Cultural and Psychosocial Correlates of co-use among Black-White Biracial Adults.

INTRODUCTION: Biracial individuals, a subset of the fastest growing population segment in the United States, frequently experience conflict with ethnic identity, according to marginality theory. Ethnic identity is associated with perceived discrimination and self-esteem, and each of these factors is associated with alcohol and marijuana use. Some research suggests that Black-White biracial individuals have specific challenges with ethnic identity, discrimination, and self-esteem, as well as have disproportionate rates of alcohol and marijuana use separately. Co-use of these substances is linked to more risk behaviors and greater quantity/frequency of use compared to singular use of alcohol or marijuana. However, research examining these cultural and psychosocial factors as correlates of recent co-use among Black-White biracial individuals is limited. METHOD: The current study examined past-year cultural (i.e., ethnic identity, perceived discrimination) and psychosocial (i.e., age, gender, self-esteem) factors associated with past 30-day co-use (i.e., alcohol, marijuana) among a sample of 195 biracial (Black-White) adults recruited and surveyed via MTurk. We analyzed data using a hierarchical logistic regression. RESULTS: Results of the final step of logistic regression indicate increases in perceived discrimination were significantly associated with a 1.06 times greater likelihood in 30-day co-use (95% CI [1.002, 1.10]; p = .002). Further, co-use is more common among women than men (OR = 0.50, 95% CI [0.25, 0.98]; p = .04). CONCLUSIONS: Findings indicate discrimination experienced among Black-White biracial adults is the most culturally relevant correlate of recent co-use in this study, of the factors measured given the framework. As such, substance use treatment with this population may focus on experiences of and coping with discrimination. Since women were also at greater risk for co-use, gender-specific treatments may be beneficial for this population. The article also discussed other culturally relevant treatment considerations.

Sexual Health Interventions for Racial/Ethnic Minorities Using Community-Based Participatory Research: A Systematic Review.

BACKGROUND: Racial/ethnic minorities (REMs) continue to carry the burden of sexual health disparities in the United States, including increased health risks and lower proportions of preventative care. Community-based participatory research (CBPR) has been useful in developing interventions aimed at reducing these disparities. Specifically, partnership with the target group members has resulted in more culturally relevant intervention strategies. AIM: The purpose of this systematic review was to analyze the existing research on sexual health interventions targeting U.S. REMs that were developed using CBPR, to highlight the role target group members played in the development of these interventions, and to explore the benefits and outcomes of these partnerships. METHOD: Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guided the search of 46 thesauri terms for CBPR, sexual health, and REMs across six databases. RESULTS: The initial search yielded 805 identified studies. After applying limiters, reviewing abstracts, and doing a full-text review, 24 appropriate studies were retained. The key findings indicated significant intervention outcomes such as increased health knowledge, attitude change, and behavioral intention that could reduce sexual risk-taking behaviors. Twelve studies detailed the methods for partnering with target group members to formulate interventions, highlighting the benefits related to recruitment, retention, and cultural relevance. DISCUSSION: CBPR is well-positioned to address sexual health disparities among REMs. While community partnership strategies vary, the findings yield evidence that CBPR addressing sexual health disparities is achievable, can influence the effectiveness of interventions, and should be considered as an orientation in future sexual health research.

Original Research: COVID-19 Vaccine Hesitancy Among Southern California Nurses.

PURPOSE: The purpose of this study was to elucidate characteristics of vaccine-hesitant nurses at two large Southern California medical centers where rates of COVID-19 vaccination were lower than expected. METHODS: This study is a secondary analysis of nurse participants in a cross-sectional study conducted at the two medical centers. Participants completed an online survey regarding their demographics; work setting and role characteristics; influenza vaccination history; COVID-19 knowledge and beliefs; and personal history of COVID-19 exposure, diagnosis, and disease impact (infection or death) on those closest to them. RESULTS: Of 869 nurse participants, most (78.6%) were vaccinated and 21.4% were unvaccinated; more than half of the unvaccinated participants reported being unwilling to be vaccinated ("vaccine hesitant"). The χ 2 comparisons revealed no significant differences between vaccinated and vaccine-hesitant nurses in terms of education, contact with COVID-19 patients, work environment, or having friends and family impacted by COVID-19. Binary logistic regression showed that nurses who had no history of recent influenza vaccination were 10 times more likely to be vaccine hesitant, those who had inaccurate knowledge about COVID-19 vaccines were seven times more likely to be vaccine hesitant, and younger nurses and those with a prior COVID-19 diagnosis were approximately three times more likely to be vaccine hesitant. Furthermore, 17.3% of all participants were unwilling to recommend COVID-19 vaccination to others. CONCLUSION: The findings offer a nuanced understanding of vaccine hesitancy among nurses and will be useful to the planning and development of policies, campaigns, and interventions aimed at increasing vaccination rates among nurses. Changing attitudes is essential, and particular attention must be paid to nurses who are unwilling to recommend vaccination to others. Effective interventions are needed.

Racial/Ethnic Variances in COVID-19 Inoculation among Southern California Healthcare Workers.

Healthcare workers (HCWs) from minoritized communities are a critical partner in moving vaccine-hesitant populations toward vaccination, yet a significant number of these HCWs are delaying or deciding against their own COVID-19 vaccinations. Our study aims to provide a more nuanced understanding of vaccine hesitancy among racially and ethnically minoritized HCWs and to describe factors associated with vaccine non-acceptance. Analysis of a sub-sample of racially and ethnically minoritized HCWs (N = 1131), who participated in a cross-sectional study at two large Southern California medical centers, was conducted. Participants completed an online survey consisting of demographics, work setting and clinical role, influenza vaccination history, COVID-19 knowledge, beliefs, personal COVID-19 exposure, diagnosis, and impact on those closest to them. While overall most HCWs were vaccinated (84%), 28% of Black, 19% of Hispanic, and 8% of Asian American HCWs were vaccine-hesitant. Age, education level, occupation, history of COVID-19, and COVID-19 related knowledge were predictive of vaccine hesitancy. We found significant variations in COVID-19 related knowledge and reasons for vaccine hesitancy among Black (governmental mistrust), Hispanic (preference for physiological immunity), and Asian-American HCWs (concern about side effects) who were vaccine-hesitant or not. Our findings highlight racial and ethnic differences in vaccine-hesitancy and barriers to vaccination among HCWs of color. This study indicates the necessity of targeted interventions to reduce vaccine hesitancy that are mindful of the disparities in knowledge and access and differences between and among racial and ethnic groups.

Rapid Implementation of a Community-Academic Partnership Model to Promote COVID-19 Vaccine Equity within Racially and Ethnically Minoritized Communities.

Coronavirus disease 2019 (COVID-19) has highlighted inequities in mortalities and associated illnesses among non-Hispanic Black and Hispanic/Latino individuals. Immunization against COVID-19 is critical to ending the pandemic, especially within racial and ethnically minoritized communities. However, vaccine hesitancy and institutional mistrust in these communities, resulting from decades of mistreatment, structural racism, and barriers to vaccination access, have translated into low vaccination uptake. Trustworthy relationships with healthcare professionals and partnerships with faith and community leaders are critical to increasing vaccination rates within these minoritized communities. Loma Linda University researchers collaborated with local faith and community organizations in San Bernardino County, CA, to rapidly implement a three-tiered approach to increase the vaccination rates within non-Hispanic Black and Hispanic/Latino communities. This community-academic partnership model provided over 1700 doses of the COVID-19 vaccine within these vaccine-hesitant, targeted minoritized communities. As over 100,000 individuals are diagnosed with COVID-19 daily and updated vaccines targeting variants of the Omicron strain are expected to rollout in the coming months, the development of sustainable programs aimed at increasing vaccine uptake within vulnerable communities are of the utmost importance.

Faith, Fear, and Facts: A COVID-19 Vaccination Hesitancy Intervention for Black Church Congregations.

BACKGROUND: Blacks are dying from the novel coronavirus of 2019 (COVID-19) at disproportionate rates and tend to have more COVID-19 vaccine hesitancy than Whites. These disparities may be attributable to health knowledge and government/medical mistrust stemming from negative experiences with the medical system historically and presently (e.g., the Tuskegee Experiment, provider maltreatment). METHOD: The present study assessed COVID-19 vaccine hesitancy and the effectiveness of a 1.5 h, dialogue-based, web intervention hosted by an academic-community partnership team. The webinar included approximately 220 male and female, English speaking, Black churchgoers in the western U.S. The webinar focused on the psychology of fear and facts about the vaccine development. RESULTS: The sample was mostly females who had higher vaccine hesitancy than men. A third of participants feared hospitalization if they contracted COVID-19. Many participants reported that learning facts about COVID-19 was most impactful. Statistical analyses indicated an increased willingness to get vaccinated after the webinar in comparison to before (t(25) = -3.08, p = 0.005). CONCLUSION: The findings suggest that virtual webinars may be effective at reducing COVID-19 vaccine hesitancy among Black churchgoers and may be applicable in addressing other health behaviors.

Predictors of COVID-19 Vaccine Acceptance and Hesitancy among Healthcare Workers in Southern California: Not Just "Anti" vs. "Pro" Vaccine.

In this study, we evaluated the status of and attitudes toward COVID-19 vaccination of healthcare workers in two major hospital systems (academic and private) in Southern California. Responses were collected via an anonymous and voluntary survey from a total of 2491 participants, including nurses, physicians, other allied health professionals, and administrators. Among the 2491 participants that had been offered the vaccine at the time of the study, 2103 (84%) were vaccinated. The bulk of the participants were middle-aged college-educated White (73%), non-Hispanic women (77%), and nursing was the most represented medical occupation (35%). Political affiliation, education level, and income were shown to be significant factors associated with vaccination status. Our data suggest that the current allocation of healthcare workers into dichotomous groups such as "anti-vaccine vs. pro-vaccine" may be inadequate in accurately tailoring vaccine uptake interventions. We found that healthcare workers that have yet to receive the COVID-19 vaccine likely belong to one of four categories: the misinformed, the undecided, the uninformed, or the unconcerned. This diversity in vaccine hesitancy among healthcare workers highlights the importance of targeted intervention to increase vaccine confidence. Regardless of governmental vaccine mandates, addressing the root causes contributing to vaccine hesitancy continues to be of utmost importance.

Longitudinal Impact of Childhood Adversity on Early Adolescent Mental Health During the COVID-19 Pandemic in the ABCD Study Cohort: Does Race or Ethnicity Moderate Findings?

BACKGROUND: During the COVID-19 pandemic in the United States, mental health among youth has been negatively affected. Youth with a history of adverse childhood experiences (ACEs), as well as youth from minoritized racial-ethnic backgrounds, may be especially vulnerable to experiencing COVID-19-related distress. The aims of this study are to examine whether exposure to pre-pandemic ACEs predicts mental health during the COVID-19 pandemic in youth and whether racial-ethnic background moderates these effects. METHODS: From May to August 2020, 7983 youths (mean age, 12.5 years; range, 10.6-14.6 years) in the Adolescent Brain Cognitive Development (ABCD) Study completed at least one of three online surveys measuring the impact of the pandemic on their mental health. Data were evaluated in relation to youths' pre-pandemic mental health and ACEs. RESULTS: Pre-pandemic ACE history significantly predicted poorer mental health across all outcomes and greater COVID-19-related stress and impact of fears on well-being. Youths reported improved mental health during the pandemic (from May to August 2020). While reporting similar levels of mental health, youths from minoritized racial-ethnic backgrounds had elevated COVID-19-related worry, stress, and impact on well-being. Race and ethnicity generally did not moderate ACE effects. Older youths, girls, and those with greater pre-pandemic internalizing symptoms also reported greater mental health symptoms. CONCLUSIONS: Youths who experienced greater childhood adversity reported greater negative affect and COVID-19-related distress during the pandemic. Although they reported generally better mood, Asian American, Black, and multiracial youths reported greater COVID-19-related distress and experienced COVID-19-related discrimination compared with non-Hispanic White youths, highlighting potential health disparities.

Ethnic Identity, Perceived Discrimination, Substance Use and Misuse among Black-White Biracial Adults.

Background: Multiracial groups are projected to be the fastest growing segment of the U.S. population, more than tripling in size over the next four decades. Marginality Theory suggests that biracial individuals, a subgroup of multiracial, may experience heightened conflict with their ethnic identity due to having to negotiate between two distinct cultures. Research shows that changes in ethnic identity is associated with perceived discrimination, and both are associated with marijuana and alcohol use among multiracial groups. These relationships are sometimes stronger among multiracial individuals than monoracial. Limited research exists among specific biracial groups, such as Black-White biracial individuals, despite unique complexities related to ethnic identity. Research conducted among Black-White biracial individuals is often limited to youth samples and shows disproportionate rates of substance use. Objectives: Given the population increase and disparate substance use outcomes among Black-White biracial youth, it is essential to extend substance use and misuse research to Black-White biracial adults to see if similar disparities exist. The present study examined the direct effect of biracial ethnic identity on marijuana use and alcohol misuse, and indirect effects of perceived discrimination to these relationships among a sample of Black-White biracial adults (n = 195) using a 46-item self-report survey administered online via MTurk. Results: Results revealed that while ethnic identity alone was not associated with marijuana use or alcohol misuse, there were significant indirect relationships between ethnic identity, marijuana use, and alcohol misuse through perceived discrimination. Conclusions/Importance: Findings suggest that substance use interventions should seek to address coping with perceived discrimination among this population.

Best practices for researching diverse groups.

The elimination of health and other disparities requires high quality and methodologically sound research on racial/ethnic minorities. Despite a general consensus on the need for valid research on racial/ethnic minorities, few guidelines are available. This article contributes to closing this gap by discussing examples and strategies for addressing concrete issues that researchers may face during these stages of the scientific process: planning and literature review (identifying meaningful gaps and appropriate theoretical perspectives), design (caveats of race-comparison, selection of appropriate terminology), measurement (measurement equivalence, effects of ethnicity of the interviewer/coder), recruitment (barriers and strategies to facilitate recruitment), data analysis (use of norms derived from other groups, hazards of combining ethnic groups in the analyses), and dissemination of study findings to professional and lay audiences. Applying appropriate methodology will result in research that may impact disparities. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Transnational trends in prescription drug misuse among women: A systematic review.

Prescription drug misuse (PDM) has been on the rise since early 2000 and is now an international epidemic. Prescription drugs are easily accessible and perceived as less harmful, yet can lead to addiction and death. Women represent half of the world's population and pose a unique risk for PDM, including a greater burden of addiction and relapse. Despite this, no identified studies have methodically reviewed the literature exploring PDM among adult women. The authors searched four EBSCOhost and World Health Organization (WHO) Global Index Medicus databases and identified 93 articles (88 vs. five respectively). Studies with data on the prevalence and correlates of PDM among women around the globe were included. In the EBSCOhost search, over 40% of the studies were secondary data analyses and nearly two-thirds (63.6%) examined opioid analgesics (similar results found in WHO articles). Women were represented in a fraction of all PDM studies yet in over a half (56.1%) of the selected studies, women abused one or more prescription drugs at equal rates or higher than men. For ethnicity, 21 studies reported that White women had higher rates of PDM than other ethnicities and 13 found no differences. Nearly all of the studies (90%) that examined problematic physical and mental health correlates found significant associations. The findings suggest that clinicians may need more inclusive and broaden their consideration of risk for PDM. As prescriptions become more readily available around the world, PDM research should be more representative and monitor unique risk and protective factors among women to better inform prevention and intervention efforts.

Psychosocial risks of prescription drug misuse among U.S. racial/ethnic minorities: A systematic review.

Prescription drug misuse (PDM) is the leading cause of accidental death in the U.S. One in five Americans report at least one lifetime incident of PDM. PDM has been studied extensively, yet there is limited inclusion of racial/ethnic minorities due to purportedly lower rates of PDM. However, health disparate groups often face more detrimental consequences of substance abuse including behavioral, social, and medical/mental health (e.g., injury, HIV/AIDS, incarceration, educational attainment, and comorbidity). Failing to characterize risk factors for and consequences of PDM in racial/ethnic minorities may mask the disproportionate negative impact of this epidemic. This systematic review of three research indexes revealed 28 peer-reviewed studies published on PDM in racial/ethnic minority adults. Results indicated a high prevalence of PDM among veterans, bisexual and gay young adults, and substance abusers compared to the general population. Demographic correlates of PDM included younger age, male gender, less educated, unmarried, and those with health/emotional issues. Rates of PDM in demographically vulnerable populations suggest that broadening inclusiveness in PDM research, interventions, and clinical practice is imperative.

Rural Incarcerated Women: HIV/HCV Knowledge and Correlates of Risky Behavior.

Rural incarcerated women have an increased risk of acquiring the human immunodeficiency virus (HIV) and the hepatitis C virus (HCV) due to prevalent engagement in drug use and sexual behaviors. Limited research has investigated HIV and HCV knowledge in this high-risk population. Furthermore, the interplay of sociodemographic factors (i.e., education, age, income, and sexual orientation) and risky behavior is understudied in this population. The present study evaluated a sample of adult, predominately White women from rural Kentucky ( n = 387) who were recruited from local jails. The sample had high HIV and HCV knowledge but also reported extensive risk behaviors including 44% engaging in sex work and 75.5% reporting a history of drug injection. The results of multiple regression analysis for risky sexual behavior indicated that sexual minority women and those with less HIV knowledge were more likely to engage in high-risk sexual behaviors. The regression model identifying the significant correlates of risky drug behavior indicated that HIV knowledge, age, and income were negative correlates and that sexual minority women were more likely to engage in high-risk drug use. When HCV knowledge was added to the regression models already including HIV knowledge, the interaction was significant for drug risk. Interventions for rural imprisoned women should consider the varied impact of sociodemographic background and prioritize HIV education to more effectively deter risky sexual and drug behaviors.

Correlates of Injection Drug Use Among Rural Appalachian Women.

BACKGROUND: Limited research has focused on correlates of injection drug use (IDU) among high-risk subgroups of drug users, particularly women, who may be at increased risk for transmission of infectious diseases such as HIV and Hepatitis C. The purpose of this study is to better understand the contextual and health correlates of IDU among women living in rural Appalachia by examining (1) differences between injectors and noninjectors, and (2) the unique correlates of recent IDU and past IDU. METHODS: This study involved random selection, screening, and face-to-face interviews with 400 rural Appalachian women from jails in one state. Analyses included descriptive statistics, multinomial logistic regression, and stepwise regression to identify significant correlates of recent IDU and past IDU compared to never injecting. RESULTS: Findings indicated that 75.3% of this randomly selected sample reported lifetime injection of drugs. Contextual factors including drug use severity (RRR = 8.66, P < .001), more male sex partners (RRR = 1.01, P < .05), and having injecting partners (RRR = 7.60, P < .001) were robust correlates of recent injection practices. CONCLUSIONS: This study makes an important contribution to understanding factors associated with IDU among rural Appalachian women drug users, which are strongly associated with both relational and health factors. Study findings on the specific factors associated with IDU risk have important implications for tailoring and targeting interventions that should include a focus on the relationship context reducing high-risk injection practices.