Eating disorder symptoms and comorbid mental health risk among teens recruited to a digital intervention research study via two online approaches.

INTRODUCTION: It is crucial to identify and evaluate feasible, proactive ways to reach teens with eating disorders (EDs) who may not otherwise have access to screening or treatment. This study aimed to explore the feasibility of recruiting teens with EDs to a digital intervention study via social media and a publicly available online ED screen, and to compare the characteristics of teens recruited by each approach in an exploratory fashion. METHOD: Teens aged 14-17 years old who screened positive for a clinical/subclinical ED or at risk for an ED and who were not currently in ED treatment completed a baseline survey to assess current ED symptoms, mental health comorbidities, and barriers to treatment. Bivariate analyses were conducted to examine differences between participants recruited via social media and those recruited after completion of a widely available online EDs screen (i.e., National Eating Disorders Association [NEDA] screen). RESULTS: Recruitment of teens with EDs using the two online approaches was found to be feasible, with 934 screens completed and a total of 134 teens enrolled over 6 months: 77% (n = 103) via social media 23% (n = 31) via the NEDA screen. Mean age of participants (N = 134) was 16 years old, with 49% (n = 66) identifying as non-White, and 70% (n = 94) identifying as a gender and/or sexual minority. Teens from NEDA reported higher ED psychopathology scores (medium effect size) and more frequent self-induced vomiting and driven exercise (small effect sizes). Teens from NEDA also endorsed more barriers to treatment, including not feeling ready for treatment and not knowing where to find a counselor or other resources (small effect sizes). DISCUSSION: Online recruitment approaches in this study reached a large number of teens with an interest in a digital intervention to support ED recovery, demonstrating the feasibility of these outreach methods. Both approaches reached teens with similar demographic characteristics; however, teens recruited from NEDA reported higher ED symptom severity and barriers to treatment. Findings suggest that proactive assessment and intervention methods should be developed and tailored to meet the needs of each of these groups. PUBLIC SIGNIFICANCE: This study examined the feasibility of recruiting teens with EDs to a digital intervention research study via social media and NEDA's online screen, and demonstrated differences in ED symptoms among participants by recruitment approach.

Examining Increasing Racial Inequities in Opioid Overdose Deaths: a Spatiotemporal Analysis of Black and White Decedents in St. Louis, Missouri, 2011-2021.

The third wave of the opioid overdose crisis-defined by the proliferation of illicit fentanyl and its analogs-has not only led to record numbers of overdose deaths but also to unprecedented racial inequities in overdose deaths impacting Black Americans. Despite this racialized shift in opioid availability, little research has examined how the spatial epidemiology of opioid overdose death has also shifted. The current study examines the differential geography of OOD by race and time (i.e., pre-fentanyl versus fentanyl era) in St. Louis, Missouri. Data included decedent records from the local medical examiners suspected to involve opioid overdose (N = 4420). Analyses included calculating spatial descriptive analyses and conducting hotspot analyses (i.e., Gettis-Ord Gi*) stratified by race (Black versus White) and time (2011-2015 versus 2016-2021). Results indicated that fentanyl era overdose deaths were more densely clustered than pre-fentanyl era deaths, particularly those among Black decedents. Although hotspots of overdose death were racially distinct pre-fentanyl, they substantially overlapped in the fentanyl era, with both Black and White deaths clustering in predominantly Black neighborhoods. Racial differences were observed in substances involved in cause of death and other overdose characteristics. The third wave of the opioid crisis appears to involve a geographic shift from areas where White individuals live to those where Black individuals live. Findings demonstrate racial differences in the epidemiology of overdose deaths that point to built environment determinants for future examination. Policy interventions targeting high-deprivation communities are needed to reduce the burden of opioid overdose on Black communities.

How do teens with a history of suicidal behavior and self-harm interact with social media?

BACKGROUND: This study examines how engagement with depression-related social media content varies by teens who report suicidal ideation, suicide attempts, and nonsuicidal self-injury (NSSI) versus those who had not experienced each behavior. METHODS: Teens aged 15-17 years old (N = 93) were recruited from social media platforms from October 2016 to August 2018. Participants were asked three open-ended questions about the advantages and disadvantages of networking about depression-related content on social media. We conducted a qualitative analysis to capture themes in responses by question item. Univariate analyses were conducted to compare differences in the frequency of themes endorsed among the behavioral groups versus their counterparts. RESULTS: Among participants (female, 73%; non-White, 45%; sexual minority, 57%), most (93%, n = 87) endorsed depressive symptoms. Sixty-five percent (n = 60) endorsed suicidal ideation within the past year, who were more likely to indicate unhelpful social interactions (p = .02) as a disadvantage of following depression content than peers who did not endorse suicidal ideation within the past year. Eighty percent (n = 74) endorsed lifetime experience of NSSI, who were more likely to indicate negative impact on relationships (p = .01) from posting depression content than peers who did not experience NSSI. Fifty-eight percent (n = 54) endorsed a lifetime suicide attempt, who were more likely to mention offering solutions (p = .03) to someone posting concerning content than peers who did not endorse a lifetime suicide attempt. CONCLUSIONS: This study provides diverse and unique perspectives on how engagement with depression-related social media varies by mental health behaviors and informs the use of social media for recruitment and outreach for teens.

Factors associated with not ready to stop using substances among adults with an unmet treatment need: findings from the National Survey of Drug Use and Health 2015-2019.

Background: A better understanding of factors associated with not ready to stop using substances may inform provider engagement with clients who have an unmet treatment need.Objectives: This study explores how treatment barriers, the number of SUD symptoms, and types of substances used are associated with not ready to stop using substances among adults with an unmet treatment need.Methods: The data came from the 2015-2019 National Survey on Drug Use and Health. Eligible adults met DSM-IV criteria for substance abuse and dependence and reported an unmet need for treatment. Among our sample (N = 1,017), a majority self-identified as male (weighted 59.3%). We employed multivariable logistic regression to examine individual-level factors associated with not being ready to stop using substances.Results: About 38% of the respondents reported that they were not ready to stop using substances. Reporting access barriers (aOR = 0.44, 95% CI: 0.29, 0.68) and attitudinal barriers (aOR = 0.47, 95% CI: 0.28, 0.80) was associated with a lower odds of not ready to stop using. Each additional increase in SUD symptoms was associated with 23% higher odds of not being ready to stop using (aOR = 1.22, 95% CI: 1.12, 1.34). Having a diagnosis of alcohol and/or marijuana abuse or dependence was associated with higher odds of not being ready to stop using when compared to respondents without these diagnoses (aOR = 2.13, 95% CI: 1.33, 3.40; aOR = 1.82 95% CI: 1.11, 2.99).Conclusion: Not ready to stop using substances may be impacted by the type of SUD, number of SUD symptoms, and certain barriers like access and attitude to care.

Association between Sexual Violence Victimization and Electronic Vaping Product Use among Adolescents: Findings from a Population-based Study.

BACKGROUND: Although studies have investigated the association between sexual violence (SV) victimization and substance use, few studies have examined the association between SV victimization and electronic vaping product (EVP) use among adolescents in the United States. The objective of this study was to examine the cross-sectional association between SV victimization and EVP use among adolescents. METHODS: Data were pooled from the 2017 and 2019 Youth Risk Behavior Survey. An analytic sample of 28,135 adolescents (51.2% female) was analyzed using binary logistic regression. The outcome variable investigated was EVP use, and the main explanatory variable was SV victimization. RESULTS: Of the 28,135 adolescents, the prevalence of past 30-day EVP use and SV victimization was 22.7% and 10.8%, respectively. Controlling for other factors, adolescents who experienced SV had 1.52 times higher odds of being EVP users when compared to their counterparts who did not experience SV (AOR = 1.52, p < .001, 95% CI = 1.27-1.82). Other factors associated with EVP use included cyberbullying victimization, symptoms of depression, and current use of cigarettes, alcohol, and marijuana. CONCLUSIONS: Experiencing SV was associated with EVP use. Future studies that employ longitudinal designs may offer more insight into the mechanisms underlying the association between SV victimization and EVP use. In addition, school-based interventions that focus on sexual violence prevention and reducing substance use among adolescents are warranted.

Using Social Media to Examine Themes Surrounding Fentanyl Misuse and Risk Indicators.

Background: Opioid misuse is a crisis in the United States, and synthetic opioids such as fentanyl pose risks for overdose and mortality. Individuals who misuse substances commonly seek information and support online due to stigma and legal concerns, and this online networking may provide insight for substance misuse prevention and treatment. We aimed to characterize topics in substance-misuse related discourse among members of an online fentanyl community. Method: We investigated posts on a fentanyl-specific forum on the platform Reddit to identify emergent substance misuse-related themes potentially indicative of heightened risk for overdose and other adverse health outcomes. We analyzed 27 posts and 338 comments with a qualitative codebook established using a subset of user posts via inductive and deductive methods. Posts and comments were independently reviewed by two coders with a third coder resolving discrepancies. The top 200 subreddits with the most activity by r/fentanyl members were also inductively analyzed to understand interests of r/fentanyl users. Results: Functional/quality of life impairments due to substance misuse (29%) was the most commonly occurring theme, followed by polysubstance use (27%) and tolerance/dependence/withdrawal (20%). Additional themes included drug identification with photos, substances cut with other drugs, injection drugs, and past overdoses. Media-focused subreddits and other drug focused communities were among the communities most often followed by r/fentanyl users. Conclusion: Themes closely align with DSM-V substance use disorder symptoms for fentanyl and other substances. High involvement in media-focused subreddits and other substance-misuse-related communities suggests digital platforms as acceptable for overdose prevention and recovery support interventions.

Leveraging Implementation Science in the Treatment of Tobacco Use Disorder.

The tobacco use disorder field has an armamentarium of approaches to help people quit smoking: medication-based treatment for tobacco use, digital therapeutics for just-intime behavioral interventions, genetic and metabolic biomarkers to guide tobacco treatment, to name a few. Whether the treatment approach is old or new, an underlying truth remains: the benefit is only as great as the extent to which these treatment approaches reach individuals who need them most and prove effective and feasible to implement in real-world settings. Further, certain treatments tend to be used more robustly in practice, namely, those that address a great need yet are low in cost, burden, and risk of clinical harms. This is where implementation science comes in, providing guidance on how best to get effective treatments adopted and used in clinical and community settings. Implementation science holds the keys to the uptake and routine use of evidence-based treatments and should be more fully leveraged in the tobacco use disorder field. At the same time, disruptive technologies in treatment are breaking new ground, pushing the field of implementation science to build a bigger "toolbox" of ways to improve access and quality of treatment in an ever-evolving landscape. In this paper, we underscore this synergy between tobacco treatment and implementation science. We spotlight emerging trends in tobacco use, effective and emerging treatment approaches for tobacco use, and ways that implementation science intersects with the current and evolving landscape of tobacco use and substance use disorder more broadly.

Topics and Sentiment Surrounding Vaping on Twitter and Reddit During the 2019 e-Cigarette and Vaping Use-Associated Lung Injury Outbreak: Comparative Study.

BACKGROUND: Vaping or e-cigarette use has become dramatically more popular in the United States in recent years. e-Cigarette and vaping use-associated lung injury (EVALI) cases caused an increase in hospitalizations and deaths in 2019, and many instances were later linked to unregulated products. Previous literature has leveraged social media data for surveillance of health topics. Individuals are willing to share mental health experiences and other personal stories on social media platforms where they feel a sense of community, reduced stigma, and empowerment. OBJECTIVE: This study aimed to compare vaping-related content on 2 popular social media platforms (ie, Twitter and Reddit) to explore the context surrounding vaping during the 2019 EVALI outbreak and to support the feasibility of using data from both social platforms to develop in-depth and intelligent vaping detection models on social media. METHODS: Data were extracted from both Twitter (316,620 tweets) and Reddit (17,320 posts) from July 2019 to September 2019 at the peak of the EVALI crisis. High-throughput computational analyses (sentiment analysis and topic analysis) were conducted. In addition, in-depth manual content analyses were performed and compared with computational analyses of content on both platforms (577 tweets and 613 posts). RESULTS: Vaping-related posts and unique users on Twitter and Reddit increased from July 2019 to September 2019, with the average post per user increasing from 1.68 to 1.81 on Twitter and 1.19 to 1.21 on Reddit. Computational analyses found the number of positive sentiment posts to be higher on Reddit (P<.001, 95% CI 0.4305-0.4475) and the number of negative posts to be higher on Twitter (P<.001, 95% CI -0.4289 to -0.4111). These results were consistent with the clinical content analyses results indicating that negative sentiment posts were higher on Twitter (273/577, 47.3%) than Reddit (184/613, 30%). Furthermore, topics prevalent on both platforms by keywords and based on manual post reviews included mentions of youth, marketing or regulation, marijuana, and interest in quitting. CONCLUSIONS: Post content and trending topics overlapped on both Twitter and Reddit during the EVALI period in 2019. However, crucial differences in user type and content keywords were also found, including more frequent mentions of health-related keywords on Twitter and more negative health outcomes from vaping mentioned on both Reddit and Twitter. Use of both computational and clinical content analyses is critical to not only identify signals of public health trends among vaping-related social media content but also to provide context for vaping risks and behaviors. By leveraging the strengths of both Twitter and Reddit as publicly available data sources, this research may provide technical and clinical insights to inform automatic detection of social media users who are vaping and may benefit from digital intervention and proactive outreach strategies on these platforms.

Marijuana Use and Increases in Use over Time among Young Adult College Students in the State of Georgia: Analyses of Sociocontexual Predictors.

BACKGROUND: While research has assessed correlates of marijuana use, there has been less focus on predictors of differing levels of changes in use during young adulthood, a critical period for use/escalation. OBJECTIVES: We examined changes in marijuana use and related sociocontextual predictors (e.g., earlier-onset substance use, parental use, college type). METHODS: Using data from Georgia college students (ages 18-25 years) in a 2-year, 6-wave longitudinal study (64.6% female, 63.4% White), 2-part random-effects modeling examined use at any assessment and number of days used. RESULTS: Predictors of use status at any assessment included being male (OR = 1.87, 95%CI = [1.28-2.73]), Black (OR = 1.91, 95%CI = [1.15-3.19]), earlier-onset marijuana (OR = 2.63, 95%CI = [1.70-4.06]), cigarette (OR = 2.04, 95%CI = [1.19-3.48]), and alcohol users (OR = 1.49, 95%CI = 1.00-2.22]), parental tobacco (OR = 2.14, 95%CI = [1.18-3.86]) and/or alcohol use (OR = 1.55, 95%CI = [1.09-2.20]), and attending private (vs. public) institutions (OR = 1.68, 95%CI = [1.10-2.59]). Predictors of lower likelihood of use over time included being male (OR = 0.87, 95%CI = [0.77-0.98]), earlier-onset cigarette use (OR = 0.82, 95%CI = [0.68-0.98]), parental alcohol use (OR = 0.86, 95%CI = [0.77-0.97]), and private institution students (OR = 1.17, 95%CI = [1.02-1.34]). Predictors of more days used at baseline included being male (OR = 1.77, 95%CI = [1.40-2.23]), Black (OR = 1.42, 95%CI = [1.04-1.93]), earlier-onset marijuana (OR = 2.32, 95%CI = [1.78-3.01]) and alcohol users (OR = 1.29, 95%CI = [1.01-1.66]), and parental tobacco use (OR = 1.90, 95%CI = [1.32-2.73]). Predictors of fewer days used over time included being older (OR = 0.98, 95%CI = [0.97-1.00]), parental tobacco use (OR = 0.86, 95%CI = [0.78-0.95]), and attending private institutions (OR = 0.89, 95%CI = [0.83-0.93]). CONCLUSIONS: Intervention efforts can be informed by current findings that correlates of baseline use (e.g., being male, attending private institutions) also predicted less use over time, and one's earlier use and parents' use of various substances impacted young adult use.

Comparing the feasibility of four web-based recruitment strategies to evaluate the treatment preferences of rural and urban adults who misuse non-prescribed opioids.

This cross-sectional study examined the feasibility of using four different web-based strategies to recruit rural and urban adults who use opioids non-medically for a survey on opioid use disorder (OUD) treatment preferences, and compared the treatment preferences of rural versus urban participants. Preferences for medication for opioid use disorder (MOUD) formulation and OUD treatment models were assessed through an online survey. Recruitment advertisements were shown on Facebook, Google AdWords, Reddit, and Amazon Mechanical Turk (MTurk). Participants were categorized by zip code into urban versus rural residence using the Centers for Medicaid and Medicaid Health Resources and Services Administration definitions. OUD treatment preferences were compared using chi-square and t-tests. Among the 851 participants recruited, 815 provided zip codes and were classified as residing in rural (n = 200, 24.5%) or urban (n = 615, 75.4%) regions. A crowdsourcing service (MTurk) recruited the most rural participants, while posts on a social news website (Reddit) recruited the most urban participants (χ23 = 17.0, p < 0.01). While preferred MOUD formulation and OUD treatment model did not differ by rurality, rural participants were more likely to report a willingness to receive OUD treatment integrated with general medical care (χ21 = 18.9, p < 0.0001). This study demonstrated that web-based strategies are feasible for recruiting rural adults who misuse opioids. Results suggest OUD treatment preferences largely did not differ by rural residence, and highlight the importance of enhancing the availability and increasing education about MOUD formulations in rural regions.

Exploring how tobacco advertisements are associated with tobacco use susceptibility in tobacco naive adolescents from the PATH study.

Adolescents' susceptibility to pro-tobacco marketing advertisements puts them at risk for initiating and continued use of tobacco. The objective of this study was to quantify the cross-sectional association between tobacco ad exposure and tobacco use susceptibility (e.g., curiosity about tobacco products, willingness, and future intention to try tobacco products) among tobacco-naive adolescents. Data came from Wave 4 of the Population Assessment of Tobacco and Health (PATH) study, a nationally-representative sample of US adolescents ages 12-17. We used logistic regression to examine (1) characteristics associated with tobacco ad exposure; (2) associations between tobacco ad exposures (by product type/venue) and tobacco use susceptibility (among tobacco-naive adolescents only). The results suggested that higher household income, living with tobacco user(s), substance use history, and mental health problem(s) were associated with increased odds of tobacco marketing exposure. Among tobacco naïve adolescents (N = 9455), tobacco ads exposure was positively associated with tobacco use susceptibility, compared with the non-exposure group. Seeing cigarettes/other non-ENDS tobacco products only was associated with a 1.64 increase in odds being susceptible to tobacco use; tobacco ads exposure via website and/or social media sites only (cigarette/other non-ENDS tobacco, AOR: 1.87, 95%CI: 1.25-2.81; ENDS, AOR: 2.25, 95%CI: 1.43-3.55) was associated with higher odds of tobacco use susceptibility, compared to the non-exposure group. With rapidly increasing rates of ENDS use in adolescents, it is crucial that advertisements promoting the initiation and continued use of ENDS are strictly regulated, especially among advertisements that are online and on social media sites.

The impact of discomfort with HIV status and hopelessness on depressive symptoms among adolescents living with HIV in Uganda.

Introduction: Discomfort with and reluctance to disclose HIV status can lead to depression, social isolation, and poor medication adherence; we examined relationships among these variables within a sample of adolescents living with HIV in Uganda. Methods: We used baseline data from the Suubi + Adherence study, which recruited a total of 702 adolescents (ages 10-16 years) living with HIV in southwestern Uganda. Structural equation models were conducted separately among in-school adolescents and out-of-school adolescents to assess associations between discomfort level with HIV status and depressive symptoms and if this association was mediated by hopelessness. Results: Out-of-school adolescents had significantly higher depression scores compared with those in-school youth (M = 6.24 vs. M = 5.03, p < 0.001). Although high discomfort level with HIV status was significantly associated with higher depression scores among both in-school adolescents and out-of-school adolescents, this association among out-of-school adolescents (B = 0.49, 95%CI: 0.19, 0.79), was more substantial than for in-school adolescents (B = 0.10, 95%CI: 0.03, 0.17). Discussion: One's discomfort with their HIV status and the extent to which they are hopeful about the future can contribute to the development of depressive symptoms and these factors need to be considered in the development of assessments and interventions for the treatment of depression among adolescents living with HIV.

Exploring How Social Media Exposure and Interactions Are Associated With ENDS and Tobacco Use in Adolescents From the PATH Study.

INTRODUCTION: Tobacco use is a current public health epidemic that puts individuals at risk for many health conditions and diseases, and adolescents are at high risk for the initiation and persistence of tobacco use behaviors partly due to engagement with social media content. The objective of this study is to examine the association between engaging in social media behaviors and patterns of electronic nicotine delivery systems (ENDS) and tobacco use at a 1-year follow-up among 11 279 adolescents from the PATH study. METHODS: Five social media variables were questioned at Wave 2 and then compared to ENDS and tobacco status transitions (i.e., initiation, persistence, and escalation) at a 1-year follow-up, respectively. Survey-weighted multivariable logistic regression models were used to calculate adjusted odds ratios and 95% confidence interval. RESULTS: Passive behaviors on social media were related to higher likelihoods of starting to use ENDS and other tobacco products. Additionally, active behaviors on social media were related to higher likelihoods for the initiation and persistence of tobacco use. In particular, sending tobacco content to other users was further associated with a higher likelihood of escalation of tobacco product use. DISCUSSION: Both exposure to and interactions with social media tobacco content had a significant impact on the patterns of ENDS and tobacco use in adolescents. Due to the amount of time adolescents spend engaging with online content, social media may be a critical place in which to intervene, possibly with the use of antitobacco or tobacco prevention messages. IMPLICATIONS: The results of this study have implications for public health and the policies surrounding adolescents and their exposure to social media. Reducing the ENDS and tobacco content to which adolescents are exposed has the potential to decrease the instances of initiation and persistence of ENDS and tobacco use. Intervening on social media may prevent or slow the progression of ENDS and tobacco use, and increase motivation and actions toward the cessation of tobacco use in adolescents.

Investigating the role of familial and peer-related factors on electronic nicotine delivery systems (ENDS) use among U.S. adolescents.

INTRODUCTION: Tobacco use is a public health concern, and adolescents are at an increased risk of starting and continuing to use tobacco relative to other age groups. Parent involvement and other social environmental factors may influence the development and persistence of tobacco use behaviors in adolescence. This study used the nationally representative Population Assessment of Tobacco and Health (PATH) study data set, and responses from 7025 adolescent participants were analyzed to illustrate the longitudinal relationship between social environment influences and use of adolescent electronic nicotine delivery systems (i.e., ENDS). METHODS: Social environmental factors were assessed at Wave 3 and then compared to electronic nicotine delivery systems (ENDS) status transitions (i.e., initiation, expansion, persistence) at follow-up. Survey-weighted multivariable logistic regression models were used to calculate adjusted odds ratios (AOR) and 95% confidence intervals (CI). RESULTS: Initiation and persistence of ENDS use were associated with tobacco availability in the house, perception of having no adverse parent reaction to discovering ENDS use and having a best friend who uses ENDS. Initiation of ENDS use was further associated with having biological relatives who have ever been diagnosed with a substance use disorder (SUD) and persistence of ENDS use was also positively associated with lack of in-house rules. Parents talking about ENDS use with adolescents had no association across all three outcomes. CONCLUSIONS: Findings suggest that parental and environmental factors alter the risk of initiation and persistence of ENDS and tobacco use in adolescents, and these should be considered when working with this at-risk population.

Understanding barriers to treatment among individuals not engaged in treatment who misuse opioids: A structural equation modeling approach.

Background: Many individuals misusing opioids do not enter into treatment. The question of who enters into treatment for their opioid abuse and under what circumstances is complex and shaped by multiple factors. The objective of the current study is to explore the risk factors for wide-ranging and numerous barriers to treatment among social media users. Method: Opioid-related forums within a popular social media platform were used to recruit non-treatment engaged individuals (≥15 years) who had misused opioids in the past month (n = 144; 66% male; median age 28). Four treatment barrier factors were identified utilizing principle component analysis: (1) stigma, (2) awareness, (3) attitudinal, and (4) denial. A structural equation model (SEM) was then created to explore the risk factors for different types of barriers to OUD treatment. Results: The most common barriers among participants not engaged in treatment for their opioid misuse were the belief that one should be able to help themselves with their condition (66%), treatment was too expensive (63%), and worries about being labeled or judged (57%). Additionally, SEM results demonstrate stigma barriers, awareness, and attitudinal barriers were associated with mental health comorbidities, opioid abuse and dependence severity, and treatment history. Denial barriers, however, were only associated with treatment history, and structural/financial barriers were only associated with opioid abuse and dependence severity. Conclusions: Our research findings are relevant for underscoring the wide-ranging and numerous barriers to treatment faced by individuals misusing opioids that are especially concentrated among those who also struggle with comorbid mental illness.

Trends in Sexual Activity and Associations With All-Cause and Cause-Specific Mortality Among US Adults.

BACKGROUND: Sexual activity can be referred to as a health behavior and may also act as an indicator of health status. AIM: To evaluate temporal trends in sexual activity and to examine associations of sexual activity with all-cause and cause-specific mortality risk. METHODS: We examined the trends and prevalence of sexual activity and association of sexual activity with all-cause and cause-specific mortality in a nationally representative sample using data from the US National Health and Nutrition Examination Survey from 2005 to 2016 and the National Health and Nutrition Examination Survey 2005-2014 Linked Mortality File (through December 31, 2015). OUTCOMES: All-cause, cardiovascular disease, and cancer mortality. RESULTS: A total of 15,269 US adults (mean age, 39.1 years [standard error, 0.18 years]) were included in the trend analysis. In the 2015-2016 cycle, while 71.7% (95% CI, 67.7-75.7%) US adults aged 20-59 years engaged in sexual activity ≥ 12 times/year (monthly), only 36.1% (95% CI, 31.6-40.7%) of them engaged in sexual activity ≥ 52 times/year (weekly). Since the 2005-2006 cycle, the estimated prevalence of sexual activity, ≥52 times/year and ≥12 times/year, were both stable over time among overall and each age group (all P for trend >0.1). During a median follow-up of 5.7 years (range, 1-11 years) and 71,960 person-years of observation, among 12,598 participants with eligible information on mortality status, 228 deaths occurred, including 29 associated with cardiovascular disease and 62 associated with cancer. Overall, participants with higher sexual activity frequency were at a lower risk of all-cause death in a dose-response manner (P for trend = 0.020) during the follow-up period. In addition, the multivariable-adjusted hazard ratios for all-cause mortality, CVD mortality, cancer mortality, and other cause mortality among participants who had sex ≥52 times/year compared with those having sex 0-1 time/year were 0.51 (95% CI, 0.34 to 0.76), 0.79 (95% CI, 0.19 to 3.21), 0.31 (95% CI, 0.11 to 0.84), and 0.52 (95% CI, 0.28 to 0.96), respectively. CLINICAL IMPLICATIONS: Sexual activity appears to be a health indicator of all-cause and cancer mortality in US middle-aged adults. STRENGTHS & LIMITATIONS: Clear strengths of the present study include the large representative sample of the noninstitutionalized US population as well as the identification of precise estimates in relation to sexual activity and mortality. However, because of the observational nature of the study design, causality could not be determined. CONCLUSIONS: Sexual activity was found to be associated with a lower risk of mortality from all cause and cancer. Cao C, Yang L, Xu T, et al. Trends in Sexual Activity and Associations With All-Cause and Cause-Specific Mortality Among US Adults. J Sex Med 2020;17:1903-1913.

Leveraging social media to explore the barriers to treatment among individuals with depressive symptoms.

BACKGROUND: Individuals with depression may not seek treatment for their symptoms due to several types of barriers to treatment. In support of the growing research on mental health care access and the role of social media, this study aimed to increase knowledge of these barriers among social media users. METHODS: Participants were recruited from several social media platforms, including Instagram, Facebook, Twitter, Reddit, Tumblr, and online depression forums. Eligible participants had endorsed having posted about feeling sad or depressed on social media, or followed social media groups that post about depression-related topics. Participants completed an online survey about their depression symptoms, interest in treatment, and potential barriers to accessing treatment. RESULTS: Of the participants reaching criteria for depression, those with major depression were more likely to seek out treatment, to report an unmet need for treatment, and have a higher risk of suicide. For participants with major depression, barriers to treatment were more likely to be attitudinal, while participants with mild depression experienced more structural barriers. CONCLUSIONS: This study demonstrates several barriers to treatment that occur for individuals struggling with depression, and that online platforms are effective mediums to recruit individuals with depression symptoms who seek mental health support.

Social and Economic Equity and Family Cohesion as Potential Protective Factors from Depression Among Adolescents Living with HIV in Uganda.

Adolescents living with HIV in Uganda are impacted by poverty and face a number of health and social challenges including access to medication, health complications, and social stigma. These stressors have been linked to depression, which can lead to lower HIV treatment adherence. This study seeks to determine how social and economic equity, family cohesion, and social supports may be related to depression among adolescents living with HIV. We used baseline data from the Suubi + Adherence study, a 5-year longitudinal randomized controlled trial among adolescents living with HIV in southwestern Uganda (n = 675; ages 10-16 years). Hierarchical logistic regression models were conducted separately among in-school adolescents and out-of-school adolescents to assess the hypothesized associations between economic and social equity, social support, and depression. About half of the participants meet the criteria for depression. Adolescents with depression were found to have fewer economic and social supports. Our findings indicate that social and economic equity [odds ratio (OR) = 0.85, 95% confidence interval (CI) 0.74, 0.99], family cohesion (OR = 0.94, 95% CI 0.91-0.96), and social support from friends (OR = 0.95, 95% CI 0.91-0.998) are associated with depression for in-school HIV infected adolescents and could be protective factors. The results of this study suggest that social and economic equity may play a protective role against depression and other poor mental health outcomes. Potential interventions for adolescents living with HIV should consider these social and familial factors as they may be protective of depression in this population.

Examining the self-reported advantages and disadvantages of socially networking about body image and eating disorders.

OBJECTIVE: The purpose of this study is to understand the self-reported advantages and disadvantages of socially networking about body image/eating disorders (EDs) and to examine the openness of these participants to online outreach and support for ED symptoms. METHOD: A cross-sectional online survey was conducted with a sample of N = 598. Eligible participants were ≥15 years old, English-speaking, and U.S. residents who endorsed posting or following thin-ideal/body-image content on social media. Quantitative measures were used to assess online peer support and online interaction preferences, and to identify ED symptoms. Deductive and inductive qualitative approaches were used to analyze open-ended items about the advantages and disadvantages of social networking about thin-ideal content on social media platforms (SMPs). RESULTS: Among those who posted about the thin-ideal on social media, 70% felt that the peer responses were positive and supportive. Participants generally favored online interaction, and a third stated that they would accept support from someone they did not know online (38%). The most common advantages noted for posting/following thin-ideal content on SMPs were motivation/encouragement to engage in a certain behavior, socializing, and information giving/seeking. The most common disadvantages mentioned for posting/following thin-ideal content on SMPs were that the content elicits negative/bad feelings, having to deal with the negative consequences/reactions of others when socially networking about this topic, and that it triggers a desire to engage in ED behaviors. DISCUSSION: With these findings, researchers, health practitioners, and social media administrators can devise ways to reduce harmful consequences of posting/following body-image/ED content on social media.

Eating disorder symptomatology, clinical impairment, and comorbid psychopathology in racially and ethnically diverse college women with eating disorders.

OBJECTIVE: To examine eating disorder (ED) symptomatology, related clinical impairment, and comorbid psychopathology in college women with EDs across five racial and two ethnic groups. METHOD: Participants were 690 women from 28 US universities who screened positive for an ED. Thirteen variables assessing ED symptoms, related clinical impairment, and comorbid psychopathology were compared across racial and ethnic groups using analyses of variance (ANOVAs) and independent samples t-tests. RESULTS: Across racial groups, significant differences emerged in binge eating and laxative use. Asian women reported significantly more binge eating than White women (p < .01). Individuals self-identified as the "Other" racial group reported greater laxative use than Asian and White women (ps ≤ .01). No other significant differences emerged across all other variables (ps ≥ .13). Across ethnic groups, Hispanic women reported significantly more laxative use (p < .01), and more comorbid insomnia symptoms (p = .03) than non-Hispanic women. No other significant differences were observed (ps ≥ .24). DISCUSSION: Findings suggest that binge eating, laxative use, and insomnia symptoms differ across racial and ethnic groups in US college women who screened positive for EDs. Findings can inform tailoring of ED screening to reduce current disparities in these underrepresented populations.