Conspiracy beliefs about HIV are related to antiretroviral treatment nonadherence among african american men with HIV

Socio-cognitive facilitators of ART-adherence among predominantly black sexual and gender minoritized persons living with HIV in Atlanta, Georgia: a latent profile analysis

The Integrated Change Model describes several social and cognitive factors (e.g., health attitudes, social support, self-efficacy) that can affect medication adherence. Guided by this model, we sought to identify profiles of socio-cognitive facilitators of ART (antiretroviral therapy) adherence among diversely minoritized persons living with HIV enrolled in a behavioral intervention trial in Atlanta, Georgia (N = 477). To do this, we performed latent profile analysis on baseline responses to scales assessing 6 indicators of interest: HIV-care self-efficacy, social support, TasP (treatment-as-prevention) beliefs, trust in healthcare providers, perceived need for ART, and trust in ART. We regressed emergent profiles on internalized, enacted, and microaggressive HIV stigma and compared prospective 30-day ART adherence and several cross-sectional HIV outcomes across profiles. Mean age was 29 years; 83% of participants were non-Hispanic Black, 53% were gay/homosexual-identifying, and 12% were gender expansive. Three profiles emerged: "Constrained/Capable" (6%), featuring high self-efficacy but low-moderate provider trust, social support, TasP beliefs, ART trust, and ART need; "Conflicted" (13%), featuring high TasP beliefs, provider trust, and ART need but moderate self-efficacy, ART trust, and social support; and "Motivated" (81%), featuring high levels of all indicators. Greater internalized, enacted, and microaggressive stigma were positively associated with "Conflicted" relative to "Motivated" profile membership. ART-nonadherence, unsuppressed viral load, and viral load unawareness were more likely for the "Conflicted" relative to the "Motivated" profile. Personalized HIV care tailored to such profiles may improve ART adherence and related outcomes for minoritized persons living with HIV.

The Roles of Social Media Use and Medical Mistrust in Black Americans' COVID-19 Vaccine Hesitancy: The RISP Model Perspective

The COVID-19 pandemic has brought unprecedented challenges to healthcare and public health messaging in the United States. One area of focus has been vaccination uptake among Black Americans, who have experienced COVID-19 deaths disproportionate to their share of the United States population, raising questions about the processes involved in vaccination perceptions and behaviors. Guided by the Risk Information Seeking and Processing model, this study explored the roles of medical mistrust and social media as a source of risk information in Black Americans' vaccine hesitancy. Survey results from a YouGov panel sample of Black Americans (n = 1,136; 53.5% female) showed that social media use and medical mistrust were positively associated with belief in misinformation related to the COVID-19 vaccine, which, in turn, was positively related to vaccine hesitancy through perceived information insufficiency and information seeking intentions. Furthermore, we found that belief in misinformation and subjective norms toward anti-vaccination also serially mediated the association between social media use and medical mistrust with vaccine hesitancy. Theoretical and practical implications are discussed.

Students' mental health during the pandemic: results of the observational cross-sectional COVID-19 MEntal health inTernational for university Students (COMET-S) study

Introduction

The aim of the study was to search rates of depression and mental health in university students, during the COVID-19 pandemic.

Materials and methods

This is an observational cross-sectional study. A protocol gathering sociodemographic variables as well as depression, anxiety and suicidality and conspiracism was assembled, and data were collected anonymously and online from April 2020 through March 2021. The sample included 12,488 subjects from 11 countries, of whom 9,026 were females (72.2%; aged 21.11 ± 2.53), 3,329 males (26.65%; aged 21.61 ± 2.81) and 133 "non-binary gender" (1.06%; aged 21.02 ± 2.98). The analysis included chi-square tests, correlation analysis, ANCOVA, multiple forward stepwise linear regression analysis and Relative Risk ratios.

Results

Dysphoria was present in 15.66% and probable depression in 25.81% of the total study sample. More than half reported increase in anxiety and depression and 6.34% in suicidality, while lifestyle changes were significant. The model developed explained 18.4% of the development of depression. Believing in conspiracy theories manifested a complex effect. Close to 25% was believing that the vaccines include a chip and almost 40% suggested that facemask wearing could be a method of socio-political control. Conspiracism was related to current depression but not to history of mental disorders.

Discussion

The current study reports that students are at high risk for depression during the COVID-19 pandemic and identified specific risk factors. It also suggested a role of believing in conspiracy theories. Further research is important, as it is targeted intervention in students' groups that are vulnerable both concerning mental health and conspiracism.

Factors Associated with Planned Future Use of PrEP in the Next 3 Months and Likelihood to Use PrEP Among Black Cisgender HIV-negative Women in Texas

Identifying and then addressing barriers and leveraging facilitators is important to help increase pre-exposure prophylaxis (PrEP) use among Black women vulnerable to HIV acquisition. The present cross-sectional study examined what factors were associated with future plans to use PrEP, and general likelihood to use it among a convenience sample of 152 adult, Black cisgender women from three metropolitan areas in Texas. The final multivariable logistic regression model revealed that relationship status (aOR = 0.20, 95% CI: 0.05-0.73, p < 0.05), PrEP anticipated stigma (aOR = 0.29, 95% CI: 0.10-0.78, p < 0.05), perceived discrimination (aOR = 0.40, 95% CI: 0.21-0.78, p < 0.01) and interest in learning more about PrEP (aOR = 5.32, 95% CI: 2.60-10.9, p < 0.001) were associated with future plans to use PrEP. The final multivariable linear regression model with maximum likelihood estimation identified that perceived discrimination (β=-0.24, SE: -0.38 - -0.10, p < 0.01), perceived HIV risk (β = 0.33, SE: 0.18-0.49, p < 0.001), willingness to use PrEP with condoms (β = 1.26, SE: 0.94-1.60, p < 0.001), and comfort communicating about PrEP with a provider (β = 0.23, SE: 0.06-0.41, p < 0.01) were associated with general likelihood to use PrEP. Findings reveal key factors that warrant further attention and examination toward improving PrEP use within this population.

Manifestation of Health Denialism in Attitudes toward COVID-19 Vaccination: A Qualitative Study

Science denialism is characterized by the refusal to accept existing consensus and available evidence. Typical strategies denialists employ include spreading conspiracies, selective use of information, relying on fake experts, or general fallacies in logic. A flood of misinformation, fake news, and conspiracy theories accompanied the COVID-19 pandemic. Simultaneously, it was a subject of many denialistic opinions, from denying the existence of the epidemic challenge to claims that questioned the safety and effectiveness of the COVID-19 vaccines. This study's main aim was to assess the manifestations of denialism in attitudes toward the preventive measures recommended during the pandemic, with a special focus on vaccination. In-depth interviews were conducted with fifty representatives of the general population, demonstrating diversified opinions about COVID-19 vaccines and other preventive behaviors. The interviews were performed face to face in participants' houses or at other places they identified as convenient. Some of the interviewees preferred to do the interview via teleconference. The interviews were carried out from November 2022 to March 2023. The interviewees were recruited initially by convenience, and in further stages, the snowball technique was used. The interviewees were residents of four main administrative districts in Poland. Out of 50 participants, 26 were males, 29 were between 18-40, 16 were inhabitants of rural areas, and 28 had a university level of education. The interviews were based on a semi-structured guide that addressed, in addition to views about the origin of the new coronavirus, respondents' attitudes toward vaccination and sanitary recommendation, the health status of interviewees, their use of healthcare services, and their health behaviors. The interviews were transcribed and analyzed with MAXQDA Analytics Pro 2022 software (Release 22.7.0). Thematic analysis (TA) was applied to the content generated from the interviews. Based on the uptake of the COVID-19 vaccine, the participants were divided into three groups: unvaccinated, hesitant, and vaccinated (18, 4, and 28 interviewees, respectively). The main themes were established based on the TA of the interviews: attitudes toward COVID-19 vaccination, perception of sources of information, and the origin of the new coronavirus. The first theme decidedly drew the greatest attention of the interviewees. There was also a clear relationship between vaccination status and the presence of denialist thinking among interviewees. Interestingly, the role of experts as a key source of information about the pandemic was underlined by study participants. However, the criteria for being an expert differed. The subject of the origin of a new coronavirus was not interesting to interviewees. The analysis of the adherence to preventive measures revealed an interplay of diversified attitudes and motivations. Individuals presenting denialist views most frequently abstained from COVID-19 vaccination. However, such views were also present among those who hesitated or even among those who had been vaccinated. Furthermore, denialism was only one of the determinants of adherence to preventive measures.

Medical mistrust as a barrier to HIV prevention and care

Medical mistrust is fueled by conspiracy theories and histories of healthcare systems abuse and is a known determinant of health outcomes in minority populations. Plagued by multiple and pervasive conspiracy theories, HIV/AIDS has proven to be particularly hampered by medical mistrust. The current paper systematically reviews the literature on medical mistrust among people at risk for or living with HIV infection. The bulk of evidence from 17 studies supports medical mistrust as a barrier to HIV testing, engagement in prevention and care services, treatment uptake and adherence, and clinical outcomes. While findings mostly indicate that medical mistrust is a barrier to HIV prevention and care, some studies report null results and others suggest that medical mistrust may actually improve some HIV-related outcomes. Additionally, most of the reviewed literature was cross-sectional. Thus longitudinal, theory-driven research is needed to reconcile inconsistent findings and determine long term outcomes of medical mistrust. Interventions may then be developed to reduce the negative consequences associated with medical mistrust.

Karakatsoulis G, Abraham S, Adorjan K, Ahmed HU, Alarcón RD, Arai K, Auwal SS, Bobes J, Bobes-Bascaran T, Bourgin-Duchesnay J, Bredicean CA, Bukelskis L, Burkadze A, Cabrera Abud II, Castilla-Puentes R, Cetkovich M, Colon-Rivera H, Corral R, Cortez-Vergara C, Crepin P, de Berardis D, Zamora Delgado S, de Lucena D, de Sousa A, di Stefano R, Dodd S, Elek LP, Elissa A, Erdelyi-Hamza B, Erzin G, Etchevers MJ, Falkai P, Farcas A, Fedotov I, Filatova V, Fountoulakis NK, Frankova I, Franza F, Frias P, Galako T, Garay CJ, Garcia-Álvarez L, García-Portilla P, Gonda X, Gondek TM, Morera González D, Gould H, Grandinetti P, Grau A, Groudeva V, Hagin M, Harada T, Hasan TM, Azreen Hashim N, Hilbig J, Hossain S, Iakimova R, Ibrahim M, Iftene F, Ignatenko Y, Irarrazaval M, Ismail Z, Ismayilova J, Jacobs A, Jakovljević M, Jakšić N, Javed A, Yilmaz Kafali H, Karia S, Kazakova O, Khalifa D, Khaustova O, Koh S, Kopishinskaia S, Kosenko K, Koupidis SA, Kovacs I, Kulig B, Lalljee A, Liewig J, Majid A, Malashonkova E, Malik K, Iqbal Malik N, Mammadzada G, Mandalia B, Marazziti D, Marčinko D, Martinez S, Matiekus E, Mejia G, Memon RS, Meza Martínez XE, Mickevičiūtė D, Milev R, Mohammed M, Molina-López A, Morozov P, Muhammad NS, Mustač F, Naor MS, Nassieb A, Navickas A, Okasha T, Pandova M, Panfil AL, Panteleeva L, Papava I, Patsali ME, Pavlichenko A, Pejuskovic B, Pinto da Costa M, Popkov M, Popovic D, Raduan NJN, Vargas Ramírez F, Rancans E, Razali S, Rebok F, Rewekant A, Reyes Flores EN, Rivera-Encinas MT, Saiz PA, Sánchez de Carmona M, Saucedo Martínez D, Saw JA, Saygili G, Schneidereit P, Shah B, Shirasaka T, Silagadze K, Sitanggang S, Skugarevsky O, Spikina A, Mahalingappa SS, Stoyanova M, Szczegielniak A, Tamasan SC, Tavormina G, Tavormina MGM, Theodorakis PN, Tohen M, Tsapakis EM, Tukhvatullina D, Ullah I, Vaidya R, Vega-Dienstmaier JM, Vrublevska J, Vukovic O, Vysotska O, Widiasih N, Yashikhina A, Prezerakos PE, Berk M, Levaj S, Smirnova D. Results of the COVID-19 mental health international for the health professionals (COMET-HP) study: depression, suicidal tendencies and conspiracism

INTRODUCTION

The current study aimed to investigate the rates of anxiety, clinical depression, and suicidality and their changes in health professionals during the COVID-19 outbreak.

MATERIALS AND METHODS

The data came from the larger COMET-G study. The study sample includes 12,792 health professionals from 40 countries (62.40% women aged 39.76 ± 11.70; 36.81% men aged 35.91 ± 11.00 and 0.78% non-binary gender aged 35.15 ± 13.03). Distress and clinical depression were identified with the use of a previously developed cut-off and algorithm, respectively.

STATISTICAL ANALYSIS

Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses, and Factorial Analysis of Variance (ANOVA) tested relations among variables.

RESULTS

Clinical depression was detected in 13.16% with male doctors and 'non-binary genders' having the lowest rates (7.89 and 5.88% respectively) and 'non-binary gender' nurses and administrative staff had the highest (37.50%); distress was present in 15.19%. A significant percentage reported a deterioration in mental state, family dynamics, and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (24.64% vs. 9.62%; p < 0.0001). Suicidal tendencies were at least doubled in terms of RASS scores. Approximately one-third of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop clinical depression was associated with a history of Bipolar disorder (RR = 4.23).

CONCLUSIONS

The current study reported findings in health care professionals similar in magnitude and quality to those reported earlier in the general population although rates of clinical depression, suicidal tendencies, and adherence to conspiracy theories were much lower. However, the general model of factors interplay seems to be the same and this could be of practical utility since many of these factors are modifiable.

Rationale and design of the Heart-to-Heart study: A church-based intervention to reduce blood pressure in African Americans

Heart-to-Heart (H2H) is a church-based behavioral cluster randomized trial to measure the effectiveness of a lifestyle education program for reducing blood pressure (BP) in African American adults with uncontrolled BP. Design and implementation of this study were informed by our ALIVE pilot study conducted with church pastors and leaders using a community-based participatory research methodology. The current study employs a cross-over design in which all participants receive two 6-month programs in different orders: the intervention arm receives the H2H program first, followed by a financial education program, and the comparator arm receives the programs in the reverse order. Approximately 34 churches will be randomized with the aim of including at least 272 participants across churches. The H2H program consists of 24 weekly dietitian-led diet and lifestyle virtual education sessions, 12 Bible studies taught by the church pastor reinforcing positive dietary behaviors from a biblical perspective, daily self-monitoring of BP, and, as needed, one-on-one support from a community health worker to assist with medication adherence. The Money Smart program consists of 14 financial education sessions and 12 Bible studies teaching the biblical basis of good financial management over a 6-month period. The primary outcome measure is systolic BP at 6 months with a follow-up at 12 months. Secondary outcome measures include medication adherence, Dietary Approaches to Stop Hypertension (DASH) diet adherence, self-efficacy for hypertension self-care, social support for eating a healthy diet, hypertension and nutrition knowledge, beliefs about medicines, barriers to medication use, depression, and financial knowledge and behaviors.

Randomized Controlled Trial of Rise, A Community-Based Culturally Congruent Counseling Intervention to Support Antiretroviral Therapy Adherence Among Black/African American Adults Living with HIV

Structural inequities have led to HIV disparities, including relatively low antiretroviral therapy adherence and viral suppression rates among Black Americans living with HIV. We conducted a randomized controlled trial of Rise, a community-based culturally congruent adherence intervention, from January 2018 to December 2021 with 166 (85 intervention, 81 control) Black adults living with HIV in Los Angeles County, California [M (SD) = 49.0 (12.2) years-old; 76% male]. The intervention included one-on-one counseling sessions using basic Motivational Interviewing style to problem solve about adherence, as well as referrals to address unmet needs for social determinants of health (e.g., housing services, food assistance). Assessments included electronically monitored adherence; HIV viral load; and baseline, 7-month follow-up, and 13-month follow-up surveys of sociodemographic characteristics, HIV stigma, medical mistrust, and HIV-serostatus disclosure. Repeated-measures intention-to-treat regressions indicated that Rise led to significantly (two-fold) higher adherence likelihood, lower HIV stigmatizing beliefs, and reduced HIV-related medical mistrust. Effects on HIV viral suppression, internalized stigma, and disclosure were non-significant. Moreover, Rise was cost-effective based on established standards: The estimated cost per person to reach optimal adherence was $335 per 10% increase in adherence. Interventions like Rise, that are culturally tailored to the needs of Black populations, may be optimal for Black Americans living with HIV (ClinicalTrials.gov #NCT03331978).

Racial Disparities in Severe Maternal Morbidity in an Integrated Health Care System, Southern California, 2008-2017

OBJECTIVE

The study's objectives were to examine rates of severe maternal morbidity (SMM) over a 10-year period and assess racial/ethnic disparities in SMM among insured women in a large, integrated health care system in Southern California.

METHODS

We included Kaiser Permanente Southern California (KPSC) health plan members who gave birth at ≥20 weeks' gestation in a KPSC-owned hospital during 2008-2017. An SMM case was defined as presence of one or more indicators of an SMM event during a birth hospitalization, identified using maternal electronic health records. Crude SMM rates/10,000 births were calculated by year and maternal race/ethnicity. Modified Poisson regression models were used to assess the association between race/ethnicity and SMM adjusted for other maternal demographics, pregnancy characteristics, and preexisting conditions.

RESULTS

We identified 5,915 SMM cases among 335,310 births. Crude SMM rates increased from 94.7 per 10,000 in 2008 to 192.6 in 2015 and 249.5 in 2017. Non-Hispanic Black (adjusted risk ratio [aRR] 1.52; 95% confidence interval [CI] 1.37-1.69), Asian/Pacific Islander (aRR 1.29, 95% CI 1.18-1.41), and Hispanic (aRR 1.18, 95% CI 1.10-1.27) women had greater likelihood of SMM than non-Hispanic White women. After further adjusting for preexisting health conditions, differences in SMM by race/ethnicity remained.

CONCLUSIONS

SMM rates increased during 2008-2017 and women of racial and ethnic minority groups, particularly non-Hispanic Black women, were more likely to experience an SMM event than non-Hispanic White women. Multilevel approaches to understanding structural and social factors that may be associated with racial and ethnic disparities in SMM are needed to develop and test effective interventions to reduce SMM.

The association of conspiracy beliefs and the uptake of COVID-19 vaccination: a cross-sectional study

The COVID-19 pandemic revealed that health denialism might be an important determinant of adherence to preventive measures during epidemic challenges. Conspiracy beliefs seem to be one of the most visible manifestations of denialism in society. Despite intensive efforts to promote COVID-19 vaccinations, the number of citizens reluctant to get vaccinated was very large in many countries. The main aim of this study was the analysis of the association between the acceptance of the COVID-19 vaccination and conspiracy beliefs among adult Internet users in Poland. The analysis was based on data from a survey performed on a sample of 2008 respondents in October 2021. Uni- and multivariable logistic regression models were applied to evaluate the association between attitudes towards COVID-19 vaccination and generic conspiracist, vaccine-conspiracy, and COVID-19-related conspiracy beliefs. In the multivariable model, the effect of conspiracy beliefs was adjusted for the level of vaccine hesitancy, future anxiety, political sympathies, and socio-demographic variables. Univariate regression models showed that COVID-19 vaccination acceptance is significantly lower among respondents with higher levels of all three types of conspiracy beliefs. In the multivariable model, the effect of COVID-19-related and vaccine conspiracy beliefs, but not generic conspiracist beliefs, was maintained after adjusting for vaccine hesitancy. We conclude that conspiracy beliefs should be treated as a potential indicator of lower adherence to preventive measures during epidemic challenges. The respondents revealing a high level of conspirational thinking are a potential group for intensified actions which employ health educational and motivational interventions.

Addressing HIV Misconceptions among Heterosexual Black Men and Communities in Ontario

Background. Black males accounted for 19.7% of all the new HIV diagnoses in Canada in 2020, yet Black people make up only 4.26% of the population. Persistent misconceptions about modes of HIV transmission need to be addressed to reduce the relatively high HIV prevalence among Black men. We described the HIV misconceptions held by some HBM in Ontario. We also identified the social determinants that are protective versus risk factors for HIV misconceptions among heterosexual Black men (HBM) in Ontario with a view to building evidence-based strategies for strengthening HIV prevention and stigma reduction among HBM and their communities in Ontario. Methods. We report quantitative findings of the weSpeak study carried out among HBM in four cities (Ottawa, Toronto, London, and Windsor) in Ontario. Sample size was 866 and sub-samples were: Ottawa (n = 210), Toronto (n = 343), London (n = 157), and Windsor (n = 156). Data were collected with survey questionnaire. The outcome variable, HIV misconception score ranging from 1 to 18, was measured by the number of statements on the HIV Knowledge Questionnaire with incorrect answers. We included three categories of independent variables in the analysis based on a stepwise and forward model selection approach. The variable categories include (i) sociodemographic background; (ii) personalised psychosocial attributes (levels of HIV misconceptions, negative condom attitude, age at sexual debut, and resilience); and (iii) socially ascribed psychosocial experiences (everyday discrimination and pro-community attitudes). After preliminary univariate and bivariate analyses, we used a hierarchical linear regression model (HLM) to predict levels of HIV misconceptions while controlling for the effect of the city of residence. Results. More than 50% of participants in all study sites were aged 20–49 years, married, and have undergone a college or university undergraduate education. Yet, a significant proportion (27.2%) held varying levels of misconceptions about HIV. In those with misconceptions, the two most common misconceptions were: (i) people are likely to get HIV by deep kissing, putting their tongue in their partner’s mouth, if their partner has HIV (40.1%); and (ii) taking a test for HIV one week after having sex will tell a person if she or he has HIV (31.6%). Discrimination (β = 0.23, p < 0.05, 95% CI = 0.01, 0.46), negative condom attitudes (β = 0.07, p < 0.05, 95% CI = 0.01, 0.12), and sexual debut at an older age (β = 0.06, p < 0.05, 95% CI = 0.01, 1) were associated with more HIV misconceptions. Being born in Canada (β = −0.96, p < 0.05, 95% CI = −1.8, −0.12), higher education (β = −0.37, p < 0.05, 95% CI = −0.52, −0.21), and being more resilient (β = −0.04, p < 0.05, 95% CI = −0.08, −0.01) were associated with fewer HIV misconceptions. Conclusion and recommendations. HIV misconceptions are still common, especially among HBM. These misconceptions are associated with structural and behavioural factors. We recommend structural and policy-driven interventions that promote more accessible and equity-driven healthcare, education, and social integration of HBM in Ontario. We also recommend building capacity for collective resilience and critical health and racial literacy as well as creating culturally safe spaces for intergenerational dialogues among HBM in their communities.

Unlocking infodemics and mysteries in COVID-19 vaccine hesitancy: Nexus of conspiracy beliefs, digital informational support, psychological Well-being, and religious fatalism

Guarding against an anti-science camouflage within infodemics is paramount for sustaining the global vaccination drive. Vaccine hesitancy remains a growing concern and a significant threat to public health, especially in developing countries. Infodemics, conspiracy beliefs and religious fatalism primarily fuel vaccine hesitancy. In addition, anti-vaccine disinformation, lack of understanding, and erroneous religious beliefs also trigger vaccine hesitancy. Global behavioral strategies such as wearing face masks and long-term preventive measures (i.e., COVID-19 vaccination) have effectively limited the virus's spread. Despite the alarming rate of global deaths (i.e., over 99% being unvaccinated), a large proportion of the global population remains reluctant to vaccinate. New evidence validates the usefulness of technology-driven communication strategies (i.e., digital interventions) to address the complex socio-psychological influence of the pandemic. Hence, the present research explored the digital information processing model to assess the interface between informational support (through digital interventions) and antecedents of vaccine hesitancy. This research involved two separate studies: a focus group to operationalize the construct of infodemics, which remained ambiguous in previous literature (Study 1), followed by a cross-sectional survey (Study 2) to examine the conceptual model. Data were collected from 1906 respondents through a standard questionnaire administered online. The focus group's findings revealed a multi-dimensional nature of infodemics that was also validated in Study 2. The cross-sectional survey results substantiated infodemics, religious fatalism and conspiracy beliefs as significant predictors of vaccine hesitancy. Similarly, conspiracy beliefs negatively influence an individual's psychological well-being. Furthermore, information support (through digital intervention) affected infodemics and religious fatalism, whereas it inversely influenced the strength of their relationships with vaccine hesitancy. Information support (through digital intervention) also moderated the relationship between conspiracy beliefs and psychological well-being.

A mixed methods study exploring requests for unproven COVID therapies such as ivermectin and healthcare distrust in the rural South

The COVID-19 pandemic has led to contentious discourse regarding unproven COVID-19 therapies (UCTs),(e.g. ivermectin). Despite recommendations against it, ivermectin remains, in some areas, highly demanded. The goal of this study is to understand patient and provider perspectives about UCTs (e.g., ivermectin) and how responses to requests for UCTs impact healthcare distrust. This mixed methods observational study was conducted in a rural healthcare system in the Southern United States. Adults (n = 26) with a history of COVID-19 or clinicians (n = 8) from the same system were interviewed using questionnaires assessing healthcare distrust and qualitatively interviewed exploring perceptions about UCTs. Patient themes were: 1) Importance of anecdotal stories for decision-making; 2) Use of haphazard approaches to 'research'; 3) Strong distrust of government and healthcare organizations; 4) Inherent trust in local healthcare; 5) Decision-making as weighing pros/cons; and 6) Feeling a right to try medications. High survey medians indicated high distrust with differences of 8.5 points for those who requested/used ivermectin versus those who did not (p = 0.027). Clinician themes were: 1) Frustration when patients trust social media over clinicians; 2) Acceptance of community beliefs about UCTs; 3) Distrust originating outside of the healthcare system; 4) Feeling torn about prescribing UCTs to build trust; and 5) Variable educational strategies. When clinicians are perceived as aligned with government, this may void patients' trust of clinicians. Clinicians should leverage trust in local healthcare and distance themselves from distrusted information sources. Ethical questions arise regarding appropriateness of acquiescing to patient requests for ivermectin for building trust.

Long-Acting Injectable Therapy for People with HIV: Looking Ahead with Lessons from Psychiatry and Addiction Medicine

Long-acting injectable antiretroviral medications are new to HIV treatment. People with HIV may benefit from a treatment option that better aligns with their preferences, but could also face new challenges and barriers. Authors from the fields of HIV, substance use treatment, and mental health collaborated on this commentary on the issues surrounding equitable implementation and uptake of LAI ART by drawing lessons from all three fields. We employ a socio-ecological framework beginning at the policy level and moving through the community, organizational, interpersonal, and patient levels. We look at extant literature on the topic as well as draw from the direct experience of our clinician-authors.

Attitudes, perceptions, and preferences towards SARS CoV-2 testing and vaccination among African American and Hispanic public housing residents, New York City: 2020-2021

BACKGROUND

African American and Hispanic populations have been affected disproportionately by COVID-19. Reasons are multifactorial and include social and structural determinants of health. During the onset and height of the pandemic, evidence suggested decreased access to SARS CoV-2 testing. In 2020, the National Institutes of Health launched the Rapid Acceleration of Diagnostics (RADx)- Underserved Populations initiative to improve SARS CoV-2 testing in underserved communities. In this study, we explored attitudes, experiences, and barriers to SARS CoV-2 testing and vaccination among New York City public housing residents.

METHODS

Between December 2020 and March 2021, we conducted 9 virtual focus groups among 36 low-income minority residents living in New York City public housing.

RESULTS

Among residents reporting a prior SARS CoV-2 test, main reasons for testing were to prepare for a medical procedure or because of a high-risk exposure. Barriers to testing included fear of discomfort from the nasal swab, fear of exposure to COVID-19 while traveling to get tested, concerns about the consequences of testing positive and the belief that testing was not necessary. Residents reported a mistrust of information sources and the health care system in general; they depended more on "word of mouth" for information. The major barrier to vaccination was lack of trust in vaccine safety. Residents endorsed more convenient testing, onsite testing at residential buildings, and home self-test kits. Residents also emphasized the need for language-concordant information sharing and for information to come from "people who look like [them] and come from the same background as [them]".

CONCLUSIONS

Barriers to SARS CoV-2 testing and vaccination centered on themes of a lack of accurate information, fear, mistrust, safety, and convenience. Resident-endorsed strategies to increase testing include making testing easier to access either through home or onsite testing locations. Education and information sharing by trusted members of the community are important tools to combat misinformation and build trust.

Who falls for fake news? Psychological and clinical profiling evidence of fake news consumers

Awareness of the potential psychological significance of false news increased during the coronavirus pandemic, however, its impact on psychopathology and individual differences remains unclear. Acknowledging this, the authors investigated the psychological and psychopathological profiles that characterize fake news consumption. A total of 1452 volunteers from the general population with no previous psychiatric history participated. They responded to clinical psychopathology assessment tests. Respondents solved a fake news screening test, which allowed them to be allocated to a quasi-experimental condition: group 1 (non-fake news consumers) or group 2 (fake news consumers). Mean comparison, Bayesian inference, and multiple regression analyses were applied. Participants with a schizotypal, paranoid, and histrionic personality were ineffective at detecting fake news. They were also more vulnerable to suffer its negative effects. Specifically, they displayed higher levels of anxiety and committed more cognitive biases based on suggestibility and the Barnum Effect. No significant effects on psychotic symptomatology or affective mood states were observed. Corresponding to these outcomes, two clinical and therapeutic recommendations related to the reduction of the Barnum Effect and the reinterpretation of digital media sensationalism were made. The impact of fake news and possible ways of prevention are discussed.

Promoting conspiracy theory: From AIDS to COVID-19

Conspiracy theories (evidence-free, improbable narratives about powerful agents conspiring to harm people) circulated widely during the acquired immune deficiency syndrome (AIDS) and COVID-19 epidemics. They travelled over time and space, adapted to local conditions and anxieties, and were promoted for commercial and political purposes. Russian conspiracy theories claiming the viruses were United States bioweapons appeared in both epidemics. So did 'cultropreneurs' who, as a marketing strategy for their 'alternative' therapies, promoted conspiracy theories about scientific medicine. Pro-science activists sought to counter medical misinformation and debunk faux cures, but their task was harder in the 'post-truth' social-media driven context of COVID-19. Conspiracy theories about vaccines are an ongoing challenge for public health.

Conspiracy mentality and health-related behaviour during the COVID-19 pandemic: a multiwave survey in Italy

OBJECTIVES

This study aimed to (1) explore the changes in conspiracy mentality across the four waves of the COVID-19 pandemic; (2) assess the relationship between conspirative mentality and psychological/behavioural variables; (3) identify the predictors of conspirative mentality; and (4) explore the effect of conspirative mentality on COVID-19 protective behaviour.

STUDY DESIGN

This was a multiwave survey.

METHODS

A total of 10,013 Italian individuals, aged 18-70 years, were assessed across the four waves (from January to May 2021) through online survey. We collected information about the sociodemographic characteristics of participants, personal experiences of COVID-19 infection, trust, COVID-19 protective behaviours, COVID-19 risk perception, arousal, auto-efficacy, resilience and well-being. Conspiracy mentality was assessed with the Conspiracy Mentality Questionnaire. The statistical analyses included exploratory factorial analyses, Pearson correlations and multiple linear regressions.

RESULTS

The conspiracy mentality score during the COVID-19 pandemic was medium-high (mean 59.0 on a 0-100 scale) and slightly increased from 58.2 to 59.9 across months, in parallel with a slight decrease in trust in health institutions and scientific informational sources. Individuals aged >35 years, poorly educated and particularly scared about their financial situation were at risk of showing higher levels of conspirative mentality. Higher levels of conspirative mentality were risk factors for low levels of COVID-19 protective behaviours.

CONCLUSIONS

Clear and effective communication may improve trust in health institutions and informational sources, decrease conspirative theories and increase compliance with protective behaviour.

The Healthcare Experiences of African Americans with a Dual Diagnosis of HIV/AIDS and a Nutrition-Related Chronic Disease: A Pilot Study

For HIV-positive African Americans, the mistrust of medical providers due to anticipation of unequal treatment care, prejudice, and bias can become a major deterrent to medication and treatment adherence. Although programs and services incorporate strategies to improve patient-provider relationships, a deeper understanding of their healthcare experiences, especially among those with a dual diagnosis of HIV/AIDS and a nutrition-related chronic disease, is lacking. This qualitative study aimed to address this gap by conducting focus groups with participants who identified themselves as being African American, and having a dual diagnosis of HIV/AIDS, and a chronic disease. Content analysis generated several major themes, highlighting the impact of a negative healthcare experience on their ability to self-manage their health. Factors such as lack of consistency in care team, negative interactions with doctors, feelings of stigma due to prejudice and bias from healthcare staff, loss of privacy, and the need for comprehensive services that targeted their physical, emotional, and nutritional health emerged as recurring sub-themes. These findings provide the foundation for the design of a comprehensive intervention model that helps participants to communicate their medical needs more effectively, thus optimizing their overall health outcomes and quality of life.

Science vs. Conspiracy Theory about COVID-19: Need for Cognition and Openness to Experience Increased Belief in Conspiracy-Theoretical Postings on Social Media

In the context of COVID-19 virus containment, there is a lack of acceptance of preventive measures in the population. The present work investigated which factors influence the belief in scientific propositions compared with belief in conspiracy theories. The focus here was on the determinants of conspiracy beliefs in the context of COVID-19 related media content. Using an online questionnaire (N = 175), results indicate that scientific compared to conspiracy-theoretical media content led to higher acceptance. Furthermore, need for cognition (NFC-K), a conspiracy-theoretical worldview (CMQ), and openness to experience (NEO-FFI) were positively associated with conspiracy beliefs derived from Facebook postings. In addition, a conspiracy-theoretical worldview was negatively associated with belief in scientific media content. Furthermore, agreeableness was unrelated to conspiracy beliefs, although it was positively associated with conspiracy-theoretical worldview. The results imply promising persuasion strategies for reducing conspiracy-theoretical beliefs and to increase the acceptance of preventive measures.

[Conspiracy theories and COVID-19: How do conspiracy beliefs arise?]

The COVID-19 pandemic caused by the novel coronavirus SARS-CoV-2 has caused an unprecedented global crisis, and a proliferation of conspiracy theories. These conspiratorial beliefs has contributed to weakening the credibility of government public health measures, limiting citizens' access to reliable sources of information, and disrupting the response of health systems to the crisis. Several hypotheses have been proposed in psychology and social science to understand the genesis of these beliefs during a pandemic, including generational, socio-cultural and political characteristics of individuals, and psychological factors such as the desire to preserve one's safety, to maintain a positive self-image, or even to strengthen its social role. However, recent discoveries in cognitive science about belief updating mechanisms offer new insights into the generation of conspiratorial beliefs across time and culture. In this paper, we offer a definition of conspiracy theory and a classification of conspiracy beliefs during the COVID-19 pandemic. We show how the mechanisms of belief updating may explain the genesis of conspiracy theories, and we propose several hypotheses supported by contemporary research in cognitive and social science.

Experiences of discrimination and endorsement of HIV/AIDS conspiracy beliefs: exploring difference among a sample of Latino, Black, and White young adults

Racial/ethnic discrimination and HIV/AIDS conspiracy beliefs may contribute to disparities in use and satisfaction with healthcare services. Previous studies that examined racial/ethnic experiences of everyday discrimination (EOD), health care discrimination (HCD), and HIV/AIDS conspiracy beliefs (HCB) focused primarily on African Americans with few studies focusing on Latinos. This study used data from in-person structured interviews with 450 Latino, Black, and White young adults from East Los Angeles, California. Multivariable models, adjusting for all demographic covariates, investigated if race/ethnicity and gender were associated with EOD and HCD and endorsing HCB, and if the associations between race/ethnicity and discriminations and HCB varied by gender. Blacks and Latinos reported more experiences of EOD and HCD in almost all forms and endorsed more HIV/AIDS conspiracy beliefs compared to Whites. Additionally, Black and Latino men reported stronger feelings of EOD than their female counterparts. More reports of experiences of HCD and endorsement of HCB beliefs were found for Blacks, Latinos, and participants with children compared to their counterparts. This study contributes to a growing understanding of how different racial/ethnic groups experience discrimination across various settings and everyday activities and their endorsement of HIV/AIDS conspiracy beliefs. The field of Public Health must address the problems of racism and discrimination similar to any other toxic pathogen. In so doing, Public Health becomes proactive in its efforts to mitigate the effects of racial discriminations on population health.

Who Can I Ask? Who Would I Tell? An Egocentric Network Analysis Among a Sample of Women At-Risk to Explore Anticipated Advice Seeking and Disclosure Around Pre-exposure Prophylaxis (PrEP)

Pre-Exposure Prophylaxis (PrEP) health campaigns invite women to talk with their provider, partner, and peers about PrEP, though they do not offer specific guidance about who and how to engage. This study uses egocentric network methods in a sample of women at risk for HIV to understand what characteristics of women (egos), their networks, and network members (alters) were associated with anticipated PrEP advice-seeking and anticipated PrEP disclosure. Multivariable generalized linear mixed models revealed that women often consider close, supportive, and trusted network members as PrEP discussants while ego-level, network-level, and cross-level interactions depict the complexity of anticipated network activation. Findings highlight the importance of considering women at risk for HIV in a broader social context. Anticipated advice-seeking and disclosure related to PrEP were associated but distinct forms of network activation, which highlights the need to develop specific recommendations about who and how women should engage with their networks around PrEP.

A systematic review and meta-analysis of the Everyday Discrimination Scale and biomarker outcomes

Discrimination has consistently been associated with multiple adverse health outcomes. Like other psychosocial stressors, discrimination is thought to impact health through stress-related physiologic pathways including hypothalamic-pituitary-adrenal (HPA) axis activation, dysregulation of inflammation responses, and accelerated cellular aging. Given growing attention to research examining the biological pathways through which discrimination becomes embodied, this systematic review and meta-analysis synthesizes empirical evidence examining relationships between self-reported discrimination and four biomarker outcomes (i.e., cortisol, C-reactive protein (CRP), interleukin-6 (IL-6), and telomere length) among studies that have used the Everyday Discrimination Scale. We conducted a systematic review of studies discussing self-reported, everyday, or chronic discrimination in the context of health by searching Medline / PubMed (National Library of Medicine, NCBI), PsycInfo (APA, Ebsco) and Web of Science Core Collection (Clarivate). Twenty-five articles met the criteria for meta-analysis, with several reporting on multiple outcomes. Discrimination was associated with elevated CRP levels (r = 0.11; 95% CI: 0.01, 0.20, k = 10), though not cortisol (r = 0.05; 95% CI: -0.06, 0.16, k = 9), IL-6 (r = 0.05; 95% CI: -0.32, 0.42, k = 5), or telomere length (r = 0.03; 95% CI: -0.01, 0.07, k = 6). We identify several points of consideration for future research including addressing heterogeneity in assessment of biomarker outcomes and the need for longitudinal assessments of relationships between discrimination and biomarker outcomes.

An Ecological Theory Application and Expansion to the COVID-19 Pandemic's Impact on African Americans and Contributors to Vaccine Hesitancy

The COVID-19 pandemic has highlighted numerous social and health disparities within the United States, particularly those that impact African Americans. African Americans have been overrepresented in the number of COVID-19 hospitalizations and deaths and have demonstrated lower vaccine inoculation compared to other ethnic groups. This article applies Urie Bronfenbrenner's Ecological Theory to the disproportionate impact the COVID-19 pandemic has had on African Americans and contributors to vaccine hesitancy while offering an expansion to the theory utilizing the Health Belief Model. The Health Belief Model was utilized to address the intervention limitations of the Ecological Theory as the better determine which system(s) would be most advantageous to for health intervention(s). This article extends the social work knowledge base and application by offering implications for practice and research.

Sex-Positivity, Medical Mistrust, and PrEP Conspiracy Beliefs Among HIV-Negative Cisgender Black Sexual Minority Men in Atlanta, Georgia

Because the public health response to the disproportionate HIV burden faced by Black sexual minority men (BSMMM) has focused on sexual risk reduction and disease prevention, other vital components of sexual health (e.g., intimacy, pleasure, benefits of sex) have been often overlooked. Sex-positive describes a more open, holistic approach toward sex and sexuality that prioritizes these other components, though such an approach is rarely applied to BSMM's sexual health. For sex-positive BSMM, risk/preventive discourse may foster or exacerbate medical mistrust as a reaction to the dissonance between how these men view sexual health and how the medical establishment views it, which may discourage sexual healthcare-seeking. We assessed sex-positivity and its association with medical mistrust and PrEP conspiracy beliefs among 206 HIV-negative cisgender BSMM in Atlanta, Georgia. We performed exploratory factor analytic procedures on responses to a sex-positivity scale, followed by multivariable linear regressions to determine sex-positivity's associations with medical mistrust and PrEP conspiracy beliefs. We extracted two sex-positivity factors: sexual freedom (α = 0.90), reflecting openness toward casual sex and rejection of sexual mores, and essence of sex (α = 0.77), reflecting the intimate, relational, and pleasurable qualities of sex. Sexual freedom was independently associated with perceived provider deception (β = 0.19, CI = 0.04, 0.34). Essence of sex was independently associated with PrEP conspiracy beliefs (β = 0.16, CI = 0.02, 0.31) and marginally associated with perceived provider deception (β = 0.14, CI = - 0.00, 0.29). Healthcare providers and public health practitioners may cultivate greater trust with BSMM by incorporating a sex-positive approach into patient/participant interactions, clinical decision-making, and interventions. Improving access to sexual pleasure acknowledges BSMM's right to optimal, holistic sexual health.

COVID-19 Related Stresses, Conspiracy Beliefs, Uncertainty, and Non-adherence to Safety Guidelines

INTRODUCTION

Inconsistent use of protective preventive measures and nonadherence of the guidelines set by the World Health Organization regarding the coronavirus are associated with increased morbidity and mortality, as well as increased health care costs.

OBJECTIVE

The purpose of this study was to examine the role of COVID-19 related worries, conspiracy beliefs, and uncertainty in adherence to preventative measures in Iran.

METHOD

In a large survey with data collected online from a volunteer sample of 599 individuals, assessments were made of the distress associated with the anticipated potential consequences associated with the COVID-19 pandemic and the lockdown, extent of agreement with conspiracy beliefs, level of situation-specific uncertainty, and self-reports of compliance with preventive measures. Data were analyzed to explore paths leading to nonadherence to safety guidelines proposed by the medical authorities.

RESULTS

A large majority of individuals report significant distress and worry associated with the COVID-19 pandemic. Results indicate that increasing levels of situation-specific uncertainty intolerance, as well as conspiracy beliefs regarding the coronavirus, are associated with non-compliance with the advised protocols. Specifically, the results show that worries related to the COVID-19 pandemic are linked to non-compliance with preventive measures through conspiracy beliefs and feelings of uncertainty associated with the COVID-19 situation even after gender, education, and perceived socioeconomic status were controlled.

CONCLUSIONS

Findings imply that emotional exhaustion is likely to have set in and become counterproductive as people choose to violate safety guidelines. The authors discuss the theoretical and practical implications of these results.

Mental health and conspirasism in health care professionals during the spring 2020 COVID-19 lockdown in Greece

INTRODUCTION

The aim of the study was to investigate mental health and conspiracy theory beliefs concerning COVID-19 among health care professionals (HCPs).

MATERIAL AND METHODS

During lockdown, an online questionnaire gathered data from 507 HCPs (432 females aged 33.86 ± 8.63 and 75 males aged 39.09 ± 9.54).

STATISTICAL ANALYSIS

A post-stratification method to transform the study sample was used; descriptive statistics were calculated.

RESULTS

Anxiety and probable depression were increased 1.5-2-fold and were higher in females and nurses. Previous history of depression was the main risk factor. The rates of believing in conspiracy theories concerning the COVID-19 were alarming with the majority of individuals (especially females) following some theory to at least some extend.

CONCLUSIONS

The current paper reports high rates of depression, distress and suicidal thoughts in the HCPs during the lockdown, with a high prevalence of beliefs in conspiracy theories. Female gender and previous history of depression acted as risk factors, while the belief in conspiracy theories might act as a protective factor. The results should be considered with caution due to the nature of the data (online survey on a self-selected but stratified sample).

COVID-19 Vaccine Hesitancy in Italy: Predictors of Acceptance, Fence Sitting and Refusal of the COVID-19 Vaccination

Background

The hesitancy in taking the COVID-19 vaccine is a global challenge. The need to identify predictors of COVID-19 vaccine reluctance is critical. Our objectives were to evaluate sociodemographic, psychological, and behavioral factors, as well as attitudes and beliefs that influence COVID-19 vaccination hesitancy in the general population of Italy.

Methods

A total of 2,015 people were assessed in two waves (March, April and May, 2021). Participants were divided into three groups: (1) individuals who accepted the vaccination (“accepters”); (2) individuals who refused the vaccination (“rejecters”); and (3) individuals who were uncertain about their attitudes toward the vaccination (“fence sitters”). Group comparisons were performed using ANOVA, the Kruskal-Wallis test and chi-square tests. The strength of the association between the groups and the participants' characteristics was analyzed using a series of multinomial logistic regression models with bootstrap internal validation (one for each factor).

Results

The “fence sitters” group, when compared to the others, included individuals of younger age, lower educational level, and worsening economic situation in the previous 3 months. After controlling for sociodemographic factors, the following features emerged as the main risk factors for being “fence sitters” (compared with vaccine “accepters”): reporting lower levels of protective behaviors, trust in institutions and informational sources, frequency of use of informational sources, agreement with restrictions and higher conspirative mentality. Higher levels of COVID-19 perceived risk, trust in institutions and informational sources, frequency of use of informational sources, agreement with restrictions and protective behaviors were associated with a higher likelihood of becoming “fence sitters” rather than vaccine “rejecters.”

Conclusions

The “fence sitters” profile revealed by this study is intriguing and should be the focus of public programmes aimed at improving adherence to the COVID-19 vaccination campaign.

COVID-19 Mitigation Compliance and Vaccination Status Among Formerly Incarcerated Individuals in the United States

BACKGROUND

To examine the relationship between incarceration history and an individual's compliance toward COVID-19 mitigation strategies and vaccination status/intentions.

METHOD

Data are from the Crime, Health, and Politics Survey (N = 1,735), a national probability sample of community-dwelling adults aged 18 and above living in the United States. Data were collected from May 10, 2021 to June 1, 2021. Multinomial logistic regression models were used to assess the relationship between incarceration history and COVID-19 mitigation strategies and vaccination status/intentions.

RESULTS

Individuals with a history of incarceration reported approximately twice the relative risk of rarely/never using hand sanitizer and rarely/never wearing a mask compared with always/very often. Incarceration history was associated with more than 3 times greater relative risk of reporting not being vaccinated and not planning to get vaccinated compared with currently being vaccinated.

CONCLUSION

Formerly incarcerated individuals are less likely to abide by key COVID-19 mitigation protocols and exhibit higher levels of vaccine hesitancy. These findings suggest that formerly incarcerated individuals, as well as their families and communities, may therefore be at greater risk of accelerated spread of COVID-19 because of these factors.

Perceived discrimination, adherence to antiretroviral therapy, and HIV care engagement among HIV-positive black adults: the mediating role of medical mistrust

Perceived discrimination and medical mistrust are contributors to HIV inequities. The current study examined whether medical mistrust mediated the associations between perceived discrimination and adherence to antiretroviral therapy (ART) as well as care engagement in a sample of 304 Black adults living with HIV. Perceived discrimination and medical mistrust were measured using validated scales; ART adherence was electronically monitored for a month; care engagement was determined by medical record data. Results support significant total indirect effects from perceived discrimination (due to HIV-serostatus, race, sexual orientation) to ART adherence through three types of medical mistrust (towards healthcare organizations, one's physician, and HIV-specific mistrust). The total indirect effects were also significant for care engagement and were largely driven by mistrust towards one's own physician. Findings suggest interventions at the provider or healthcare organization levels should address medical mistrust to improve the health and well-being of Black Americans living with HIV.

Impact of conspiracist ideation and psychotic-like experiences in patients with schizophrenia during the COVID-19 crisis

Conspiratorial belief is a type of argument that accepts implausible explanations in situations of great uncertainty or mystery. Claiming that the coronavirus is an artificial fabrication of laboratories is an example of conspiracist belief. The aim of this research was to analyze the impact of conspiracist ideation and psychotic-like experiences in patients with schizophrenia, patients with other mental disorders, and participants with no psychiatric history with a 132-day follow-up during the COVID-19 crisis. Analysis of variance (ANOVA) was applied and Bayesian inferences were carried out. The results conclude that conspiracist ideation and psychotic-like experiences increased significantly after 132 days of social-health restrictions in the general population. However, psychotic-like experiences did not increase in patients with schizophrenia. Conspiracist ideation has a quantitative degradation similar to the continuum model of psychosis; it is present both in patients with schizophrenia and in those participants with no clinical history. The psychopathological value of conspiracist ideation within the spectrum of psychosis is discussed.

A model of factors influencing COVID-19 vaccine acceptance: A synthesis of the theory of reasoned action, conspiracy theory belief, awareness, perceived usefulness, and perceived ease of use

The aim of this study is to investigate the key factors influencing the acceptance of COVID-19 vaccines and develop a model based on the theory of reasoned action, belief in conspiracy theory, awareness, perceived usefulness, and perceived ease of use. The authors created and distributed a self-administered online questionnaire using Google Forms. Data were collected from 351 respondents ranging in age from 19 to 30 years, studying at the graduate and postgraduate levels at various public universities in Bangladesh. The Partial Least Squares Structural Equation Modeling (PLS-SEM) method was used to analyze the data. The results indicate that belief in conspiracy theory undermines COVID-19 vaccine acceptance, thereby negatively impacting the individual attitudes, subjective norms, and acceptance. Individual awareness, on the other hand, has a strong positive influence on the COVID-19 vaccine acceptance. Furthermore, the perceived usefulness of vaccination and the perceived ease of obtaining the vaccine positively impact attitude and the acceptance of immunization. Individuals’ positive attitudes toward immunization and constructive subjective norms have a positive impact on vaccine acceptance. This study contributes to the literature by combining the theory of reasoned action with conspiracy theory, awareness, perceived usefulness, and perceived ease of use to understand vaccine acceptance behavior. Authorities should focus on campaigns that could reduce misinformation and conspiracy surrounding COVID-19 vaccination. The perceived usefulness of vaccination to prevent pandemics and continue normal education will lead to vaccination success. Furthermore, the ease with which people can obtain the vaccine and that it is free of cost will encourage students to get vaccinated to protect themselves, their families, and society.

Results of the COVID-19 mental health international for the general population (COMET-G) study

INTRODUCTION

There are few published empirical data on the effects of COVID-19 on mental health, and until now, there is no large international study.

MATERIAL AND METHODS

During the COVID-19 pandemic, an online questionnaire gathered data from 55,589 participants from 40 countries (64.85% females aged 35.80 ± 13.61; 34.05% males aged 34.90±13.29 and 1.10% other aged 31.64±13.15). Distress and probable depression were identified with the use of a previously developed cut-off and algorithm respectively.

STATISTICAL ANALYSIS

Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses and Factorial Analysis of Variance (ANOVA) tested relations among variables.

RESULTS

Probable depression was detected in 17.80% and distress in 16.71%. A significant percentage reported a deterioration in mental state, family dynamics and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (31.82% vs. 13.07%). At least half of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop depression was associated with history of Bipolar disorder and self-harm/attempts (RR = 5.88). Suicidality was not increased in persons without a history of any mental disorder. Based on these results a model was developed.

CONCLUSIONS

The final model revealed multiple vulnerabilities and an interplay leading from simple anxiety to probable depression and suicidality through distress. This could be of practical utility since many of these factors are modifiable. Future research and interventions should specifically focus on them.

HIV Testing Correlates: U.S. and Foreign Born High-Risk Black Heterosexual Men

In the U.S., Black men are disproportionately affected by HIV, with some of the highest HIV incidence rates and lowest rates of HIV testing. We examined correlates of HIV testing and knowledge among participants of the Barbershop Talk with Brothers (BTWB) project, an HIV prevention program targeting high-risk sexual behaviors among Black heterosexual men in Brooklyn, New York. Specifically, we examined differences between U.S. vs. foreign-born status and HIV testing rates, HIV knowledge, and socio-demographic factors. Of the 855 men included, the mean age was 33 years and 35.0% were foreign-born. Lifetime HIV testing was reported at 84%, with greater proportion of U.S. vs foreign-born men reporting lifetime (88.6% vs. 75.0%) and recent testing (68.6% vs. 51.0%), p < 0.001. Among foreign-born men, recent HIV testing was associated with lower stigma and greater HIV transmission knowledge than those un-tested. The authors recommend tailored approaches to increasing HIV testing in Black communities, based on nativity and social factors.

Examining conspiracy beliefs and COVID-19 in four countries: The role of disgust towards the political system and implications for prosocial behavior

Since late 2019, the coronavirus SARS-COV-2 responsible for the COVID-19 disease has continued to spread across different regions of the world. As a result, governments have been implementing measures for controlling the disease which rely on people's cooperation. In this research, we considered predictors and implications of people's beliefs that they “haven’t been told the ‘whole story’ about COVID-19.” Specifically, we examined the role of disgust towards the political system in predicting conspiratorial tendencies across four countries, in Europe (Italy and the UK), North America (the USA), and Asia (South Korea). In addition, we investigated the implications of conspiratorial beliefs for individuals’ intentions to engage in prosocial cooperative behavior. In line with the idea that feelings of disgust towards the political system may indicate that people perceive the system as violating core norms, results showed that disgust was associated with stronger conspiratorial tendencies. Individuals’ conspiratorial tendencies were in turn associated with lower intentions to help others during the pandemic. Results were broadly consistent across the countries tested. Directions for future research are discussed.

LOCO: The 88-million-word language of conspiracy corpus

The spread of online conspiracy theories represents a serious threat to society. To understand the content of conspiracies, here we present the language of conspiracy (LOCO) corpus. LOCO is an 88-million-token corpus composed of topic-matched conspiracy (N = 23,937) and mainstream (N = 72,806) documents harvested from 150 websites. Mimicking internet user behavior, documents were identified using Google by crossing a set of seed phrases with a set of websites. LOCO is hierarchically structured, meaning that each document is cross-nested within websites (N = 150) and topics (N = 600, on three different resolutions). A rich set of linguistic features (N = 287) and metadata includes upload date, measures of social media engagement, measures of website popularity, size, and traffic, as well as political bias and factual reporting annotations. We explored LOCO's features from different perspectives showing that documents track important societal events through time (e.g., Princess Diana's death, Sandy Hook school shooting, coronavirus outbreaks), while patterns of lexical features (e.g., deception, power, dominance) overlap with those extracted from online social media communities dedicated to conspiracy theories. By computing within-subcorpus cosine similarity, we derived a subset of the most representative conspiracy documents (N = 4,227), which, compared to other conspiracy documents, display prototypical and exaggerated conspiratorial language and are more frequently shared on Facebook. We also show that conspiracy website users navigate to websites via more direct means than mainstream users, suggesting confirmation bias. LOCO and related datasets are freely available at https://osf.io/snpcg/ .

Understanding Medical Distrust Among African American/Black and Latino Persons Living With HIV With Sub-Optimal Engagement Along the HIV Care Continuum: A Machine Learning Approach

Medical distrust is a potent barrier to participation in HIV care and medication use among African American/Black and Latino (AABL) persons living with HIV (PLWH). However, little is known about sociodemographic and risk factors associated with distrust. We recruited adult AABL PLWH from low socio-economic status backgrounds with insufficient engagement in HIV care (N = 512). Participants completed structured assessments on three types of distrust (of health care providers, health care systems, and counter-narratives), HIV history, and mental health. We used a type of machine learning called random forest to explore predictors of trust. On average, participants were 47 years old (SD = 11 years), diagnosed with HIV 18 years prior (SD = 9 years), and mainly male (64%) and African American/Black (69%). Depression and age were the most important predictors of trust. Among those with elevated depressive symptoms, younger participants had less trust than older, while among those without depression, trust was greater across all ages. The present study adds nuance to the literature on medical distrust among AABL PLWH and identifies junctures where interventions to build trust are needed most.

The HCT Index: a typology and index of health conspiracy theories with examples of use

Background: Conspiracy theories regarding vaccination programmes, medical side effects, and cover-ups by governments or pharmaceutical companies are prevalent in many countries and have highly detrimental and far-reaching effects on people’s wellbeing. For research and policymaking in public health, it is vital to understand the nature, construction and dissemination of these health conspiracy theories (HCTs). Inspired by tale typologies developed in folkloristics, this paper presents a typology and index of international HCTs as a tool for researchers to identify and categorise the HCTs they come across, and to provide a pool of examples of HCTs which could be used in various fields of research. To illustrate this, two studies are also presented (Study 1 and Study 2). Methods: HCTs were collected from relevant academic literature, news journalism, a survey of known health-related, general conspiracy theorist websites, and web searches based around known HCTs. From this, 14 core types were identified, and a numbered index was constructed with brief descriptions, examples, and motifs. Study 1 is a survey of HCT exposure and belief in the UK. Study 2 is a focus group discussion of health rumours in rural Sri Lanka including discussion of HCTs. Results: The HCT Index provides valuable insights into the international dissemination of HCTs. Study 1 found that familiarity with and belief in HCTs were high: 97% of Britons are familiar with at least one HCT and 49% of Britons believed that at least one HCT was likely to be true. Study 2 highlighted concerns over threats to fertility and about how to verify information that falls outside of typical experience. Conclusions: The HCT Index provides a useful framework for future cross-cultural research. As a typology it encompasses a wide range of beliefs which can be more effectively categorized and compared and, ultimately, challenged.

Analytic Thinking and Political Orientation in the Corona Crisis

With much unknown about the new coronavirus, the scientific consensus is that human hosts are crucial to its spread and reproduction-the more people behave like regular socializing beings they are, the more likely it is that the virus will propagate. Hence, many nations worldwide have mandated physical-distancing measures. In the current preregistered research, we focus on examining two factors that may help explain differences in adherence to COVID-19 preventive behaviors and policy support across different countries-political orientation and analytic thinking. We positioned our research within the dual-process framework of human reasoning and investigated the role of cognitive reflection, open-minded thinking, and political ideology in determining COVID-19 responsible behavior (physical distancing and maintaining hygiene) and support for restrictive COVID-19 policies on a sample of 12,490 participants from 17 countries. We have not been able to detect substantial relationships of political orientation with preventive behaviors and policy support, and overall found no reliable evidence of politicization, nor polarization regarding the issue. The results of structural equation modeling showed that the inclination towards COVID-19 preventive measures and their endorsement were defined primarily by the tendency of open-minded thinking. Specifically, open-minded thinking was shown to be a predictor of all three criteria-avoiding physical contact, maintaining physical hygiene, and supporting COVID-19 restrictive mitigation policies. Cognitive reflection was predictive of lesser adherence to stricter hygiene and only very weakly predictive of lesser policy support. Furthermore, there was no evidence of these effects varying across political contexts. The mediation analysis suggested a partial mediation effect of COVID-19 conspiracy beliefs on the relationships of open-mindedness and cognitive reflection with physical distancing (but not adherence to stricter hygiene) and COVID-19 policy support, albeit very small and significant primarily due to sample size. There was also no evidence of these effects varying across political contexts. Finally, we have not been able to find strong evidence of political orientation modifying the relationship between analytical thinking and COVID-19 behaviors and policy support, although we explored the pattern of these effects in the US and Canadian samples for exploratory purposes and comparison with other similar studies.

Dynamic relationships between different types of conspiracy theories about COVID-19 and protective behaviour: A four-wave panel study in Poland

RATIONALE

Conspiracy theories about COVID-19 pose a serious threat to public health by providing false information and undermining official health recommendations. However, existing studies rarely employed longitudinal designs, precluding the determination of the directionality between endorsement of conspiracy theories and its societal consequences. Also, relatively little research examined whether the association between protective health behaviour and the endorsement of conspiracy theories is affected by the content of a given theory.

METHODS

A four-wave longitudinal panel survey on the association between belief in a wide range of conspiracy theories about COVID-19 and protective behaviour was carried out on a representative sample of Polish citizens (T1 = 1130, T2 = 971, T3 = 818, T4 = 688). Analyses were performed using Random Intercept Cross-Lagged Panel Models.

RESULTS

The results showed a reciprocal, bidirectional association between conspiracy mentality and protective behaviour. The same effect was also observed between protective behaviour and threat of authoritarianism. We did not find evidence that specific COVID-19 related conspiracy theories directly (and differently) predict within-person changes in protective behaviour over time.

CONCLUSIONS

Our results showed that the association between various conspiracy-related variables and anti-pandemic COVID-19 variables differs at within- and between-person levels. Changes in the adherence to pro-health measures were negatively predicted by conspiracy mentality and a feeling of threat that the solutions introduced by the government may limit civil rights. Specific conspiracy beliefs were significantly related to protective behaviour only at the between-person level.

Coronavirus conspiracy beliefs and distrust of science predict risky public health behaviours through optimistically biased risk perceptions in Ukraine, Turkey, and Germany

The present paper examines the extent to which conspiracy beliefs about the COVID-19 outbreak and distrust of epidemiological science are likely to predict optimistically biased risk perceptions at the individual and group levels. We explored the factor structure of coronavirus conspiracy beliefs and their associations with trust in science in predicting risk perceptions using survey data collected in Ukraine ( N = 390), Turkey ( N = 290), and Germany ( N = 408). We further expected conspiracy beliefs and distrust of science to predict people’s willingness to attend public gatherings versus maintaining preventive physical distancing through optimistically biased risk perceptions. Metric noninvariance for key constructs across the samples was observed so the samples were analysed separately. In Ukraine, a two-factor structure of conspiracy beliefs was found wherein COVID-19 bioweapon (but not COVID-19 profit) beliefs were negatively associated with public gathering through optimistically biased individual risk perceptions. In Turkey and Germany, conspiracy beliefs showed a single-factor solution that was negatively associated with preventive distancing and positively related to public gathering through optimistically biased public risk metaperceptions. The hypothesis about the direct and indirect effects of trust in science on risky health behaviour was partially confirmed in all three samples. The observed discrepancies in our findings are discussed.

Sexual Empowerment Among Young Black Men Who Have Sex with Men

Sexual empowerment represents an important HIV intervention strategy, yet limited attention has examined the multidimensional nature of sexual empowerment in prior studies. Using a sample (n = 465) of young Black men who have sex with men (MSM), we used confirmatory factor analysis (CFA) to test a multifactorial operationalization of sexual empowerment. CFA indicated that a bifactor model was best suited to characterize the sexual empowerment factor (SEF), suggesting that items for four sub-constructs (self-efficacy to refuse sexual behavior, emotional support, condom use self-efficacy, and social norms on condom use) contributed to their respective constructs, while also contributing to a latent sexual empowerment construct. We then examined the association between SEF and mental health outcomes (anxiety and depression symptoms) and safer sex intentions. SEF was negatively associated with mental health outcomes and positively associated with safer sex intentions. Ultimately, individuals with greater sexual empowerment might be better equipped to develop strategies to buffer their vulnerability to HIV. We discuss the implications of SEF as a bifactor during the design and evaluation of HIV risk-reduction interventions seeking to address sexual empowerment among MSM.

The Impact of Individual Behaviors and Governmental Guidance Measures on Pandemic-Triggered Public Sentiment Based on System Dynamics and Cross-Validation

Negative online public sentiment generated by government mishandling of pandemics and other disasters can easily trigger widespread panic and distrust, causing great harm. It is important to understand the law of public sentiment dissemination and use it in a timely and appropriate way. Using the big data of online public sentiment during the COVID-19 period, this paper analyzes and establishes a cross-validation based public sentiment system dynamics model which can simulate the evolution processes of public sentiment under the effects of individual behaviors and governmental guidance measures. A concrete case of a violation of relevant regulations during COVID-19 epidemic that sparked public sentiment in China is introduced as a study sample to test the effectiveness of the proposed method. By running the model, the results show that an increase in government responsiveness contributes to the spread of positive social sentiment but also promotes negative sentiment. Positive individual behavior suppresses negative emotions while promoting the spread of positive emotions. Changes in the disaster context (epidemic) have an impact on the spread of sentiment, but the effect is mediocre.

The Effect of Various Supportive Housing Models on ART Adherence Among Persons Living With HIV in Supportive Housing

BACKGROUND

Providing permanent supportive housing to chronically homeless persons living with human immunodeficiency virus (PLH) contributes to improved human immunodeficiency virus (HIV) outcomes, including adherence to antiretroviral therapy (ART). This study seeks to understand whether certain components of housing, namely intensity of case management and specialized HIV housing programs, affects ART adherence for PLH in supportive housing.

METHODS

From 2015 to 2019 we conducted quantitative assessments with 157 PLH in supportive housing at baseline, 6-, 12-, and 18-month postbaseline to identify factors associated with ART adherence. General Estimating Equations for repeated measures were performed to assess bivariate and multivariate measures.

RESULTS

Two thirds of PLH in supportive housing reported 95% or greater adherence to ART. Multivariate analyses indicate that neither intensity of case management services nor specialized housing for PLH were associated with greater ART adherence. Greater time since diagnosis was positively associated with ART adherence. Greater depressive symptoms and African American race were negatively associated with ART adherence.

CONCLUSIONS

Study findings reveal that although prior research has established the importance of receipt of housing for homeless PLH, the type or intensity of case management services associated with that housing may not be as important as simply being housed. Our results highlight the importance of considering mental health and more recent HIV diagnosis when developing treatment and case management plans to enhance residents' ART adherence.

Irrational beliefs differentially predict adherence to guidelines and pseudoscientific practices during the COVID-19 pandemic

In the coronavirus "infodemic," people are exposed to official recommendations but also to potentially dangerous pseudoscientific advice claimed to protect against COVID-19. We examined whether irrational beliefs predict adherence to COVID-19 guidelines as well as susceptibility to such misinformation. Irrational beliefs were indexed by belief in COVID-19 conspiracy theories, COVID-19 knowledge overestimation, type I error cognitive biases, and cognitive intuition. Participants (N = 407) reported (1) how often they followed guidelines (e.g., handwashing, physical distancing), (2) how often they engaged in pseudoscientific practices (e.g., consuming garlic, colloidal silver), and (3) their intention to receive a COVID-19 vaccine. Conspiratorial beliefs predicted all three outcomes in line with our expectations. Cognitive intuition and knowledge overestimation predicted lesser adherence to guidelines, while cognitive biases predicted greater adherence, but also greater use of pseudoscientific practices. Our results suggest an important relation between irrational beliefs and health behaviors, with conspiracy theories being the most detrimental.

What drives us to be (ir)responsible for our health during the COVID-19 pandemic? The role of personality, thinking styles, and conspiracy mentality

The study aimed to investigate the role of personality, thinking styles, and conspiracy mentality in health-related behaviors during the COVID-19 pandemic, i.e., recommended health behaviors according to COVID-19 guidelines and engagement in pseudoscientific practices related to COVID-19. Basic personality space was defined by the HEXACO model complemented by Disintegration, which represents psychotic-like experiences and behaviors reconceptualized as a personality trait. Mediation analyses conducted on a convenient sample from the general population recruited via social media and by snowballing (N = 417) showed that engagement in pseudoscientific behaviors was predicted by high Disintegration. However, this relationship was entirely mediated by high experiential and low rational thinking styles. Adherence to health practices recommended by COVID-19 guidelines was predicted by high Honesty traits, while low Disintegration had both direct and indirect effects through conspiracy mentality.