US States Research Articles

State-Level Changes in Youth Inpatient, Residential, and Outpatient Mental Health Services, 2010-2022.

There are rising concerns over the availability of mental health services for children and youth. Recent evidence has shown reductions in the use of psychiatric inpatient, residential, and outpatient services among youths ages 0-17, with the COVID-19 pandemic and mental health workforce shortages identified as reasons for recent declines. The current study builds upon this evidence by exploring predictors of state-level changes in youth inpatient, residential, and outpatient service use from 2010 to 2022. This investigation involved secondary analysis of data collected from a Substance Abuse and Mental Health Services Administration (SAMHSA) annual survey of mental health treatment facilities across all 50 US states, D.C., and Puerto Rico, and publicly available data from the US Census Bureau and Kaiser Family Foundation. Results from longitudinal panel data models identified several state-level factors explaining variation in service use beyond reductions associated with COVID-19. Medicaid expansion, higher Federal Medical Assistance Percentage (FMAP), and more treatment facilities per capita were associated with higher utilization, and a greater percentage of youths from racial or ethnic minority backgrounds was associated with lower utilization. These findings suggest some actionable steps and service gaps needing further attention to help states improve service use in youth populations.

Cannabis Social Equity Initiatives Across 5 US States Case Studies of Colorado, Washington, Massachusetts, Connecticut, and Missouri.

Given the historic cannabis-related injustices in the US, several states that have legalized nonmedical cannabis also launched social equity (SE) initiatives involving criminal justice reform, equitable entrepreneurship assistance, and community reinvestment programs. This manuscript explores SE initiatives across 5 states. Case studies of 5 states were conducted using a drug policy framework. Two researchers dual-coded cannabis-related SE policies pertaining to expungements/pardons, equitable entrepreneurship assistance, and revenue allocation (as of December 2024). Colorado, Washington, Massachusetts, Connecticut, and Missouri. Colorado, Washington, and Massachusetts implemented pardons for certain offenses; Connecticut and Missouri implemented expungement. There was variability in the eligible offenses and numbers of pardons and expungements granted across states. Regarding entrepreneurship assistance, the states' SE eligibility criteria were similar, albeit with some distinctions (eg, income restrictions, veterans). Each state either reserved licenses for SE applicants or had specific SE licenses. The states offered similar trainings but used distinct approaches (such as accelerator programs or role-specific tracks). Additionally, financial benefits, such as grants, loans, and fee waivers, differed across states. Each state implemented cannabis sales taxes, which varied in level and type (retail sales tax vs. excise tax). Revenues across states were directed to cannabis program costs, the general fund, and health care and educational initiatives and organizations, although there were differences in allocation across states. Findings highlight the important efforts these states have made toward SE goals. However, given the varied approaches and limited evidence base, ongoing evaluation across states is needed to inform effective future SE initiatives.

Exploring Mental Health and Bicultural Identity: Through the Photo Lenses of Refugee Youth

ABSTRACT Refugee youth are particularly vulnerable to mental health challenges because of their exposure to trauma before, during, and after migration. They may face barriers to accessing mental health support, such as stigma, lack of awareness, and cultural differences. This community-based participatory research (CBPR) study explored the mental health experiences of refugee youth living in a midwestern US state, emphasizing their navigation of dual cultures and support systems. Utilizing photovoice methodology, the study engaged nine refugee youth as co-researchers to capture and discuss their experiences through photography and storytelling. Using interpretive phenomenological analysis (IPA), three themes were identified: (1) What mental health means to us, (2) Navigating cultural and familial expectations, and (3) Coping with mental health. Findings suggested that interventions should be culturally attuned, trauma-informed, and systemic, focusing on family, peers, and community support. Implications for mental health professionals include adopting family-centered therapeutic approaches, promoting peer support networks, and integrating school-based mental health programs tailored to the unique needs of refugee youth. This research underscores the necessity for holistic, community-led, and culturally sensitive mental health support strategies to foster resilience and well-being among refugee youth in the US and globally.

Beyond hearing loss: exploring neurological and neurodevelopmental sequelae in asymptomatic congenital cytomegalovirus infection.

Congenital cytomegalovirus (cCMV) infection is common, and usually clinically inapparent. The prevalence of infection is approximately 1:200 births, but only 10-15% of infants have clinically apparent CMV disease (CACMV) as newborns. The most common long-term disability is sensorineural hearing loss (SNHL), which occurs in 10-15% of all cases. Infants with CACMV are also at increased risk for intellectual disability, cerebral palsy, learning disabilities, ocular and cortical blindness, seizure disorders, developmental delay, and autism spectrum disorders. Although infants with clinically inapparent cCMV (CICMV) are at risk for SNHL, the spectrum of other adverse neurodevelopmental outcomes is less clear, since few studies have tracked neurodevelopment in this setting. With the advent of universal cCMV screening, most cCMV infections will now be identified in infants with CICMV. These infants require serial audiologic monitoring, but many questions are unanswered, including what kinds of diagnostic evaluations are required; what kinds of central nervous system (CNS) imaging studies are recommended; what the utility and value of developmental assessments is; and whether there are biomarkers that can inform the long-term prognosis and direct anticipatory guidance in monitoring for neurologic and neurodevelopmental adverse outcomes. IMPACT: Universal newborn screening for congenital CMV (cCMV) infection has been implemented in many US states and Canadian provinces. Most infants identified by universal screening have CICMV infections. All require audiologic monitoring, but there is minimal experience to direct other evaluations, including laboratory tests, brain imaging and neurodevelopmental assessments. Adverse neurodevelopmental outcomes in CICMV may be more extensive than previously appreciated. Research is needed to define the full range of potential neurocognitive disability. New knowledge generated by studying CICMV infections may aid in reclassification of the scope of disease in an emerging era of universal cCMV screening.

Incarceration and Psychiatric Emergency Department Visits Among Black Americans

Policy Points The spillover effects of jail and prison incarceration extend to acute psychiatric emergencies in Black communities. State‐level drug reform policies and policies that reduce labor market and housing discrimination for former inmates may have salutary mental health benefits for the broader community. ContextThe justice system incarcerates nearly 2.3 million individuals in the United States. Black Americans comprise 40% of those incarcerated despite representing less than 15% of the population. Theoretical work posits that mass incarceration can erode social capital by straining social and family networks as well as inducing carceral churn and coercive mobility within Black communities. Scholars report that greater incarceration may influence population‐level health, specifically in communities of color. However, previous work does not address whether incarceration, as well as the racial disparity in incarceration, corresponds with psychiatric help seeking in the Black community.MethodsWe examine the relation between incarceration and psychiatric emergency department (ED) visits among Black Americans from 2006 to 2015. As the exposure, we use 1) jail and prison incarceration among Black Americans (per 100,000 population), and 2) the ratio of non‐Hispanic Black to non‐Hispanic White American incarcerated populations as a measure of racial inequity in the criminal legal system. We examine, as the outcome, annual psychiatric ED visits (per 100,000 population) among Black Americans in 404 counties from ten US states between 2006 and 2015 (2,360 county‐years). Linear fixed effects analyses control for time‐invariant county factors as well as percentage below the federal poverty line, percentage unemployed, number of hospitals, and arrests for violent crime.FindingsOne additional individual incarcerated (per 100,000 population) corresponds with a 1.4% increase in psychiatric ED visits in Black communities (p < 0.001). An increase in racial inequity in incarceration (non‐Hispanic Black to non‐Hispanic White American ratio) also coincides with a 2.2% increase in psychiatric emergencies among Black Americans (p < 0.001).ConclusionsThe long arm of incarceration may extend to psychiatric emergencies among Black Americans in the broader community. Researchers and policymakers may consider measures, such as drug reform or other social policies, to reduce the influence of mass incarceration on acute and adverse mental health in the Black community.

War for Work’s Sake

This essay evaluates the ideological compact between U.S. state violence deployed across a decades-long War on Terror and that violence’s foremost cultural mediator, the post-9/11 Hollywood war film. It argues that, counter the tendency to view the Hollywood war film as mere “ideological apparatus,” a media form conscripted into the project of U.S. imperialism, what implicates state and medium is instead a more immanent strategy of mutual self-justification and institutional renewal powered by nostalgia for the Fordist-industrial mode of production and its gendered division of labor. Less neoliberal-imperial jingo than neo-protectionist, post-imperial swansong, the post-9/11 Hollywood war film diagnoses rather than refutes U.S. declension, tracing that declension, as economists Robert Brenner and Giovanni Arrighi do, to the 1970s crises in industrial “overcapacity” and “over accumulation” that precipitated U.S. deindustrialization. The genre moreover implicates Hollywood’s own declension in that systemic diagnosis, coarticulating the institution’s struggle to adapt to increasingly fragmented production processes. The genre’s insistently retrograde protagonists embody a fantasy of reindustrialization in the shadow of global outsourcing, widespread deskilling, and imminent automation that ultimately sublimates war’s violence into the labor of artistic production, binding Hollywood’s fortunes and failures to the state while staking the state’s renewal on Hollywood’s. Doing so, they subsequently convey the cinematic medium’s structural implication in US state violence while affirming its primacy to US hegemony’s maintenance.

Self-Reported Versus County-Based Rurality of People Who Gave Birth in 6 US States, 2020.

Objectives. To measure concordance between postpartum people's self-reported residence in rural, urban, or suburban areas and county-based measurement of rurality. Methods. We used survey data (collected January 2021-March 2022) from a representative sample of postpartum people with a live birth in 2020 in 6 US states (n = 3225), comparing respondents' self-report to county designations based on Rural‒Urban Continuum Codes (RUCCs). Results. Nearly 80% of postpartum people had concordant self-reported and RUCC-based residency. That is, 70% lived in counties that matched their self-report as urban (19%) or suburban (51%), and 9% lived in counties that matched their self-report as rural. However, almost 20% were rural discordant (lived in urban RUCC counties and self-reported as rural); these residents were more likely to lack a high-school degree and to have Medicaid-paid births compared with concordant respondents living in the same RUCC counties. Conclusions. County-based measures of rurality may incorrectly categorize substantial portions of rural residents, and those potentially misclassified are of lower socioeconomic status. Public Health Implications. Maternal health programs and policies using county-based definitions of rurality should account for rural residents living in areas designated as urban. (Am J Public Health. 2025;115(7):1095-1105. https://doi.org/10.2105/AJPH.2025.308058).

A value-based care program in dentistry centered on caries risk assessment: Preliminary results.

A value-based care program in dentistry centered on caries risk assessment: Preliminary results.

Rotavirus Vaccine in Offspring Exposed in Utero to Tumor Necrosis Factor Inhibitors Was Not Associated with an Increased Risk of Diarrhea Events During the First 6 Months of Life

ObjectivesGuidelines previously recommended withholding the rotavirus vaccine among in utero TNFi-exposed infants until 6 months due to infection risk in immunosuppressed infants.[1] However, delaying vaccination may increase diarrhea-associated morbidity compared to routine immunization starting at 2 months. We compared the risk of diarrhea-associated healthcare events (“diarrhea events”) during the first 6 months among in utero TNFi-exposed and -unexposed infants based on vaccination status.MethodsWe created a cohort of offspring born to mothers with chronic inflammatory diseases (MarketScan; 2011-2021) and identified those exposed to ≥1 TNFi prescription in utero and those not. Infants born in the 13 US states with a state-funded universal rotavirus vaccine program were excluded due to the absence of private insurer claims. Time-varying vaccine status was identified by ≥1 billing code for RV1 or RV5 vaccines administered between 2 and 6 months. Follow-up began at 2 months and ended at 6 months. Diarrhea events were defined by relevant ICD-9/10 codes for hospitalizations or outpatient visits. We estimated the association of the vaccine with diarrhea risks among TNFi-exposed and -unexposed offspring using Cox proportional hazards models, as well as among infants exposed to TNFi in the third trimester and those exposed in the first and second trimesters. Models were adjusted for in utero drug exposure (non-biologic immunomodulators, corticosteroids), preterm birth, sex, geographic region, year and season of birth, and TNFi placental transfer.ResultsWe identified 49,585 offspring; 3,167 were TNFi-exposed in utero; 83% received at least 1 dose of the rotavirus vaccine between 2-6 months (Figure 1A). Among TNFi-unexposed offspring, the vaccine was associated with a 32% increase in diarrhea events (hazard ratio, HR, 1.32; 95% confidence interval, CI, 1.13, 1.54) (Figure 1B). However, among TNFi-exposed offspring, no statistically significant association was found between the vaccine and diarrhea event risk (HR 1.07; 95% CI 0.72, 1.61), including in those TNFi-exposed during the third trimester (HR 1.13; 95% CI 0.68, 1.86), or only during the first and/or second trimesters (HR 0.89; 95% CI 0.45, 1.76). When looking at the vaccine’s effect among those exposed to high placental transfer TNFi in the third trimester, no statistically significant association was found (HR 0.97; 95% CI 0.57, 1.66).Figure 1.Baseline Characteristics and Survival Analysis.Panel A shows the baseline characteristics of infants exposed in utero to tumour necrosis factor inhibitors (TNFi) and unexposed offspring born to mothers with chronic inflammatory diseases during their first 6 months of age and stratified based on their rotavirus vaccination status during the first 2-6 months. Panel B shows the adjusted hazard ratios for the association of the rotavirus vaccine with the risk of diarrhea-related healthcare events during the first 6 months of life in TNFi-exposed and -unexposed offspring. The model was adjusted for TNFi trimester of exposure, in utero drug exposures (i.e. corticosteroids, non-biologic immunomodulators), sex, preterm birth, gestational diabetes, geographic region, year of birth (odd vs even), birth season (October-March vs April-September), TNFi placental transfer.ConclusionOur findings suggest no increased risk of diarrhea events related to rotavirus vaccination during the first 6 months of life among in utero TNFi-exposed offspring, even for late TNFi exposure during pregnancy. These results support the updated recommendation not to delay rotavirus vaccination in TNFi-exposed infants.[2] [1.] Bass AR. Arthritis Care Res 2023;75(3):449-64. [2.] Förger F. Ann Rheum Dis 2024;83(Suppl 1):2075.Best Abstract by a Post-Graduate Research Trainee Award

Association of Obstetric Comorbidity Index Score with Postpartum Contraception Use among Medicaid Recipients in the United States.

Association of Obstetric Comorbidity Index Score with Postpartum Contraception Use among Medicaid Recipients in the United States.

How politics affect pandemic forecasting: spatio-temporal early warning capabilities of different geo-social media topics in the context of state-level political leaning

ObjectivesDue to political polarization, adherence to public health measures varied across US states during the COVID-19 pandemic. Although social media posts have been shown effective in anticipating COVID-19 surges, the impact of political leaning on the effectiveness of different topics for early warning remains mostly unexplored. Our study examines the spatio-temporal early warning potential of different geo-social media topics across republican, democrat, and swing states.MethodsUsing keyword filtering, we identified eight COVID-19-related geo-social media topics. We then utilized Chatterjee's rank correlation to assess their early warning capability for COVID-19 cases 7 to 42 days in advance across six infection waves. A mixed-effect model was used to evaluate the impact of timeframe and political leaning on the early warning capabilities of these topics.ResultsMany topics exhibited significant spatial clustering over time, with quarantine and vaccination-related posts occurring in opposing spatial regimes in the second timeframe. We also found significant variation in the early warning capabilities of geo-social media topics over time and across political clusters. In detail, quarantine related geo-social media post were significantly less correlated to COVID-19 cases in republican states than in democrat states. Further, preventive measure and quarantine-related posts exhibited declining correlations to COVID-19 cases over time, while the correlations of vaccine and virus-related posts with COVID-19 infections.ConclusionOur results highlight the need for a dynamic spatially targeted approach that accounts for both how regional geosocial media topics of interest change over time and the impact of local political ideology on their epidemiological early warning capabilities.

Obstetric Care Access Declined In Rural And Urban Hospitals Across US States, 2010–22

Obstetric Care Access Declined In Rural And Urban Hospitals Across US States, 2010–22

WIC Participation During Pregnancy and Low and Very Low Birth Weight by Race and Ethnicity.

WIC Participation During Pregnancy and Low and Very Low Birth Weight by Race and Ethnicity.

Genetic diversity, population structure, and cannabinoid variation in feral Cannabis sativa germplasm from the United States

Cannabis sativa is one of the earliest plants to be domesticated for fiber, food and medicine. Seed from Cannabis grown for industrial purposes during the 18th through 20th centuries have escaped production and established feralized populations across the United States. To maximize the potential of feral Cannabis germplasm, determining the genetic structure and cannabinoid profile is crucial for selection and breeding of new compliant regionally adapted hemp cultivars. To resolve this, a collection of feral Cannabis, comprising 760 plants across twelve US states were sequenced using Genotyping-by-Sequencings (GBS), genotyped at the cannabinoid synthase (CBDAS) gene, and subject to gas chromatography-mass spectrometry (GC-MS) to assess cannabinoid profiles. Clustering analyses by ADMIXTURE and Principal Component Analysis (PCA) stratified the germplasm into five clusters (Mississippi-River, West North Central-b, West North Central-a, New York, and Indiana). The cannabinoid genotyping assay resolved the feral collections into Type I - B2/B2 (6%), Type II - B2/B1 (15%), and Type III - B1/B1 (78%). Total cannabinoid content ranged from 0.21 to 4.73%. The assessment of genetic diversity, population structure, and cannabinoid profile of the US feral Cannabis collection provides critical information and germplasm resources to develop new and improve existing hemp cultivars.

Cost and Cost-Effectiveness of Online Recruitment to Increase HIV Self-Testing Among Black and Hispanic/Latino Men Who Have Sex With Men in the United States, 2020–2021

Background: Black or African American and Hispanic/Latino gay, bisexual, and other men who have sex with men (BMSM and HLMSM) in the United States are disproportionately affected by HIV. We analyze the cost and cost-effectiveness of HIV self-testing through online recruitment of BMSM and HLMSM into an HIV self-testing study. Setting: Eleven US states, February 2020–February 2021. Methods: BMSM and HLMSM aged ≥18 years without previous HIV diagnosis or current pre-exposure prophylaxis use were recruited through dating and general interest websites/apps (sites). Using the health care provider perspective and a 16-month timeframe, we assessed economic costs (2022 US Dollars) of online recruitment, HIV self-test (HIVST) distribution, and participant support. A time–motion study tracked staff time spent on study implementation activities. We reported incremental program cost, cost per HIVST used, and cost per new HIV diagnosis comparing recruitment through dating versus general interest sites. Results: The total cost was $275,776 to enroll 1306 participants through dating sites, and support 1005 MSM who used an HIVST (11.74% positivity). The total cost was $168,099 to enroll 600 participants through general interest sites, and support 511 MSM who used an HIVST (5.48% positivity). Recruitment through dating versus general interest sites was more costly and more effective, with incremental cost-effectiveness ratios of $218/HIVST used and $1196/new diagnosis, relatively low cost per new HIV diagnosis compared with those estimated in other HIV testing interventions. Incremental cost-effectiveness ratios were higher for HLMSM versus BMSM. Conclusions: HIV self-testing through dating and general interest site recruitment may be an effective and cost-effective approach to increase new HIV diagnoses.

US state implementation of policies restricting sales of flavoured E-cigarettes: a qualitative analysis.

E-cigarettes are the most popular nicotine product among youth in the USA and the majority of young people use products with flavours such as mint, menthol, fruit and candy. Between December 2019 and December 2022, seven US states and the District of Columbia put in place restrictions on the sale of flavoured e-cigarettes. Studies of e-cigarette flavour restrictions have found varied policy effects across different populations. While some qualitative research has investigated policy implementation details, no studies to date have systematically examined how flavour restrictions are implemented. From April to December 2023, we conducted key informant interviews guided by Bullock's policy implementation process model and determinants framework to investigate how states are implementing flavour restriction policies. Key themes in implementation included the roles of clear product definitions and enforcement processes, coordination across state and local governments, adequate resources and communication with retailers. We found between-state heterogeneity in these factors, with key informants reporting challenges with one or more of these components. Implementing policies restricting the sale of flavoured e-cigarettes is complex and variable from state to state. Future implementation efforts and policy evaluations should take this variability into account.

Medicaid Reimbursement for Maternal Depression Screening and Care for Postpartum Depression

Clinical guidelines recommend routine screening for postpartum depression (PPD) during well-child visits. All but 5 US states provide Medicaid reimbursement to pediatric practitioners for screening mothers for PPD during well-child visits, but little is known about how reimbursement affects screening, diagnosis, and treatment. To evaluate the association between Medicaid reimbursement for PPD screening during well-child visits and screening, diagnosis, and treatment for mood or anxiety disorders in the postpartum year. This cohort study used a difference-in-differences study design to analyze claims data and birth records obtained from the Colorado All Payer Claims Database for the period January 1, 2013, to December 31, 2019, for Medicaid-insured and commercially insured births that occurred between 2012 and 2018. Data were analyzed between February 16, 2024, and March 21, 2025. Colorado Medicaid reimbursement for PPD screenings during well-child visits. The primary outcome was billed depression screens during well-child visits. Secondary outcomes were diagnoses of a postpartum mood or anxiety disorder and outpatient mental health care or prescription medication use during the postpartum year. We defined an indicator variable for before (2013) vs after (2014-2019) the Colorado Medicaid program began reimbursing for maternal depression screening during well-child visits on January 1, 2014. This study included 137 867 births, 104 085 of which were paid by Medicaid and 33 782 of which were paid by commercial insurance. The mean (SD) age of mothers in the Medicaid-insured group during the 2013 prepolicy period was 25.6 (5.7) years compared with 31.7 (4.7) years among mothers in the commercially insured group; during the postpolicy period, the mean (SD) ages were 26.5 (5.7) years and 32.1 (4.4) years, respectively. During the prepolicy period, for births insured by Medicaid vs commercial insurance, the mothers were more likely to have been born outside the US (14.2% vs 10.3%; P = .01), reside in a more rural area (14.5% vs 8.1%; P < .001), have not completed high school or college (24.8% vs 1.1%; P < .001), and have a lower income (80.3% vs 8.2%; P < .001). In adjusted difference-in-differences models, reimbursement for maternal depression screening during well-child visits among Medicaid-insured mothers was associated with a 9.60-percentage point (ppt) (95% CI, 9.10-10.00 ppt) increase in the probability of billed depression screens during well-child visits (P < .001), 0.18 (95% CI, 0.17-0.19) additional billed well-child visit depression screens per birth (ie, 18 additional screens per 100 births), a 2.5-ppt (95% CI, 1.40-3.50 ppt) increase in the probability of being diagnosed with a postpartum mood or anxiety disorder, a 3.3-ppt (95% CI, -4.60 to 2.00 ppt) decrease in prescription medication (P < .001), and a 3.3-ppt (95% CI, 2.50-4.10 ppt) increase in any outpatient mental health treatment (P < .001) compared with mothers who had commercial insurance. The findings of this cohort study suggest that Medicaid reimbursement for PPD screening during well-child visits may increase rates of detection, postpartum mood or anxiety disorder diagnoses, and outpatient treatment among mothers in the postpartum year. Insurance reimbursement for PPD screenings during well-child visits appears to be a promising policy strategy; however, additional interventions may be needed to address barriers to conducting screenings and referrals in pediatric settings and accessing postpartum mental health treatment.

Abortion Shield Laws in Action

This Viewpoint discusses the enactment of shield laws in abortion-supportive US states following the Dobbs decision.

The Current Landscape of Deepfake Legislation in the United States

Abstract This article analyzes deepfake legislation through 319 state bills proposed in all 50 states between 2019 and 2024. California, Texas, and Virginia were the first to enact laws regulating deepfakes in 2019. Since then, forty-eight of fifty US states have introduced or enacted at least one deepfake bill, with a surge in deepfake bills in 2024. Thematic analysis indicates a fragmented approach, with most bills focusing on political and sexually explicit content, and visualization highlights the status, trends over time, concentration, and sponsorship of deepfake bills across states to guide researchers and policymakers toward a stronger framework.

Humility Throughout the Lifespan and a Global Pandemic: Evidence From a Large-Scale Cross-Sectional Study.

We provide a fine-grained portrait of age-graded differences in Humility across the lifespan. Specifically, we shed light on year-by-year differences and explore differences-in-differences in the wake of the COVID pandemic. We used large-scale cross-sectional data (n = 2,025,004) and employed multigroup confirmatory factor analysis, ANOVAs, and multilevel modeling to examine mean-score differences in Humility from age 10 to 70 across the entire sample, and for temporal (pre-COVID, COVID) and geographical (9 countries, 6 US states) subsamples. Across cultures and geographies, Humility mean scores were lowest in late childhood and rose steadily thereafter. They reached their highest levels in late adulthood and exhibited more erratic patterns around retirement age. In the overall and pre-COVID samples, mean-score differences were most pronounced during the transition from early to middle adulthood. In the COVID sample, similar patterns emerged, though we observed generally higher Humility scores, pronounced adolescent disruption, and the biggest differences between early and middle adulthood. Age-graded trends in Humility aligned fully with some established patterns of personality trait development (i.e., psychological maturation, maturation reversal) and partially with others (i.e., disruption hypothesis). Moreover, the COVID analyses provide preliminary insights into the potential effects of the pandemic on personality development trajectories.