Diverse Sample Of Adults Research Articles

Visual and behavioral responses to social and non-social threats: A multi-site replication

Researchers have proposed that humans have evolved psychological mechanisms that facilitate the detection, rapid response, and subsequent avoidance of potential threats. However, some inconsistent results in the literature have called into question the robustness of these responses. Here, we sought to replicate previous findings on the rapid detection of both social (i.e., angry faces) and nonsocial (i.e., snakes) threats within a large and diverse sample of adults, and to examine the robustness of our effects across three data-collection sites using two response metrics—visual latency to detect threatening versus non-threatening stimuli and motor (i.e., button press) responses to indicate that threatening versus non-threatening targets had been detected. We found an advantage for both social (angry facial configurations) and non-social (snakes) threats across all three data collection sites, demonstrating that the phenomenon is both replicable and robust. Further, we found that the threat advantage was only significant for visual latency to first detect threatening stimuli and not for subsequent motor responses—the overall replication effect was driven by first fixations—suggesting that biases for threat might be perceptually based.

Health literacy and COVID-19 pandemic impacts among adults in rural northern Arizona.

Limited health literacy - the ability to access, process, and use health information and services - contributes to persistent health inequities. Yet little is known about associations of limited health literacy with impacts from the COVID-19 pandemic, particularly for US adults in rural areas. This study sought to determine associations of limited health literacy with impacts from the COVID-19 pandemic among a diverse sample of adults in rural Northern Arizona. A cross-sectional, interviewer-administered survey was conducted with 119 adults from June 2020 to August 2021. Participants were recruited from two federally qualified health centers and by word of mouth. The Newest Vital Sign was used to measure health literacy, and the Epidemic-Pandemic Impacts Inventory was used to measure the effects of the COVID-19 pandemic on various aspects of personal and family life (eg spent more time on screens and devices, had family celebrations canceled or restricted). Descriptive, bivariate, and multivariable linear regression statistics were computed. Nineteen percent of participants had limited health literacy, and participants had an average of 22 individual impacts and 2 household impacts of the 92 COVID-19 impacts assessed. Multivariable regression model results showed that being male versus female or having public only versus any private insurance was significantly associated with fewer individual COVID-19 impacts on average. Being black, Indigenous, people of color versus White or being Hispanic, Latino, or Spanish versus not were each associated with significantly more individual COVID-19 impacts on average. Limited versus adequate health literacy was significantly associated with more household COVID-19 impacts on average. Sensitivity analysis results further showed that limited versus adequate health literacy was associated with significantly higher adjusted rates of household social, emotional, and infection COVID-19 impacts. This study's findings highlight the importance of assessing and accounting for health literacy in clinical practice and health services research addressing the impacts of the COVID-19 pandemic and future emergency events.

Characterizing the momentary association between loneliness, depression, and social interactions: Insights from an ecological momentary assessment study

Evidence suggests that loneliness causes people to feel more depressed. It is unknown, however, why this association occurs and whether momentary versus chronic experiences of loneliness are implicated. Theoretical accounts suggest that momentary feelings of loneliness produce two competing motivations: social reaffiliation and social withdrawal. Social affiliation is protective against depression; social withdrawal, in contrast, is a risk factor. Thus, engaging in frequent and high-quality interactions following experiences of loneliness may protect against subsequent depression. We tested this hypothesis using a random-interval experience sampling design (5x/day/day, 14 days; Nobs = 6568) with a racially/ethnically diverse sample of adults with elevated depression symptoms (N = 102). Momentary loneliness was associated with depressed mood at the same time point and ∼2.5h and ∼5h later. Frequency and quality of social interaction did not moderate these associations. Findings suggest that momentary feelings of loneliness may be an important target for clinical intervention.

Sociodemographic predictors of perceived weight discrimination.

Perceived weight discrimination is associated with increased risk for chronic diseases and reduced life expectancy. Nevertheless, little is known about perceived weight discrimination in racial, ethnic, and sexual minority groups or in individuals at the intersections of those groups. The goal of this study was to identify sociodemographic predictors of perceived weight discrimination. A diverse sample of adults (37% Black/African American, 36% Latino, 29% sexual minority) with a body mass index (BMI) ≥ 18.5 kg/m2 were recruited from a national US panel to complete an online survey (N = 2454). Perceived weight discrimination was assessed with the Stigmatizing Situations Survey-Brief (SSI-B). Using hierarchical linear regression analysis, SSI-B scores were predicted from the four sociodemographic characteristics of interest (gender, race, ethnicity, and sexual orientation) while controlling for BMI, age, education, and income (Step 1). At Step 2, all two-way interactions between the four sociodemographic characteristics were added to the model. At Step 1, higher SSI-B scores were observed for Latino (vs. non-Latino) adults, sexual minority (vs. heterosexual) adults, younger (vs. older) adults, adults with higher (vs. lower) levels of education, and adults with higher (vs. lower) BMI. At Step 2, race interacted with gender, ethnicity, and sexual orientation to predict SSI-B scores such that relatively higher scores were observed for non-Black women, Black men, adults who identified as Black and Latino, and non-Black sexual minority adults. Perceived weight discrimination varied across sociodemographic groups, with some subgroups reporting relatively high frequency. Black race appeared to be protective for some subgroups (e.g., Black women), but risk-enhancing for others (e.g., Black men, individuals who identified as Black and Latino). Additional research is needed to identify specific factors that cause certain sociodemographic groups -and indeed, certain individuals-to perceive higher levels of weight discrimination than others.

Changing sustainable diet behaviours during the COVID-19 Pandemic: inequitable outcomes across a sociodemographically diverse sample of adults.

The objective of this study was to describe changes in sustainable dietary behaviours (those that support environmental, economic, and physical health) among a sample of US adults during the COVID-19 pandemic and to examine differences in changes by individuals' race/ethnicity and socioeconomic status. Therefore, a cross-sectional online survey study was conducted in April 2021 (N = 1,488, mean age = 42.7 (SD = 12.6)) receiving outpatient care from Michigan Medicine, the University of Michigan health system. Enrolment quotas were established to ensure a diverse sample-one-third of participants identified as African American/Black, one-third Hispanic/Latino, one-third White, and one-third low-income. Participants reported engaging in more behaviours that are supportive of a sustainable diet one year into the COVID-19 pandemic compared to before. This is particularly true regarding ecologically and economically sustaining behaviours such as taking fewer trips to the grocery store, increased use of home grocery delivery, increased cooking at home, and greater consumption of healthy foods. Not all behaviour changes promoted sustainable food systems; namely, the use of farmer's markets and Community Supported Agriculture (CSAs) declined. White and high-income participants were more likely than African American/Black, Hispanic/Latino, and low-income individuals to engage in ecologically and economically sustainable dietary behaviours during the pandemic. Meanwhile, African American/Black participants reported large increases in physical health sustainable dietary behaviours. To support the continuation of greater engagement with sustainable diets, policies that increase access to public transportation, limit the frequency with which consumers have groceries delivered, increase work-from-home options, and improve access for low-income populations should be prioritised.

Factors Associated with the Decision to Complete Bariatric Metabolic Surgery among a Racially and Ethnically Diverse Sample of Adults: A Classification and Regression Tree Analysis.

Less than 50% of eligible candidates who are referred complete Bariatric Metabolic Surgery (BMS). The factors influencing the decision to complete BMS, particularly how these factors vary across different racial and ethnic groups, remain largely unexplored. This prospective cohort study included adult patients referred to a bariatric surgeon or obesity medicine program between July 2019-September 2022. Sociodemographic characteristics, body mass index (BMI), anxiety, depression, body appreciation, and patient-physician relationship information were collected via survey and electronic health records. The association between BMS completion and potential decision-driving factors was examined using Classification and Regression Tree (CART) analysis. A total of 406 BMS -eligible patients participated in the study (mean [SD] age: 47.5 [11.6] years; 87.2% women; 18.0% Hispanic, 39% non-Hispanic Black [NHB], and 39% non-Hispanic White [NHW]; mean [SD] BMI: 45.9 [10.1] kg/m2). A total of 147 participants (36.2%) completed BMS. Overall, the most influential factor driving the decision to complete BMS was younger age (< 68.4years), higher patient satisfaction, and BMI (≥ 38.0kg/m2). Hispanic participants prioritized age (< 55.4years), female sex, and body appreciation. For NHB participants, the highest ranked factors were age < 56.3years, BMI ≥ 35.8kg/m2, and higher patient satisfaction. For NHW patients, the most influential factors were age (39.1 to 68.6years) and higher body appreciation. These findings highlight racial and ethnic group differences in the factors motivating individuals to complete BMS. By acknowledging these differences, healthcare providers can support patients from different backgrounds more effectively in their decision-making process regarding BMS.

COVID-19 Vaccine Confidence Mediates the Relationship between Health Literacy and Vaccination in a Diverse Sample of Urban Adults.

We sought to analyze the relationship between health literacy, confidence in COVID-19 vaccines, and self-reported vaccination. We hypothesized that the relationship between health literacy and vaccination would be mediated by vaccine confidence. We recruited (N = 271) English- and Spanish-speaking adults in Boston and Chicago from September 2018 to September 2021. We performed a probit mediation analysis to determine if confidence in COVID-19 vaccines and health literacy predicted self-reported vaccination. We hypothesized that the relationship between health literacy and vaccination would be mediated by vaccine confidence. Participants were on average 50 years old, 65% female, 40% non-Hispanic Black, 25% Hispanic, and 30% non-Hispanic White; 231 (85%) reported at least one COVID-19 vaccination. A higher mean vaccine confidence score (t = -7.9, p < 0.001) and higher health literacy (t = -2.2, p = 0.03) were associated with vaccination, but only vaccine confidence predicted vaccination in a multivariate model. Vaccine confidence mediated the relationship between health literacy and COVID-19 vaccination (mediated effects: 0.04; 95% CI [0.02, 0.08]). We found that using a simple tool to measure vaccine confidence identified people who declined or delayed COVID-19 vaccination in a diverse sample of adults with varying levels of health literacy. Simple short survey tools can be useful to identify people who may benefit from vaccine promotion efforts and evidence-based communication strategies.

Unique contributions of anxiety, stress and depression to immunity: A cross-cultural investigation

While immunity and psychological distress are strongly associated, studies seldom consider how different types of distress relate to immune functioning. The literature tends to emphasis the impact of stress on immunity. The present cross-sectional study estimated the unique contributions of depression, anxiety, and stress on immune function in culturally diverse samples of adults from Italy, New Zealand and India. Participants were Italian (n = 1061), New Zealand (n = 1037), and Indian (n = 384) volunteers. Stepwise multiple linear regression and dominance analysis were used to analyse differences in immunity uniquely explained by anxiety, depression, and stress. While samples from the three countries differed significantly, anxiety consistently explained the greatest proportion of differences in immunity. After accounting for the effect of anxiety, stress and depression explained only negligible variation in immune functioning. This association of anxiety with immune functioning was consistent across three different countries and this unique impact was further confirmed by the results of dominance analysis. These findings suggest a clear link between anxiety and immunity, which advances the prevailing stress-disease model and foster further experimental and longitudinal research into the impact of anxiety on immunity.

Prevalence and Predictors of Medical Mistrust Among African Americans with Serious Mental Illness Receiving Care in an Urban Setting.

Patients with serious mental illness are reported to have a 10-25 year reduction in life expectancy. Medical mistrust may influence their willingness to seek care (Bynum, S. A., Davis, J. L., Green, B. L., & Katz, R. V. (2012). Unwillingness to participate in colorectal cancer screening: Examining fears, attitudes, and medical mistrust in an ethnically diverse sample of adults 50 years and older. American Journal of Health Promotion : Ajhp, 26(5), 295-300. https://doi.org/10.4278/ajhp.110113-QUAN-20 ). This cross-sectional study used baseline data from a SAMHSA funded demonstration project to describe the prevalence and of medical mistrust among a sample of African American adults with serious mental illness. Medical mistrust was identified using the Medical Mistrust Scale. One hundred and fifty-four participants completed the medical mistrust scale. Approximately, a third (34.4%) reported medical mistrust. After adjusting for financial stability, those endorsing medical mistrust reported nearly 3 times the odds of lacking support (AOR [95% CI]: 2.84 [1.01-7.97]) compared to those not endorsing medical mistrust. The study is among the first to describe elevated rates of medical mistrust among a sample of African Americans people with serious mental illness. An association between medical mistrust and lack of social support was demonstrated.

Prerandomization withdrawals from a Type 2 diabetes self-care support intervention trial are associated with lack of available support person coparticipant.

Dyadic interventions, involving two persons with a preexisting close relationship, offer the opportunity to activate support persons (SPs) to improve health for adults with chronic conditions. Requiring SP coparticipation can challenge recruitment and bias samples; however, the associations between voluntary SP coparticipation and recruitment outcomes across patient characteristics are unknown. The Family/Friend Activation to Motivate Self-care 2.0 randomized controlled trial (RCT) enrolled adults with Type 2 diabetes (T2D) from an academic health system. Participants were asked-but not required-to invite an SP to coenroll. Using data from the electronic health record we sought to describe RCT enrollment in the setting of voluntary SP coparticipation. In a diverse sample of adults with (T2D) (48% female, 44% minoritized race/ethnicity), most participants (91%) invited SPs and (89%) enrolled with SPs. However, prerandomization withdrawal was significantly higher among participants who did not have consenting SPs than those who did. Females were less likely to invite SPs than males and more Black PWD were prerandomization withdrawals than randomized. Voluntary SP coenrollment may benefit recruitment for dyadic sampling; however, more research is needed to understand if these methods systematically bias sampling and to prevent these unintended biases.

Frequency of Non-Specific Cervical Pain Experienced by the Adult Population in Peshawar A Review Article

Non-specific cervical pain is a prevalent health concern affecting individuals across various age groups and populations. This study aims to investigate the frequency of non-specific cervical pain experienced by the adult population in Peshawar. A cross-sectional survey was conducted, gathering data from a diverse sample of adults residing in Peshawar. The results revealed valuable insights into the prevalence and characteristics of non-specific cervical pain in this region. The findings emphasize the need for public health interventions and awareness campaigns to address this issue effectively.

Are People Generous When the Financial Stakes Are High?

How generous are people when making consequential financial decisions in the real world? We took advantage of a rare opportunity to examine generosity among a diverse sample of adults who received a gift of U.S. $10,000 from a pair of wealthy donors, with nearly no strings attached. Two-hundred participants were drawn from three low-income countries (Indonesia, Brazil, and Kenya) and four high-income countries (Australia, Canada, the United Kingdom, and the United States) as part of a preregistered study. On average, participants spent over $6,400 on purchases that benefited others, including nearly $1,700 on donations to charity, suggesting that humans exhibit remarkable generosity even when the stakes are high. To address whether generosity was driven by reputational concerns, we asked half the participants to share their spending decisions publicly on Twitter, whereas the other half were asked to keep their spending private. Generous spending was similar between the groups, in contrast to our preregistered hypothesis that enhancing reputational concerns would increase generosity.

Effects of Modified Tobacco Risk Products with Claims and Nicotine Features on Perceptions among Racial and Ethnic Groups.

Research suggests consumers may misunderstand modified risk tobacco product (MRTP) claims. We examined the effects of nicotine content across four tobacco products with and without MRTP claims among a racially and ethnically diverse sample of adults who do and do not smoke. Adults (n = 1484) aged 21-65 completed an online experiment using a 2 × 2 × 4 mixed factorial design to examine the effects of tobacco product (Classic White Snus, IQOS, JUUL e-cigarette, and VLN cigarette) and nicotine content (high vs. low) stratified by MRTP claim (present vs. absent) across four outcomes: (1) likely to try (2) serious disease if used regularly, (3) least addictive, and (4) ease of quitting smoking. Not including an MRTP claim resulted in an increased likelihood of trying a product, decreased concern of serious disease, lower perceived addictiveness, and increased ease of quitting smoking. Participants selected low nicotine IQOS without a claim as the least likely to cause serious disease. Low nicotine JUUL, without a claim, was selected as least addictive and most likely to facilitate quitting. Intentions to try were highest for low nicotine JUUL. Participants selected low-nicotine products as less addictive than high nicotine products. Regulatory efforts should consider how MRTP claims interact with different product characteristics. Subtle differences exist across outcomes between racial and ethnic groups, which indicates that further research is warranted.

65-LB: Social Determinants of Health Predict Self-Care in Type 1 Diabetes

Social determinants of health (SDH), or the conditions in which people live, learn, work, play, and age strongly influence health inequities among adults with type 1 diabetes (T1D). Diabetes self-care, or daily behaviors performed to maintain health (maintenance), monitor for changes (monitoring), and manage illness (management), is essential for T1D management, but may also be impacted by SDH. We aimed to determine if SDH predicted self-care maintenance, monitoring and management, and if so, identify which SDH items were the most salient predictors. A diverse sample of adults with T1D (n=200, 27% Black, 61% female, median age: 35 years, disease duration: 19 years) completed an SDH risk assessment (PRAPARE tool; Risk Tally Scoring Method applied to 14 items to yield a composite risk score) and self-care assessment (Self-Care of Diabetes Inventory [SCODI]; 3 self-care [maintenance, monitoring, and management] and 1 confidence scale). A multivariable linear regression model of each self-care scale was built with SDH risk and confidence as predictors of self-care. For each self-care scale exhibiting a significant association with SDH risk, an exploratory multivariable model was built to determine which of the 14 SDH items were the most salient predictors. SDH risk was a significant predictor of self-care maintenance. For every 1 unit increase in SDH risk, maintenance was estimated to decrease by 1.14 units (p&amp;lt; .01). Exploratory multivariable analysis revealed employment insecurity and material insecurity to be the most salient SDH risk predictors of maintenance. Participants who were not employed full-time were estimated to have maintenance scores 5.15 ± 2.27 units (p&amp;lt;.05) less. For every 1 unit increase in material insecurity (score range:0 - 7), estimated maintenance decreased by 2.6 ± .89 units (p &amp;lt; .01). Those with higher SDH risks are less likely to perform behaviors to maintain health. Providers may facilitate self-care of patients by assessing SDH risks and offering self-care guidance considerate of SDH risks. Disclosure A. M. Matus: None. B. Riegel: None. M. R. Rickels: Consultant; Sernova, Corp., Vertex Pharmaceuticals Incorporated, Zealand Pharma A/S, Research Support; Dompé. Funding National Institutes of Health (31NR020137, R01DK091331)

Using Digital Tools to Study the Health of Adults Born Preterm at a Large Scale: e-Cohort Pilot Study.

Preterm birth is a global health concern. Its adverse consequences may persist throughout the life course, exerting a potentially heavy burden on families, health systems, and societies. In high-income countries, the first children who benefited from improved care are now adults entering middle age. However, there is a clear gap in the knowledge regarding the long-term outcomes of individuals born preterm. This study aimed to assess the feasibility of recruiting and following up an e-cohort of adults born preterm worldwide and provide estimations of participation, characteristics of participants, the acceptability of questions, and the quality of data collected. We implemented a prospective, open, observational, and international e-cohort pilot study (Health of Adult People Born Preterm-an e-Cohort Pilot Study [HAPP-e]). Inclusion criteria were being an adult (aged ≥18 years), born preterm (<37 weeks of gestation), having internet access and an email address, and understanding at least 1 of the available languages. A large, multifaceted, and multilingual communication strategy was established. Between December 2019 and June 2021, inclusion and repeated data collection were performed using a secured web platform. We provided descriptive statistics regarding participation in the e-cohort, namely, the number of persons who registered on the platform, signed the consent form, initiated and completed the baseline questionnaire, and initiated and completed the follow-up questionnaire. We also described the main characteristics of the HAPP-e participants and provided an assessment of the quality of the data and the acceptability of sensitive questions. As of December 31, 2020, a total of 1004 persons had registered on the platform, leading to 527 accounts with a confirmed email and 333 signed consent forms. A total of 333 participants initiated the baseline questionnaire. All participants were invited to follow-up, and 35.7% (119/333) consented to participate, of whom 97.5% (116/119) initiated the follow-up questionnaire. Completion rates were very high both at baseline (296/333, 88.9%) and at follow-up (112/116, 96.6%). This sample of adults born preterm in 34 countries covered a wide range of sociodemographic and health characteristics. The gestational age at birth ranged from 23+6 to 36+6 weeks (median 32, IQR 29-35 weeks). Only 2.1% (7/333) of the participants had previously participated in a cohort of individuals born preterm. Women (252/333, 75.7%) and highly educated participants (235/327, 71.9%) were also overrepresented. Good quality data were collected thanks to validation controls implemented on the web platform. The acceptability of potentially sensitive questions was excellent, as very few participants chose the "I prefer not to say" option when available. Although we identified room for improvement in specific procedures, this pilot study confirmed the great potential for recruiting a large and diverse sample of adults born preterm worldwide, thereby advancing research on adults born preterm.

Diabetes distress mediates the relationship between depressive symptoms and glycaemic control among adults with type 2 diabetes: Findings from a multi-site diabetes peer support intervention.

Diabetes distress is positively associated with HbA1c and may mediate the relationship between depressive symptoms and HbA1c . This study examined these relationships in a geographically, socioeconomically, and ethnically diverse sample of adults with type 2 diabetes. Using data from five US sites evaluating peer support for diabetes management (n= 917), Structural Equation Modeling (SEM) examined whether diabetes distress (four items from Diabetes Distress Scale) mediated the relationship between depressive symptoms (PHQ-8) and HbA1c . Sites compared interventions of varying content and duration with control conditions. Time from Baseline Assessment to Final Assessment varied from six to 18 months. Site characteristics were controlled by entering site as a covariate along with age, sex, education, diabetes duration, insulin use, and intervention/control assignment. Depressive symptoms, diabetes distress, and HbA1c were all intercorrelated cross-sectionally and from Baseline to Final Assessment (rs from 0.10 to 0.57; ps <0.05). In SEM analyses, diabetes distress at Final Assessment mediated the relationship between Baseline depressive symptoms and HbA1c at Final Assessment (indirect effect: b= 0.031, p< 0.001), controlling for Baseline HbA1c and covariates. Parallel analysis of whether depressive symptoms mediated the relationship between Baseline diabetes distress and HbA1c at Final Assessment was not significant. In this diverse sample, diabetes distress mediated the influence of depressive symptoms on HbA1c but the reverse, depressive symptoms mediating the effect of distress, was not found. These findings add to the evidence that diabetes distress is a worthy intervention target to improve clinical status and quality of life among individuals with type 2 diabetes.

Exploring the experiences of loneliness in adults with mental health problems: A participatory qualitative interview study.

Loneliness is associated with many mental health conditions, as both a potential causal and an exacerbating factor. Richer evidence about how people with mental health problems experience loneliness, and about what makes it more or less severe, is needed to underpin research on strategies to help address loneliness. Our aim was to explore experiences of loneliness, as well as what helps address it, among a diverse sample of adults living with mental health problems in the UK. We recruited purposively via online networks and community organisations, with most interviews conducted during the COVID-19 pandemic. Qualitative semi-structured interviews were conducted with 59 consenting participants face-to-face, by video call or telephone. Researchers with relevant lived experience were involved at all stages, including design, data collection, analysis and writing up of results. Analysis led to identification of four overarching themes: 1. What the word "lonely" meant to participants, 2. Connections between loneliness and mental health, 3. Contributory factors to continuing loneliness, 4. Ways of reducing loneliness. Central aspects of loneliness were lack of meaningful connections with others and lack of a sense of belonging to valued groups and communities. Some drivers of loneliness, such as losses and transitions, were universal, but specific links were also made between living with mental health problems and being lonely. These included direct effects of mental health symptoms, the need to withdraw to cope with mental health problems, and impacts of stigma and poverty. The multiplicity of contributors to loneliness that we identified, and of potential strategies for reducing it, suggest that a variety of approaches are relevant to reducing loneliness among people with mental health problems, including peer support and supported self-help, psychological and social interventions, and strategies to facilitate change at community and societal levels. The views and experiences of adults living with mental health problems are a rich source for understanding why loneliness is frequent in this context and what may address it. Co-produced approaches to developing and testing approaches to loneliness interventions can draw on this experiential knowledge.

The mediating effect of health literacy on COVID-19 vaccine confidence among a diverse sample of urban adults in Boston and Chicago

BackgroundA high rate of COVID-19 vaccination is critical to reduce morbidity and mortality related to infection and to control the COVID-19 pandemic. Understanding the factors that influence vaccine confidence can inform policies and programs aimed at vaccine promotion. We examined the impact of health literacy on COVID-19 vaccine confidence among a diverse sample of adults living in two major metropolitan areas. MethodsQuestionnaire data from adults participating in an observational study conducted in Boston and Chicago from September 2018 through March 2021 were examined using path analyses to determine whether health literacy mediates the relationship between demographic variables and vaccine confidence, as measured by an adapted Vaccine Confidence Index (aVCI). ResultsParticipants (N = 273) were on average 49 years old, 63 % female, 4 % non-Hispanic Asian, 25 % Hispanic, 30 % non-Hispanic white, and 40 % non-Hispanic Black. Using non-Hispanic white and other race as the reference category, Black race and Hispanic ethnicity were associated with lower aVCI (−0.76, 95 % CI −1.00 to −0.50; −0.52, 95 % CI −0.80 to −0.27, total effects from a model excluding other covariates). Lower education was also associated with lower aVCI (using college or more as the reference, −0.73 for 12th grade or less, 95 % CI −0.93 to −0.47; −0.73 for some college/associate's/technical degree, 95 % CI −1.05 to −0.39). Health literacy partially mediated these effects for Black and Hispanic participants and those with lower education (indirect effects −0.19 and −0.19 for Black race and Hispanic ethnicity; 0.27 for 12th grade or less; −0.15 for some college/associate's/technical degree). ConclusionsLower levels of education, Black race, and Hispanic ethnicity were associated with lower scores on health literacy, which in turn were associated with lower vaccine confidence. Our findings suggest that efforts to improve health literacy may improve vaccine confidence, which in turn may improve vaccination rates and vaccine equity.Clinical Trials Number: NCT03584490.

One virus, many lives: a qualitative study of lived experiences and quality of life of adults from diverse backgrounds living in the UK during the COVID-19 pandemic

ObjectivesThe coronavirus disease 2019 (COVID-2019) pandemic has had far-reaching consequences for people’s lives. In the UK, more than 23 million have been infected and nearly 185 000 have lost their...

The Role of Anxiety Sensitivity in the Association Between Childhood Maltreatment and Sleep Disturbance Among Adults in Psychiatric Inpatient Treatment.

The present investigation examined associations of childhood maltreatment, anxiety sensitivity (AS), and sleep disturbance among a diverse sample of adults in psychiatric inpatient treatment. We hypothesized that childhood maltreatment would be indirectly associated with greater sleep disturbance through elevated AS. Exploratory analyses examined the indirect effect models with three AS subscales ( i.e. , physical, cognitive, and social concerns) as parallel mediators. A sample of adults in acute-care psychiatric inpatient treatment ( N = 88; 62.5% male; Mage = 33.32 years, SD = 11.07; 45.5% White) completed a series of self-report measures. After accounting for theoretically relevant covariates, childhood maltreatment was indirectly associated with sleep disturbance through AS. Parallel mediation analyses revealed that no individual subscale of AS significantly accounted for this association. These findings suggest that heightened levels of AS may explain the association between childhood maltreatment and sleep disturbance among adults in psychiatric inpatient treatment. Interventions targeting AS can be brief and efficacious and have the potential to improve clinical outcomes among psychiatric populations.