Brief virtual intervention associated with increased social engagement and decreased negative affect among people aging with HIV.

Virtual Villages-online communities that deliver supports to promote aging in place-are proposed to mitigate isolation and support the health of aging populations. Using a community-engaged approach, we developed and pilot-tested a Virtual Village intervention tailored for people living with HIV (PLWH) aged 50+ . The intervention employed a Discord server featuring social interaction, regional and national resources, expert presentations, and mindful meditation exercises. In 2022, a sample of PLWH aged 50+ from three U.S. study sites participated in a four-week pilot. Pre- and post-intervention surveys assessed participants' demographic characteristics; degree of loneliness, social connectedness, HIV-related stigma, and technology acceptance; mental wellbeing and physical health outcomes; and user experience. Participants (N = 20) were socioeconomically and racially/ethnically diverse, aged 51-88 years, and predominantly identified as gay or bisexual men (75%). Paired t-tests revealed a significant increase in participants' mean social engagement scores and a significant decrease in participants' mean negative affect scores, following the intervention. User experience scores were acceptable and participants reported a positive sense of connectedness to the Virtual Village community. Results suggest that a virtual community can be accessible to older PLWH and may enhance social engagement and improve aspects of mental wellbeing.

Barriers and facilitators to HPV and meningococcal vaccination among men who have sex with men: a qualitative study.

BACKGROUND: Men who have sex with men (MSM) have suboptimal uptake of human papillomavirus (HPV) and meningococcal vaccines. This study examines barriers and facilitators to HPV and meningococcal vaccination among MSM in a large, racially/ethnically diverse, and medically underserved U.S. region. METHODS: In 2020, we conducted five focus groups with MSM living in the Inland Empire, California. Participants discussed (1) their knowledge about and attitudes toward HPV, meningococcal disease, and related vaccines; and (2) factors that would encourage or discourage vaccine uptake. Data were systematically analyzed to identify salient barriers and facilitators to vaccination. RESULTS: Participants (N = 25) had a median age of 29. Most were Hispanic (68%), self-identified as gay (84%), and had college degrees (64%). Key barriers to vaccination included: (1) limited awareness and knowledge about HPV and meningococcal disease, (2) reliance on mainstream healthcare providers for vaccine information, (3) stigma and reluctance to disclose sexual orientation, (4) uncertainty about health insurance coverage and vaccine costs, and (5) distance and time required to access vaccines. Key facilitators to vaccination were: (1) vaccine confidence, (2) perceived severity of HPV and meningococcal disease, (3) bundling vaccination into routine healthcare, and (4) pharmacies as vaccination sites. CONCLUSIONS: Findings highlight opportunities for HPV and meningococcal vaccine promotion, including targeted education and awareness campaigns for MSM, LGBT inclusivity training for healthcare providers, and structural interventions to improve vaccine accessibility.

"If People Were Told About the Cancer, They'd Want to Get Vaccinated": Knowledge, Attitudes, and Beliefs About HPV Vaccination Among Mid-Adult Men.

In 2018, nine-valent human papillomavirus (HPV) vaccine eligibility expanded to include adults aged 27 to 45. This study aimed to identify knowledge, attitudes, and beliefs (KABs) about HPV and HPV vaccination among newly eligible mid-adult men, for whom uptake in adolescence and younger adulthood remains suboptimal. We conducted six virtual focus groups (N = 34 participants) with unvaccinated men aged 27 to 45 living in Southern California's Inland Empire. Data were systematically analyzed to identify emergent themes using the rigorous and accelerated data reduction technique. The sample of men was diverse (79% Hispanic, non-Hispanic Black, Asian, or mixed race/ethnicity; 26% gay or bisexual) and captured participants from across the socioeconomic spectrum. Eighty-eight percent of participants had never received a provider recommendation to be vaccinated against HPV. Many had unanswered questions about HPV and HPV vaccination, could not recall any HPV-related cancers that affect men, and were unaware of their current eligibility for vaccination. Embarrassment and stigma surrounding vaccination against a sexually transmitted infection, concerns about vaccine side effects and safety, and preferences for preventing HPV via "safer sex" and monogamy were salient barriers to vaccination. Nevertheless, many men were eager to learn more about HPV vaccination and engage with health care providers around that topic. Interventions aimed at improving men's knowledge, changing social norms, and supporting health providers to identify HPV vaccine-eligible patients may be especially fruitful for facilitating shared clinical decision-making between mid-adult men and their health care providers.

Sexual Orientation and Gender Identity Differences in Influenza, Shingles, and Pneumococcal Vaccination Among U.S. Older Adults.

Purpose: LGBT older adults face challenges accessing and receiving culturally competent health care and may be more vulnerable to serious outcomes from vaccine-preventable diseases. This study examines whether sexual orientation and gender identity are associated with older adult influenza, zoster ("shingles"), and pneumococcal vaccine uptake. Methods: Data come from the 2020 Behavioral Risk Factor Surveillance System. The sample included older adults aged 50+ (eligible for influenza and shingles vaccination; n = 136,528) and 65+ (eligible for pneumococcal vaccination; n = 74,779). We calculated rates of influenza, shingles, and pneumococcal vaccine uptake by gender-stratified sexual orientation groups and for transgender versus cisgender populations. Logistic regression models tested for associations between sexual orientation, gender identity, and vaccine uptake, controlling for key sociodemographic characteristics. Results: Transgender adults had the lowest rates of uptake across all three vaccines, including 46% lower odds of shingles vaccination and 61% lower odds of pneumococcal vaccination, when compared with cisgender adults. Gay (vs. straight) men had 1.5-1.9 times greater odds of flu and shingles vaccination. Bisexual (vs. straight) women had 32% lower odds of flu vaccination. Conclusion: Our findings indicate that vaccine uptake among LGBT older adults varies by sexual orientation, gender identity, and vaccine type. Bisexual women and transgender people are groups that tend to underutilize health care services and are at increased risk of nonvaccination, making them important targets for older adult vaccine promotion.

Trends and Disparities in Suicidality Among Heterosexual and Sexual Minority/Two-Spirit Indigenous Adolescents in Canada.

PURPOSE: To explore trends in sexual orientation group differences in suicidality among Indigenous adolescents and evaluate whether gaps between heterosexual and sexual minority/Two-Spirit adolescents have changed over time. METHODS: Leveraging pooled school-based population data from five waves of the British Columbia Adolescent Health Survey (1998-2018), we used age-adjusted logistic regression models, separately for boys and girls, to examine 20-year trends and disparities in past year suicidal ideation and suicide attempts among heterosexual and sexual minority/Two-Spirit Indigenous adolescents (N = 13,788). RESULTS: Suicidal ideation increased among all sexual orientation groups in 2018 compared to previous survey waves. Suicide attempts spiked for heterosexual girls in 2003, remained stable for heterosexual boys, and decreased for sexual minority/Two-Spirit boys and girls over time. Compared to their heterosexual peers, sexual minority/Two-Spirit boys had higher odds of suicidal ideation since 1998, whereas sexual minority/Two-Spirit girls had higher odds of suicidal ideation since 2003. Sexual minority/Two-Spirit (vs. heterosexual) boys were approximately 4-7 times more likely to attempt suicide since 2008, whereas sexual-minority/Two-Spirit (vs. heterosexual) girls were approximately 3-4 times more likely to attempt suicide since 2003. These gaps in suicidality were persistent across time. DISCUSSION: Sexual minority/Two-Spirit Indigenous adolescents are at an elevated risk for suicidality compared to their heterosexual Indigenous peers. While trends of suicidal ideation worsened for all Indigenous adolescents, suicide attempts either lessened or remained stable over time. Greater efforts are needed to help reduce suicidality among Indigenous adolescents in Canada, especially among sexual minority/Two-Spirit young people.

Scarier than the flu shot? : The social determinants of shingles and influenza vaccinations among U.S. older adults.

BACKGROUND: Although more than half of older adults receive the annual influenza vaccine (flu shot), only about one-third have ever been vaccinated for shingles. With this in mind, our study examines how the associations between sociodemographic characteristics, health behaviors, and vaccine uptake differ between these two viruses. In doing so, it also investigates whether the social predictors of shingles vaccination changed after the rollout of a new vaccine in 2017. METHODS: Data come from the 2017 and 2020 waves of the Behavioral Risk Factor Surveillance System survey, using a subset of older adults aged 60-plus (N = 389,165). We use logistic regression models to test for associations between individual-level characteristics and vaccine uptake. RESULTS: One, when compared to Whites, Black respondents had approximately 30 % lower odds of having received the annual influenza vaccine (Odds Ratios  [OR] = 0.72 [95 % CI 0.66-0.78] in 2017, and 0.66 [0.60-0.72] in 2020). For the shingles vaccine, these racial differences were starker (OR = 0.53 [0.48-0.59] in 2017, and OR = 0.55 [0.49-0.60] in 2020). Two, self-rated health was negatively associated with having received the influenza vaccine, but showed little relationship with shingles vaccination. Three, men were less likely than women to receive both vaccines in 2020 (OR = 0.88 [0.83-0.94] for influenza, and OR = 0.80 [0.75-0.85] for shingles). Four, older adults who abstained from alcohol were, generally, less likely to receive either vaccine, when compared to both moderate and heavy drinkers. Finally, we found that the release of a new shingles vaccine in 2017 (Shingrix) had little effect on vaccination prevalence or its social determinants. CONCLUSION: The importance of social groups, health, and health behaviors on vaccination status may be disease-dependent. This study also provides possible guidance to health care providers and health organizations looking to increase vaccine uptake among older adults, which may have more urgency since the arrival of COVID-19.

Attitudes Toward Payment for Research Participation: Results from a U.S. Survey of People Living with HIV.

Little is known about how payment affects individuals' decisions to participate in HIV research. Using data from a U.S. survey of people living with HIV (N = 292), we examined potential research participants' attitudes toward payment, perceived study risk based on payment amount, and preferred payment forms, and how these factors vary by sociodemographic characteristics. Most respondents agreed people should be paid for HIV research participation (96%) and said payment would shape their research participation decisions (80%). Men, less formally educated individuals, and members of some minoritized racial-ethnic groups were less likely to be willing to participate in research without payment. Higher payment was associated with higher perceived study risks, while preferences for form of payment varied by age, gender, education, race-ethnicity, and census region of residence. Findings suggest payment may influence prospective research participants' risk-benefit calculus and participation, and that a one-size-fits-all approach to payment could differentially influence participation among distinct sociodemographic groups.

RESUMEN: Se sabe poco acerca de cómo el pago afecta a la decisión de participar en investigaciones sobre VIH. Utilizando data de una encuesta de Estados Unidos sobre personas viviendo con VIH (N = 292), se examinó la actitud de potenciales participantes de investigación acerca del pago, el riesgo de estudio percibido basado en la cantidad del pago, las formas de pago preferidas y cómo estos factores varían según las características sociodemográficas. La mayoría de los que respondieron la encuesta estuvieron de acuerdo en que las personas debían recibir un pago por participar en una investigación sobre VIH (96%) y dijeron que el pago podría moldear su decisión de participar en la investigación (80%). Los hombres, individuos con menor educación formal y los miembros de algún grupo racial-étnico minoritario se mostraron menos propensos a participar en una investigación sin recibir pago. Se asoció un pago más alto con una mayor percepción de riesgos en el estudio, mientras que las preferencias por las formas de pago variaron según la edad, el género, la educación, la raza-etnicidad y la región. Los resultados sugirieron que el pago podría influir en el cálculo del riesgo-beneficio y en la participación de los potenciales participantes en una investigación prospectiva, y que un enfoque único para el pago podría influir de manera diferencial entre los distintos grupos sociodemográficos en lo que respecta a su participación.

"I Thought It Was Just For Teenagers": Knowledge, Attitudes, and Beliefs about HPV Vaccination Among Women Aged 27 to 45.

PURPOSE: We aimed to identify human papillomavirus (HPV) and HPV vaccine-related knowledge, attitudes, and beliefs among women aged 27-45 years, who became eligible for HPV vaccination in 2018. METHODS: Eight virtual focus groups were conducted with 52 unvaccinated cisgender women aged 27-45 years living in Southern California's Inland Empire. Themes related to women's knowledge, attitudes, and beliefs were systematically identified using the rigorous and accelerated data reduction technique. RESULTS: The sample was diverse: 62% of participants were Hispanic, Black, or Asian; 17% identified as lesbian or bisexual; and annual household incomes ranged from $0 to $260,000 (median, $60,500). Key qualitative themes centered on 1) questions about HPV and HPV vaccination, 2) knowledge and beliefs about HPV and HPV vaccination, 3) concerns about vaccine side effects and safety, 4) low perceived benefits of vaccination, and 5) social factors influencing vaccine acceptance. Few participants were aware adults aged 27-45 years are eligible for HPV vaccination or that vaccination can still be beneficial after sexual debut. Many believed HPV vaccination caused serious side effects among adolescents and questioned whether safety had been adequately studied for newly eligible adults. Although many participants associated HPV vaccination with social stigma, some emphasized that vaccination was a way to exercise control over their health and prevent illness, given they could not always control the actions of their sexual contacts. CONCLUSIONS: Findings provide insight into knowledge, attitudes, and beliefs about HPV and HPV vaccination among women aged 27-45 years, which may be useful for informing interventions to promote shared clinical decision-making between patients and health providers.

Promoting vaccination during rapid HIV testing: Recommendations from men who have sex with men in California.

Community-based rapid HIV testing is effective for reaching racial-ethnically diverse men who have sex with men (MSM), offering an opportunity for bundled health promotion interventions. Given MSM experience a heightened prevalence of human papillomavirus (HPV) and meningococcal disease, we examined their preferences for bundling rapid HIV testing with an intervention to promote vaccination against these infections. In 2020, we conducted five virtual focus groups (N = 25 participants) in English and Spanish with MSM in Southern California's Inland Empire. Participants discussed their knowledge about HPV and meningitis vaccination and attitudes toward receiving vaccination information and referrals during rapid HIV tests. We used the rigorous and accelerated data reduction technique to systematically analyse the data. Participants had a mean age of 30, were socioeconomically diverse, and predominantly (68%) Hispanic. 96% had ever been tested for HIV, while only 28% were vaccinated against HPV and/or meningitis. Most participants were unaware of MSM's elevated risk for HPV and meningitis and were eager to receive vaccination information from LGBTQ+-friendly providers. However, many participants emphasised rapid HIV testing was stressful and anticipated feeling overwhelmed if presented with vaccination information in this setting. Preferred formats for vaccine promotion included pamphlets and resources that could be discretely accessed online, supported by broader advertising featuring diverse MSM on social media, dating apps, and posters in the community. Overall, our findings suggest that bundling health promotion messages with rapid HIV testing may be ineffective, as the anxiety associated with taking an HIV test may interfere with such messages and their impact.

Social Determinants of Shingles Vaccination in the United States.

OBJECTIVE: Only about one-third of older adults in the United States are vaccinated against shingles, contributing to approximately 1 million shingles cases annually. This study examines how sociodemographic characteristics, health behaviors, and self-rated health are associated with shingles vaccine uptake. METHOD: Data come from the 2017 wave of the Behavioral Risk Factor Surveillance System survey, using a subset of older adults aged 60-plus (N = 208,301). Logistic regression models test (a) for associations between individual-level sociodemographic characteristics and vaccine uptake and (b) whether health behaviors and self-rated health moderate these associations. RESULTS: Black and Hispanic older adults have almost 50% lower odds of shingles vaccination, compared to non-Hispanic Whites. Abstaining from alcohol, being employed, living with children, and having poor self-rated health are also associated with lower uptake. Unmarried (vs married) individuals have lower odds of vaccination that are explained by broad differences in health behavior. DISCUSSION: Our study contributes to understanding how shingles vaccination coverage systematically differs among social groups. In doing so, it provides guidance for public health interventions to increase uptake. This line of research is increasingly salient in a world facing novel virus threats and antivaccine social movements.

A Qualitative Evaluation of Transgender and Gender-Nonconforming Patients' Experiences in Southern California's Inland Empire.

Purpose: To evaluate negative and positive health care experiences within the racial-ethnically diverse transgender and gender-nonconforming (TGNC) community in the Inland Empire, California. Methods: Three focus groups were conducted with a racial-ethnically diverse sample of 20 TGNC-identified individuals in California's Inland Empire. The rigorous and accelerated data reduction (RADaR) technique was used to systematically analyze the qualitative data and identify salient themes. Results: Key themes included the following: a lack of TGNC cultural competency among providers, interpersonal barriers to health care, perceived systemic barriers to health care, and the effects of improper care on TGNC patients' health. Lack of cultural competency included providers' conflations of gender and sexuality and unawareness of nonbinary gender identities. Interpersonal barriers included patient experiences of being misgendered, refused treatment, and referred to by their deadnames. Perceived systemic barriers included insurance coverage, transportation issues, and a lack of expedient care. The effects of improper care were highlighted by participants seeking alternative and sometimes unsafe forms of care when timely and appropriate care was inaccessible. Conclusion: Participants recommended increasing representation of TGNC perspectives into provider trainings, involving providers in outreach with the TGNC community, and requiring letters of recommendation and certifications for providers to be deemed TGNC culturally competent as means of improving TGNC patient care.

Evaluating the Impact of Incentives on Clinical Trial Participation: Protocol for a Mixed Methods, Community-Engaged Study.

BACKGROUND: Monetary incentives in research are frequently used to support participant recruitment and retention. However, there are scant empirical data regarding how researchers decide upon the type and amount of incentives offered. Likewise, there is little guidance to assist study investigators and institutional review boards (IRBs) in their decision-making on incentives. Monetary incentives, in addition to other factors such as the risk of harm or other intangible benefits, guide individuals' decisions to enroll in research studies. These factors emphasize the need for evidence-informed guidance for study investigators and IRBs when determining the type and amount of incentives to provide to research participants. OBJECTIVE: The specific aims of our research project are to (1) characterize key stakeholders' views on and assessments of incentives in biomedical HIV research; (2) reach consensus among stakeholders on the factors that are considered when choosing research incentives, including consensus on the relative importance of such factors; and (3) pilot-test the use of the guidance developed via aims 1 and 2 by presenting stakeholders with vignettes of hypothetical research studies for which they will choose corresponding incentive types. METHODS: Our 2-year study will involve monthly, active engagement with a stakeholder advisory board of people living with HIV, researchers, and IRB members. For aim 1, we will conduct a nationwide survey (N=300) among people living with HIV to understand their views regarding the incentives used in HIV research. For aim 2, we will collect qualitative data by conducting focus groups with people living with HIV (n=60) and key informant interviews with stakeholders involved in HIV research (people living with HIV, IRB members, and biomedical HIV researchers: n=36) to extend and deepen our understanding of how incentives in HIV research are perceived. These participants will also complete a conjoint analysis experiment to gain an understanding of the relative importance of key HIV research study attributes and the impact that these attributes have on study participation. The data from the nationwide survey (aim 1) will be triangulated with the qualitative and conjoint analysis data (aim 2) to create 25 vignettes that describe hypothetical HIV research studies. Finally, individuals from each stakeholder group will select the most appropriate incentive that they feel should be used in each of the 25 vignettes (aim 3). RESULTS: The stakeholder advisory board began monthly meetings in March 2021. All study aims are expected to be completed by December 2022. CONCLUSIONS: By studying the role of incentives in HIV clinical trial participation, we will establish a decision-making paradigm to guide the choice of incentives for HIV research and, eventually, other types of similar research and facilitate the ethical recruitment of clinical research participants. TRIAL REGISTRATION: ClinicalTrials.gov NCT04809636; https://clinicaltrials.gov/ct2/show/NCT04809636. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/33608.

How do patient-provider relationship continuity, gender, and language affect pediatric HPV vaccine acceptance?

Increasing human papillomavirus (HPV) vaccine uptake remains a challenge. We compared reasons for HPV vaccine acceptance between two Southern California pediatric clinics serving diverse populations: an academically affiliated resident clinic that offered little continuity of care (n = 53) and a private-practice clinic with well-established physician-patient relationships (n = 200). We found strong doctor recommendation and information dissemination about the importance of HPV vaccination were the most important drivers of acceptance across these distinct settings. The top-cited reasons for vaccine acceptance also varied by gender, language (English vs. Spanish), and clinic type. Findings point to the need for (1) robust provider education on vaccines, vaccine-preventable diseases, and vaccine hesitancy and (2) increased efforts to raise public awareness of the importance of HPV vaccination.

The impact of school-entry mandates on social inequalities in human papillomavirus vaccination.

Fundamental cause theory (FCT) is influential for explaining the enduring relationship between social position and health, yet few empirical studies test FCT's contention that policy supporting the equal distribution of interventions across populations can help reduce health inequalities. Following human papillomavirus (HPV) vaccine approval, complex socioeconomic and racial-ethnic inequalities emerged in distinct stages of the diffusion of this health innovation. Virginia and the District of Columbia were the first U.S. jurisdictions to implement school-entry HPV vaccination mandates for sixth-grade girls, offering an opportunity to test whether inequalities in HPV vaccination are mitigated by policy that seeks to standardize the age of vaccine administration and remove barriers to knowledge about the vaccine. Using data from the 2008, 2009, 2011, 2012, and 2013 National Immunization Survey-Teen (N = 4579) and a triple-difference approach, this study tests whether vaccine mandates are associated with smaller socioeconomic and racial-ethnic inequalities in health provider recommendation and vaccine uptake. It finds mandates were associated with improvements in provider recommendation and vaccine uptake for some socioeconomic and racial-ethnic groups. However, mandates also likely led to a decline in HPV vaccine series completion overall. Implications of these findings for informing FCT and vaccination policy are discussed.

Transgender and Gender Nonconforming Patient Experience in the Inland Empire, California.

Analyzing secondary data from a 2015 survey of 90 transgender and gender nonconforming individuals in California's Inland Empire, this study reports frequencies of physical and mental health and health care access and discrimination outcomes and differences by age, race/ethnicity, and sex assigned at birth. Nearly three-quarters of respondents reported positive physical health, yet only about half reported positive mental health-an outcome poorer for respondents <50 years. Lesser than 50% found it very easy to find providers for routine care and only 16% found it very easy to find a transgender-competent provider, underscoring the need for more health professional training.

Socioeconomic status differences in parental immunization attitudes and child immunization in Canada: Findings from the 2013 Childhood National Immunization Coverage Survey (CNICS).

Childhood vaccination efforts in Canada have been negatively impacted by parents' vaccine hesitancy based on their knowledge, attitudes, and beliefs (KAB) about vaccinations. Less understood is the extent to which child vaccination receipt and KAB vary by parents' socioeconomic status (SES). Analyzing different age groups of children and vaccinations, we examine the extent to which (a) family SES (parent education, household income) is a determinant of Canadian parents' vaccination KAB and child vaccination receipt, and (b) whether SES was indirectly associated with receipt via KAB. In 2017, we analyzed 2013 Childhood National Immunization Coverage Survey (CNICS) data. We estimated models for parental KAB and child vaccination receipt for measles, mumps, and rubella (MMR) at age 2 (n = 3620); diphtheria, pertussis, and tetanus (DPT) at age 7 (n = 3465); and human papillomavirus (HPV) at ages 12-14 (n = 5213 females). SES is inconsistently associated with KAB and vaccine receipt across the three age groups. SES differences in KAB mostly center on vaccine-specific side effect and safety concerns, with lower education and income levels associated with higher odds of being concerned. Non-receipt of minimum age-specific vaccination dosages was associated with concerns about vaccine effectiveness (DPT, HPV) and side effects (MMR, HPV) and lower perceived importance of immunizing a child (MMR, HPV). KAB mediation was mostly limited to SES patterns in MMR. We discuss the implications of these findings for designing general and population-specific vaccination education strategies and future studies of KAB and undervaccination.

Socioeconomic and Racial-ethnic Disparities in Prosocial Health Attitudes: The Case of Human Papillomavirus (HPV) Vaccination for Adolescent Males.

Research on prosocial attitudes, social networks, social capital, and social stratification suggest that lower-socioeconomic status (SES), Hispanic, and nonwhite individuals will be more likely than their higher-SES and non-Hispanic white counterparts to engage in health behaviors that serve a social good. Analyzing data from the University of North Carolina Human Papillomavirus (HPV) Immunization in Sons Study, we test whether SES and race-ethnicity are associated with willingness to vaccinate via prosocial attitudes toward HPV vaccination among adolescent males (n = 401) and parents (n = 518). Analyses revealed that (a) parents with lower education and (b) black and Hispanic parents and adolescent males reported higher prosocial vaccination attitudes, but only some attitudes were associated with higher willingness to vaccinate. We discuss these findings in terms of how prosocial attitudes may motivate certain health behaviors and serve as countervailing mechanisms in the (re)production of health disparities and promising targets of future public health interventions.

Getting by with a little help from friends and colleagues: Testing how residents' social support networks affect loneliness and burnout.

OBJECTIVE: To determine how residents' relationships with their sources of social support (ie, family, friends, and colleagues) affect levels of burnout and loneliness. DESIGN: Cross-sectional survey. SETTING: Faculty of Medicine at the University of British Columbia in Vancouver. PARTICIPANTS: A total of 198 physician-trainees in the university's postgraduate medical education program. MAIN OUTCOME MEASURES: Residents' personal and work-related burnout scores (measured using items from the Copenhagen Burnout Inventory); loneliness (measured using a 3-item loneliness scale); and social support (assessed with the Lubben Social Network Scale, version 6). RESULTS: Of the 234 respondents who completed the Internet-based survey (a 22% response rate), 198 provided complete information on all study variables and thus constituted the analytic sample. Seemingly unrelated regression analyses indicated that loneliness was significantly (P < .01) and positively associated with both personal and work-related burnout scores. Greater friend-based and colleague-based social support were both indirectly associated with lower personal and work-related burnout scores through their negative associations with loneliness. CONCLUSION: Social relationships might help residents mitigate the deleterious effects of burnout. By promoting interventions that stabilize and nurture social relationships, hospitals and universities can potentially help promote resident resilience and well-being and, in turn, improve patient care.