, 1.94; 95% CI, 1.33 to 2.85), adjusting for age, sex, education, marital status, annual household income, insurance, and employment status. CONCLUSIONS: Racial and ethnic discrimination may have adversely influenced exercise and screen time changes among racial and ethnic minorities during the COVID-19 pandemic in the United States. Further studies are needed to investigate the mechanisms through which racial and ethnic discrimination can impact lifestyles and to develop potential strategies to address racial and ethnic discrimination as a barrier to healthy lifestyles.

Identification of Deaths Caused by Cancer and COVID-19 in the US During March to December 2020.

This cross-sectional study uses 2020 mortality data in the US to analyze deaths caused by cancer and COVID-19 in terms of demographic characteristics, cancer site, and place of death.

The first year of the COVID-19 pandemic and health among cancer survivors in the United States.

BACKGROUND: Cancer survivors represent a population with high health care needs. If and how cancer survivors were affected by the first year of the coronavirus disease 2019 (COVID-19) pandemic are largely unknown. METHODS: Using data from the nationwide, population-based Behavioral Risk Factor Surveillance System (2017-2020), the authors investigated changes in health-related measures during the COVID-19 pandemic among cancer survivors and compared them with changes among adults without a cancer history in the United States. Sociodemographic and health-related measures such as insurance coverage, employment status, health behaviors, and health status were self-reported. Adjusted prevalence ratios of health-related measures in 2020 versus 2017-2019 were calculated with multivariable logistic regressions and stratified by age group (18-64 vs. ≥65 years). RESULTS: Among adults aged 18-64 years, the uninsured rate did not change significantly in 2020 despite increases in unemployment. The prevalence of unhealthy behaviors, such as insufficient sleep and smoking, decreased in 2020, and self-rated health improved, regardless of cancer history. Notably, declines in smoking were larger among cancer survivors than nonelderly adults without a cancer history. Few changes were observed for adults aged ≥65 years. CONCLUSIONS: Further research is needed to confirm the observed positive health behavior and health changes and to investigate the role of potential mechanisms, such as the national and regional policy responses to the pandemic regarding insurance coverage, unemployment benefits, and financial assistance. As polices related to the public health emergency expire, ongoing monitoring of longer term effects of the pandemic on cancer survivorship is warranted.

Racism Experience Among American Adults During COVID-19: A Mixed-Methods Study.

Purpose: Despite escalating racism in the United States during COVID-19, few studies have identified correlates of racism experience among Americans using nationally representative data. This study seeks to quantitatively identify correlates of racism experience and qualitatively categorize racism experience and its coping using nationally representative survey data. Methods: Based on data from the "Health, Ethnicity and Pandemic Survey" (N=2,506), a nationally representative survey conducted in October 2020, multivariable logistic regression was estimated to examine the association between self-reported racism experience and selected correlates. Thematic analysis was conducted to qualitatively classify types of racism experience and related coping strategies. Results: When asked whether they had been discriminated or unfairly treated during COVID-19 because of their racial/ethnic background, 19% non-Hispanic Asian and Black respondents said yes, followed by 15% among Hispanics and 3% among non-Hispanic Whites. Besides significant correlates of racism experience identified at the individual and household level, three contextual factors at the neighborhood or state level were associated with lower odds of racism experience, including living in a blue state (adjusted odds ratio [AOR]=0.69, 95% confidence interval [CI]: 0.50-0.95; reference category: red state), living in the top third of the neighborhoods in the sample in terms of racial diversity (AOR=0.65%, 95% CI: 0.42-0.99; reference: bottom third), and coming from neighborhoods with a median population age of 35-39 (AOR=0.67, 95% CI: 0.46-0.98; reference: younger than 35). Prevailing coping strategies against experienced racism included social avoidance, direct confrontation, seeking social and religious support, resorting to hobbies for relief, and taking legal actions. Conclusion: Racism experience is not only correlated with factors at individual level, it is also associated with contextual factors such as political climate, neighborhood diversity, and population age structure. Future efforts in supporting victims of racism might be more cost-effective by focusing on the identified vulnerable groups and related contextual factors.

Changes in Smoking Cessation-Related Behaviors Among US Adults During the COVID-19 Pandemic.

Importance: Smoking cessation is an urgent public health priority given that smoking is associated with increased risk of severe COVID-19 outcomes and other diseases. It is unknown how smoking cessation changed nationally during the COVID-19 pandemic. Objective: To investigate changes in smoking cessation-related behaviors in the US during the COVID-19 pandemic. Design, Setting, and Participants: This cross-sectional study was conducted using 2011 to 2020 data on 788 008 individuals who had smoked in the past year from the nationally representative Behavioral Risk Factor Surveillance System (BRFSS) survey. Representative retail scanner sales data between January 2017 and July 2021 for 1004 unique nicotine replacement therapy (NRT) universal product codes in 31 US states from NielsenIQ were also used. Exposures: Calendar year and 4-week sales periods. Main Outcomes and Measures: Changes in annual self-reported prevalence of past-year quit attempts and recent successful cessation before (ie, 2011-2019) and during (ie, 2020) the COVID-19 pandemic and changes in sales volumes in millions of pieces of nicotine gum, lozenge, and patch brands before (1271 four-week sales periods between January 2017 and February 2020) and during (558 four-week sales periods between March 2020 and July 2021) the COVID-19 pandemic were calculated. Results: The 2011 to 2020 pooled BRFSS sample (response rate range, 45.2%-49.9%) included 788 008 respondents (243 061 individuals ages 25-44 years [weighted percentage, 42.5%]; 374 519 men [weighted percentage, 55.7%]). For the first time since 2011, annual past-year quit attempt prevalence decreased between 2019 and 2020, from 65.2% (95% CI, 64.5% to 65.9%) to 63.2% (95% CI, 62.3% to 64.0%), with the largest relative decreases among individuals ages 45 to 64 years (61.4% [95% CI, 60.3% to 62.5%] vs 57.7% [95% CI, 56.3% to 59.2%]), those with 2 or more comorbidities (67.1% [95% CI, 66.0% to 68.2%] to 63.0% [95% CI, 61.6% to 64.4%]), and Black individuals (72.5% [95% CI, 70.3 to 74.6] vs 68.4% [95% CI, 65.3% to 71.3%]). Recent successful cessation remained unchanged during 2019 to 2020. Observed mean (SD) 4-week NRT sales volume in the prepandemic period was 105.6 (66.2) million gum pieces, 51.9 (31.6) million lozenges, and 2.0 (1.1) million patches. Compared with expected sales, observed sales during the COVID-19 pandemic were lower by 13.0% (95% CI, -13.7% to -12.3%) for lozenges, 6.4% (95% CI, -7.3% to -5.5%) for patches, and 1.2% (95% CI, -1.7% to -0.7%) for gum. Conclusions and Relevance: This study found that serious smoking cessation activity among US adults decreased immediately and remained depressed for more than a year during the COVID-19 pandemic. These findings suggest that smokers experiencing disproportionately negative outcomes during the pandemic should be reengaged and assisted in quit attempts.

Gender difference in working from home and psychological distress - A national survey of U.S. employees during the COVID-19 pandemic.

The COVID-19 pandemic has precipitated broad and extensive changes in the way people live and work. While the general subject of working from home has recently drawn increased attention, few studies have assessed gender differences in vulnerability to the potential mental health effects of working from home. Using data from 1,585 workers who participated in the Health, Ethnicity, and Pandemic (HEAP) study, a national survey conducted in the U.S. during the COVID-19 pandemic in October 2020, associations of working from home with psychological distress were examined with weighted logistic regression among 1,585 workers and stratified by gender. It was found that workers who worked from home had higher odds of psychological distress (aOR and 95% CI = 2.62 [1.46, 4.70]) compared to workers who did not work from home, adjusting for demographic factors, socioeconomic status, and health behaviors. In gender-stratified analyses, this positive association between working from home and psychological distress was significant in women (aOR and 95% CI = 3.68 [1.68, 8.09]) but not in men. These results have implications for female workers' mental health in the transition towards working from home in the COVID-19 pandemic era.

Association between racial discrimination and delayed or forgone care amid the COVID-19 pandemic.

Racial discrimination has intensified in the U.S. during the COVID-19 pandemic, but how it disrupted healthcare is largely unknown. This study investigates the association of racial discrimination with delaying or forgoing care during the pandemic based on data from a nationally representative survey, the Health, Ethnicity and Pandemic (HEAP) study (n = 2552) conducted in October 2020 with Asians, Hispanics and non-Hispanic Blacks oversampled. Racial discrimination during the pandemic was assessed in three domains: experienced racial discrimination, race-related cyberbullying, and Coronavirus racial bias beliefs. Respondents answered whether they had delayed or forgone any type of healthcare due to the pandemic. Overall, 63.7% of respondents reported delaying or forgoing any healthcare during the pandemic. About 20.3% East/Southeast Asians, 18.6% non-Hispanic Blacks and 15.9% Hispanics reported experiences of racial discrimination, compared with 2.8% of non-Hispanic Whites. Experienced racial discrimination was associated with delaying/forgoing care among non-Hispanic Blacks (Adjusted odds ratios[AOR] = 4.58, 95% confidence interval[CI]: 2.22-9.45), Hispanics (AOR = 3.88, 95%CI: 1.51-9.98), and East/Southeast Asians (AOR = 2.14, 95%CI: 1.22-3.77). Experiencing race-related cyberbullying was significantly associated with delaying/forgoing care among non-Hispanic Blacks (AOR = 1.34, 95%CI: 1.02-1.77) and East/Southeast Asians (AOR = 1.51, 95%CI: 1.19-1.90). Coronavirus racial bias was significantly associated with delaying/forgoing care among East/Southeast Asians (AOR = 1.55, 95%CI: 1.16-2.07). The three domains of racial discrimination were consistently associated with delayed or forgone health care among East/Southeast Asians during the COVID-19 pandemic; some of the associations were also seen among non-Hispanic Blacks and Hispanics. These results demonstrate that addressing racism is important for reducing disparities in healthcare delivery during the pandemic and beyond.

Changes in Cancer Screening in the US During the COVID-19 Pandemic.

Importance: Health care was disrupted in the US during the first quarter of 2020 with the emergence of the COVID-19 pandemic. Early reports in selected samples suggested that cancer screening services decreased greatly, but population-based estimates of cancer screening prevalence during 2020 have not yet been reported. Objective: To examine changes in breast cancer (BC), cervical cancer (CC), and colorectal cancer (CRC) screening prevalence with contemporary national, population-based Behavioral Risk Factor Surveillance System (BRFSS) data. Design, Setting, and Participants: This survey study included respondents from the 2014, 2016, 2018, and 2020 BRFSS surveys who were eligible for BC (women aged 50-74 years), CC (women aged 25-64 years), and CRC (women and men aged 50-75 years) screening. Data analysis was performed from September 2021 to February 2022. Exposures: Calendar year. Main Outcomes and Measures: Self-reported receipt of a recent (defined as in the past year) BC, CC, and CRC screening test. Adjusted prevalence ratios (aPRs) comparing 2020 vs 2018 prevalence and 95% CIs were computed. Results: In total, 479 248 individuals were included in the analyses of BC screening, 301 453 individuals were included in CC screening, and 854 210 individuals were included in CRC screening, In 2020, among respondents aged 50 to 75 years, 14 815 (11.4%) were Black, 12 081 (12.6%) were Hispanic, 156 198 (67.3%) were White, and 79 234 (29.9%) graduated from college (all percentages are weighted). After 4 years (2014-2018) of nearly steady prevalence, past-year BC screening decreased by 6% between 2018 and 2020 (from 61.6% in 2018 to 57.8% in 2020; aPR, 0.94; 95% CI, 0.92-0.96), and CC screening decreased by 11% (from 58.3% in 2018 to 51.9% in 2020; aPR, 0.89; 95% CI, 0.87-0.91). The magnitude of these decreases was greater in people with lower educational attainment and Hispanic persons. CRC screening prevalence remained steady; past-year stool testing increased by 7% (aPR, 1.07; 95% CI, 1.02-1.12), offsetting a 16% decrease in colonoscopy (aPR, 0.84; 95% CI, 0.82-0.88) between 2018 and 2020. Conclusions and Relevance: In this survey study, stool testing increased and counterbalanced a decrease in colonoscopy during 2020, and BC and CC screening modestly decreased. How these findings might be associated with outcomes is not yet known, but they will be important to monitor, especially in populations with lower socioeconomic status, who experienced greater screening decreases during the COVID-19 pandemic.

Racial Discrimination, Mental Health and Behavioral Health During the COVID-19 Pandemic: a National Survey in the United States.

BACKGROUND: While hate crimes rose during the COVID-19 pandemic, few studies examined whether this pandemic-time racial discrimination has led to negative health consequences at the population level. OBJECTIVE: We examined whether experienced and perceived racial discrimination were associated with mental or behavioral health outcomes during the pandemic. DESIGN: In October 2020, we conducted a national survey with minorities oversampled that covered respondents' sociodemographic background and health-related information. PARTICIPANTS: A total of 2709 participants responded to the survey (response rate: 4.2%). MAIN MEASURES: The exposure variables included (1) experienced and encountered racial discrimination, (2) experienced racial and ethnic cyberbullying, and (3) perceived racial bias. Mental health outcomes were measured by psychological distress and self-rated happiness. Measures for behavioral health included sleep quality, change in cigarette smoking, and change in alcohol consumption. Weighted logistic regressions were performed to estimate the associations between the exposure variables and the outcomes, controlling for age, gender, race and ethnicity, educational attainment, household income, eligibility to vote, political party, COVID-19 infection, and geographic region. Separate regressions were performed in the six racial and ethnic subgroups: non-Hispanic White, non-Hispanic Black, Hispanic, East Asian, South Asian, and Southeast Asian respondents. KEY RESULTS: Experienced racial discrimination was associated with higher likelihood of psychological distress (adjusted odds ratio [AOR] = 2.18, 95% confidence interval [95% CI]: 1.34-3.55). Experienced racial discrimination (AOR = 2.31, 95% CI: 1.34-3.99) and perceived racial bias (AOR = 1.05, 95% CI: 1.00-1.09) were both associated with increased cigarette smoking. The associations between racial discrimination and mental distress and substance use were most salient among Black, East Asian, South Asian, and Hispanic respondents. CONCLUSIONS: Racial discrimination may be associated with higher likelihood of distress, and cigarette smoking among racial and ethnic minorities. Addressing racial discrimination is important for mitigating negative mental and behavioral health ramifications of the pandemic.

Negative Employment Changes During the COVID-19 Pandemic and Psychological Distress: Evidence From a Nationally Representative Survey in the U.S.

OBJECTIVE: We examined associations of negative employment changes during the COVID-19 pandemic with mental health in a national sample of U.S. workers, and whether the associations differed by race. METHODS: Data were from the Health, Ethnicity, and Pandemic Study, a cross-sectional survey. The effects of negative employment changes on psychological distress in 1510 workers were examined via linear regression, and stratified analyses were conducted across racial subgroups. RESULTS: After adjustment for covariates, compared to workers with no change in employment, those who experienced permanent job loss had the highest psychological distress (ß and 95% CI = 3.27 [1.89, 4.65]). Permanent job loss had the greatest effect on psychological distress in Blacks and Asians. CONCLUSION: Negative employment changes related to the pandemic may have deleterious impacts on workers' mental health, with disproportionate effects on racial minorities.

Disparities in telehealth utilization during the COVID-19 pandemic: Findings from a nationally representative survey in the United States.

Telehealth is an important source of health care during the COVID-19 pandemic. Evidence is scarce regarding disparities in telehealth utilization in the United States. We aimed to investigate the prevalence and factors associated with telehealth utilization among US adults. Our data came from the Health, Ethnicity, and Pandemic Study, a nationally representative survey conducted in October 2020, with 2554 adults ≥ 18 and an oversample of racial/ethnic minorities. Telehealth utilization was measured as self-reported teleconsultation with providers via email, text message, phone, video, and remote patient monitoring during the pandemic. Logistic regressions were performed to examine the association between telehealth use and factors at the individual, household, and community levels. Overall, 43% of the sample reported having used telehealth, representing 114.5 million adults in the nation. East and Southeast Asians used telehealth less than non-Hispanic Whites (OR = 0.5, 95% CI: 0.3-0.8). Being uninsured (compared with private insurance: OR = 0.4, 95% CI: 0.2-0.8), and those with limited broadband coverage in the community (OR = 0.5, 95% CI: 0.3-0.8) were less likely to use telehealth. There is a need to develop and implement more equitable policies and interventions at both the individual and community levels to improve access to telehealth services and reduce related disparities.

Changes of Exercise, Screen Time, Fast Food Consumption, Alcohol, and Cigarette Smoking during the COVID-19 Pandemic among Adults in the United States.

OBJECTIVE: To investigate the impact of the COVID-19 pandemic on multiple lifestyle changes among adults in the United States (USA). METHODS: We conducted a survey, the Health, Ethnicity, and Pandemic (HEAP) Study, in October 2020 among USA adults. Participants were selected from the United States using 48 sampling strata, including age, race, ethnicity, education, and gender, and were asked to report five lifestyle behaviors (i.e., exercise time, screen time, fast-food meal consumption, alcohol drinking, and cigarette smoking) before and during the COVID-19 pandemic. The associations of sociodemographic factors with each lifestyle change were estimated using weighted multivariable logistic regression models. RESULTS: All 2709 HEAP participants were included in this study. Compared to pre-pandemic, the time spent on exercise decreased (32.06 vs. 38.65 min/day; p < 0.001) and screen time increased (6.79 vs. 5.06 h/day; p < 0.001) during the pandemic. The percentage of individuals who reported consuming fast-food meals ≥3 times/week decreased from 37.7% before the pandemic to 33.3% during the pandemic. The percentage of heavy drinkers (≥5 times/week) increased from 20.9% before the pandemic to 25.7% during the pandemic. Among smokers, heavy smoking (≥11 cigarettes/day) increased from 5.8% before the pandemic to 7.9% during the pandemic. We also identified subgroups who were more vulnerable to adverse influences from the pandemic, including racial/ethnic minority groups and young adults. CONCLUSIONS: The COVID-19 pandemic had negative impacts on multiple lifestyle behaviors among Americans. Mitigating such negative impacts of COVID-19 requires effective interventions, particularly for some vulnerable subgroups.