Do healthcare providers consider the social determinants of health? Results from a nationwide cross-sectional study in the United States.

BACKGROUND: While the social determinants of health (SDOH) have a greater impact on individual health outcomes than the healthcare services a person receives, healthcare providers face barriers to addressing these factors in clinical settings. Previous studies have shown that providers often lack the necessary knowledge and resources to adequately screen for and otherwise assist patients with unmet social needs. This study explores the perceptions and behaviors related to SDOH among healthcare providers in the United States (US). METHODS: This cross-sectional study analyzed data from a 22-item online survey using Reaction Data's research platform of healthcare professionals in the US. Survey items included demographic questions as well as Likert scale questions about healthcare providers' perceptions and behaviors related to SDOH. Descriptive statistics were calculated, and further analyses were conducted using t-tests and analysis of variance. RESULTS: A total of 563 respondents completed the survey, with the majority being male (72.6%), White (81%), and located in urban areas (82.2%). In terms of perceptions, most providers agreed or strongly agreed that SDOH affect the health outcomes of all patients (68.5%), while only 24.1% agreed or strongly agreed that their healthcare setting was set up to address SDOH. In terms of behavior, fewer than half currently screened for SDOH (48.6%) or addressed (42.7%) SDOH in other ways. Most providers (55.7%) wanted additional resources to focus on SDOH. Statistical analyses showed significant differences by gender, with females being more likely than males to prioritize SDOH, and by specialty, with psychiatrists, pediatricians, and family/general medicine practitioners being more likely to prioritize SDOH. CONCLUSION: Most healthcare providers understand the connection between unmet social needs and their patients' health, but they also feel limited in their ability to address these issues. Ongoing efforts to improve medical education and shift the healthcare system to allow for payment and delivery of more holistic care that considers SDOH will likely provide new opportunities for healthcare providers. In addition to what they can do at the institutional and patient levels, providers have the potential to advocate for policy and system changes at the societal level that can better address the root causes of social issues.

The effects of COVID-19 stressors and family life on anxiety and depression one-year into the COVID-19 pandemic.

The purpose of this study was to examine the effects of Coronavirus (COVID-19)-related stressors and family health on adult anxiety and depressive symptoms 1 year into the pandemic. The sample consisted of 442 adults living in the United States who were recruited via Amazon Mechanical Turk. Data were analyzed using multiple logistic regression. Results indicated that compared to a sample 1 month into the pandemic, participants in the current sample reported worse family health and increases in both positive and negative perceptions of the pandemic on family life and routines. COVID-19 stressors and perceived negative effects of the pandemic on family life increased the odds for moderate-to-severe depression and anxiety while having more family health resources decreased the odds for depression and anxiety symptoms. Participants reported lower odds for worse depression and anxiety since the beginning of the pandemic when they reported more positive family meaning due to the pandemic. The results suggest a need to consider the impact of family life on mental health in pandemics and other disasters.

The longitudinal association between cognitive control capacities, suicidality, and depression during late adolescence and young adulthood.

This study examined the association between cognitive control capacities, suicidal thoughts and attempts, and depressive symptoms during late adolescence and young adulthood. The sample included 4192 participants (55.5% female) from the United States who participated in Waves III (2001-2002; respondent age 18-26 years) and IV (2007-2008; respondent age 24-33 years) of the National Longitudinal Study of Adolescent to Adult Health. Data were analyzed using structural equation modeling. Suicidality in late adolescence predicted depressive symptoms in young adulthood. Depressive symptoms were not predictive of later suicide ideation nor attempts. Working memory was associated with lower depressive symptoms. Higher verbal ability was associated with more suicidal thoughts but not attempts. Internal locus of control was associated with decreased depressive symptoms and suicidal thoughts/attempts in young adulthood. Findings suggest that cognitive control capacities developed in adolescence differentially predict depressive symptoms, suicidal thoughts, and suicide attempts in young adulthood.

Risk and protective factors associated with being bullied on school property compared with cyberbullied.

BACKGROUND: We identified bullying victimization (bullied on school property versus cyberbullied) by selected demographic, personal characteristic, and behavior variables. METHODS: A cross-sectional analysis was conducted on adolescents (n = 13,583) completing the 2013 Youth Risk Behavior Survey (YRBS) in grades 9 through 12. RESULTS: Being bullied on school property in the past 12 months was significantly more common in females than males, in earlier school grades, and in Whites and other racial groups compared with Blacks and Hispanics. Being bullied on school property generally decreased with later school grades, but cyberbullying in the past 12 months remained constant. Being bullied on school property or cyberbullied was significantly positively associated with mental health problems, substance use, being overweight, playing video games for 3 or more hours per day, and having asthma. The association was greatest with having mental health problems. Cyberbullying was generally more strongly associated with these conditions and behaviors. Protective behaviors against bullying victimization included eating breakfast every day, being physically active, and playing on sports teams. Those experiencing victimization on school property and cyberbullying were significantly more likely to experience mental health problems compared with just one of these types of bullying or neither. CONCLUSIONS: Cyberbullying victimization is generally more strongly associated with mental health problems, substance use, being overweight, playing video games for 3 or more hours per day, and having asthma than bullying victimization on school property. However, because bullying on school property is more common in grades 9-11, this form of bullying has a greater burden on these conditions and behaviors in these school grades.

Health Education Specialists' Knowledge, Attitudes, and Perceptions of the Patient Protection and Affordable Care Act.

The changing landscape of health care as a result of the Patient Protection and Affordable Care Act (ACA) may provide new opportunities for health education specialists (HES). The purpose of this study was to survey HES in the United States on their knowledge and attitudes of the ACA and assess their perceptions of job growth under the law. A random sample of 220 (36% response rate) certified HES completed a 53-item cross sectional survey administered online through Qualtrics. Findings were compared to public opinion on health care reform. HES are highly favorable of the law (70%) compared to the general public (23%). A total of 85% of respondents were able to list a provision of the ACA, and most (81%) thought the ACA would be successful at increasing insured Americans. Over half (64.6%) believe job opportunities will increase. Those who viewed the law favorably were significantly more likely to score better on a knowledge scale related to the ACA. HES understand publicized provisions but are uncertain about common myths and specific provisions related to Title IV, "Prevention of Chronic Disease and Improving Public Health." Directed and continuing education to HES regarding the ACA is warranted.

Understanding and predicting social media use among community health center patients: a cross-sectional survey.

BACKGROUND: The use of social media by health care organizations is growing and provides Web-based tools to connect patients, caregivers, and providers. OBJECTIVE: The aim was to determine the use and factors predicting the use of social media for health care-related purposes among medically underserved primary care patients. METHODS: A cross-sectional survey was administered to 444 patients of a federally qualified community health center. RESULTS: Community health center patients preferred that their providers use email, cell phones for texting, and Facebook and cell phone apps for sharing health information. Significantly more Hispanic than white patients believed their providers should use Facebook (P=.001), YouTube (P=.01), and Twitter (P=.04) for sharing health information. Use and intentions to use social media for health-related purposes were significantly higher for those patients with higher subjective norm scores. CONCLUSIONS: Understanding use and factors predicting use can increase adoption and utilization of social media for health care-related purposes among underserved patients in community health centers.

Psychometric Evaluation of the Trauma-Informed Care Provider Assessment Tool.

The increasing recognition of adverse childhood experiences as a significant factor in adult health outcomes underscores the need for trauma-informed care (TIC) in healthcare settings. The purpose of this study was to assess the psychometric properties of the TIC Provider Assessment Tool (TIC-PAT) designed for primary care providers. The TIC-PAT aligns with the TIC Pyramid framework and assesses both universal trauma precautions and trauma-specific care. A total of 176 primary care providers in the United States completed the TIC-PAT through an anonymous online survey. Findings through exploratory and confirmatory factor analyses revealed a unidimensional (one-factor) model, consolidating questions into a concise 10-item measure. This study contributes an efficient assessment tool for the provision of TIC by primary care providers in healthcare settings, promoting better patient-provider interactions and enhancing provider awareness of trauma's impact on health.

U.S. Physicians' Training and Experience in Providing Trauma-Informed Care in Clinical Settings.

Trauma-informed care (TIC) is a comprehensive approach that focuses on the whole individual. It acknowledges the experiences and symptoms of trauma and their impact on health. TIC prioritizes physical and emotional safety through a relationship of trust that supports patient choice and empowerment. It provides a safe and respectful healing environment that considers specific needs while promoting a greater sense of well-being, patient engagement, and partnership in the treatment process. Given the prevalence of trauma, this descriptive cross-sectional study examined the attitudes and perspectives of U.S. physicians (N = 179; 67% males; 84% White; 43% aged 56-65) in providing trauma-informed care using an anonymous 29-item online survey administered by Reaction Data. Findings showed that 16% (n = 18) of physicians estimated that >50% of their patients have a history of trauma. Commonly perceived barriers to providing TIC were resource/time/administrative constraints, provider stress, limited awareness of the right provider to refer patients who experienced trauma, and inadequate TIC emphasis in medical education/training. Expanding physicians' knowledge base of trauma through training and organizational policy/support is crucial in enhancing their TIC competence, particularly in caring for patients with complex care needs whose social determinants increase their risk of exposure to adverse experiences that carry lasting physical and psychological effects.

Tweaking and tweeting: exploring Twitter for nonmedical use of a psychostimulant drug (Adderall) among college students.

BACKGROUND: Adderall is the most commonly abused prescription stimulant among college students. Social media provides a real-time avenue for monitoring public health, specifically for this population. OBJECTIVE: This study explores discussion of Adderall on Twitter to identify variations in volume around college exam periods, differences across sets of colleges and universities, and commonly mentioned side effects and co-ingested substances. METHODS: Public-facing Twitter status messages containing the term "Adderall" were monitored from November 2011 to May 2012. Tweets were examined for mention of side effects and other commonly abused substances. Tweets from likely students containing GPS data were identified with clusters of nearby colleges and universities for regional comparison. RESULTS: 213,633 tweets from 132,099 unique user accounts mentioned "Adderall." The number of Adderall tweets peaked during traditional college and university final exam periods. Rates of Adderall tweeters were highest among college and university clusters in the northeast and south regions of the United States. 27,473 (12.9%) mentioned an alternative motive (eg, study aid) in the same tweet. The most common substances mentioned with Adderall were alcohol (4.8%) and stimulants (4.7%), and the most common side effects were sleep deprivation (5.0%) and loss of appetite (2.6%). CONCLUSIONS: Twitter posts confirm the use of Adderall as a study aid among college students. Adderall discussions through social media such as Twitter may contribute to normative behavior regarding its abuse.

COVID-19 Stress, Religious Affiliation, and Mental Health Outcomes Among Adolescents.

PURPOSE: To examine the relationship between religious affiliation, stressors due to the COVID-19 pandemic, and mental health challenges in a representative sample of adolescents. METHODS: The sample was composed of 71,001 Utah adolescents who participated in a survey by the Utah Department of Health in 2021. Data are representative of all Utah adolescents in grades 6, 8, 10, and 12. Bootstrapped mediation was used to test indirect effects of religious affiliation on mental health challenges through COVID-19 stressors. RESULTS: Religious affiliation was related to significantly lower rates of teen mental health challenges as measured by suicidal thoughts, suicide attempts, and depression. For religiously affiliated adolescents, the rate of considering and attempting suicide was nearly half of that of unaffiliated adolescents. In mediation analyses, affiliation was indirectly related to mental health challenges (suicide ideation, suicide attempt, and depression) through stressors from COVID-19, including affiliated adolescents experiencing the following: less anxiety, fewer family fights, fewer school difficulties, and fewer skipped meals. However, affiliation was positively related to becoming sick with COVID-19 (or having COVID-19 symptoms), which was related to more suicidal thoughts. DISCUSSION: Findings suggest that adolescent religious affiliation may be a promotive factor that decreases mental health challenges through a reduction in COVID-19-related stressors, except religious individuals may be more likely to become sick. To increase positive mental health outcomes among adolescents during pandemic times, consistent and clear policies that facilitate religious connections that also align with good physical health measures will be critical.

Influence of Social Media Uses and Gratifications on Family Health among U.S. Parents: A Cross-Sectional Study.

Some research suggests that parents on social media have access to greater social support and health information. However, evidence also connects parental social media use to negative outcomes including increased parental stress, depression, and distraction. Using the uses and gratification theory, this study goes beyond measures of parents' individual mental health and explores social media use and its association with family well-being. Family health outcomes were predicted to vary with parents' use and gratifications of social media, with parents who use social media primarily for information and connection scoring higher on family health and parents who used social media for entertainment scoring worse on family health. The sample included 482 heterosexual married or cohabiting partners recruited through a Qualtrics panel. All participants were parents of children ages of 3-13, with mothers and fathers each completing the survey. Findings indicated that fathers' use of social media for entertainment and connecting with family and friends was associated with better family well-being and health resources (p < 0.01). However, mothers' use of social media did not have a statistically meaningful relationship with family health variables. There was no evidence that parental social media use was associated with negative family health outcomes. Longitudinal data is needed to determine the temporal relationship between social media use and family health. Public health professionals interested in improving family health may consider how to better reach fathers on social media to increase health resources.

Positive adult experiences as turning points for better adult mental health after childhood adversity.

Background: The purpose of this study was to examine whether positive adult experiences (PAEs) were associated with lower odds for anxiety and depression even in the presence of high adverse childhood experiences (ACEs) or low positive childhood experiences (PCEs). Methods: The sample was comprised of 435 adults (48% female), ages 18-56 years and who were living in the United States. Participants completed a survey about their childhood experiences, PAEs, and mental health. A series of multiple logistic regression models were estimated in Stata 17 to examine the aims. Results: Positive childhood experiences were associated with higher PAE scores, but ACEs did not significantly correlate with PAEs. Positive adult experiences were associated with lower odds of moderate-to-severe anxiety and depression, especially among those who had experienced high ACEs or low PCEs. Younger adults were more likely to experience a positive benefit from PAEs compared to adults 35 years and older. Conclusion: Even when ACEs were high or PCEs were low, adults with high PAEs had lower odds for moderate-to-severe anxiety and/depression. Positive adult experiences may be an opportunity to turn the tide for individuals who experienced childhood adversity and/or low levels of support or connection.

COVID-19 and Psychosocial Well-Being: Did COVID-19 Worsen U.S. Frontline Healthcare Workers' Burnout, Anxiety, and Depression?

Healthcare workers are highly regarded for their compassion, dedication, and composure. However, COVID-19 created unprecedented demands that rendered healthcare workers vulnerable to increased burnout, anxiety, and depression. This cross-sectional study assessed the psychosocial impact of COVID-19 on U.S. healthcare frontliners using a 38-item online survey administered by Reaction Data between September and December 2020. The survey included five validated scales to assess self-reported burnout (Maslach Summative Burnout Scale), anxiety (GAD-7), depression (PHQ-2), resilience (Brief Resilience Coping Scale), and self-efficacy (New Self-Efficacy Scale-8). We used regression to assess the relationships between demographic variables and the psychosocial scales index scores and found that COVID-19 amplified preexisting burnout (54.8%), anxiety (138.5%), and depression (166.7%), and reduced resilience (5.70%) and self-efficacy (6.5%) among 557 respondents (52.6% male, 47.5% female). High patient volume, extended work hours, staff shortages, and lack of personal protective equipment (PPE) and resources fueled burnout, anxiety, and depression. Respondents were anxious about the indefinite duration of the pandemic/uncertain return to normal (54.8%), were anxious of infecting family (48.3%), and felt conflicted about protecting themselves versus fulfilling their duty to patients (44.3%). Respondents derived strength from their capacity to perform well in tough times (74.15%), emotional support from family/friends (67.2%), and time off work (62.8%). Strategies to promote emotional well-being and job satisfaction can focus on multilevel resilience, safety, and social connectedness.

There's an app for that: content analysis of paid health and fitness apps.

BACKGROUND: The introduction of Apple's iPhone provided a platform for developers to design third-party apps, which greatly expanded the functionality and utility of mobile devices for public health. OBJECTIVE: This study provides an overview of the developers' written descriptions of health and fitness apps and appraises each app's potential for influencing behavior change. METHODS: Data for this study came from a content analysis of health and fitness app descriptions available on iTunes during February 2011. The Health Education Curriculum Analysis Tool (HECAT) and the Precede-Proceed Model (PPM) were used as frameworks to guide the coding of 3336 paid apps. RESULTS: Compared to apps with a cost less than US $0.99, apps exceeding US $0.99 were more likely to be scored as intending to promote health or prevent disease (92.55%, 1925/3336 vs 83.59%, 1411/3336; P<.001), to be credible or trustworthy (91.11%, 1895/3336 vs 86.14%, 1454/3349; P<.001), and more likely to be used personally or recommended to a health care client (72.93%, 1517/2644 vs 66.77%, 1127/2644; P<.001). Apps related to healthy eating, physical activity, and personal health and wellness were more common than apps for substance abuse, mental and emotional health, violence prevention and safety, and sexual and reproductive health. Reinforcing apps were less common than predisposing and enabling apps. Only 1.86% (62/3336) of apps included all 3 factors (ie, predisposing, enabling, and reinforcing). CONCLUSIONS: Development efforts could target public health behaviors for which few apps currently exist. Furthermore, practitioners should be cautious when promoting the use of apps as it appears most provide health-related information (predisposing) or make attempts at enabling behavior, with almost none including all theoretical factors recommended for behavior change.

Use of social media in health promotion: purposes, key performance indicators, and evaluation metrics.

Despite the expanding use of social media, little has been published about its appropriate role in health promotion, and even less has been written about evaluation. The purpose of this article is threefold: (a) outline purposes for social media in health promotion, (b) identify potential key performance indicators associated with these purposes, and (c) propose evaluation metrics for social media related to the key performance indicators. Process evaluation is presented in this article as an overarching evaluation strategy for social media.

Life experience pathways to college student emotional and mental health: A structural equation model.

Objective: Previous research suggests that both adverse childhood experiences (ACEs), positive childhood experiences (PCEs), and current life experiences are associated with emotional wellbeing and mental health. The purpose of this study was to explore the influence of these life experience and coping processes on college student emotional and mental health. Participants: College students (N = 555) were recruited from a large western university. Methods: Participants completed an online cross-sectional survey measuring early and current life experiences, cognitive and emotional coping efforts, and emotional and mental health outcomes. Data were analyzed using structural equation modeling. Results: There was an indirect effect of PCEs on emotional and mental health through cognitive and emotional coping efforts. No association was observed between ACEs and mental health. Conclusions: Increases in PCEs are protective, enhance coping efforts, and strengthen emotional and mental health outcomes among college students.

COVID-19 Health Beliefs Regarding Mask Wearing and Vaccinations on Twitter: Deep Learning Approach.

Background: Amid the global COVID-19 pandemic, a worldwide infodemic also emerged with large amounts of COVID-19-related information and misinformation spreading through social media channels. Various organizations, including the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), and other prominent individuals issued high-profile advice on preventing the further spread of COVID-19. Objective: The purpose of this study is to leverage machine learning and Twitter data from the pandemic period to explore health beliefs regarding mask wearing and vaccines and the influence of high-profile cues to action. Methods: A total of 646,885,238 COVID-19-related English tweets were filtered, creating a mask-wearing data set and a vaccine data set. Researchers manually categorized a training sample of 3500 tweets for each data set according to their relevance to Health Belief Model (HBM) constructs and used coded tweets to train machine learning models for classifying each tweet in the data sets. Results: In total, 5 models were trained for both the mask-related and vaccine-related data sets using the XLNet transformer model, with each model achieving at least 81% classification accuracy. Health beliefs regarding perceived benefits and barriers were most pronounced for both mask wearing and immunization; however, the strength of those beliefs appeared to vary in response to high-profile cues to action. Conclusions: During both the COVID-19 pandemic and the infodemic, health beliefs related to perceived benefits and barriers observed through Twitter using a big data machine learning approach varied over time and in response to high-profile cues to action from prominent organizations and individuals.

The effects of adverse and advantageous childhood experiences on adult health in a low-income sample.

BACKGROUND: Previous studies have indicated the advantageous childhood experiences (counter-ACEs) may improve health in adulthood regardless of adverse childhood experiences (ACEs) scores. However, these studies have primarily been conducted in low-risk communities, and little is known whether the results are similar in low-income settings. OBJECTIVE: The purpose of this study was to examine the effects of ACEs and counter-ACEs on mental and physical health in a low-income sample. A secondary objective was to assess the effects of repeated and prolonged exposure to ACEs on later health. PARTICIPANTS AND SETTING: The sample included 206 low-income adults living in the western United States who completed a survey about their childhood experiences and adult health. METHODS: A series of logistic regression analyses were performed to examine the effects of ACEs and counter-ACEs on adult health. RESULTS: Irrespective of ACEs, counter-ACEs were associated with lower odds of having two or more emotional and cognitive health problems and lower odds of suicidality in the past 12 months. When accounting for counter-ACEs, ACEs were associated with higher odds of having ever smoked and suicidality in the past 12 months, though these odds were attenuated compared to the unadjusted models. In the presence of repeated or prolonged ACEs exposure, counter-ACEs were associated with lower odds of having ever smoked and emotional and cognitive health problems. CONCLUSIONS: The findings suggest that helping children develop healthy relationships within their family, community, and school may lead to improved health in adulthood even in the presence of poverty and childhood adversity.

Protection Motivation During COVID-19: A Cross-Sectional Study of Family Health, Media, and Economic Influences.

BACKGROUND: Protection motivation to practice preventive behaviors is necessary for sustained mitigation during coronavirus disease 2019 (COVID-19); however, limited research exists on the ecological sources of influence for COVID-19 protection motivation. AIM: To explore sources of influence (family health, media consumption, and loss of work hours) on COVID-19 protection motivation. METHOD: An online quantitative survey of U.S. adults (N = 501) aged 18 years or older was administered using Qualtrics with participants recruited through Amazon Mechanical Turk. Data were collected on constructs related to the protection motivation theory and theory of planned behavior as well as sources of influence and intention to socially distance and socially isolate during COVID-19. Constructs were further defined through exploratory and confirmatory factor analyses. Structural equation modeling was used to determine relationships between constructs. RESULTS: A two-factor model was identified with threat appraisal as one factor and subjective norms appraisal, coping appraisal, and behavioral intention loading as another factor. Higher news media consumption and loss of work hours due to COVID-19 were both significant predictors of increased threat appraisal. Family healthy lifestyle and family health resources were significantly related to increases in the subjective norms, coping appraisal, and behavioral intention appraisal factor. CONCLUSIONS: Family health, news media consumption, and loss of work hours are associated with COVID-19 protection motivation. COVID-19 protection motivation might be enhanced through policies and messaging that can affect ecological sources of influence.

Family well-being and individual mental health in the early stages of COVID-19.

BACKGROUND: The objective of the study was to examine the association of COVID-19 with family well-being and adult mental health 1 month into the COVID-19 pandemic in the United States. Prior pandemics have had long-term effects on mental health. COVID-19 and its related stressors, such as loss of work and social distancing requirements, may have a profound impact on short-term and long-term mental health. Family stress theory indicates that subjective family meaning making and family resources affect how stressors lead to outcomes. METHOD: Participants, adults ages 18 years and older (N = 416), completed a cross-sectional online survey measuring depressive and anxiety symptoms, family health, subjective family meaning making, and loss of work resulting from COVID-19. Data were analyzed using a structural equation modeling framework. RESULTS: Results indicated that subjective negative family meaning and effects were associated with more depression and anxiety. Higher family health resources were associated with less depression and anxiety. Family health resources mediated the relationships between COVID-19 loss of work with depression and anxiety. CONCLUSION: COVID-19 associated stressors 1 month into the pandemic had modest effects on family meaning making and family health resources. Individuals from families whose health resources were negatively impacted by COVID-19 reported more anxiety and depressive symptoms. Health care and public health systems should consider family health resources to help reduce the negative effects of COVID-19 on mental health. Longitudinal research is needed to examine the accumulation of stressors over time and the directionality of relationships. (PsycInfo Database Record (c) 2021 APA, all rights reserved).