Background: Opioid use disorder (OUD) is often under-addressed in hospitalized patients. In the absence of formal addiction consult services, volunteer physician-led models can increase access to inpatient OUD treatment. This paper describes a novel, volunteer physician-led interprofessional approach to identifying patients with OUD, initiating buprenorphine, and linking to office-based opioid treatment. Methods: The intervention took place from April 2018 to August 2020 at a large, urban, tertiary care center and teaching hospital in New York, NY that does not have an addiction consult service. Hospitalized patients with OUD were identified by provider-driven referrals or an automated daily patient list generated by a bioinformatics search algorithm. Eligible patients with OUD were started on buprenorphine during their hospitalization and linked to primary care-based buprenorphine treatment. Patients were followed longitudinally via chart review to assess follow-up clinic rates at >30 days, >60 days, >90 days, >6 months, >12 months, and >24 months after discharge. Results: Over a 2-year period, 178 patients were evaluated, 88 were eligible for inpatient buprenorphine, and 47 were started on buprenorphine while hospitalized. Sixty-seven patients were referred to a post-discharge visit at a primary care practice, 29 (43%) of whom attended an appointment at least 30 days after discharge. Of these, 22 (76%) returned at >60 days and 20 (69%) at 6 months. At the 1-year time point, 16 of a possible 17 patients (94%) and 15 of a possible 16 patients (94%) were still engaged in care at 2 years. Conclusion: This intervention represents a proof of principle, adaptable model for identifying patients with OUD and engaging patients in primary care-based buprenorphine treatment. Limitations to consider include the sustainability of a volunteer-based initiative and that retention rates for 1 to 2 years post-discharge may be more indicative of the strengths of office-based opioid treatment itself as opposed to in-hospital engagement and the intervention.

BACKGROUND:Self-reported health (SRH) is an important indicator of mental health outcomes. More information, however, is needed on whether this association varies by birthplace (defined as US-born or non-US-born) and citizenship status (i.e., non-US-born citizen, non-US citizen, and US-born citizen). METHODS:We examined the associations between SRH and depression among non-US-born US citizens, non-US citizens, and US-born citizens aged 18 years and older using weighted cross-sectional data from the 2010-2018 National Health Interview Survey (n = 139,884). Logistic regression models were used to assess the association between depression and SRH by citizenship status, adjusting for covariates. RESULTS:US-born citizens reported the highest prevalence of depression (40.3 %), and non-US-born citizens reported the highest prevalence of poor/fair SRH (14.5 %). Individuals with fair/poor SRH had a significantly increased likelihood of depression relative to those with good/very good/excellent for non-US-born US citizens (Adjusted Odds Ratio [AOR] = 2.42, 95 % Confidence Interval [95 % CI] = 2.04-2.88), non-US citizens (AOR = 2.80, 95 % CI = 2.31-3.40), and US-born citizens (AOR = 2.31, CI = 2.18-2.45). LIMITATIONS:The study is cross-sectional, reducing the strength of determining causal relationships. Also, there is a possible response bias due to the self-reported nature of the data. CONCLUSIONS:Our study indicates that fair/poor SRH is significantly associated with an increased likelihood of depression regardless of an individual citizenship status. Additionally, immigrants with fair/poor SRH had higher increased odds of depression. Therefore, mental healthcare interventions tailored for immigrants can reduce mental health problems and disparities among immigrants.

Abstract Background Strict social distancing public health measures to decrease COVID-19 spread increased social distancing stress. However, differences in social distancing stress by anxiety/depression symptoms are understudied, especially based on COVID-19 diagnosis status, gender identity, and immigration status. We examined whether the association between social distancing stress and anxiety/depression symptoms was moderated by COVID-19 diagnosis status, gender identity, and immigration status. We further examined the associations of social distancing stress with anxiety/depression symptoms, gender identity, and immigration status among individuals with and without COVID-19. Methods We utilized data from a national cross-sectional survey among adults aged ≥ 18 years in the United States between May 13, 2021, and January 9, 2022 (n = 5,255). Multivariable logistic regression models were used to examine the associations. Results The prevalence of social distancing stress was higher among individuals with COVID-19 (79.23%) than among those without COVID-19 (67.51%). We observed significant associations between social distancing stress and anxiety/depression symptoms, moderated by COVID-19 diagnosis status, immigration status, and gender identity, respectively. Anxiety/depression symptoms were associated with social distancing stress among both individuals with and without COVID-19. Gender identity and immigration status were associated with social distancing stress among only individuals without COVID-19. Conclusions Our findings revealed that the association between social distancing stress and anxiety/depression varied by COVID-19 diagnosis status, gender identity, and immigration status. The findings underscore the need for more targeted psychological distress strategies to reduce social distancing stress and anxiety/depression among diverse US populations, while considering the impacts of COVID-19 diagnosis status, gender identity, and immigration status.

Knowledge of Mexican immigrant sleep health is limited. We investigated the association between acculturation, depression, and having trouble sleeping among a nationally representative sample of Mexican immigrant adults. We used a logistic regression model on cross-sectional data from the 2005-2018 National Health and Nutrition Examination Survey on 2,670 non-U.S.-born Mexican adults aged ≥18 years old. Living in the U.S. for ≥10 years (Adjusted Odds Ratio (AOR) = 2.18; 95% Confidence Interval (CI) = 1.39-3.41), speaking majority English (AOR = 1.62; 95% CI = 1.00-2.64), and mild (AOR = 2.70; 95% CI = 1.82-4.02), moderate (AOR = 3.96; 95% CI = 2.53-6.19), and moderately severe/severe (AOR = 5.75; 95% CI = 3.08-10.75) depression levels were associated with having trouble sleeping. Non-U.S. citizenship status was associated with lower odds of having trouble sleeping (AOR = 0.62; 95% CI = 0.43-0.88). Greater acculturation and depression are associated with higher odds of having trouble sleeping. We provide new knowledge on how citizenship status may be linked to the sleep health of Mexican immigrant communities.

ImportanceAdolescent suicide in the US is a major public health problem, yet temporal trends in suicide methods by demographics are understudied.ObjectiveTo examine national trends in suicide mortality by method (firearm, poisoning, hanging and asphyxiation, and all other means) from 1999 to 2020 by demographic characteristics.Design, Setting, and ParticipantsThis serial cross-sectional study used national death certificate data of adolescent (aged 10-19 years) suicide decedents compiled by the National Center for Health Statistics from January 1, 1999, to December 31, 2020. Data analysis was performed from April 1, 2023, to July 9, 2023.ExposuresAge, sex, and race and ethnicity.Main Outcomes and MeasuresTrends in age-standardized mortality rates and average annual percent change (AAPC) in rates were estimated by age, sex, and race and ethnicity for each suicide method.ResultsThis study assessed data from 47 217 adolescent suicide decedents. From 1999 to 2020, suicide by firearm (AAPC, 1.0; 95% CI, 0.1-1.9), poisoning (AAPC, 2.7; 95% CI, 1.0-4.4), hanging and asphyxiation (AAPC, 2.4; 95% CI, 0.2-4.6), and other means (AAPC, 2.9; 95% CI, 1.2-4.6) increased. Rapidly increasing rates were observed among female adolescents for poisoning (AAPC, 4.5; 95% CI, 2.3-6.7) and hanging and asphyxiation (AAPC, 5.9; 95% CI, 5.0-6.8) suicides. From 2007 to 2020, firearm suicides sharply increased among female (annual percent change [APC], 7.8; 95% CI, 6.0-9.5) and male (APC, 5.3; 95% CI, 4.3-6.3) adolescents. Firearm suicide rates increased among Black adolescents from 2012 to 2020 (APC, 14.5; 95% CI, 9.7-19.5), Asian and Pacific Islander adolescents from 2008 to 2020 (APC, 12.0; 95% CI, 9.7-14.5), American Indian and Alaska Native adolescents from 2014 to 2020 (APC, 10.6; 95% CI, 2.6-19.3), and Hispanic or Latino adolescents from 2011 to 2020 (APC, 10.2; 95% CI, 6.3-13.8). During the study period, Black adolescents had the highest average increase in hanging and asphyxiation suicides (AAPC, 4.2; 95% CI, 3.2-5.2). From 2011 to 2020, poisoning suicide deaths increased (APC, 12.6; 95% CI, 8.5-16.7) among female adolescents.Conclusions and RelevanceSuicide rates increased across all methods from 1999 to 2020. Differences were noted by sex, age, and race and ethnicity. Increasing suicide rates among racial and ethnic minoritized youth are especially concerning, and effective prevention strategies are urgently needed.

Although moderate intensity physical activity (MIPA) improves general mental health, morbidity, and mortality, the COVID-19 pandemic may have adversely impacted individuals' ability to engage in MIPA. We examined the extent of socioeconomic factors, body mass index, anxiety/depression, and cancer diagnosis associated with MIPA before and during the COVID-19 pandemic. Multivariable logistic regression models were conducted on 4,551 U.S. adults aged 18-64 years using nationally representative samples from the 2019 and 2020 Health Information National Trends Survey datasets. The prevalence of MIPA before the pandemic was higher (77.07%) than during the pandemic (76.21%). Before the COVID-19 pandemic, lower odds of MIPA were observed for individuals with fair/ poor health (OR= 0.24, 95% CI= 0.27, 0.63), obesity (OR= 0.51, 95% CI= 0.33, 0.79), anxiety/depression (OR= 0.60, 95% CI= 0.42, 0.85), or a cancer diagnosis (OR= 0.56, 95% CI= 0.32, 0.98). During the pandemic, lower odds were observed among those with obesity (OR= 0.44, 95% CI= 0.28, 0.70), anxiety/depression (OR= 0.61, 95% CI= 0.43, 0.86), less than high school education (OR= 0.33, 95% CI= 0.16, 0.70), or family income of $20,000 - $34,999 (OR= 0.42, 95% CI= 0.24, 0.74). There was a decline in MIPA during the pandemic, with certain subgroups, such as individuals of lower socioeconomic and physical and mental health status, less likely to engage in MIPA. This study highlights the need for concerted physical activity educational strategies aimed at improving access to and utilization of MIPA within subgroups to reduce MIPA disparities, particularly among disadvantaged groups during pandemics.

Purpose: Alternative high schools (AHS) are designed to provide individualized education, more flexible scheduling, and smaller class sizes for students referred out of traditional high school. AHS students report higher levels of substance use (SU) and face disproportionately higher levels of trauma and toxic stress than their traditional high school peers. We sought to examine whether generational immigration (GenIm) status modifies the association of mental health and SU among AHS students using a longitudinal study of 1,060 Southern California AHS students. Methods: Subscales from the 21-item Depression Anxiety Stress Scale were administered. Effect modification was examined by GenIm status defined as first generation (born outside of the United States), second generation (born in the United States with a parent born outside the United States), or third generation (born in the United States with US-born parent(s)). Main outcomes included the number of times different substances were used in the past year over a 3-year period. Results: Multilevel, negative binomial, covariate-adjusted latent growth curve models generated incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of the time-varying association between depression, anxiety, or stress and the use of cigarettes, e-cigarettes, cigars, alcohol, or marijuana. Multiple-group models examined effect modification by GenIm status. Discussion: The link between mental health and SU was stronger among first- and second- generation students than third-generation students. For example, a one-unit increase in stress relative to the average stress of students from the same school was associated with an increase in the rate of e-cigarette use among first-generation (IRR = 2.03, 95% CI = 1.07-3.85), second-generation (IRR = 2.25, 95% CI = 1.86-2.72), and third-generation (IRR = 1.68, 95% CI = 1.31-2.16) students. Effective strategies tailored to subgroups of AHS students are needed to counter disparities between traditional and alternative school systems that may contribute to long-term trajectories of SU. Published by Elsevier Inc. on behalf of Society for Adolescent Health and Medicine.

BackgroundDiscrimination and xenophobia toward Hispanic and Latino communities increased during the COVID-19 pandemic, likely inflicting significant harm on the mental health of Hispanic and Latino individuals. Pandemic-related financial and social instability has disproportionately affected Hispanic and Latino communities, potentially compounding existing disparities and worsening mental health. ObjectiveThis study aims to examine the association between discrimination and depressive symptoms during the COVID-19 pandemic among a national sample of Hispanic and Latino adults. MethodsData from a 116-item web-based nationally distributed survey from May 2021 to January 2022 were analyzed. The sample (N=1181) was restricted to Hispanic or Latino (Mexican or Mexican American, Puerto Rican; Cuban or Cuban American, Central or South American, and Dominican or another Hispanic or Latino ethnicity) adults. Depression symptoms were assessed using the 2-item Patient Health Questionnaire. Discrimination was assessed using the 5-item Everyday Discrimination Scale. A multinomial logistic regression with a block entry model was used to assess the relationship between discrimination and the likelihood of depressive symptoms, as well as examine how controls and covariates affected the relationship of interest. ResultsMexican or Mexican American adults comprised the largest proportion of the sample (533/1181, 45.13%), followed by Central or South American (204/1181, 17.3%), Puerto Rican (189/1181, 16%), Dominican or another Hispanic or Latino ethnicity (172/1181, 14.6%), and Cuban or Cuban American (83/1181, 7.03%). Approximately 31.26% (367/1181) of the sample had depressive symptoms. Regarding discrimination, 54.56% (634/1181) reported experiencing some form of discrimination. Compared with those who did not experience discrimination, those who experienced discrimination had almost 230% higher odds of depressive symptoms (adjusted odds ratio [AOR] 3.31, 95% CI 2.42-4.54). Also, we observed that sociodemographic factors such as age and gender were significant. Compared with participants aged 56 years and older, participants aged 18-35 years and those aged 36-55 years had increased odds of having depressive symptoms (AOR 3.83, 95% CI 2.13-6.90 and AOR 3.10, 95% CI 1.74-5.51, respectively). Women had higher odds of having depressive symptoms (AOR 1.67, 95% CI 1.23-2.30) than men. Respondents with an annual income of less than US $25,000 (AOR 2.14, 95% CI 1.34-3.41) and US $25,000 to less than US $35,000 (AOR 1.89, 95% CI 1.17-3.06) had higher odds of depressive symptoms than those with an annual income of US $50,000 to less than US $75,000. ConclusionsOur findings provide significant importance especially when considering the compounding, numerous socioeconomic challenges stemming from the pandemic that disproportionately impact the Hispanic and Latino communities. These challenges include rising xenophobia and tensions against immigrants, inadequate access to mental health resources for Hispanic and Latino individuals, and existing hesitations toward seeking mental health services among this population. Ultimately, these findings can serve as a foundation for promoting health equity.

In the United States, Asian and Pacific Islander (A/PI) communities have faced significant discrimination and stigma during the COVID-19 pandemic. We assessed the association between discrimination and depression, anxiety, and loneliness symptoms among Asian or Pacific Islander adults (n = 543) using data from a 116-item nationally distributed online survey of adults (≥ 18 years old) in the United States conducted between 5/2021–1/2022. Discrimination was assessed using the 5-item Everyday Discrimination Scale. Anxiety, depression, and loneliness symptoms were assessed using the 2-item Generalized Anxiety Disorder, 2-item Patient Health Questionnaire, and UCLA Loneliness Scale—Short form, respectively. We used multivariable logistic regression to estimate the association between discrimination and mental health. Overall, 42.7% of participants reported experiencing discrimination once a month or more. Compared with no discrimination, experiencing discrimination once a month was associated with increased odds of anxiety (Adjusted Odds Ratio [aOR] = 2.60, 95% CI = 1.38–4.77), depression (aOR = 2.58, 95% CI = 1.46–4.56), and loneliness (aOR = 2.86, 95% CI = 1.75–4.67). Experiencing discrimination once a week or more was associated with even higher odds of anxiety (aOR = 6.90, 95% CI = 3.71–12.83), depression, (aOR = 6.96, 95% CI = 3.80–12.74), and loneliness (aOR = 6.91, 95% CI = 3.38–13.00). Discrimination is detrimental to mental health, even at relatively low frequencies; however, more frequent discrimination was associated with worse mental health symptoms. Public health interventions and programs targeting anti-A/PI hate and reducing A/PI mental health burden are urgently needed.

Purpose: To examine alcohol use (AU) among intersectional subgroups within a longitudinal cohort of predominantly Hispanic/Latino alternative high school (AHS) students in southern California. Methods: Past month AU was measured over a period of three years among 1,029 students (mean age 17.5 years, 49.7% female, 76.1% Hispanic/Latino) from 29 AHSs. Multilevel models that adjusted for age, socioeconomic status, parental education, weekly income, sensation seeking, depression, anxiety, and stress estimated trends in AU over time among intersectional subgroups de fined by gender, ethnicity, and generational immigration. Results: Students with parents born in the United States had high rates of AU at the baseline that remained stable over time. In contrast, first-generation Hispanic/Latino students had lower levels of AU at the baseline that increased over time. First-generation, female, Hispanic/Latino students exhibited one of the lowest probabilities of AU at the baseline (28.6%, confidence interval [CI]: 15.9%-41.3%) but at the two-year follow-up had one of the highest probabilities (47.4%, CI: 29.3%-65.5%). A similar trend was observed among first-generation, male, Hispanic/Latino students whose probability of past month AU rose between the baseline (23.1%, CI: 12.4%-33.8%) and twoyear follow-up (36.0%, CI: 19.2%-52.7%). Discussion: Findings underscore the heterogeneity of AHS students, showing a more nuanced picture of AU by the intersection of gender, ethnicity, and generational immigration. Underage AU prevention efforts among AHS students must provide targeted messages to intersectional identities. (c) 2024 Published by Elsevier Inc. on behalf of Society for Adolescent Health and Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/ 4.0/).

Health EquityVol. 7, No. 1 EditorialOpen AccessCreative Commons licenseThe COVID-19 Pandemic and Hispanic/Latina/o Immigrant Mental Health: Why More Needs to Be DoneCameron K. Ormiston, Jolyna Chiangong, and Faustine WilliamsCameron K. Ormiston*Address correspondence to: Cameron K. Ormiston, BS, Division of Intramural Research, National Institute on Minority Health and Health Disparities, Two White Flint North, 11545 Rockville Pike, Rockville, MD 20852, USA. E-mail Address: [email protected]https://orcid.org/0000-0002-3598-616XDivision of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA.†These authors contributed equally to this study.Search for more papers by this author, Jolyna ChiangongDivision of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA.†These authors contributed equally to this study.Search for more papers by this author, and Faustine WilliamsDivision of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA.Search for more papers by this authorPublished Online:9 Jan 2023https://doi.org/10.1089/heq.2022.0041AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail The United States (U.S.) Hispanic/Latina/o population comprises individuals of Cuban, Mexican, Puerto Rican, South American, Central American, and/or other Spanish culture or origin, regardless of race, and those of Latin American descent.1,2 Hispanic refers to individuals who are from or have ancestral origins from a Spanish-speaking country, whereas Latina/o is a pan-ethnic term that refers to individuals from >20 countries.3 Recently, Latinx has been used by popular culture and researchers to be more gender expansive, neutral, and inclusive, however, only 2–4% of Hispanics/Latinos report using the term.4For the purposes of this editorial and based on recommendations from existing literature, we will use Hispanic/Latina/o and Latinx interchangeably according to what is used in the cited article and to be inclusive of all genders.3,4 As of 2021, 62.1 million Hispanics/Latinos reside in the U.S., and roughly a third of them were born in another country.5 People of Mexican origin make up a majority of the Hispanic/Latina/o population (59.5%), with Puerto Rican (9.3%), Salvadorean (4.0%), Cuban (3.8%), and Dominican (3.8%) being the next largest heritage groups.5The median household income of Hispanics is $49,010, and an estimated 19% of Hispanics live in poverty, 59% have a high school degree or less, and 47% are homeowners. These numbers vary greatly by heritage group, underlining the heterogeneity of the U.S. Hispanic/Latina/o population.3 In addition, health disparities persist compared with non-Hispanic whites with Hispanics having higher rates of poverty, liver disease mortality, and uninsured individuals as well as being disproportionately affected by obesity and diabetes.6The COVID-19 pandemic has especially laid bare the health inequities affecting Hispanic/Latina/o immigrants, with recent reports indicating Hispanics have the highest age-adjusted infection rates than all other racial/ethnic groups, and COVID-19 cases are higher in areas with a larger proportion of Hispanics, undocumented individuals, and immigrants.7,8 Furthermore, Hispanics are at the highest risk for SARS-CoV-2 infection, hospitalization, and mortality.7 Hispanic/Latina/o immigrants are also more likely to have low-paying jobs and live in lower income neighborhoods and overcrowded housing,7,9 which increase the risk for COVID-19 transmission.Hispanic immigrants—particularly noncitizens—face numerous structural and health inequities that can increase COVID-19 vulnerability, such as diminished health care access due to citizenship status, fear of deportation, stigma, and exclusion from social program eligibility.7,10,11 These structural barriers coupled with heightened risk for COVID-19 exposure may increase risk of mental health symptoms and adverse mental health outcomes for Hispanic/Latina/o immigrants.7,12,13 More evidence, however, is needed on Hispanic/Latina/o immigrant mental health in the U.S. in relation to the effects of the COVID-19 pandemic.12,14The pandemic's negative effects on mental health among the general U.S. population have been well documented, with psychological distress prevalence being significantly higher than prepandemic levels.15,16 Moreover, immigrant populations experience socioeconomic and structural vulnerabilities that can negatively impact mental health.17 Indeed, Hispanics were disproportionally affected by the pandemic-induced recession in the spring of 2020, in part reflecting their over-representation in some of the hardest hit sectors of the economy.18According to the U.S. Bureau of Labor Statistics, in 2020, the unemployment rate for Hispanics was 10.4%, as compared with 7.5% for non-Hispanic whites.19 In addition, among full-time year-round workers in 2020, the average Hispanic/Latina/o median household income was $55,321 in comparison with $74,912 for non-Hispanic white households, which showcase an alarming socioeconomic disparity.19 Therefore, understanding that Hispanic immigrant populations face unique vulnerabilities, there is potential that they may experience a high burden of COVID-19-related adverse mental health outcomes.12The Social Determinants of Health (SDH) provide a framework that can be utilized to categorize and explain the disparities in mental health outcomes experienced in the Hispanic/Latina/o community during the COVID-19 pandemic. Indeed, the link between mental health outcomes and SDH is well documented among Hispanic/Latina/o immigrants.20–22 The U.S. Department of Health and Human Services defines SDH as the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.23These determinants can be further grouped into five domains: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context.23 For this editorial, we have chosen to focus on the domains of economic stability, neighborhood and built environment, and health care access and quality as we conceptualize and delve into the adverse mental health experiences of Hispanic/Latina/o immigrants during the COVID-19 pandemic.Economic StabilityEconomic instability, financial stress, and worry are associated with psychological distress.24–26 Notably, Hispanic immigrants are more likely to be frontline, low-wage, and uninsured workers,7,10,11 which provides additional financial mental health stressors during the COVID-19 pandemic. Furthermore, there is evidence of a pandemic-related economic downturn disproportionately affecting Hispanic immigrants, especially noncitizen immigrants.10,12 For example, Hispanic immigrant families with at least one noncitizen have experienced higher rates of job loss, difficulties in paying bills, and food insecurity due to the pandemic.10Social insecurity and economic and employment difficulties have been previously identified as risk factors for psychological distress among immigrant communities.12 The inequitable impact of these economic fallouts likely places Hispanic immigrants at risk for negative mental health consequences. For instance, Serafini et al12 reported a significant association between days being unable to work and psychological distress among undocumented Hispanic immigrants during the pandemic (March 2020).As previously mentioned, Hispanic immigrants are more likely to be essential workers and are less likely to have occupations that allow for virtual at-home employment, increasing the risk of infection and subsequently disease anxiety.7,10,11 For example, Hispanic immigrants disproportionately make up the agricultural, meatpacking, and service-based industries, where numerous COVID-19 outbreaks have been reported and in-person contact risk is higher.7,10,11A study of Mexican immigrants living in Los Angeles and New York City found participants working as essential workers felt compelled to continue working out of fear of losing their job, even if a family member at home was COVID-19 positive.7 These situations may contribute to inequitable burden of adverse mental health among Hispanics/Latinos. In July 2020, the rate of U.S. adults seriously considering suicide was highest among Latinx and essential workers.13Neighborhood and Built EnvironmentThe physical environment is widely acknowledged to be a determinant of health, and factors such as crowded living and poor housing quality have been noted to negatively impact mental health.27 Hispanic immigrants are more likely to live in overcrowded and/or intergenerational households compared with other racial/ethnic groups.7 This makes quarantining, social distancing, or self isolating from other members difficult and may increase COVID-19 transmission risk, especially if there is an essential worker or positive case in the household.7 These living situations may in turn increase disease anxiety.7,9In addition, COVID-19 containment measures, although important, may be detrimental to Hispanic/Latina/o immigrant mental health. For instance, stay-at-home orders and travel bans may have isolated immigrants from their support systems in their local community and host country, which could exacerbate mental health issues.Health Care Access and QualityAccording to Serafini et al's12 March 2020 study of Hispanic immigrant outpatients in New York City, 50% reported worsened depression/anxiety symptoms during the pandemic compared with prepandemic symptoms. Furthermore, they found 60% of patients had serious mental illness.12 A national sample of U.S. adults also found Hispanic participants were significantly more likely to report not only fears and worries about COVID-19 than non-Hispanics, but also anxiety and depressive symptoms than whites.15Unfortunately, initial reports from August 2020 to February 2021 indicated Hispanics/Latinos have a significantly higher unmet need for mental health services during the pandemic than other racial/ethnic groups.14 They also face an inadequate number of mental health providers and services, especially with heightened demands during the pandemic, transition to telehealth, and barriers to care for individuals with limited or no internet access.7,9,14 These issues are not new, however, as insufficient and inaccessible mental health services for immigrants existed before the pandemic due to poor infrastructure for affordable and linguistically accessible and culturally competent services.7,9,14,28Moreover, care access issues during the pandemic may be further compounded by the already low mental health utilization by Hispanic/Latina/o immigrants before the pandemic due to inadequate awareness of services and how to access them, sociocultural factors, stigma, financial constraints (i.e., lack of insurance), immigration status, discrimination, and language barriers.7,9In addition, both undocumented and documented Hispanic immigrants have reported fears of immigration authorities that is heightened by threat of surveillance, policing, or deportation.7,29 They have also reported fear of acquiring a public charge through the Public Charge Rule (e.g., rule that imposes sanctions: revocation or denial of visas, precluding the right to sponsor a family member for immigration, or even deportation, for lawful permanent residents who are eligible for or have utilized social programs in the past).7,9,11,13,30Although the Public Charge Rule was overturned in March 2021, many immigrants are either unaware or residual fear still remains.9 Concerns about law enforcement and public charge have increased distress, mistrust in health systems, and reluctance toward accessing health services both before and during the pandemic.7,9,11,13,30 Owing to this mistrust and legal fears, Hispanic/Latina/o immigrants may not feel safe to reach out to mental health care providers, making them less likely to seek care and more likely to delay care, which in turn may worsen their mental health.9SolutionsA solution with roots in public health and medicine is warranted to formulate practitioner, research, and policy recommendations.Practitioner recommendationsPractitioners should continue to provide both telehealth and, when possible, in-person mental health services or a combination of the two services for patients. A study on undocumented Hispanic immigrants in New York City found >90% of participants agreed that the availability of remote psychiatry sessions helped manage their mental health.12 In addition, language services should always be available as the lack of language-concordant providers has been cited as a barrier to mental health care access.9 Although telehealth has shown potential in ameliorating barriers to mental health care utilization,12 practitioners should be wary of the digital divide and adapt to the needs of each patient.For instance, Hispanic immigrants may be vulnerable to resource scarcity and may lack access and/or feel comfortable or safe utilizing virtual care services given concerns of confidentiality, cultural competency, language concordance, internet access, and lack of interpersonal connection with providers.7,12 Given many of these issues can be resolved through providing in-person care, it is suggested that telehealth should be provided on a case-by-case basis.12In addition, practitioners must be educated on culturally humble, evidence-informed methods of care that recognize the unique heterogeneous experiences of Hispanic/Latina/o immigrants. In fact, culturally humble care may attenuate the adverse effects of negative provider encounters and can improve trust and patient satisfaction among Latinos.31,32 Moreover, Garcini et al's13 community-based study of community health workers (CHWs) found emphasizing family, religious, and social support through peer groups, as well as culturally relevant cognitive approaches (i.e., collectivist thinking) were effective ways to limit distress during the pandemic among Latino immigrants along the U.S.–Mexico border.Also, consideration and integration of Latino cultural values such as respeto (mutual and reciprocal respect), controlarse (self-control of negative affect), aguantarse (ability to survive stressful situations during hard times), familismo (importance of family), personalismo (personal relationships), confianza (relationship trust), fatalismo (fatalism), dichos (popular sayings), and sobreponerse (self-suppression) into care plans and therapeutic alliances can also assist in creating more culturally informed mental health care plans.33,34 Importantly, clinicians must be educated in immigrant-specific processes, such as acculturation.Having CHWs and Promotor/as (Latino community members trained to provide health education and resources to the local community) be actively involved in public health interventions may also be effective.13 For instance, the relatability and comfortability of community members within health care settings can assist in wearing down barriers between Hispanic/Latina/o patients and health care providers by providing culturally adapted and relevant education and strengthening trust.35 Previous research has highlighted the positive impacts CHWs can have on both the physical and mental health of Hispanics/Latinos given their unique position in their respective communities.35,36 Bolstering community care centers with trained medical translators and interpreters is also essential.9,12,13Research recommendationsOur understanding of health inequities and disparities is often based on how data are interpreted and disseminated. Research and data collection, therefore, must be improved to better capture the diverse situations and needs of Hispanic/Latina/o immigrants. For example, the Hispanic/Latina/o immigrant population is often analyzed as an aggregated group,9 which obscures several differences across heritage groups, region of residence, intersectional identity, as well as immigration and generational status. Through disaggregated data collection, interventions can be more culturally specific and tailored to the specific needs of the local immigrant community.Moreover, national data sets and cross-sectional surveys are often not culturally adapted to diverse communities, particularly with the health assessments and questionnaires used in national surveys in addition to conceptualizations and interpretations of findings. Data collected among these communities subsequently may not reflect the actual lived mental health experiences.37 Thus, qualitative and longitudinal studies that utilize primary data are warranted. There is also a need for ongoing research to address the long-term effects of the pandemic on Hispanic/Latina/o mental health. Ultimately, research and data should be used to directly benefit the study population—Hispanic/Latina/o immigrants—by informing policy and public health interventions to mitigate the structural and systemic barriers to mental well-being.Policy recommendationsThe COVID-19 pandemic has particularly exacerbated the unmet needs and social insecurity of undocumented Hispanics, with >50% reporting difficulty paying for their rent, food, and utilities.12 Alarmingly, these numbers may continue to increase given the long-term effect of the pandemic on health and well-being, and most especially since some immigrants were not eligible for stimulus packages despite being essential contributors to the U.S. economy.9,12,38 Living in mixed-status households (households with individuals of variable immigration status) may also cause delays in accessing or/forgoing mental health services due to fear of bringing attention to undocumented members of the household.9Breaking down structural barriers by (1) including undocumented individuals in government stimulus packages, (2) providing greater free and/or affordable mental health resources to immigrant populations, and (3) creating an environment where immigrants have equitable access to health care without fear of immigration authorities or repercussions is paramount.Wide-scale mental health screening should be initiated especially within Hispanic/Latina/o immigrant communities with limited access to services and/or resources. However, these initiatives require public and private funding for the necessary workforce and support of social workers, psychiatrists, and other trained mental health care providers. Furthermore, investment should also be put into CHWs to help educate Hispanic/Latina/o immigrants on current mental health resources, how to access them, and engage in dialogue to dispel fears regarding the use of mental health resources, seeing that this has served as a barrier.ConclusionIn summary, researchers, policymakers, and practitioners should directly engage with stakeholders and members of all Hispanic/Latina/o immigrant heritage groups, generational status, and intersectional identity.9 By doing so, we can work toward preventing the harmful long-lasting impacts of the COVID-19 pandemic on the mental health and well-being of the fastest growing immigrant subpopulations in the United States.Authors' ContributionsC.K.O. contributed to conceptualization, investigation, writing–original draft, writing–review and editing, visualization, and project administration. J.C. carried out investigation and writing–review and editing. F.W. was involved in supervision, writing-review and editing, funding acquisition, and project administration.DisclaimerThe content is solely the responsibility of the authors and does not necessarily reflect the views of the National Institutes of Health.Author Disclosure StatementWe declare no competing interests.Funding InformationC.K.O., J.C., and F.W. efforts were supported by the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health (Grant No. ZIA MD000015).References1. Aragones A, Hayes SL, Chen MH, et al. Characterization of the Hispanic or latino population in health research: A systematic review. J Immigr Minor Health 2014;16(3):429–439. Crossref, Medline, Google Scholar2. Martínez DE, Gonzalez KE. "Latino" or "Hispanic"? The Sociodemographic Correlates of Panethnic Label Preferences among U.S. Latinos/Hispanics. Sociol Perspect 2021;64(3):365–386. Crossref, Google Scholar3. 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Crossref, Google ScholarCite this article as: Ormiston CK, Chiangong J, Williams F (2023) The COVID-19 pandemic and Hispanic/Latina/o immigrant mental health: why more needs to be done, Health Equity 7:1, 3–8, DOI: 10.1089/heq.2022.0041.Abbreviations UsedCHWscommunity health workersSDHSocial Determinants of HealthFiguresReferencesRelatedDetails Volume 7Issue 1Sep 2023 Information© Cameron K. Ormiston et al., 2023; Published by Mary Ann Liebert, Inc.To cite this article:Cameron K. Ormiston, Jolyna Chiangong, and Faustine Williams.The COVID-19 Pandemic and Hispanic/Latina/o Immigrant Mental Health: Why More Needs to Be Done.Health Equity.Sep 2023.3-8.http://doi.org/10.1089/heq.2022.0041creative commons licensePublished in Volume: 7 Issue 1: January 9, 2023Open accessThis Open Access article is distributed under the terms of the Creative Commons License [CC-BY] ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.PDF download

Abstract Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth bear a disproportionate burden of mental health difficulties during the COVID-19 pandemic relative to non-LGBTQ youth due to systemic disadvantages and barriers that LGBTQ youth uniquely face. Efforts in the US to minimize the pandemic’s impact are inadequate or impeded by a growing wave of anti-LGBTQ sentiment and legislation. As such, public health and policy play a crucial role in implementing necessary systemic change.

Introduction The COVID-19 pandemic has had drastic effects on worldwide mental health and laid bare health disparities and inequities among marginalised groups and racial/ethnic minoritised communities in the USA. This is especially the case among Hispanic/Latino/a immigrants who face numerous structural and socioeconomic barriers to well-being. The increased mental health burden on Hispanic/Latino/a immigrants may have far reaching effects if left unaddressed. Thus, by understanding further Hispanic/Latino/a immigrant mental health during the pandemic, communities and health providers may be able to better address this growing issue. This scoping review aims to assess and outline the current literature on the pandemic’s effects on Hispanic/Latino/a immigrant mental health in the USA, identify research gaps and areas of urgent concern, and inform future research and public health interventions and guidelines.Methods and analysis A scoping review following the Joanna Briggs Institute methodology will be conducted. The PsycINFO, PubMed, Scopus and Web of Science: Core Collection databases and five grey literature sources will be searched for articles published in English from 1 January 2020 to 31 December 2022. Two independent reviewers will screen the search results at title and abstract and then full text using Covidence with conflicts resolved by a third reviewer. Data collection will also be performed in duplicate using Microsoft Excel with discrepancies resolved by a third reviewer and consensus discussion.Ethics and dissemination Ethics approval is not required for this scoping review. Results will be published in a peer-reviewed journal as well as presented at local and national conferences and meetings relevant to our field. Furthermore, to make our findings accessible to non-scientific audiences, we will use various mediums, such as graphical abstracts, policy briefs and fact sheets to share the results in both English and Spanish on different platforms.

There is limited evolving literature on COVID-19 vaccine uptake and its barriers among sexual minority populations (lesbian, gay, bisexual, transgender, and queer [LGBTQ]), despite their increased COVID-19 risk factors. We assessed the differences in intention to receive the COVID-19 vaccine by self-reported likelihood of contracting COVID-19, anxiety/depression, discrimination frequency, social distancing stress, and sociodemographic factors across sexual orientation. An online national cross-sectional survey was conducted in the United States between 13 May 2021, and 9 January 2022, among adults aged ≥18 (n = 5404). Sexual minority individuals had a lower intention of receiving the COVID-19 vaccine (65.62%) than heterosexual individuals (67.56%). Disaggregation by sexual orientation, however, showed that gay participants had a higher intention of COVID-19 vaccination (80.41%) and lesbian (62.63%), bisexual (64.08%), and non-heterosexual, non-LGB sexual minority (56.34%) respondents had lower intentions of receiving the COVID-19 vaccine than heterosexual respondents. Sexual orientation significantly moderated the association between the perceived likelihood of receiving the COVID-19 vaccine and the self-reported likelihood of contracting COVID-19, anxiety/depression symptoms, and discrimination. Our findings further underline the importance of improving vaccination efforts and access among sexual minority individuals and other vulnerable groups.

OBJECTIVE:To assess differences in the prevalence of anxiety/depression symptoms among cancer patients before (2019) and during the COVID-19 pandemic (2020); and the associations between anxiety/depression and sociodemographic and health behavior factors among cancer patients before and during the pandemic. METHODS:We analyzed data from the 2019 (n = 856) and 2020 (n = 626) Health Information National Trends Survey, a nationally representative survey of United States adults aged ≥18 years. Only adults with a cancer diagnosis were used in the analyses. Anxiety/depression was assessed using the Patient Health Questionnaire-4 (low/none [0-2], mild [3-5], moderate [6-8], and severe [9-12]) and dichotomized as low/none and current anxiety/depression (mild/moderate/severe). Multivariate analysis was performed. RESULTS:The prevalence of anxiety/depression symptoms among cancer patients was 32.7% before the COVID-19 pandemic and 31.1% during the pandemic. The odds of anxiety/depression among patients with fair/poor health status was higher during the pandemic relative to before (before: odds ratio [OR] = 1.85 vs. during: OR = 3.89). Participants aged 50-64 years (before: OR = 0.29, 95% confidence interval [95% CI] = 0.11-0.76; during: OR = 0.33, 95% CI = 0.11-0.97) and ≥65 years (before: OR = 0.13, 95% CI = 0.05-0.34; during: OR = 0.18, 95% CI = 0.07-0.47) had lower odds of anxiety/depression before and during the pandemic compared to those aged 35-49 years. Hispanics/Latinos had higher odds of anxiety/depression (OR = 2.70, 95% CI = 1.11-6.57) before the pandemic and lower odds of anxiety/depression during the pandemic (OR = 0.2, 95% CI = 0.05-1.01) compared to non-Hispanic Whites. Those who completed high school (before: OR = 0.08, 95% CI = 0.01-0.42), some college (before: OR = 0.10, 95% CI = 0.02-0.42), ≥college degree had lower odds of anxiety/depression symptoms (before: OR = 0.05, 95% CI = 0.01-0.26; during: OR = 0.06, 95% CI = 0.01-0.61) compared to those with less than a high school education. CONCLUSION:Our results suggest the need to increase the provision of mental health services to cancer patients at high risk of developing anxiety/depression symptoms, particularly during public health emergencies, to alleviate further health burdens.

Acculturation and depression are linked to poor sleep quality and sleep problems that may explain ongoing health disparities for Hispanics/Latinos. We examined the associations of acculturation, depression, and sleep duration among the Mexican American population. We used a multinomial logistic regression model on cross-sectional data from the 2005-2018 National Health and Nutrition Examination Survey on 4,700 Mexican American adults aged ≥18 years old. The outcome of sleep duration was operationalized as short (≤6 h), optimal (7-8 h), and long (≥9 h). Acculturation was constructed using years living in the U.S. and language(s) spoken at home (majority Spanish, English and Spanish equally, majority English). Depression severity was assessed using the 9-item Patient Health Questionnaire. Covariates included gender, age, marital status, income, and U.S. citizenship. Speaking majority English (Adjusted Odds Ratio (AOR) = 1.23; 95% Confidence Interval (CI) = 1.00-1.52) and mild (AOR = 1.63; 95%CI = 1.32-2.01), moderate (AOR = 1.94; 95%CI = 1.43-2.63), and moderately severe/severe (AOR = 2.58; 95%CI = 1.72-3.88) levels of depression were significantly associated with short sleep duration. Living in the U.S. for ≥10 years (AOR = 1.61; 95%CI = 1.17-2.23) and moderately severe/severe depression (AOR = 2.30; 95%CI = 1.34-3.93) were significantly associated with long sleep duration. Our results provide additional evidence of a link between acculturation, depression, and short and long sleep duration among the Mexican American population. Understanding the sleep health of this population is important for informing future public health interventions and research. Additional investigation into the relationship between acculturation/depression and other sleep health measures among this population is warranted.

This review highlights the key components of a heart-healthy diet and presents an evidence-based overview of recent research. Diets that increase plant-based food sources and healthy unsaturated fats consumption and limit foods that are processed and/or high in sodium, refined sugar, and saturated fat are recommended. Dietary modification can be supplemented with lifestyle-based therapies (eg, exercise, time-restricted eating) to maximize clinical benefit and achieve the "cardiometabolic jackpot." Physicians should take into account cultural preferences, affordability and accessibility of foods, and their patients' cultural values or expectations when recommending dietary interventions.

Background: Although several studies examined the association between e-cigarettes, substance use, and mental health conditions, there is limited research on whether COVID-19-related stress and health outcomes, mental health symptoms, and substance use differ by the frequency of e-cigarette use during the COVID-19 pandemic. We assessed the association of past 30-day frequent use of e-cigarettes with alcohol, cannabis, anxiety/depression, and COVID-19 impact. Methods: We conducted a national online cross-sectional survey among a random sample of US adults aged 18 years or older (N = 5065) between 13 May 2021, and 9 January 2022. A multinomial logistic regression analysis was performed to assess the study aims. Results: Of the participants, 7.17% reported once to several times per month (OSTPM), 6.95% reported once to several times per week (OSTPW), and 6.57% reported every day to several times per day (ESTPD) use of e-cigarettes in the past month. Alcohol and cannabis use ESTPD and once to several times per week/month (OSTPW/M) were associated with a higher likelihood of e-cigarette use ESTPD and OSTPW/M, respectively. Anxiety/depression was associated with e-cigarette use ESTPD and OSTPW. Individuals who considered social distancing to be stressful were more likely to use e-cigarettes ESTPD and OSTPW/M compared to those that considered social distancing as not stressful. Conclusion: Individuals who engaged in the frequent use of alcohol or cannabis, had depression/anxiety, and considered social distancing to be stressful were more likely to engage in frequent e-cigarette use. Improving efforts geared toward reducing the use of substances may help decrease the health risks associated with e-cigarette use.

Over a quarter of the workforce in industrialized countries does shift work, which increases the risk for car-diometabolic disease. Yet shift workers are often excluded from lifestyle intervention studies to reduce this risk. In a randomized control trial with 137 firefighters who work 24-h shifts (23-59 years old, 9% female), 12 weeks of 10-h time-restricted eating (TRE) was feasible, with TRE participants decreasing their eating win-dow (baseline, mean 14.13 h, 95% CI 13.78-14.47 h; intervention, 11.13 h, 95% CI 10.73-11.54 h, p = 3.29E-17) with no adverse effects, and improved quality of life assessed via SF-36 (ClinicalTrials.gov: NCT03533023). Compared to the standard of care (SOC) arm, TRE significantly decreased VLDL particle size. In participants with elevated cardiometabolic risks at baseline, there were significant reductions in TRE compared to SOC in glycated hemoglobin A1C and diastolic blood pressure. For individuals working a 24-h shift schedule, TRE is feasible and can improve cardiometabolic health, especially for individuals with increased risk.

Postural orthostatic tachycardia syndrome (POTS) is a complex multisystem disorder characterized by orthostatic intolerance and tachycardia and may be triggered by viral infection. Recent reports indicate that 2%–14% of coronavirus disease 2019 (COVID-19) survivors develop POTS and 9%–61% experience POTS-like symptoms, such as tachycardia, orthostatic intolerance, fatigue, and cognitive impairment within 6–8 months of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Pathophysiological mechanisms of post–COVID-19 POTS are not well understood. Current hypotheses include autoimmunity related to SARS-CoV-2 infection, autonomic dysfunction, direct toxic injury by SARS-CoV-2 to the autonomic nervous system, and invasion of the central nervous system by SARS-CoV-2. Practitioners should actively assess POTS in patients with post–acute COVID-19 syndrome symptoms. Given that the symptoms of post–COVID-19 POTS are predominantly chronic orthostatic tachycardia, lifestyle modifications in combination with the use of heart rate–lowering medications along with other pharmacotherapies should be considered. For example, ivabradine or β-blockers in combination with compression stockings and increasing salt and fluid intake has shown potential. Treatment teams should be multidisciplinary, including physicians of various specialties, nurses, psychologists, and physiotherapists. Additionally, more resources to adequately care for this patient population are urgently needed given the increased demand for autonomic specialists and clinics since the start of the COVID-19 pandemic. Considering our limited understanding of post–COVID-19 POTS, further research on topics such as its natural history, pathophysiological mechanisms, and ideal treatment is warranted. This review evaluates the current literature available on the associations between COVID-19 and POTS, possible mechanisms, patient assessment, treatments, and future directions to improving our understanding of post–COVID-19 POTS.