Trust in and Use of COVID-19 Information Sources Differs by Health Literacy among College Students.

People's health information-seeking behaviors differ by their health literacy levels. This study assessed the relationship between health literacy and college students' levels of trust in and use of a range of health information sources of COVID-19. We collected data from August to December 2020 among college students (n = 763) through an online survey. We used a health literacy measure containing three self-reported survey questions, developed by the CDC. We assessed the extent to which participants trusted and used any of the sixteen different sources of information about COVID-19. Respondents reported high levels of trusting and using COVID-19 information from the CDC, health care providers, the WHO, state/county/city health departments, and official government websites when compared to other sources. After controlling for demographic characteristics (i.e., gender, age, race, ethnicity, and income), those who reported having lower health literacy were significantly less likely to trust and use COVID-19 information from these health authorities when compared to participants who reported having higher health literacy. Students with lower self-reported health literacy indicated not trusting or using official health authority sources for COVID-19 information. Relying on low-quality information sources could create and reinforce people's misperceptions regarding the virus, leading to low compliance with COVID-19-related public health measures and poor health outcomes.

Correction: Desires for Individual- and Interpersonal-Level Patient Portal Use for HIV Prevention Among Urban Sexual Minority Men: Cross-sectional Study.

[This corrects the article DOI: 10.2196/43550.].

Desires for Individual- and Interpersonal-Level Patient Portal Use for HIV Prevention Among Urban Sexual Minority Men: Cross-sectional Study.

BACKGROUND: Gay, bisexual, and other sexual minority men have expressed the acceptability of patient portals as tools for supporting HIV prevention behaviors, including facilitating disclosure of HIV and other sexually transmitted infection (STI/HIV) laboratory test results to sex partners. However, these studies, in which Black or African American sexual minority men were undersampled, failed to determine the relationship of reported history of discussing HIV results with sex partners and anticipated willingness to disclose web-based STI/HIV test results using a patient portal. OBJECTIVE: Among a sample of predominantly Black sexual minority men, this study aimed to (1) determine preferences for patient portal use for HIV prevention and (2) test the associations between reported history of discussing HIV results and anticipated willingness to disclose web-based STI/HIV test results with most recent main and nonmain partners using patient portals. METHODS: Data come from audio-computer self-assisted interview survey data collected during the 3-month visit of a longitudinal cohort study. Univariate analysis assessed patient portal preferences by measuring the valuation rankings of several portal features. Multiple Poisson regression models with robust error variance determined the associations between history of discussing HIV results and willingness to disclose those results using web-based portals by partner type, and to examine criterion validity of the enhancing dyadic communication (EDC) scale to anticipated willingness. RESULTS: Of the 245 participants, 71% (n=174) were Black and 22% (n=53) were White. Most participants indicated a willingness to share web-based STI/HIV test results with their most recent main partner. Slightly fewer, nonetheless a majority, indicated a willingness to share web-based test results with their most recent nonmain partner. All but 2 patient portal features were valued as high or moderately high priority by >80% of participants. Specifically, tools to help manage HIV (n=183, 75%) and information about pre- and postexposure prophylaxis (both 71%, n=173 and n=175, respectively) were the top-valuated features to include in patient portals for HIV prevention. Discussing HIV test results was significantly associated with increased prevalence of willingness to disclose web-based test results with main (adjusted prevalence ratio [aPR] 1.46, 95% CI 1.21-1.75) and nonmain partners (aPR 1.54, 95% CI 1.23-1.93). CONCLUSIONS: Our findings indicate what features Black sexual minority men envision may be included in the patient portal's design to optimize HIV prevention, further supporting the criterion validity of the EDC scale. Efforts should be made to support Black sexual minority men's willingness to disclose STI/HIV testing history and status with partners overall as it is associated significantly with a willingness to disclose testing results digitally via patient portals. Future studies should consider discussion behaviors regarding past HIV test results with partners when tailoring interventions that leverage patient portals in disclosure events.

The COVID-19 experience: A survey of RNs.

PURPOSE: To explore the psychological factors that impacted RNs during the COVID-19 pandemic. METHODS: Survey response data were collected from 151 respondents across 25 states and various healthcare system settings. RESULTS: RNs in clinical settings had slightly more emotional stress than those in academia. Concerns ranged from personal health and family considerations to large-scale sociopolitical issues. CONCLUSIONS: RNs in all settings experienced at least some emotional stress during the early stages of the pandemic. However, in a majority of respondents, none of the stressors individually or in combination were so great as to encourage departure from the profession.

COVID-19 Related Experiences Among College Students With and Without Disabilities: Psychosocial Impacts, Supports, and Virtual Learning Environments.

This cross-sectional analysis estimated differences, based on disability status, in college students' (n = 777) experiences during the COVID-19 pandemic. Data were modeled using t-tests and logistic regression. Most participants were white (86.2%), and women (66.4%). The mode age was 23. A third (35.6%) had at least one disability. Students reported high rates of psychosocial distress, like fear of contracting (59.7%) and spreading (74.3%) COVID-19, worry about friends and family (83.7%), and increased anxiety (72.5%), depression (59.9%), and substance use (24.7%). Forty-two percent (42.2%) were scared they would miss out on their education through virtual classes. About a third feared forgetting assignments (34.1%) and making mistakes (33.9%). Fewer students expressed apprehension about (27.9%) and intimidation by (26.3%) virtual learning. Only 17.2% would continue taking virtual classes after the pandemic. Students with disabilities (M = 12.4, SD = 4.1) experienced more psychosocial stressors compared to students without disabilities (M = 9.9, SD = 4.2), [t(775) = 7.86, p < 0.001]. In adjusted models, disabled students were more than twice as likely to experience worry about medical bills (OR = 2.29), loneliness (OR = 2.09), and increased anxiety (OR = 2.31). They were also more than three times as likely to report increased depression (OR = 3.51) and changes in sexual activity (OR = 3.12). However, students with disabilities (M = 1.5, SD = 1.1) also reported receiving more support compared to their non-disabled classmates (M = 1.1, SD = 1.1), [t(775) = 6.06, p < 0.001]. Disabled students were more likely to feel a sense of contributing to society by following precautions (OR = 1.80) and receive support from family and others (emotional support: OR = 2.01, financial support: OR = 2.04). Interestingly, no significant differences were found in students' feelings associated with online or virtual learning [t(526.08) = 0.42, p = 0.68]. Students with disabilities, though, trended toward reporting negative experiences with virtual learning. In conclusion, students with disabilities were disproportionately affected by COVID-19 stressors, but also expressed more support and a sense of contributing to the common good.

Rural College Students' Amenability Toward Using At-Home Human Immunodeficiency Virus and Sexually Transmitted Infection Testing Kits.

BACKGROUND: College students residing in rural areas of the United States have limited access to human immunodeficiency virus (HIV) and sexually transmitted infection (STI) screening programs; yet, have increased rates of infection. METHODS: Students (N = 326), attending a state university located within a rural community, completed an online survey containing open-ended questions that gauged their perceptions and experiences with HIV/STI testing, amenability to at-home testing technology, and preferences for obtaining at-home testing kits. Inductive coding was used to create themes for each open-ended question. RESULTS: Students encounter a number of perceived barriers to accessing clinical HIV/STI testing venues including cost, utilization of parents' medical insurance, and stigma. Students desired screening paradigms that allow for a greater sense of privacy and the ability to be empowered through self-sampling methods. This includes the use of at-home testing kits, which could be accessed via mail, campus, or the local community. Although students were overwhelmingly amenable to using at-home testing, students discussed concerns with potential user error that could impact testing accuracy. CONCLUSIONS: Study findings suggest the importance of developing less clinically oriented systems of HIV/STI screening, which allow students to choose from an array of screening options. Removing perceived barriers, notably access and privacy concerns, to HIV/STI testing by leveraging at-home testing is one potential method to increase screening uptake among this at-risk population.

Evaluating the Feasibility of Implementing an HIV Prevention Intervention for Incarcerated African American Men: Lessons Learned From a Pilot Study.

This pilot study evaluated the feasibility of implementing an evidence-based, culturally adapted HIV intervention with substance-using African American men in a prison setting. We recruited 60, soon-to-be released African American male prisoners from a larger study (N = 211) to be randomly selected for participation in the group-based HIV intervention, Real Men Are Safe-Culturally Adapted (REMAS-CA). Participants who were not selected for participation in the intervention received standard Centers for Disease Control and Prevention HIV prevention counseling education, provided during participant assessment in the larger study. Nearly all of the participants who were selected to participate (87%) completed the REMAS-CA intervention. To examine feasibility, data were collected about any revisions made to the HIV intervention components for the prison setting, time needed to implement the program in full, details of implementing the intervention to ensure participation and maintain retention, and participant perception of the intervention. Revisions to the intervention included reducing the number of sessions from five to three, modifying the protocol language based on the setting, and removing six activities deemed inappropriate and/or unallowable by the prison officials. The cultural considerations and intervention, overall, were well received by the participants. However, several revisions made specific to the prison and its administration could affect the potential effectiveness of the intervention. Future research is needed to determine the effectiveness of REMAS-CA among this community.

Pre-Incarceration Rates of Nonmedical Use of Prescription Drugs among Black Men from Urban Counties.

There are inconsistent findings regarding the rates of nonmedical prescription drug use (NMPDU) among Black Americans. The majority of previous studies used pharmaceutical names of drugs and relied on national data that excludes incarcerated populations, in which Black men are overrepresented. Therefore, the current study aimed to describe pre-incarceration rates of NMPDU among Black men in prison using culturally relevant alternative drug names. We recruited 208 incarcerated (adult age 18 or older) Black men nearing community reentry to urban counties from four state prisons in Kentucky. Results indicated the majority of participants engaged in lifetime NMPDU. The most commonly endorsed class of prescription drug was, "Other Sedatives, Hypnotics, and Tranquilizers" and the most commonly endorsed specific prescription drugs were "Syrup," Lortab/Hydrocodone, and Xanax. There were significant age differences in the number of days that drugs were used in the year prior to incarceration. The current study contributes to the dearth of literature on NMPDU among Black Americans. These findings have implications for disease transmission, overdose risk, and culturally relevant data collection methods and interventions aimed at reducing NMPDU among Black men.

Life After: Examining the Relationship Between Sociobehavioral Factors and Mental Health Among African American Ex-Offenders.

Mental health problems are 3 times higher among prisoners than the general population. After release, reentry barriers and other factors can exacerbate mental problems. This study of 250 African American ex-offenders examines the relationship between sociobehavioral factors and mental health. Independent variables included self-reported health, alcohol use, employment, and history of mental problems before prison. Covariates included the number of immediate family with mental problems and the number of serious conflicts with family members or friends. Analyses revealed that men who had serious conflicts, used alcohol more often, reported less than excellent health, and not employed were more likely to report being troubled by mental problems. Family mental health history was not statistically significant. The current study adds to the literature by identifying selected factors associated with the mental health of African American male, ex-offenders. Findings from this study can inform interventions to address mental health issues and reduce recidivism.

Perceived Risk of HIV Infection Among Drug-Using African American Male Prisoners: One Year After Community Re-entry.

BACKGROUND: African Americans represent 13% of the U.S. population but 46% of people living with HIV and nearly 40% of state and federal prisoners. Disproportionate rates of HIV among African American males involved in the criminal justice system have been associated with risk factors, including: contracting sexually transmitted infections (STIs), substance misuse, and inconsistent condom use. However, many African American males may not perceive an elevated risk of HIV upon re-entering the community. OBJECTIVE: The current study examines correlates of perceived HIV risk among incarcerated African American drug-using males about one year after release from prison. METHODS: Derived from a larger Health Services Utilization study, interviewing (N = 661) incarcerated men at baseline with a 92% follow-up rate approximately one year after community re-entry, the current study is a secondary data analyses from self-identified African American men (N = 250). After list-wise deletion, the total N = 221 for the final study results. RESULTS: An ordered logistic regression model examining perceived risk of HIV as the dependent variable found age, cocaine use before sex, and condom use were significant correlates in the model. Alcohol use before sex mediated the relationship between cocaine use before sex and perceived HIV risk. CONCLUSIONS: Results suggest men in this study are engaged in HIV risk behaviors and risk perception varies. Implications for individual-level, community-level and policy interventions are discussed.

Psychosocial Determinants of Health among Incarcerated Black Women: A Systematic Literature Review.

Black women are disproportionately incarcerated and experience worse health outcomes compared with White and Hispanic women. This systematic literature review aims to identify the major psychosocial determinants of health and service utilization among incarcerated Black women. The ecological model for health behavior was used to frame the literature presented and explain how individual, interpersonal, and societal factors affect health. Nineteen articles met inclusion criteria for this review. Psychosocial factors were identified at each level, including mental health problems (individual); sexual behavior (interpersonal); and dysfunctional/negative relationships (community). The factors interact in a dynamic relationship that influences the health and service utilization of Black women. Future research should examine within-group differences to highlight the unique needs and culture within the Black community in the context of psychosocial determinants. This synthesis of relevant studies can serve to inform change in correctional policies, practices, and help reduce health disparities.

John Henryism Active Coping as a Cultural Correlate of Substance Abuse Treatment Participation Among African American Women.

The rates of illicit drug use among African American women are increasing, yet African American women are least likely to participate in treatment for substance use disorders when compared to women of other racial groups. The current study examined family history of substance use, perceived family support, and John Henryism Active Coping (JHAC) as correlates to seeking treatment for substance abuse. The underlying theoretical frame of JHAC (James et al., 1983) suggests that despite limited resources and psychosocial stressors, African Americans believe that hard work and self-determination are necessary to cope with adversities. The current study is a secondary data analyses of 206 drug-using African American women (N=104 urban community women with no criminal justice involvement and N=102 women living in the community on supervised probation) from urban cities in a southern state. It was expected that African American women with a family history of substance abuse, higher levels of perceived family support, and more active coping skills would be more likely to have participated in substance abuse treatment. Step-wise logistic regression results reveal that women on probation, had children, and had a family history of substance abuse were significantly more likely to report participating in substance abuse treatment. Perceived family support and active coping were significant negative correlates of participating in treatment. Implication of results suggests coping with psychosocial stressors using a self-determined and persistent coping strategy may be problematic for drug-using women with limited resources.

Implications for Improving Oral Health Care Among Female Prisoners in Georgia's Correctional System.

Georgia has the eighth-highest state rate of incarceration and fourth-highest number of prisoners in the country. Aside from receiving a dental examination at intake to assess oral health needs, there are no efforts to determine the barriers and determinants that contribute to the presenting oral health status of Georgia's state prisoners. Also, there is no prerelease planning to establish a health care home for prisoners being released back into the community to continue oral health care services in an effort to support successful reentry.This study assessed the barriers that impact N=98 female inmates' access to oral health care, prior to incarceration, within Georgia's prison system using a 21-item survey developed by a division of an academic institution and administered by the staff of a state department. Majority of the survey respondents reported that they do not have a regular dental provider (83%), lack insurance coverage (66%), and had their last dental visit more than a year ago because they did not have money for service or treatment (64%). The data collected from this study will be utilized to inform future project efforts to both reduce costs and increase access to oral health care for Georgia's uninsured and underinsured, and especially the incarcerated and reentry populations.

"I Want a Second Chance": Experiences of African American Fathers in Reentry.

With over 700,000 people on average released from prison each year to communities, greater attention is warranted on the experiences and needs of those who are parents and seeking to develop healthy relationships with their children and families. This study seeks to explore the experiences of African American fathers in reentry. Qualitative data from 16 African American men enrolled in a fellowship program for fathers were collected from a focus group and analyzed for common themes and using standpoint theory. Four themes emerged that focused on fathers' commitment toward healthy and successful reintegration postincarceration: redemption, employment, health care, and social support. Focus group participants actively strive to develop and rebuild healthy relationships with their children through seeking gainful employment and through bonding with like-minded peers. Barriers in accessing health care are also discussed. Research findings may inform future programs and policies related to supporting fathers and their children in reentry.

Psychosocial, socio-cultural, and environmental influences on mental health help-seeking among African-American men.

The social determinants unique to African-American men's health contribute to limited access and utilization of health and mental health care services and can have a deleterious effect on their overall health and well-being. There is a need to examine the complex issues concerning African-American men's help-seeking behaviors relative to mental health concerns. Current research estimates that African-American men are approximately 30% more likely to report having a mental illness compared to non-Hispanic Whites and are less likely to receive proper diagnosis and treatment. There is an extensive body of research that supports the view that women are more likely to seek help for psychological problems than African-American men. This review explores the psychosocial, environmental and socio-cultural factors that influence mental health help-seeking behavior among African-American men and explains the urgency to engage various stakeholders to pursue effective behavioral strategies. Research literature concerning the relationships between social determinants of health and their mental health help-seeking behaviors is reviewed and discussed in this paper. The article illustrates the need for mental health providers and researchers to establish feasible, culturally competent prevention and intervention strategies to increase help seeking behavior among African-American men, thereby contributing to the reduction of mental health disparities.