The politics of vaccination: a closer look at the beliefs, social norms, and prevention behaviors related to COVID-19 vaccine uptake within two US political parties.

COVID-19 vaccine hesitancy and suboptimal vaccine uptake rates are pressing public health challenges. Vaccine hesitancy has been observed for different vaccines. For COVID-19 vaccines, multiple factors influence vaccine uptake in the U.S. including political ideology. A more nuanced understanding of the factors influencing COVID-19 vaccine uptake within political parties is needed. This study assesses the relationship between known vaccine hesitancy factors and vaccine uptake within two major political parties. Data from 804 U.S. participants in an online survey from June 2021 was used to assess the association between COVID-19 vaccine uptake (no dose vs. any dose) and categories of factors thought to influence vaccine uptake (sociodemographic variables, COVID-19 disease and vaccine belief variables, belief in COVID-19 prevention behavior variables, and social network features variables) for Republicans and Democrats using bivariate and multivariate regression. 65.4% of the sample reported having received at least one dose of the COVID-19 vaccine (22.6% Republican and 52.1% Democrat). In the total sample bivariate model, Democrat participants had significantly greater odds of having received a dose of the vaccine as compared to Republican participants (OR = 2.51, 95%CI = 1.73-3.64). In adjusted models, the speed of vaccine development was negatively associated with vaccine uptake for both Republicans (aOR = 0.18, 95%CI = 0.06-0.57) and Democrats (aOR = 0.40, 95%CI = 0.19-0.86), as was concern about side effects from the vaccine (Republicans: aOR = 0.15; 95%CI = 0.05-0.47; Democrats: aOR = 0.14, 95%CI = 0.06-0.31). COVID-19 vaccine uptake among Republicans, but not Democrats, was associated with belief that the vaccine prevents COVID-19 (aOR = 3.29, 95%CI = 1.29-8.37) and belief about friends' vaccine intentions (aOR = 6.19, 95%CI = 2.39-16.05). There were no significant factors unique to Democrats. Concerns about aspects of COVID-19 vaccine safety for both political groups suggest that vaccine advocacy interventions should universally address these factors. However, Republican beliefs in vaccine efficacy and in friends' vaccine intentions suggest a need for Republican-specific messaging.

Child Mental Health and Sleep Disturbances During the Early Months of the COVID-19 Pandemic in the United States.

Many children have experienced unprecedented levels of stress as a result of the COVID-19 pandemic due to school closures, strained resources, and excess morbidity and mortality. The current study examines change in children's mental health and sleep during the early months of the US pandemic and identifies risk and protective factors. In May 2020, a total of 225 parents reported on the mental health and sleep of each child (N = 392 children) living in their household prior to the onset of the COVID-19 pandemic and about their functioning in the past month. McNemar's test examined change in mental health and sleep disturbance across developmental stage. Bivariate and multivariate generalized estimating equations examined predictors of change in mental health and sleep. Each age group showed a significant change in mental health and sleep outcomes, but the development of mental health problems was greater for older children. Parental caregiving strain (adjusted odds ratio [aOR] = 2.42; 95% confidence interval [CI], 1.11-5.27) was identified as a risk factor associated with children developing anxiety, and income loss was associated with developing sleep disturbances (aOR = 2.34; 95% CI, 1.06-5.17). Parental receipt of emotional support was identified as a protective factor for all child health outcomes. Policies and interventions that promote access to mental health services, provide financial safety nets, and strengthen social support networks for families are needed.

Social norms and prevention behaviors in the United States early in the COVID-19 pandemic.

The current study assessed how social norms were associated with the three effective Covid-19 prevention behaviors of social distancing, handwashing, and wearing protective face masks during the early stages of the pandemic in the US. Study participants were recruited online. Data from the present study was from a baseline quantitative survey administered from March 25th-27th, 2020. The 808 study participants were recruited for a longitudinal study online. Eligibility requirements included age 18 or older, living in the United States, English speaking and reading had heard of the Coronavirus or Covid-19, and provided informed consent. The three outcome variables were handwashing, mask wearing, and social distancing. Injunctive and descriptive norms were assessed. The injunctive norm of perceiving friends would find them rude if they did not affiliate with them because Covid-19 was associated with all three outcomes in both the bivariate and multivariate logistic regression models with adjusted odds ratios ranging from (aOR) = .80 for handwashing to aOR = .63 for social distancing and aOR = .77 for mask wearing. The descriptive cognitive norm of friends worrying about becoming infected was associated with all three outcomes in the bivariate analysis but only mask wearing in the multivariate models (aOR = 1.74). The study findings suggest there are strong social factors that correlate with behaviors to prevent the transmission of SARS-CoV-2. These findings also suggest that public health communication campaigns should focus on more than heightening risk perceptions. They should include attention to social norms and perceptions of social risks to significant others.

Behavioral and psychosocial factors associated with COVID-19 skepticism in the United States.

COVID-19 skepticism can be conceptualized as the denial of the seriousness of the illness and the perception that the pandemic is overblown or a hoax. In the current study, we examined the association between COVID-19 skepticism and frequency of engaging in COVID-19 prevention behaviors, political ideology, social norms about distancing, COVID-19 information-seeking behaviors, and COVID-19 conspiracy theories. A survey was administered from May 5th-14th. At that time, there were over 1 million COVID-19 cases in the US. Participants were recruited online through MTurk. The three outcome variables were handwashing, mask wearing, and social distancing. Injunctive and descriptive norms were assessed as well as measures of perceived risk to self and others. There were 683 participants in the analyses. In the multiple logistic regression model, those who were of younger age (aOR = 0.97, p < 0.05), better health (aOR = 0.56, p < 0.01), and more politically conservative (aOR = 1.32, p < 0.01) were more likely to endorse COVID-19 skepticism statements. People who reported higher Skepticism were also less likely to that believe people close to them would die from COVID-19 (aOR = 4.2, p < 0.01), engage in COVID-19 prevention behaviors, including spending time inside to prevent coronavirus (aOR = 0.33, p < 0.01) and frequently wear a mask outside (aOR = 0.44, p < 0.01). Those who were more skeptical about COVID-19 were also more likely to believe the conspiracy theory that China purposefully spread the virus (aOR = 6.38 p < 0.01). COVID-19 Skepticism was strongly associated with reduced engagement in COVID-19 prevention behaviors. These findings bolster the arguments for making these public health recommendations mandatory.

Understanding HIV/AIDS prevention and care in the context of competing health and well-being priorities among Black men who have sex with men in Baltimore, MD.

This study examines health and well-being priorities among Black men who have sex with men (BMSM) in Baltimore, MD and their association with condom use. Among 148 sexually active BMSM, 43% were HIV positive. The majority ranked financial stability (68%), physical health (53%), and stable housing (59%) as top priorities. Fewer participants identified top priorities as mental health (37%), HIV prevention (35%), relationships with family (25%), and romantic partners (23%). Identifying HIV prevention (aOR: 2.25; 95% CI: 1.07-4.72) and relationship with family (aOR: 2.19; 95% CI: 0.99-4.89) as top priorities were associated with increased odds of always using condoms. Reporting stable housing as a top priority (aOR: 0.47; 95% CI: 0.22-1.00) reduced the odds of always using a condom. To increase relevance, HIV/AIDS prevention programs should address BMSM's financial, housing and physical health needs.

The role of overdose reversal training in knowing where to get naloxone: Implications for improving naloxone access among people who use drugs.

Background: Naloxone distribution and training programs have been implemented to combat the opioid overdose crisis. While many individuals are trained, ongoing naloxone access is not ensured by these programs. We explored whether people who use drugs (PWUD) in Baltimore City, Maryland could identify a location where they would go to obtain naloxone and how training changed where they would be willing to access naloxone. Methods: We surveyed 574 PWUD as to whether they had heard of, been trained to use, and knew where to get naloxone. Among participants who had heard of naloxone, we tested for differences in knowing where to get naloxone by training. Results: The majority (95.3%) had heard of naloxone. Of these, 84.0% could name a location where they would access naloxone, but only 11.7% named multiple. Pharmacies (32.3%) and medical providers (excluding drug treatment providers) (22.9%) were the most commonly identified sources. Participants who had been trained to use naloxone were more likely to report that they would obtain naloxone from the needle exchange and were less likely to report they did not know where they would go to get it or that they would go to a medical provider (excluding drug treatment providers) for naloxone. Conclusions: Naloxone training was associated with participants' ability to name a location where they would obtain naloxone. Medicalized sources of naloxone remained the most commonly reported. These sources, however, may be associated with significant barriers to access, such as cost. Trainings should provide comprehensive education about low-cost/free sources to ensure ongoing naloxone access among people who use drugs.

Determinants of worry using the SARS-CoV-19 worry (CoV-Wo) scale among United States residents.

We sought to develop a brief Severe Acute Respiratory Syndrome Coronavirus 2-related worry (CoV-Wo) scale to understand COVID-19-related worry among adults in the United States. We also aimed to model key determinants of worry in the early stage of the COVID-19 pandemic in the United States. A total of 806 participants completed an online survey in late March 2020. Exploratory and confirmatory factor analyses assessed scale structure. Factor analysis stratified by depression was used to assess measurement invariance. Linear regression models examined COVID-19-related worry determinants. The CoV-Wo scale exhibited good reliability (α = 0.80) and a two-factor structure: health (α = 0.83) and resources (α = 0.71). The full scale and both subscales were higher among participants who stopped working due to COVID-19 and those with depression. Perception of quality medical care if infected with COVID-19 was associated with reduced worry. The CoV-Wo scale is a low burden assessment of COVID-19-related worry, that captures common worries in domains affected by COVID-19 and can be used to develop psychosocial resources.

An Assessment of the Rapid Decline of Trust in US Sources of Public Information about COVID-19.

We conducted a longitidinal assessment of 806 respondents in March, 2020 in the US to examine the trustworthiness of sources of information about COVID-19. Respondents were recontacted after four months. Information sources included mainstream media, state health departments, the CDC, the White House, and a well-known university. We also examined how demographics, political partisanship, and skepticism about COVID-19 were associated with the perceived trustworthiness of information sources and decreased trustworthiness over time. At baseline, the majority of respondants reported high trust in COVID-19 information from state health departments (75.6%), the CDC (80.9%), and a university (Johns Hopkins, 81.1%). Mainstream media was trusted by less than half the respondents (41.2%), and the White House was the least trusted source (30.9%). At the 4-month follow-up, a significant decrease in trustworthiness in all five sources of COVID-19 information was observed. The most pronounced reductions were from the CDC and the White House. In multivariate analyses, factors associated with rating the CDC, state health department, and a university as trustworthy sources of COVID-19 information were political party affiliation, level of education, and skepticism about COVID-19. The most consistent predictor of decreased trust was political party affiliation, with Democrats as compared to Republicans less likely to report decreased trust across all sources.

Fentanyl and Drug Overdose: Perceptions of Fentanyl Risk, Overdose Risk Behaviors, and Opportunities for Intervention among People who use Opioids in Baltimore, USA.

BACKGROUND: Fentanyl-related mortality has skyrocketed among people who use opioids (PWUO) in North America. The current study of PWUO aims to examine the perceived fentanyl risk and training needs; fatal overdose prevention behaviors; and, feasibility of a peer education approach to reducing fentanyl-related fatal overdoses in Baltimore, Maryland, USA. METHODS: 316 street-recruited PWUO were interviewed about fentanyl in Baltimore, MD. RESULTS: Most participants (56%) reported that "all" or "almost all" heroin in Baltimore was adulterated with fentanyl and were worried (75%) about their drug buddies overdosing on fentanyl. Half (54%) the participants felt that they needed more training to respond to an overdose. Many participants (66%) reported receiving naloxone or a prescription for it, yet only 17% carried naloxone with them "often" or "always." Among people who inject drugs (PWID) only 13% had naloxone available "often" or "always" when they injected with others, and 51% "often" or "always" injected alone. Almost half of participants (47%) were "very willing" to talk with people in their neighborhood about fentanyl. CONCLUSIONS: The majority of PWUO perceived that most heroin in Baltimore was adulterated with fentanyl, yet most did not carry naloxone and PWID often did so alone. Given the high perceived risk of fentanyl and relatively low uptake of fatal overdose prevention behaviors, there is an urgency for safe injection facilities, access to medically assisted treatment, and programs that work with the drug-using community to deliver overdose prevention training as well as promote behaviors to carry naloxone and not use drugs alone.

'They Talk about the Weather, but No One Does Anything about It': A Mixed-Methods Study of Everyday Climate Change Conversations.

Understanding everyday conversations about climate change may provide insights into framing the issue to promote climate change action. As part of a longitudinal online study in the US launched in June 2021, 805 respondents were asked if they had discussed climate change with a friend or family member in the prior month; if not, why not, and if yes, they were asked to delineate the conversation topic. Concurrent mixed methods were used to analyze the data. The majority (62.6%) of respondents reported not having a conversation about climate change in the prior month. Among those who indicated that they had discussed climate change, five themes were identified from the conversation topics, with many having reported discussing the impact of climate change on weather patterns. Very few discussed actions to address climate change, and most of these discussions focused on individual-level behaviors rather than collective actions. Among participants who had not recently discussed climate change, the most prevalent theme was that it was not a priority or an issue they cared about. Results suggest that conversations may not lead to collective actions and that policymakers and environmental organizations should provide guidance on effectively channeling climate change concerns into action.

Family Communication About Climate Change in the United States.

Family discussions about climate change are a critical factor influencing children's climate change perceptions and behaviors. Yet, there is limited research on family communication about climate change in the US. Drawing from an online longitudinal sample, 214 parents reported on their 336 children. Descriptive statistics examined engagement in family climate change communication. Children's climate change concerns and parents' interest in engaging in conversations about climate change were assessed by the child's age. Logistic models examined how recent family climate change communication was associated with parents' perceived roles and barriers to engaging in conversations. Most parents (68%) were interested in talking to their children about climate change; of those expressing interest, only 46% reported recent communication. Parents reported that older children were more concerned about climate change than younger children (0-5 years: 21%; 6-11 years: 43%; 12-17 years: 56%), but no differences were identified in parents' interest in communicating with their children by the child's age. Recent family climate change communication was significantly associated with not knowing what to say and parents' perception that their role was to support their children in action. Study findings suggest a significant opportunity to involve families in climate change communication. Parents may benefit from training resources, especially those tailored to children's age, to help them communicate with their children about climate change. Strategies that engage parents and children in activism activities together are also needed.

Trusted information sources in the early months of the COVID-19 pandemic predict vaccination uptake over one year later.

INTRODUCTION: COVID-19 vaccine uptake has been a major barrier to stopping the pandemic in many countries with vaccine access. This longitudinal study examined the capability to predict vaccine uptake from data collected early in the pandemic before vaccines were available. METHODS: 493 US respondents completed online surveys both at baseline (March 2020) and wave 6 (June 2021), while 390 respondents completed baseline and wave 7 (November 2021) surveys. The baseline survey assessed trust in sources of COVID-19 information, social norms, perceived risk of COVID-19, skepticism about the pandemic, prevention behaviors, and conspiracy beliefs. Multivariable logistic models examined factors associated with the receipt of at least one COVID-19 vaccine dose at the two follow-ups. RESULTS: In the adjusted model of vaccination uptake at wave 6, older age (aOR = 1.02, 95 %CI = 1.00-1.04) and greater income (aOR = 1.69, 95 %CI = 1.04-2.73) was associated with positive vaccination status. High trust in state health departments and mainstream news outlets at baseline were positively associated with vaccination at wave 6, while high trust in the Whitehouse (aOR = 0.42, 95 %CI = 0.24-0.74) and belief that China purposely spread the virus (aOR = 0.66, 95 %CI = 0.46-0.96) at baseline reduced the odds of vaccination. In the adjusted model of vaccination uptake at wave 7, increased age was associated with positive vaccination status, and Black race (compared to white) was associated with negative vaccination status. High trust in the CDC and mainstream news outlets at baseline were both associated with being vaccinated at wave 7, while high trust in the Whitehouse (aOR = 0.24, 95 %CI = 0.11-0.51) and belief that the virus was spread purposefully by China (aOR = 0.60, 95 %CI = 0.39-0.93) were negatively associated with vaccination. CONCLUSIONS: These findings indicated that vaccine uptake could be predicted over a year earlier. Trust in specific sources of COVID-19 information were strong predictors, suggesting that future pandemic preparedness plans should include forums for news media, public health officials, and diverse political leaders to meet and develop coherent plans to communicate to the public early in a pandemic so that antivaccine attitudes do not flourish and become reinforced.

Associations between depressive esymptoms and identity-specific social support among Black men who have sex with men (BMSM) in Baltimore City, Maryland.

Introduction: Depression and other adverse mental health outcomes are prevalent among Black men who have sex with men (BMSM). Social support can be protective against symptoms of depression, the effects of which may be amplified by experiences of a shared social identity. Methods: We explored the associations between BMSM-specific social support and depressive symptoms among a sample of 280 BMSM. We used chi-square and t-tests to examine bivariate associations between social support, depressive symptoms, and key correlates, and logistic regression to adjust the relationship between social support and depressive symptoms. Results: Most participants reported high (43.2%) or moderate (41.8%) levels of BMSM-specific social support, 38% reported depressive symptoms, and 47.6% were living with HIV. Adjusting for socioeconomic and structural vulnerabilities, health, and involvement in the gay community, high social support was associated with a marginal decrease in the odds of depressive symptoms compared to low social support. Conclusions: Results indicate that BMSM-specific social support is protective against depressive symptoms even in the context of other socioeconomic and structural vulnerabilities, suggesting that strengths-based interventions focused on building community and mutual support among BMSM may be valuable tools to prevent depression and promote positive mental health outcomes for members of this population.

Pandemic detention: life with COVID-19 behind bars in Maryland.

Background: People incarcerated during the COVID-19 pandemic face higher vulnerability to infection due to structural and social factors in carceral settings. Additionally, due to the higher prevalence of chronic health conditions among carceral populations, they are also at risk for more severe COVID-19 disease. This study was designed to explore the experiences of people incarcerated in prisons and jails in Maryland during the height of the pandemic. Methods: We conducted semi-structured phone interviews between January 2021 and April 2022 with ten individuals incarcerated in Maryland carceral facilities during the height of the U.S. COVID-19 pandemic and were subsequently released from prison or jail. We transcribed the interviews, coded them, and engaged in content analysis, an inductive analytical approach to developing themes and meaning from qualitative data. Results: Four themes emerged from participants' descriptions of their experiences: (1) distress from fear, vulnerability, and lack of knowledge about COVID-19 and how to protect themselves, (2) shortcomings of prison and jail administrators and other personnel through lack of transparency and arbitrary and punitive enforcement of COVID-19 protocols, (3) lack of access to programming and communication with others, and (4) absence of preparation for release and access to usual re-entry services. Conclusion: Participants responded that the prison and jails' response during the COVID-19 pandemic was ill-prepared, inconsistent, and without appropriate measures to mitigate restrictions on liberty and prepare them for release. The lack of information sharing amplified their sense of fear and vulnerability unique to their incarceration status. Study findings have several institutional implications, such as requiring carceral facilities to establish public health preparedness procedures and making plans publicly available.

Perceived Barriers to Climate Change Activism Behaviors in the United States Among Individuals Highly Concerned about Climate Change.

BACKGROUND: There is a tremendous gap between the proportion of the population expressing concern about climate change and those engaged in climate change activism. We examined barriers to climate change activism among respondents stating climate change was an important issue to them. METHODS: Participants in a national online longitudinal study reported on 12 reasons for lack of involvement in climate change actions. Five months later, engagement in six climate change actions was assessed. The primary analyses focused on the 319 respondents who, out of 592 respondents who participated in both surveys, reported that the issue of global warming was extremely or very important to them. RESULTS: Participants showed a range of engagement in climate change activism behaviors: 29.8% donated money to an organization to reduce climate change, 32.3% signed a petition, 69.0% voted for candidates who support measures to reduce climate change, 11.9% wrote letters, e-mailed, or phoned government officials to urge them to take action, and 9.4% volunteered with organizations working to curb climate change. The median number of barriers was 5. The most frequent reasons for lack of involvement in climate change activism were other people are better at it (57.4%), hadn't been trained (56.7%), hadn't been asked (50.8%), not knowing how to get involved (49.8%), activities like letter writing not appealing (49.8%), too busy (38.9%), organizations would ask them for money (39.8%), and not encouraged to become involved (38.2%). Several barriers were associated with engagement in climate change activism five months later. The most consistent association with activism was with talking about climate change in the prior month. CONCLUSION: Most respondents cited several barriers that impeded their involvement in climate change activism. Select barriers were associated with reduced engagement in activism. Organizations that address climate change should acknowledge barriers but emphasize that individuals can engage in climate change activism regardless of barriers.

Temporal reliability and stability of delay discounting: A 2-year repeated assessments study of the Monetary Choice Questionnaire.

The Monetary Choice Questionnaire (MCQ) is one of the most commonly used measures to assess delay discounting of reward. Reliable measurement by the MCQ is necessary for use in experimental settings or prognostic validity within clinical contexts. The present analysis expands prior work to evaluate temporal reliability and stability over an extended period, including repeated measurements, a larger and more broadly representative sample, and demonstrations of covariation with clinically significant health behaviors (e.g., cigarette use, COVID-19 vaccination, body mass index). Participants (N = 680; 55.6% female) were recruited through crowdsourcing and completed the MCQ approximately quarterly over 2 years. Measures of reliability, stability, and correlations with clinical constructs were determined for each timepoint and pairwise comparison. Test-retest reliabilities were high across all pairwise comparisons (all rxx > .75; range = .78-.86; mean = .83). Stability was also high with within-subject effect size differences all within a less-than-small effect size range (range dz = -0.09 to 0.19; mean = 0.04). Positive associations between smoking status and delay discounting rates were observed consistent with prior clinical studies. These findings of test durability support the use of MCQ administration for repeated measurement of delay-constrained choice as a stable respondent characteristic and illustrate its association with important health behaviors over extended time periods. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Fentanyl overdose concerns among people who inject drugs: The role of sex, racial minority status, and overdose prevention efforts.

BACKGROUND: People who inject drugs (PWID) have an elevated risk of fentanyl-related overdoses. This study explores fentanyl overdose concerns among PWID and the role of sex, racial minority status, and overdose prevention efforts in these concerns. METHOD: Data were from 498 PWID from Baltimore City, MD, recruited using street-based outreach between 2016 and 2019. Multinomial logistic regressions assessed correlates of participants' level of concern for themselves and their peers overdosing from fentanyl. RESULTS: A third of participants were female, half were Black, over two-thirds perceived fentanyl to be in all/most of heroin, 40% expressed low fentanyl overdose concern, and a third overdosed in the past 6 months. After controlling for sociodemographic characteristics, female sex was associated with being very concerned about fentanyl overdoses for oneself (adjusted relative risk [aRR]: 2.13; 95% CI: 1.22, 3.72) and peers (aRR: 1.98; 95% CI: 1.14, 3.45). Compared to Black participants, White participants were less likely to be very concerned about fentanyl overdoses for themselves (aRR: 0.35; 95% CI: 0.19, 0.65). Participants who often/always carried naloxone (aRR: 2.91; 95% CI: 1.42, 5.95) perceived fentanyl in most heroin (aRR: 2.78; 95% CI: 1.29, 5.97) or were on medications for opioid use disorder (MOUD) (quite a bit concerned aRR: 2.18; 95% CI: 1.28, 3.69; very concerned: aRR: 1.96; 95% CI: 1.19, 3.22) were more likely than their counterparts to report being concerned for their peers, but not for themselves. CONCLUSION: Female sex and racial minority status were associated with greater concern regarding fentanyl overdoses for oneself. Increasing overdose deaths in these populations suggests disparate access to harm-reduction initiatives rather than interest or concern. Furthermore, findings on naloxone, MOUD, and concerns for peers support social network-based interventions among PWID. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

What predicts climate change activism?: An examination of how depressive symptoms, climate change distress, and social norms are associated with climate change activism.

Background: The current and future harms caused by climate change are highly distressing. Different theoretical models suggest diverse impacts of distress on behavior. We examined how psychological distress, climate change distress, and social norms may foster or impede climate change activism. Methods: As part of an ongoing online longitudinal study in the US beginning in March 2020, respondents were assessed on their depressive symptoms (CES-D 10), climate change distress, climate change mitigation social norms, and six outcomes of the climate change activism behaviors of writing letters, e-mailing, or phoning government officials; voting for candidates who support measures to reduce climate change; signing petitions; volunteering with organizations; donating money to organizations; and attending protests. Results: Of the 775 respondents, 53% were female, 72% white, 12% Black, 7% Hispanic, and 6% Asian. Climate change social norms predicted all six climate change actions in the bivariate and multivariable cross-sectional logistic regression models. A similar finding was observed with the brief climate change distress scale (BCCDS), except it was not associated with volunteering in the multivariable model. Depressive symptoms were associated with greater odds of contacting government officials and signing petitions in the bivariate models but did not retain significance in the multivariable models. Longitudinal models indicated a weak association between depressive symptoms and climate change activism. Conclusions: Climate change distress and social norms are positively associated with climate change activism. Although climate change distress may not usually impede climate change activism, organizations addressing climate change should consider providing social support to members and assisting those with high levels of psychological and climate change distress. Social norms around climate change activism should be fostered.

A socio-ecological perspective on parents' intentions to vaccinate their children against COVID-19.

INTRODUCTION: Vaccinating children against COVID-19 protects children's health and can mitigate the spread of the virus to other community members. OBJECTIVE: The primary objective of this study was to use a socio-ecological perspective to identify multi-level factors associated with US parents' intention to vaccinate their children. METHODS: This study used a longitudinal online cohort. Multinomial logistic regression models assessed socio-ecological predictors of negative and uncertain child COVID-19 vaccination intentions compared to positive intentions. RESULTS: In June 2021, 297 parents were surveyed and 44% reported that they intended to vaccinate their children while 25% expressed uncertainty and 31% did not intend to vaccinate their children. The likelihood of reporting uncertain or negative intention, compared to positive intention to vaccinate their children was higher among parents who had not received a COVID-19 vaccination and those who did not have trusted information sources. Parents who talked to others at least weekly about the COVID-19 vaccine were less likely to endorse uncertain compared to positive vaccine intentions (aRRR: 0.44; 95% CI: 0.20-0.93). A sub-analysis identified that parents had significantly higher odds of intending to vaccinate older children compared to younger children (children ages 16-17 years v. 0-4 years OR: 2.01, 95% CI: 1.05-3.84). An additional sub-analysis assessed the stability of parents' intention to vaccinate their children between March 2021 and June 2021 (N=166). There was transition within each intention group between the study periods; however, symmetry and marginal homogeneity test results indicated that the shift was not statistically significant. Parents expressing uncertainty in March 2021 were the most likely to change their intention, with 24% transitioning to positive intention and 23% to negative intention in June 2021. CONCLUSION: Study findings suggest that programs to promote vaccination uptake should be dyadic and work to promote child and parent vaccination. Peer diffusion strategies may be particularly effective at promoting child vaccination uptake among parents expressing uncertainty.