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.

A Modified Menstrual Attitudes Scale: Heteronormative Attitudes, Sexism, and Attitudes Toward Menstruation in Male and Female Adults.

Social shame and stigma surround menstruation, which may compromise women's health and rights in various contexts. Men's attitudes are particularly important because men often hold positions of power that influence women's experience. This study examined factors associated with menstrual attitudes, including heteronormative attitudes, sexism, and family influences. A cross-sectional Qualtrics panel survey (n = 802; aged 18-44; 50.8% female) was performed. We tested a revised menstrual attitudes scale based on items drawn from previously validated measures. Data were analyzed using a structural equation modeling framework. Factor analysis identified and confirmed a 5-factor model for menstrual attitudes. Men endorsed more negative attitudes toward menstruation than women; however, this difference was largely explained by factors other than gender in the structural equation model. After controlling for family and demographic characteristics, attitudes toward openness and secrecy surrounding menstruation were most strongly associated with gender role expectations and hostile sexism. Benevolent sexism was associated with finding menstruation debilitating, denying menstrual symptoms, and endorsing avoidance of activities during menstruation. Heteronormative and sexist attitudes were associated with more negative menstrual attitudes, while increased menstrual knowledge was associated with more positive menstrual attitudes. The difference in menstrual attitudes between males and females was explained largely by heteronormative attitudes and sexism. This suggests that attitudes toward menstruation are closely linked to social ideals about men and women.

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.

Accessibility of Pharmacist-Prescribed Contraceptives in Utah.

OBJECTIVE: To assess pharmacy participation in and accessibility of pharmacist-prescribed contraception after legislation effective in the state of Utah in 2019. METHODS: A secret-shopper telephone survey was used to assess participation in pharmacist-prescribed contraception. Geospatial analysis was used to map the distribution of participating pharmacies by population characteristics. RESULTS: Of all operating Class A retail pharmacies in Utah, 127 (27%) were providing pharmacist-prescribed contraception 1 year after implementation of the Utah standing order. Oral contraceptive pills were widely accessible (100%); however, other allowed methods were not (vaginal ring 14%; contraceptive patch 2%). Consultation fees and medication costs varied widely. Participating pharmacies were mainly concentrated in population centers. Assuming access to a personal vehicle, urban areas with a high percentage of Hispanic people (Utah's largest minority race or ethnicity group) have access to a participating pharmacy within a 20-minute driving distance. However, access in rural areas with a high percentage Hispanic or other minority were limited. We identified 235 (40%) census tracts with a high proportion of Utah's residents living below the poverty line or of minority race or ethnicity who also had low access to pharmacist-prescribed contraception. CONCLUSIONS: Although the pharmacy-based model is intended to increase access to contraception, practical availability 1 year after the authorization of pharmacist-prescribed contraception in Utah suggests that this service does not adequately serve rural areas, particularly rural areas with a high proportion of minorities and those living below the federal poverty line.

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.

The Family Health Scale: Reliability and Validity of a Short- and Long-Form.

Families strongly influence the health of communities and individuals across the life course, but no validated measure of family health exists. The absence of such a measure has limited the examination of family health trends and the intersection of family health with individual and community health. The purpose of this study was to examine the reliability and validity of the Family Health Scale (FHS), creating a multi-factor long-form and a uniform short-form. The primary sample included 1,050 adults recruited from a national quota sample Qualtrics panel. Mplus version 7 was used to analyze the data using a structural equation modeling framework. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) confirmed a 32-item, 4-factor long-form scale. The four factors included (1) family social and emotional health processes; (2) family healthy lifestyle; (3) family health resources; and (4) family external social supports. A 10-item short-form of the FHS was also validated in the initial sample and a second sample of 401 adults. Both the long-form and short-form FHS correlated in the expected direction with validated measures of family functioning and healthy lifestyle. A preliminary assessment of clinical cutoffs in the short-form were correlated with depression risk. The FHS offers the potential to assess family health trends and to develop accessible, de-identified databases on the well-being of families. Important next steps include validating the scale among multiple family members and collecting longitudinal data.

Political and personal reactions to COVID-19 during initial weeks of social distancing in the United States.

OBJECTIVE: To examine perceptions, behaviors, and impacts surrounding COVID-19 early in the pandemic response. MATERIALS AND METHODS: A cross-sectional survey of 1,030 U.S. adults was administered on March 31st, 2020. This survey examined attitudes toward media, government, and community responses to COVID-19 by political ideology and sociodemographic factors. Knowledge, anxieties, and impacts of COVID-19 were also assessed. RESULTS: Conservatives were more likely to report that COVID-19 was receiving too much media coverage and people were generally overreacting; liberals were more likely to report the government had not done enough in response to the pandemic. Females and those with lower income experienced more COVID-19 related economic anxieties. Those working and with children at home reported higher social, home, and work disruption. Social distancing behaviors were more common among liberals and were associated with increases in depressive symptoms. General knowledge about COVID-19 was widely exhibited across the sample, however, Black and Hispanic respondents were less likely to correctly answer questions about the availability of a vaccine and modes of transmission. CONCLUSIONS: Public health experts should consider the political climate in crafting messaging that appeals to the values of those across the political spectrum. Research on the COVID-19 pandemic should continue to monitor the effects of social distancing on mental health and among vulnerable populations.

The influence of adverse and advantageous childhood experiences during adolescence on young adult health.

BACKGROUND: Research indicates that adverse childhood experiences (ACEs) can lead to poorer adult health, but less is known how advantageous childhood experiences (counter-ACEs) may neutralize the negative effects of ACEs, particularly in young adulthood. PURPOSE: We examined the independent contributions of Adverse Childhood Experiences (ACEs) and Advantageous Childhood Experiences (counter-ACEs) that occur during adolescence on five young adult health indicators: depression, anxiety, risky sexual behaviors, substance abuse, and positive body image. PARTICIPANTS AND SETTING: The sample included 489 adolescents from a large northwestern city in the United States who were 10-13 years at baseline (51 % female). METHODS: Flourishing Families Project survey data were used for this secondary analysis using structural equation modeling. Adolescents and their parents completed an annual survey. ACEs and counter-ACEs were measured over the first five years of the study. The five health indicators were measured in wave 10 when participants were 20-23 years old. RESULTS: Participants had on average 2.7 ACEs and 8.2 counter-ACEs. When both ACEs and counter-ACEs were included in the model, ACEs were not predictive of any of the health indicators and counter-ACEs were predictive of less risky sex (-.12, p < .05), substance abuse (-.12, p < .05), depression (-.11, p < .05), and a more positive body image (.15, p < .01). Higher ratios of counter-ACEs to ACEs had a particularly strong effect on improved young adult health. CONCLUSIONS: Counter-ACEs that occur in adolescence may diminish the negative effects of ACEs on young adult health and independently contribute to better health.

Family-Centered Health Promotion: Perspectives for Engaging Families and Achieving Better Health Outcomes.

Communities and populations are comprised of individuals and families who together affect the health of the community. The family unit is an unparalleled player for maintaining health and preventing disease for public health because members may support and nurture one another through life stages. Preliminary research confirms that family-oriented health promotion and disease prevention are promising strategies because the family unit is both a resource and a priority group needing preventative and curative services across the life course. Although there are growing numbers of successful efforts, family health systems are generally underutilized in health promotion practice. This lack of utilization in policy and practice have hampered the collection of robust evidence for family health. This paper purports that families are important actors in public health. Yet, since no one pattern for healthy families is known, public health practitioners can consider six principle-based approaches to legitimately and respectfully advance the families' innate potential for health promotion and disease prevention. Each perspective aims to foster higher capacity for family health systems to function appropriately in public health practice. Health promotion practitioners and researchers can explore family health perspectives with the potential for systems policy and practice adjustments in public health.

Executive functions and health behaviors associated with the leading causes of death in the United States: A systematic review.

Research indicates that executive functioning may predict health behavior. This systematic review provides an overview of the relationship between domains of executive functioning and health behaviors associated with the leading causes of death in the United States. A total of 114 articles met the inclusion criteria (adult sample, published in English between 1990 and November 2016) and were reviewed and synthesized. Results indicated that although many studies had mixed findings, at least one executive function component was associated with every health behavior. Based on these results, health professionals should consider the role of executive functions in behavior change interventions.

ACEs and counter-ACEs: How positive and negative childhood experiences influence adult health.

BACKGROUND: Numerous studies over the past two decades have found a link between adverse childhood experiences (ACEs) and worse adult health outcomes. Less well understood is how advantageous childhood experiences (counter-ACEs) may lead to better adult health, especially in the presence of adversity. OBJECTIVE: To examine how counter-ACEs and ACEs affect adult physical and mental health using Resiliency Theory as the theoretical framework. PARTICIPANTS AND SETTING: Participants were Amazon mTurk users ages 19-57 years (N = 246; 42% female) who completed an online survey. METHODS: We conducted a series of regression analyses to examine how counter-ACEs and ACEs predicted adult health. RESULTS: Corresponding to the Compensatory Model of Resiliency Theory, higher counter-ACEs scores were associated with improved adult health and that counter-ACEs neutralized the negative impact of ACEs on adult health. Contrary to the Protective Factors Model, there was a stronger relationship between ACEs and worse adult health among those with above average counter-ACEs scores compared to those with below average counter-ACEs scores. Consistent with the Challenge Model, counter-ACEs had a reduced positive effect on adult health among those with four or more ACEs compared to those with fewer than four ACEs. CONCLUSIONS: Overall, the findings suggest that counter-ACEs protect against poor adult health and lead to better adult wellness. When ACEs scores are moderate, counter-ACEs largely neutralize the negative effects of ACEs on adult health. Ultimately, the results demonstrate that a public health approach to promoting positive childhood experiences may promote better lifelong health.

Family-Focused Public Health: Supporting Homes and Families in Policy and Practice.

Life expectancy in the US is on the decline. Mental health issues associated with opioid abuse and suicide have been implicated for this decline necessitating new approaches and procedures. While Public Health 3.0 provides a call to action for stakeholders to work closely together to address such complex problems as these, less attention has been given to engaging and supporting the most important stakeholders and primary producers of health within the US: families and households. The idea that health begins at home is discussed from the perspective of primary, secondary, and tertiary prevention levels. Primary prevention where research provides evidence for the role of the family in healthy child development. Secondary and tertiary prevention where research offers evidence for the role of the family in caregiving. Despite this evidence, greater focus and attention must be placed on the family at all prevention levels as an often overlooked setting of public health practice and level of influence. Prevention across all levels is enhanced as public health practitioners think family when designing and implementing public health policy. Four family impact principles are presented to help guide planning and implementation decisions to nourish family engagement.

Survey of Heteronormative Attitudes and Tolerance Toward Gender Non-conformity in Mountain West Undergraduate Students.

INTRODUCTION: Heteronormative attitudes are prevalent in the United States and may contribute to discrimination against individuals who do not conform to traditional gender roles. Understanding the attitudes of undergraduate students is of particular interest as they may represent emergent societal views toward gender non-conformity. MATERIALS AND METHODS: We conducted an online survey of Mountain West college students between the ages of 18-24 years to assess perceptions of personal gender conformity using the Traditional Masculinity-Femininity Scale (TMF), endorsement of heteronormative beliefs using the Heteronormative Attitudes and Beliefs Scale (HABS), and explicit tolerance of gender non-conformity on a seven-point Likert Scale. RESULTS: The sample (n = 502) was 84% female and 78% white. Approximately 21% of respondents identified as a sexual minority and 36% identified as liberal or somewhat liberal (27% were conservative). The mean score on the TMF was 5.23 (95% CI: 5.15-5.32), indicating moderate levels of personal gender conformity. The mean HABS score was 3.31 (95% CI: 3.19-3.43), indicating relatively low endorsement of heteronormative attitudes. TMF and HABS scores were both highest in heterosexual males. Most respondents (73%) were taught traditional gender roles in their childhood home, and 89% had heard negative opinions about non-conformity. The majority (80.6%) of respondents reported that they know someone who displays non-conforming characteristics and 61% said that they associate gender non-conformity with homosexuality. Approximately, 7% reported they had bullied others for not conforming to their gender. Among heterosexuals, 13.6% reported they had been bullied for gender non-conformity as did 42.7% of LGBTQ-identified individuals. Nearly 1-in-4 (23.6%) believed that male cross-dressing is wrong. Nearly 1-in-5 (17.2%) agreed with the statement that those who dress or act like the opposite sex were more likely to be abused or neglected during their development. CONCLUSION: Students reported relatively low endorsement of heteronormative attitudes and moderate levels of acceptance toward gender non-conforming persons. The sample may reflect shifting attitudes when compared with outside data sets.

Attitudes of U.S. Hispanic and non-Hispanic women toward congenital CMV prevention behaviors: a cross sectional study.

BACKGROUND: Congenital cytomegalovirus (CMV) infection is the most common intrauterine infection. The only way to protect against congenital CMV infection is to practice CMV prevention behaviors. CMV seroprevalence rates are high in Hispanic women. It is unknown whether communication strategies should differ by ethnicity. The purpose of this study was to understand differences between U.S. Hispanic and non-Hispanic women's attitudes toward CMV prevention behaviors and examine the relationship between perceived subjective norms and these attitudes. METHODS: This was a cross-sectional study using an online panel. Participants were U.S. women of childbearing age. The dependent variable was attitude toward practicing CMV prevention behaviors, specifically avoiding sharing cups, food, and utensils with a child and not kissing a child on the lips. RESULTS: Among 818 women (50% Hispanic), 16.8% of Hispanic women and 9.7% of non-Hispanic women (p = 0.002) reported familiarity with CMV. Attitudes toward CMV prevention through avoiding sharing behaviors (M Hispanic = 5.55 vs. M non-Hispanic  = 5.20; p = 0.002) and not kissing a child on the lips (M Hispanic = 4.80 vs. M non-Hispanic = 4.21; p = 0.001) were positive for both ethnicities, but higher for Hispanic women. Hispanic women (M = 5.11) reported higher perceived behavioral control for avoiding kissing a child on the lips than non-Hispanic women (M = 4.63; p = 0.001). Hispanic women who were U.S. born or spoke English primarily more frequently kissed a child on the lips or engaged in sharing behaviors. Additionally, those who spoke Spanish mostly held more positive attitudes toward not kissing on the lips. Significant predictors for more positive attitudes toward CMV prevention behaviors were associated with perceived subjective norms, perceived behavioral control and pre-survey participation in risk behaviors. CONCLUSIONS: Hispanic women have more positive attitudes toward CMV prevention behaviors than non-Hispanic women, however in regression models other factors are more important predictors of positive attitudes than ethnicity. In developing strategies to encourage women to practice CMV prevention behaviors, a focus on further understanding and increasing subjective norms and perceived control over those behaviors may be warranted.

Growth in Adolescent Self-Regulation and Impact on Sexual Risk-Taking: A Curve-of-Factors Analysis.

Adolescent self-regulation is increasingly seen as an important predictor of sexual risk-taking behaviors, but little is understood about how changes in self-regulation affect later sexual risk-taking. Family financial stress may affect the development of self-regulation and later engagement in sexual risk-taking. We examined whether family financial stress influences self-regulation in early adolescence (age 13) and growth in self-regulation throughout adolescence (from age 13-17 years). We then assessed the effects of family financial stress, baseline self-regulation, and the development of self-regulation on adolescent sexual risk-taking behaviors at age 18 years. Using a curve-of-factors model, we examined these relationships in a 6-year longitudinal study of 470 adolescents (52% female) and their parents from a large northwestern city in the United States. Results indicated that family financial stress was negatively associated with baseline self-regulation but not with growth in self-regulation throughout adolescence. Both baseline self-regulation and growth in self-regulation were predictive of decreased likelihood of engaging in sexual risk-taking. Family financial stress was not predictive of later sexual risk-taking. Intervening to support the development of self-regulation in adolescence may be especially protective against later sexual risk-taking.

Effectiveness of message framing on women's intention to perform cytomegalovirus prevention behaviors: a cross-sectional study.

BACKGROUND: The purpose of this study was to evaluate the effect of message framing on women's intention to perform cytomegalovirus (CMV) prevention behaviors involving handwashing, not sharing food and eating utensils, not kissing a child on the lips and not placing a pacifier in the mouth after it was in a child's mouth. METHODS: An online panel of women 18-40 years, who were pregnant or planning a pregnancy were randomized in a 2 × 2 factorial design to receive 1 of 4 CMV fact sheets. The fact sheets were framed as either what could be gained or be lost by following (or not) the recommendations and the likelihood of being affected by CMV (i.e., small chance or one of the most common infections in infants). The questionnaire measured CMV knowledge, participation in CMV risk or prevention behaviors, perceived severity of and susceptibly to CMV, and the perceived control over and the efficacy of recommended prevention behaviors. The dependent variable, intention to modify behavior, was an index score that ranged from 0 to 16 with higher values indicating greater intention. Linear regression was used to evaluate the association between all independent variables and overall behavioral intention. RESULTS: The sample included 840 women; 15.5% were familiar with CMV. Behavioral intention was high (M = 10.43; SD = 5.13) but did not differ across the message frames (p = 0.23). Overall, behavioral intention was predicted by CMV knowledge, message credibility, perceived severity of CMV, perceived behavioral control and response efficacy. Significant interactions with gain vs. loss frame were observed for perceived behavioral control (p = 0.03) and response efficacy (p = .003). CONCLUSIONS: Framing CMV messages by what women stand to gain or lose interacts with perceived behavioral control and response efficacy to influence behavioral intention. Perceived behavioral control and response efficacy were most predictive of behavioral intention overall regardless of frame. Messaging that focuses on these two variables, particularly for avoiding kissing a child on the lips and sharing food, cups and utensils, may result in greater gains in intention to participate in CMV prevention behaviors.

Perceptions of Public Breastfeeding Images and Their Association With Breastfeeding Knowledge and Attitudes Among an Internet Panel of Men Ages 21-44 in the United States.

BACKGROUND: Men's attitudes toward public breastfeeding may influence a woman's decisions about breastfeeding and her perceived comfort with public breastfeeding. Research aim: This study aimed to evaluate factors associated with men's visual perception of images of public breastfeeding. METHODS: A 95-item online survey was administered to 502 U.S. men ages 21 to 44. Respondents were presented with four images of women breastfeeding and asked to evaluate agreement with 15 adjectives describing each image. Based on factor analysis, 13 of these adjectives were combined to create the Breastfeeding Images Scale for each image. An 8-item Situational Statements Scale and the 17-item Iowa Infant Feeding Attitude Scale (IIFAS) were used to assess breastfeeding knowledge and attitudes. Multiple regression was used to evaluate the association between breastfeeding attitudes and knowledge and the Breastfeeding Images Scale. RESULTS: The image depicting a woman breastfeeding privately at home had the highest mean score of 71.95, 95% confidence interval (CI) [70.69, 73.22], on the Breastfeeding Images Scale, compared with 61.93, 95% CI [60.51, 63.36], for the image of a woman breastfeeding in a public setting. The overall mean scale score for the IIFAS was 56.99, 95% CI [56.27, 57.70], and for the Situational Statements Scale was 28.80, 95% CI [27.92, 29.69]. For all images, increasing breastfeeding knowledge and attitudes measured by the IIFAS and the Situational Statements Scale were associated with a more positive perception of the image. CONCLUSION: Images of public breastfeeding are viewed less favorably by men in the sample than are images of private breastfeeding. Knowledge and attitudes toward breastfeeding are positively associated with perception of breastfeeding images.

Family Financial Stress and Adolescent Sexual Risk-Taking: The Role of Self-Regulation.

The ability to control one's emotions, thoughts, and behaviors is known as self-regulation. Family stress and low adolescent self-regulation have been linked with increased engagement in risky sexual behaviors, which peak in late adolescence and early adulthood. The purpose of this study was to assess whether adolescent self-regulation, measured by parent and adolescent self-report and respiratory sinus arrhythmia, mediates or moderates the relationship between family financial stress and risky sexual behaviors. We assessed these relationships in a 4-year longitudinal sample of 450 adolescents (52 % female; 70 % white) and their parents using structural equation modeling. Results indicated that high family financial stress predicts engagement in risky sexual behaviors as mediated, but not moderated, by adolescent self-regulation. The results suggest that adolescent self-regulatory capacities are a mechanism through which proximal external forces influence adolescent risk-taking. Promoting adolescent self-regulation, especially in the face of external stressors, may be an important method to reduce risk-taking behaviors as adolescents transition to adulthood.

Women's attitudes toward practicing cytomegalovirus prevention behaviors.

Congenital cytomegalovirus (CMV) infection causes severe disabilities and developmental delays. Women's awareness of CMV is low. Only about half of healthcare providers report counseling women about behaviors to reduce CMV risk and public health education is limited. Routine CMV counseling is not recommend. Providers may lack time to counsel women; other conditions may take priority for counseling; there may be a perception that women are reluctant to follow advice. This cross-sectional descriptive study examined women's attitudes toward CMV prevention behaviors. Data were collected from an online panel of 840 U.S. women 18-40 years of age, who had a child < 5 years of age, and were pregnant or planning a pregnancy in the next 12 months. Questions assessed CMV awareness, frequency of past behaviors that transmit CMV, and attitudes toward eight CMV prevention behaviors. Only 15.5% of women were somewhat or very familiar with CMV. Very few women (6.1%) reported hearing from their provider about CMV. Women held positive attitudes toward the CMV prevention behaviors and perceived them as feasible. Least positive attitudes were toward not kissing a child on the lips and not sharing foods. Predictors of positive attitudes were CMV awareness, past behavior, talking to a healthcare provider, and perceived risk reduction. Healthcare providers and public health practitioners should collaborate to increase CMV awareness. Encouraging behaviors to reduce saliva sharing may result in greater gains in reducing CMV infection.

Media Agenda Setting Regarding Gun Violence before and after a Mass Shooting.

Gun violence is related to substantial morbidity and mortality with surrounding discussions framed and shaped by the media. This study's objective was to explore national news media's reporting of gun violence around a mass shooting. National news pieces were coded according to categories of gun violence, media frames, entities held responsible, responses, and reporting of the public heath approach. Individuals were held responsible for gun violence in 63% of pieces before and 32% after the shooting. Lawmakers were held responsible in 30% of pieces before and 66% after. Background checks were a proposed gun violence prevention method in 18% of pieces before and 55% after Sandy Hook, and lethality reduction of firearms was in 9% before and 57% after. Following a mass shooting, the media tended to hold government, not individuals, primarily responsible. The media often misrepresented the real picture of gun violence and key public health roles.