Sociopolitical, mental health, and sociodemographic correlates of COVID-19 vaccine hesitancy among young adults in 6 US metropolitan areas.

Given the need to increase COVID-19 vaccine uptake among US young adults, we examined the extent of COVID-19 vaccine hesitancy in this population and related factors. We analyzed Fall 2020 survey data from 2,453 young adults (ages 18-34) across 6 US metropolitan statistical areas (MSAs; Meanage = 24.67; 55.8% female; 5.4% Black, 12.7% Asian, 11.1% Hispanic; 75.5% college degree or higher). Multivariable linear regression examined correlates of COVID-19 vaccine hesitancy (index score of willingness and likelihood of being vaccinated), including sociopolitical factors (MSA, political orientation, COVID-related news exposure), COVID-19 symptoms and testing, mental health (e.g., COVID-related stress), and sociodemographics. 45.3% were "extremely willing" to get the vaccine (19.8% very, 14.2% somewhat, 3.7% don't know, 7.0% a little, 10.1% not at all); 40.2% were "extremely likely" to get vaccinated (22.1% very, 14.2% somewhat, 5.2% don't know, 7.9% a little, 10.3% not at all). Greater vaccine hesitancy was significantly related to living in specific MSAs (i.e., Atlanta, Oklahoma City, San Diego, Seattle vs. Minneapolis or Boston), identifying as Republican or "no lean" (vs. Democrat), and reporting less COVID-related news exposure and less COVID-related stress, as well as identifying as older, female, Black or other race, having less (vs. greater) than a college education, being married/cohabitating, and having children in the home. Interventions to improve COVID-19 vaccine uptake among hesitant young adults should include communication that address concerns, particularly among women, minority groups, and those from certain geographic regions and/or differing political orientations, and require identifying communication channels that appeal to these groups.

SARS-CoV-2 surveillance and outbreak response on an urban American college campus.

OBJECTIVE: The George Washington University (GW) in Washington, D.C., USA established the Public Health Laboratory and Campus COVID-19 Support Team (CCST) to develop and implement its SARS-CoV-2 surveillance testing and outbreak response for the 2020-2021 academic year. PARTICIPANTS AND METHODS: Approximately 4,000 GW members had access to campus for living accommodations, limited in-person instruction, athletics, research, and university operations. The outbreak response included daily risk assessment surveys, weekly surveillance testing, symptomatic and voluntary testing, case investigation, and contact tracing. RESULTS: Between August 17 - November 24, 2020, 42,350 SARS-CoV-2 PCR tests were performed, and 194 (0.46%) of tests were positive. Surveillance testing identified 59 (30.4%); voluntary testing 97 (50%); and symptomatic testing 30 (15.5%) of the cases, respectively. CONCLUSIONS: Robust testing of asymptomatic people and rapid isolation and quarantine of members who are exposed or infected effectively limited the spread of SARS-CoV-2 during the Fall 2020 semester.

Review of Web-Based Toolkits for Health Care Practitioners Working With Women and Girls Affected by or at Risk of Female Genital Mutilation/Cutting.

Increased migration has given rise to more advocacy efforts against female genital mutilation or cutting (FGM/C), legislation that criminalizes the practice, and guidance to the health sector for managing care of affected groups. More women and girls who have been cut or who are at risk of FGM/C are migrating from regions where it is common to countries where it is not and interacting with health professionals and other community practitioners in these host countries. Despite numerous studies on the negative health impacts of FGM/C, little is known about toolkits on FGM/C that providers can use in their prevention and response efforts. We sought to explore the nature of Internet-based products referenced as toolkits and materials characteristic of toolkits aimed at different service providers who may interact with women and girls affected by FGM/C. Through an online search, we identified 45 toolkits and collected data about each one. We found that the toolkits targeted different audiences and offered a diverse set of information and resources. The majority of toolkits were aimed at health professionals and provided factual and epidemiological-focused content, yet many did not include research evidence, skills development application, or approaches for implementing the toolkit in practice. This review is the first completed in the area of FGM/C to show a rich diversity of online materials. Future toolkits can be improved with the provision of evidence-based information and practical skills development for use by health professionals in implementing best practices in working with women and girls affected by FGM/C.

Toward Understanding Youth Athletes' Fun Priorities: An Investigation of Sex, Age, and Levels of Play.

Colloquial conjecture asserts perceptions of difference in what is more or less important to youth athletes based on binary categorization, such as sex (girls vs. boys), age (younger vs. older), and level of competitive play (recreational vs. travel). The fun integration theory's FUN MAPS, which identify 11 fun-factors comprised of 81 fun-determinants, offers a robust framework from which to test these conceptions related to fun. Therefore, the purposes of this study were to scientifically explore: (a) the extent to which soccer players' prioritization of the 11 fun-factors and 81 fun-determinants were consistent with the gender differences hypothesis or the gender similarities hypothesis, and (b) how their fun priorities evolved as a function of their age and level of play. Players' (n = 141) data were selected from the larger database that originally informed the conceptualization of the fun integration theory's FUN MAPS. Following selection, innovative pattern match displays and go-zone displays were produced to identify discrete points of consensus and discordance between groups. Regardless of sex, age, or level of play, results indicated extraordinarily high consensus among the players' reported importance of the fun-factors (r = .90-.97) and fun-determinants (r = .92-.93), which were consistently grouped within strata of primary, secondary, and tertiary importance. Overall, results were consistent with the gender similarities hypothesis, thereby providing the first data to dispel common conceptions about what is most fun with respect to sex, in addition to age and level of play, in a sample of youth soccer players.

Is There a Link Between Childhood Family Violence and Adult Health? Understanding Family Violence Amongst South Asian American Women.

The devastating effects of experiencing violence in childhood has been particularly difficult to assess among South Asians (SA) living in the U.S. due to a lack of race specific data. A cross-sectional quantitative study of 535 SA adult women living in the U.S. was conducted to better understand the relationship between childhood exposure to violence and health behaviors in adulthood. Measures included socio-demographics, exposure to violence as a child via witnessing parental violence, and experience of childhood violence, adult IPV, suicide ideation and attempt, and body esteem and subjective well-being in adulthood. Significant associations were found between childhood verbal abuse and body esteem and subjective well-being in adulthood; childhood physical abuse and subjective well-being in adulthood; and having a battered mother and subjective well-being in adulthood. To date, this is the first study to examine childhood violence and its relationship to adult IPV and health among SA women in the U.S.

Understanding Health, Violence, and Acculturation Among South Asian Women in the US.

The devastating effects of experiencing violence in childhood are seen well into adulthood. This has been particularly difficult to assess among South Asians living in the U.S., due to a lack of disaggregated data on this ethnic group. In a web-based survey administered to a convenience sample of South Asian women living in the U.S. (n = 535), information was gathered on experience/exposure to childhood violence; adult intimate partner violence; and adverse health outcomes, including ever suicide ideation/attempt, experiences of quality of life and body esteem in adulthood. Further, an individual's acculturation levels were measured specifically looking at cultural identity which was guided by Berry's biculturalism model. This study found that acculturation status is a key factor with respect to childhood verbal, physical, and sexual abuse, as well as body esteem and an individual's well-being. These results suggest that acculturation plays a key role for childhood violence, as well as key adult health indicators. The findings in this study, suggest that more research is warranted to better understand the complex relationships between acculturation status and health. While studies of South Asian immigrants have increased substantially, the study on how acculturation influences family violence and health outcomes has lagged behind. The findings in this study will provide guidance for future work in understanding how acculturation can play a key role in addressing the health and well-being of South Asian women in the U.S.

The impact of intimate partner violence, substance use, and HIV on depressive symptoms among abused low-income urban women.

Intimate partner violence (IPV), substance use, and HIV are often co-occuring health problems affecting low-income urban women, and have been described as connected epidemics making up a "syndemic." Research suggests that each issue separately is associated with depressive symptoms, but no studies have examined the combined effect of IPV, substance use and HIV on women's depression. Interviews were conducted with 96 women recruited from community health clinics serving low-income women in an urban U.S. city. All women were over 17, not pregnant, English-speaking, without private insurance and had experienced physical IPV in the past year. Women were primarily African American (82%) and 82% were receiving income assistance. Twenty seven percent were HIV-positive, and 27% had used heroin or cocaine in the past 6 months. Based on the Centers for Epidemiological Studies Depression Scale (CES-D ), 73% were depressed. Women who experienced severe IPV in the past 6 months were compared to women who experienced no IPV or psychological IPV only in the past 6 months; those who experienced severe IPV were 5.3 times more likely to be depressed, controlling for HIV status, drug use, age, and relationship status. Women who experienced severe IPV, were HIV-positive, and used drugs (7.3% of sample) were 7.98 times as likely to be depressed as women without these characteristics. These findings confirm that severe IPV is significantly associated with depression among urban abused women. Furthermore, this research suggests that the syndemic effect of IPV, substance use, and HIV could be even more detrimental to women's mental health. Health practitioners and researchers should be aware of the combined impact of the IPV, substance use, and HIV syndemic and consider how they can address the mental health needs of urban women.

Can E-Gaming Be Useful for Achieving Recommended Levels of Moderate- to Vigorous-Intensity Physical Activity in Inner-City Children?

OBJECTIVE: The purpose of this study was to compare the energy expenditure of a tailored, interactive genre of e-gaming ("Winds of Orbis: An Active Adventure"; Entertainment Technology Center, Carnegie Mellon, Pittsburgh, PA) ( www.activeadventuregame.com ) with that of a tethered videogame ("Dance Dance Revolution" [DDR]; Konami Digital Entertainment, El Segundo, CA) and with traditional physical education (PE) activities in meeting recommended levels of moderate- to vigorous-intensity physical activity (MVPA). SUBJECTS AND METHODS: Schoolchildren (n=104) in grades 3-8 from inner-city Washington, DC completed three randomly ordered 20-minute bouts of DDR, "Orbis," and PE. Energy expenditure was measured using accelerometry. RESULTS: Overall, energy expenditure was significantly greater from PE compared with "Orbis" and DDR (P<0.01). Among girls (n=58) and children with obesity (n=49), however, energy expenditure from "Orbis" and PE was similar, and both resulted in higher energy expenditure compared with DDR (P<0.01). After adjustment for sex, grade, and body mass index, we observed that among children in grades 3-5 energy expenditure from all three activities was sufficient to meet recommended intensity criteria for vigorous activity (>6 metabolic equivalents). Among children in grades 6-8, however, these vigorous-intensity criteria were met only by boys and only with PE activities. CONCLUSIONS: In the school setting, traditional PE activities continue to work well for some children in meeting MVPA recommendations. Among special subgroups, however, e-gaming may provide a useful supplement to PE in increasing activity levels during the school day and beyond.

Thinness expectations and weight cycling in a sample of middle-aged adults.

BACKGROUND: The False Hope Syndrome suggests that unrealistic expectations of dieting and weight loss are key constructs in the prediction of behavioral failure and may exacerbate weight cycling. The objective of this study was to determine cross-sectional associations among dieting and thinness expectations and weight cycling history within the framework of the False Hope Syndrome. METHODS: Participants were middle-aged (45±12 years) women (n=116) and men (n=98) recruited via worksite intranet distributions. Information on dieting and thinness expectations, weight loss attempts, and weight cycling history was gathered using standard questionnaires. RESULTS: More women than men reported currently dieting (43% vs. 26%; p<0.01). Moderate [OR=2.54; 95%CI: 1.01-6.45] and higher [OR=2.70; 95%CI: 1.07-6.80] levels of the thinness expectation score were significantly associated with the greater odds of weight cycling, independent of age, sex, BMI, and weight loss attempts. CONCLUSIONS: These data are the first to extend the pervasive and potent influence of thinness expectancy to middle-aged persons and in particular, to men.

Profiling abusive men based on women's self-reports: findings from a sample of urban low-income minority women.

Understanding abusive behaviors among nonclinical samples of men is important to help women in the community understand the risks they may face. The purpose of the current study is to identify abusive profiles and subgroups of non-treatment-seeking men using women's self reports. Of the sample of 611 women, 43% reported current abuse; chronicity of psychological aggression was the highest. Cluster analysis results revealed three different types of abusers. Findings provided support for recognizing batterer heterogeneity, especially based on women's reports. Recommendations for future research and the limitations of using batterer typologies are discussed.

Defining appropriate stages of change for intimate partner violence survivors.

Recent research suggests that the transtheoretical model of behavior change is a promising approach for interventions addressing women's experiences of intimate partner violence. This study explores the distribution of abused women across the stages of change for (a) staying safe from intimate partner violence and (b) leaving an abusive relationship. It explores the relationship between stage assignment and other indicators of a woman's stage (i.e., safety behaviors and desire for services). Quantitative surveys were conducted with 96 low-income, urban abused women recruited from six health care clinics. The findings call into question the appropriateness of using a staging algorithm that uses one "global" question about keeping safe and suggest that staging questions focused on a single action stage (e.g., leaving) are also problematic. In conclusion, additional work remains to be done to develop and validate quantitative measures of stages of change for survivors of intimate partner violence and to design, implement, and evaluated stage-based, tailored intimate partner violence interventions.

HIV/AIDS and intimate partner violence: intersecting women's health issues in the United States.

This article reviews 35 U.S. studies on the intersection of HIV and adult intimate partner violence (IPV). Most studies describe rates of IPV among women at risk or living with HIV/AIDS and identify correlates, using multiple types of convenience samples (e.g., women in methadone treatment, women in shelters or clinics), cross-sectional designs, and self-reported risk behaviors. HIV-positive women appear to experience any IPV at rates comparable to HIV-negative women from the same underlying populations; however, their abuse seems to be more frequent and more severe. The authors found only four relevant interventions and none addressed sexually transmitted HIV and partner violence risk reduction simultaneously. There is a critical need for research on (a) causal pathways and cumulative effects of the syndemic issues of violence, HIV, and substance abuse and (b) interventions that target IPV victims at risk for HIV, as well as HIV-positive women who may be experiencing IPV.

Community pediatrics: gender differences in perspectives of residents.

OBJECTIVE: The Future of Pediatric Education II Report affirmed the importance of providing resident education in community settings. Yet we know little about related experiences of trainees and whether experiences and perspectives regarding community involvement vary by gender. We assessed gender differences in pediatric residents' involvement in and perspectives regarding community activities. METHODS: A national survey of US pediatric residents assessed residents' involvement in 14 activities before medical school and the intensity and perceived importance of involvement in 17 activities during medical school and residency. Expected future involvement 10 years hence was assessed for 11 community settings. chi2 and analysis of variance were used to examine bivariate relations by gender. Multivariate linear regression was used to model the relationship between gender and expected future involvement. RESULTS: Of the 700 respondents, 68% were women. Relative to men, more women reported exposure to child health advocacy and other community activities before and during medical school. Women and men reported similar involvement in residency, although women placed greater importance on inclusion of 16 of 17 community activities in their training. Female residents were more likely to report that current training in the community would influence their future career activities. Women anticipated greater future involvement in 6 of 11 settings. In adjusted analyses, gender remained associated with future involvement in 5 settings. CONCLUSIONS: As women come to comprise an increasing proportion of the pediatric workforce, further efforts are needed to understand the impact of gender on future involvement in community child health activities.

The role of physician characteristics in clinical trial acceptance: testing pathways of influence.

Eight videotaped vignettes were developed that assessed the effects of three physician-related experimental variables (in a 2 x 2 x 2 factorial design) on clinical trial (CT) knowledge, video knowledge, information processing, CT beliefs, affective evaluations (attitudes), and CT acceptance. It was hypothesized that the physician variables (community versus academic-based affiliation, enthusiastic versus neutral presentation of the trial, and new versus previous relationship with the patient) would serve as communication cues that would interrupt message processing, leading to lower knowledge gain but more positive beliefs, attitudes, and CT acceptance. A total of 262 women (161 survivors and 101 controls) participated in the study. The manipulated variables primarily influenced the intermediary variables of post-test CT beliefs and satisfaction with information rather than knowledge or information processing. Multiple regression results indicated that CT acceptance was associated with positive post-CT beliefs, a lower level of information processing, satisfaction with information, and control status. Based on these results, CT acceptance does not appear to be based on a rational decision-making model; this has implications for both the ethics of informed consent and research conceptual models.

A review of breast, cervical, and colorectal cancer screening interventions in older women.

Although cancer-screening guidelines recommend periodic testing for women 50 years of age and older, these tests are underused. A search of databases identified 156 community-based breast, cervical, and colorectal cancer screening intervention studies published before April 2003. Most were conducted in the United States. More than half used randomization procedures or pre-post measures, and one third used both. Most reported significant intervention effects. Cervical and combined cervical and breast studies had higher rates of pre-post designs, and breast studies had the highest percentage using randomization. Although effective community-based breast and cervical interventions have been conducted, there is an urgent need for amplification of colorectal cancer screening.

An introduction to concept mapping as a participatory public health research method.

In this article, the authors introduce concept mapping as a useful participatory research method for public health researchers interested in generating hypotheses and developing theory. The authors first provide an overview of concept mapping, which combines qualitative approaches with quantitative analytical tools to produce visual displays of the relationship between ideas. Then, they present an illustrative research application of the method to the exploration of women's perceptions of the relationship between residential neighborhood factors and intimate partner violence experiences. They give attention to the data collection and analysis procedures and to demonstrating the intricacies of using concept mapping for public health research purposes. Finally, the article concludes with a discussion of the unique contributions and challenges associated with concept mapping.

Intimate partner violence, substance use, and HIV among low-income women: taking a closer look.

This article focuses on the intersection of intimate partner violence (IPV), substance use, and HIV status among a sample of low-income urban women (n = 611). Differences emerged by drug type, categorization of IPV, and HIV status. Rates of IPV did not differ between HIV-negative and HIV-positive women, but differing rates of substance use were found to be highly significant. The relationship between IPV and drug use appeared to be stronger for HIV-negative women. Descriptive data capturing temporal relationships between substance abuse and IPV support continued examination of types of IPV separately. These findings indicate the need to create comprehensive intervention strategies to address all three issues.

Abuse, HIV status and health-related quality of life among a sample of HIV positive and HIV negative low income women.

The assessment of a person's quality of life as it relates to health, HIV status and intimate partner violence (IPV) among women has been limited in its scope of investigation. Consequently, little is known about the adjusted and combined effects of IPV and HIV on women's health status and QOL. 445 women (188 HIV + 257 HIV -) residing in an urban low income area were interviewed regarding current IPV experiences (no IPV, IPV more than 1 year ago, IPV in last year), HIV status (positive and negative), use of illicit drugs, and presence of instrumental social support. Health-related QOL (HRQOL) was measured using the MOS-HIV. Stratified bivariate analyses demonstrate that living with HIV or having experienced IPV in the past year was significantly associated with poorer levels of HRQOL. Multiple logistic regression models indicate a robust negative relationship between the experience of IPV in the past year, living with HIV, use of illicit drugs and a protective effect of social support on women's reported HRQOL. The results of the bivariate and multivariate analyses provide evidence that there are independent and adjusted detrimental associations of the experience of IPV and living with HIV with women's HRQOL. As HRQOL is a good indicator of physical and mental health, these findings should alert health care and other service providers to their responsibility to screen and treat women experiencing intimate partner violence and living with HIV.

Uncovering neighbourhood influences on intimate partner violence using concept mapping.

While neighbourhood influences on the risk of intimate partner violence have been reported, this body of research has suffered from a lack of strong theoretical and conceptual guidance, and few studies have examined the potential pathways from neighbourhoods to intimate partner violence. This paper used concept mapping methods with 37 women who were residents of Baltimore City to obtain cluster maps representing the important neighbourhood domains that affect the prevalence, perpetration, severity, and cessation of intimate partner violence. Domains important for intimate partner severity and perpetration differed from those important for cessation of intimate partner violence. Finally, diagrams of the domains, drawn by the concept mapping participants, illustrated the pathways by which neighbourhood characteristics potentially influence intimate partner violence severity, perpetration, and cessation. These results can be used to generate testable hypotheses regarding neighbourhood influences on intimate partner violence in future quantitative research and to inform the design of public health intimate partner violence programmes.

Suicide risk and mental health indicators: Do they differ by abuse and HIV status?

PURPOSE: This study examines the association between women's HIV serostatus, intimate partner violence (IPV) experience, and risk of suicide and other mental health indicators. Using data from Project WAVE (Women, AIDS, and the Violence Epidemic), we 1) describe the rates of suicidal thoughts and attempts, anxiety, and depression; 2) examine whether and to what extent these outcomes differ by women's HIV and IPV status. METHODS: A one-time interview was conducted with a sample 611 women living in an urban area, one-half of whom were HIV-positive. RESULTS: Having thought about suicide was reported by 31% of the sample and 16% reported having attempted suicide. Among HIV-positive women, thoughts of suicide occurred more frequently among those who were recently diagnosed. One-half of the sample reported problems with depression, and 26% reported problems with anxiety; of women reporting these problems, 56% received mental health treatment. Rates varied significantly by HIV and IPV status, with women who were both HIV-positive and abused consistently faring worse. Relative to HIV-negative non-abused women, HIV-positive abused women were 7.0 times as likely to report problems with depression, 4.9 times as likely to report problems with anxiety, 3.6 times as likely to have thought about suicide, and 12.5 times as likely to have ever attempted suicide. Our findings that abused HIV-negative women were also at significantly elevated risk for all of these outcomes lends support to the conclusion that it is the experience of abuse that is associated with the negative outcomes. CONCLUSIONS: Health care and service providers interacting with women who may be HIV-positive and/or in abusive relationships should routinely assess for mental health status, especially suicide risk, which may need crisis intervention.