Stress and Mental Health: A Focus on COVID-19 and Racial Trauma Stress

Health Care Stereotype Threat During the COVID-19 Pandemic Among Sexual and Gender Minority Individuals

Objectives. To determine the levels and differentials in health care stereotype threat experienced during the COVID-19 pandemic by individuals with sexual or gender minority identities. Methods. The National Couples' Health and Time Use Study is a national cross-sectional US population‒ based sample of partnered individuals interviewed during the pandemic between September 2020 and April 2021 with oversamples of sexual and gender minority individuals. The analytic sample consisted of 3614 individuals (n = 2043 heterosexual and n = 1571 sexual minority individuals along with 3489 cisgender and 125 noncisgender people). Results. Individuals with sexual minority identities experienced significantly more health care stereotype threat than heterosexual people. Cisgender women and those with another gender identity experienced significantly more health care stereotype threat than cisgender men. These results persisted after the inclusion of indicators of health conditions, insurance, COVID-19 experience, and sociodemographic factors. Conclusions. Gender and sexual minority‒identifying people reported high levels of worries about health discrimination. Our work suggests that providing positive health care experiences may reduce these worries and offer a potential antidote to sexual and gender minority health disparities that are driven by structural and interpersonal discrimination. These findings support calls for the further education and transformation of health care provision and systems. (Am J Public Health. Published online ahead of print January 16, 2025:e1-e9. https://doi.org/10.2105/AJPH.2024.307926).

The Impact of Marriage on Breastfeeding Duration: Examining the Disproportionate Effect of COVID-19 Pandemic on Low-Income Communities

Background

Marriage promotes breastfeeding duration through economic and social supports. The COVID-19 pandemic disproportionately affected marginalized communities and impacted women's employment and interpersonal dynamics. This study examined how marital status affects breastfeeding duration across socioeconomic and racially minoritized groups during COVID-19, aiming to inform social support strategies for vulnerable families in public health crises.

Methods

Data were drawn from the 2017-2021 North Dakota Pregnancy Risk Assessment Monitoring System(weighted n=41433). Breastfeeding duration was self-reported, and 2-, 4-, and 6-month duration variables were calculated. Marital status(married, unmarried) and education ($48,000) and race/ethnicity (White, American Indian, Other) were self-reported. Infant birth date was used to identify pre-COVID(2017-2019) and COVID(2020-2021) births. Logistic regression estimated odds ratios and 95% confidence intervals for the association between marital status and breastfeeding duration outcomes. Models were fit overall, by COVID-19 era and by demographic factors. Lastly, demographic-specific models were further stratified by COVID era. Models were adjusted for maternal health and sociodemographic factors.

Results

Overall, married women consistently had 2-fold higher odds of breastfeeding across all durations during both pre-COVID and COVID eras. Pre-COVID, marriage was a stronger predictor for all breastfeeding durations in low-income women (4-month duration OR4.07,95%CI 2.52,6.58) than for high-income women (4-month duration OR1.76,95%CI 1.06,2.91). Conversely, during COVID, marriage was a stronger predictor of breastfeeding duration for high-income women (4-month duration OR 2.89,95%CI1.47,5.68) than low-income women (4-month duration OR 1.59,95%CI0.80, 3.15). Findings were similar among American Indian women and those with less than high school education, in that both groups lost the benefit of marriage on breastfeeding duration during the COVID-19 pandemic.

Conclusion

Marriage promotes breastfeeding duration, yet the benefit of marriage was reduced for low-socioeconomic and racially minoritized populations during the COVID-19 pandemic. Policies like paid parental leave and enhanced access to lactation consultants could help mitigate disproportionate impacts during public health crises. Continued research examining how major societal disruptions intersect with social determinants to shape breastfeeding outcomes can inform more equitable systems of care.

Development and refinement of a communication guide to help young adults in Texas reconnect and reduce loneliness

Objective

Loneliness among young people is a contemporary public health crisis exacerbated by the COVID-19 pandemic. The present research examined the development of a modest yet meaningful health communication intervention resource that would become an asset in a larger health campaign: a communication guide aimed at helping young people reach out and reconnect with others.

Methods

Study One established the need for a loneliness intervention in Texas with survey data (N = 795). A communication guide was developed based on research and theory. Study Two employed focus group interviews with potential audience members (N = 31) to critically assess and inform revisions to the communication guide.

Results

Study One results indicated that a substantial proportion of young adult Texans felt as though their social connection had decreased and their loneliness had increased since the onset of the pandemic. Themes in focus group responses from Study Two suggested several strengths of the communication guide and some opportunities for revision.

Conclusion

A communication guide with tips for reconnecting could be a valuable tool to empower young people and promote social connection.

Innovation

This study involved the development and refinement of a new communication resource that was informed by a priority audience of a major health communication campaign.

A Reasoned Action Approach to Social Connection and Mental Health: Racial Group Differences and Similarities in Attitudes, Norms, and Intentions

This study employed a Reasoned Action Approach to investigate two communication behaviors that were being built into a statewide behavioral health campaign: initiating a conversation about one's own mental health struggles, and starting a conversation to discuss someone else's mental health difficulties. We examined whether the extent of attitudes, perceived norms, and perceived behavioral control regarding intent to perform these behaviors varied by racial identity. Using original survey data from Texans (N = 2,033), we conducted regression analyses for the two communication behaviors and found that intention to seek help was primarily explained by instrumental attitude, injunctive norm, descriptive norm, and perceived capacity; and intention to start a conversation to help someone else was primarily explained by instrumental attitude, injunctive norm, and perceived capacity. Additionally, we identified important common and distinct determinants of the two behaviors across different racial groups. Implications for health communication campaign message development and audience segmentation are discussed.

Dual Pandemics: Race-Related COVID Stress and Mental Health Outcomes in Black Individuals

Black individuals have been disproportionately affected by the COVID-19 pandemic, likely due in part to historically rooted stressors that lie at the intersection of the COVID-19 pandemic and racism. We used secondary data from The Association of Black Psychologists' multi-state needs assessment of 2480 Black adults to examine the link between race-related COVID stress (RRCS) and mental health outcomes. We also examined the moderating roles of everyday discrimination, cultural mistrust, Black activism, Black identity, and spirituality/religiosity in these associations. T-tests revealed that several demographic and cultural factors are associated with RRCS endorsement. A series of regression analyses showed that endorsement of RRCS is associated with higher psychological distress and lower well-being, above and beyond several sociodemographic characteristics. While traditional cultural protective factors did not buffer against the effects of RRCS on mental health, cultural mistrust strengthened the positive association between RRCS and psychological distress; nonetheless, the association of cultural mistrusts with psychological distress was only seen in those who endorsed RRCS. We provide recommendations for policymakers, clinicians, and researchers to consider the impact of RRCS when addressing Black mental health and well-being in the age of COVID-19.

Associations of role, area deprivation index, and race with health behaviors and body mass index among localized prostate cancer patients and their partners

PURPOSE

To examine the associations of role (localized prostate cancer (PCa) patient vs. their intimate partner), area deprivation index (ADI-higher scores indicating higher neighborhood deprivation levels), and race (Black/African American (AA) vs. White) with health behaviors and body mass index (BMI) among PCa patients and partners. The behaviors include smoking, alcohol consumption, diet quality, sedentary behaviors, and physical activity (PA).

METHODS

This study used the baseline data collected in a clinical trial. Given the nested structure of the dyadic data, multi-level models were used.

RESULTS

Significant role-race interaction effects on smoking, ADI-race effects on alcohol consumption, and role-ADI effects on BMI were found. Meanwhile, patients smoked more cigarettes, decreased alcohol consumption, had less healthful diets, spent longer time watching TV, did fewer sedentary hobbies, had more confidence in PA, and had higher BMIs than their partners. High ADI was independently associated with lower odds of drinking alcohol, using computer/Internet, and doing non-walking PA, and higher BMI compared to low ADI controlling for role and race. Black/AA dyads had less smoking amount and alcohol consumption and higher sedentary time and BMI than White dyads when adjusted for role and ADI.

CONCLUSIONS

This study identified significant interaction and main effects of role, ADI, or race on health behaviors and BMI.

IMPLICATIONS FOR CANCER SURVIVORS

Future behavioral interventions should address divergent individual needs between patients and partners, social and neighborhood barriers, and cultural indicators of racial groups to promote healthful behaviors and improve the quality of survivorship for PCa patients and partners.

COVID-19 stigma and depression across race, ethnicity and residence

Our cross-sectional study seeks to understand how COVID-19 stigma, race/ethnicity [Asian, Black, Hispanic/Latinx, white] and residency [New York City (NYC) resident vs. non-NYC resident] associated with depression. Our sample includes 568 participants: 260 (45.77%) were NYC residents and 308 (54.3%) were non-NYC residents. A series of multiple linear regression were run to examine the relationship between race/ethnicity, COVID-19 stigma, and depressive symptoms. Irrespective of residency, older age and ever being diagnosed with COVID-19 were negatively associated with depressive symptoms. Stigma and thinking less of oneself significantly associates with depressive symptoms across residency. Our study expects to benefit mental health care providers and public health professionals in designing best practices to mitigate stigma in ongoing or future pandemics.