Background: Although physical activity (PA) offers substantial physical and psychosocial benefits, engagement remains suboptimal among cancer survivors. A theory-informed understanding of survivors' perceived barriers, facilitators, and recommendations is needed to inform patient-centered PA about survivorship interventions. Objective: This study aimed to explore perceived barriers, facilitators, and recommendations for PA engagement among adult cancer survivors using the Theoretical Domains Framework (TDF). Methods: A phenomenological qualitative design was used. Eighteen cancer survivors from Nebraska participated in semi-structured interviews via Zoom or telephone. Semi-structured interviews (guided by open-ended questions with flexibility for probing) were transcribed verbatim, imported into MAXQDA 2024, and analyzed using TDF to identify themes and subthemes. Results: Three overarching themes emerged: barriers, facilitators, and recommendations related to PA engagement. Barriers included individual factors (low motivation and self-efficacy, limited awareness of PA guidelines, time constraints, and physical limitations due to treatment and comorbidities), social factors (limited support from family, friends), clinical factors (limited PA guidance from healthcare providers), and environmental factors (restricted access to resources and unfavorable weather). Facilitators included individual factors (PA knowledge, motivation, goals, and health benefits), social factors (support from family, friends), and clinical factors (encouragement from healthcare providers), and environmental factors (favorable weather and available community PA resources). Recommendations emphasized the need for tailored education, supportive counseling, and structured PA programs within survivorship care. Conclusions: Cancer survivors described multilevel determinants of PA engagement across individual, social, and environmental contexts. Findings highlight the importance of theory-informed, patient-centered strategies that enhance PA guideline awareness, strengthen social and clinical support, and improve access to community resources to promote sustained PA during cancer survivorship.

Abstract Introduction Community Health Workers (CHWs) play a critical role in addressing health inequities and improving access to essential health services. However, their perspectives are often underrepresented in research examining their roles, challenges, and experiences within healthcare systems and communities. Objective This study explored CHWs’ perspectives on perceived barriers and facilitators influencing healthcare service delivery and identified recommendations to strengthen workplace supports and broader CHW workforce development. Methods A qualitative phenomenological approach was used. A purposive sample of 65 CHWs participated in nine focus groups conducted across five health agencies in Nebraska. Data were transcribed verbatim and analyzed using thematic analysis. Results Three major themes emerged: barriers to CHW healthcare service delivery, facilitators of health promotion, and recommendations for strengthening the CHW workforce. Community-level barriers included undocumented immigration status, cultural and gender norms, language barriers, transportation challenges, financial constraints, and limited access to affordable insurance. Structural and workplace barriers included limited awareness of community resources, healthcare provider shortages, excessive documentation requirements, restrictive eligibility criteria, unclear role definitions, low pay, heavy workload, and emotional stress. Facilitators included parental education, technology use, financial incentives, job flexibility, empowerment, communication, collaboration, trust-building, and recognition. Participants recommended strengthening funding stability, prevention-focused reimbursement policies, staffing support, workload management, collaboration, and cultural competence training. Conclusion This study highlights structural, workplace, and community-level factors significantly shape CHWs’ capacity to deliver effective services. Strengthening policy support, ensuring stable funding, improving working conditions, and integrating CHWs clearly within healthcare systems may enhance workforce sustainability and improve community-based efforts to reduce health inequities.

This study examined national trends in adherence to aerobic physical activity (PA) guidelines and identified demographic, socioeconomic, behavioral, and health-related factors associated with aerobic PA adherence among adult cancer survivors in the United States. A repeated cross-sectional analysis was conducted using data from the National Health Interview Survey (NHIS) 2010, 2015, and 2020 cycles. The analytic sample included 9,752 adult cancer survivors. Adherence to aerobic PA guidelines was defined as engaging in ≥ 150 min/week of moderate-intensity activity, ≥ 75 min/week of vigorous-intensity activity, or an equivalent combination. Survey-weighted descriptive analyses and multivariable logistic regression models were conducted to estimate prevalence and adjusted odds ratios (aORs) with 95

The escalation of prejudice and hate crimes against Asian Americans during the COVID-19 pandemic underscored the need for robust measures to quantify anti-Asian racism. This study proposes a novel county-level index specifically designed to capture the multifaceted nature of anti-Asian racism. The index integrates data sets from diverse sources, including Twitter, the Federal Bureau of Investigation’s Uniform Crime Reporting System, Google Search Trends, and Asian Pacific American Justice. A validation of the index using nationally representative survey data indicates it significantly predicts area racism against Asian respondents. This study offers a nuanced understanding of anti-Asian racism and has the potential to inform targeted interventions, the allocation of resources for community support and educational initiatives, and can be instrumental for policymakers in identifying areas with heightened anti-Asian bias. Additionally, the index serves as a foundation for future research, facilitating the exploration of correlations between anti-Asian racism and various health and social outcomes. While limitations exist regarding data subjectivity and availability, this index represents a significant advancement in measuring anti-Asian racism at the county level. It facilitates a more comprehensive understanding of this critical issue and the development of effective strategies to combat racial injustice and address related geographic disparities.

Background: Physical activity (PA) is associated with lower mortality and cancer recurrence risks. Although evidence shows health benefits for cancer patients before, during, and immediately after treatment, PA recommendations are not regularly included in the standard care. Objective: The study aimed to identify perceived knowledge, barriers, and facilitators of oncology providers’ PA promotion for cancer patients using the 5A (Assess, Advise, Agree, Assist, and Arrange) framework. Methods: A qualitative research design with a phenomenological approach was adopted. A purposive sample of 16 oncology care providers in Nebraska participated in semi-structured interviews via Zoom/phone. Interviews were audio-recorded, transcribed, and imported into MAXQDA 2024 for thematic analysis. Results: Analysis of the qualitative data identified five themes: (i) Broad and inclusive conceptualizations of PA among oncology care providers suggested that they were able to define PA; (ii) Current Practices in PA Counseling included advising on PA and assessment; (iii) Barriers to PA counseling included lack of guideline awareness, insufficient training, low prioritization, uncertainty about responsibility, time constraints, limited resources, lack of referral systems, patient health conditions, and environmental factors; (iv) Facilitators were identified as acknowledged health benefits for cancer survivors, awareness of PA recommendations, access to community resources, and support from interdisciplinary teams; and (v) Expressed desire among oncology care providers for training on incorporating PA into oncology care. Conclusions: Oncology providers recognized PA’s health benefits for cancer survivors but did not promote it due to inadequate knowledge of guidelines and lack of resources. These barriers require improved PA counselling education to help providers incorporate PA into clinical care.

Background: Despite the growing use of remote patient monitoring (RPM) in diabetes management, few studies have assessed program enrollment and attrition. This study adopted a mixed-methods approach to examining factors linked to program enrollment and attrition amongst a large sample of patients who went through RPM in diabetes management. Methods: Based on quantitative data from the Remote Interventions Improving Specialty Complex Care program conducted in Nebraska from 2014 to 2018, chi-squared or t tests were used to compare three groups of patients with diabetes who had been contacted for program participation: those who completed the intervention, withdrew from the intervention, or declined to participate. Logistic regression was used to identify factors associated with program dropout. Inductive thematic analysis was conducted to assess patient feedback based on semi-structured interviews with patients from the three groups. Results: Out of the 1993 patients with diabetes invited for participation, 13% (n = 256) declined to participate, 16% (n = 317) withdrew before completion, and 71% (n = 1420) completed the intervention. Being younger or having poorer health (as indicated by higher blood glucose or blood pressure) at the baseline was associated with higher odds of program withdrawal. The top reason patients cited for declining participation or withdrawal from RPM was not having enough time to complete the intervention. Patients who declined to participate mentioned that an offer of incentives or more information at the beginning of the intervention may increase their motivation for participation. Conclusions: Being younger or having poorer health at the baseline was associated with higher odds of withdrawing from the RPM program. Future RPM programs can increase program retention by becoming more responsive to the health needs of vulnerable patients who struggle with managing their diabetes or related comorbidities at the baseline.

Cognitive decline is a global health concern that leads to significant impairment in daily functioning and quality of life. Limited large-scale cohort studies have concurrently examined the effects of lifestyle and social factors on cognitive status and the potential gender and age cohort differences in middle-aged and older adults. This longitudinal study examined the temporal associations between lifestyle and social factors and cognitive status in middle-aged and older adults in the United States. The sample comprised 2192 individuals (mean age = 71.6 years, SD = 6.6) drawn from two waves of the National Social Life, Health, and Aging Project conducted in 2010-11 and 2015-16. Lifestyle factors (vigorous physical activity, cigarette smoking, alcohol drinking, and sleep quality) and social factors (number of close social ties, frequency of volunteering, participation in group meetings, informal socialization, and religious services) were measured in 2010-11. Cognitive status was assessed via the Chicago Cognitive Function Measure at both waves. Regression analysis examined the effects of lifestyle and social factors on cognitive status and its change across the two waves. Past smoking and current drinking showed significant and positive effects on cognitive status. Maintaining robust social connections and active attendance in formal and informal social activities were significant predictors of healthier changes in cognitive status for those with normal cognition or mild cognitive impairment. Subgroup analysis revealed gender and age cohort differences in the effects of lifestyle and social factors on cognitive status, with females showing stronger effects for lifestyle and social factors than males. The present findings underscored the predominant influence of social factors over lifestyle factors on cognitive status and provided a more nuanced understanding of the social and lifestyle determinants across gender and age groups. Further research should aim to explore the causal direction of these associations, considering specific cognitive domains and underlying mechanisms.

Objectives: We examined racial and ethnic differences in the association between changes in lifestyle behaviors and weight gain during COVID-19. Methods: We obtained data from a 2020 national survey involving 2,709 adult Americans. The outcome of interest was self-reported weight change status; behavioral measures included changes in exercise time, screen time, fast food meals consumed, and alcohol and tobacco use. We performed weighted multivariable logistic regression analyses to examine the association. Results: Non-Hispanic (NH) black adjusted odds ratio (AOR) (AOR = 1.59, 95% CI: 1.21-2.10) and Hispanic respondents (AOR = 1.89; 95% CI: 1.48-2.42) were more likely to experience weight gain, relative to the NH white respondents. Among NH Whites, changes in exercise time (AOR = 0.93), screen time (AOR = 1.16), fast-food meals consumptions (AOR = 1.14), and being drinkers (AOR = 1.35) and smokers (AOR = 0.53) were associated with weight gain; while among Hispanics, only changes in exercise time (AOR = 0.92) and screen time (AOR = 1.14) were associated with weight gain. Changes in exercise time (AOR = 0.94) among NH Blacks and changes in screen time (AOR = 1.16) among NH Asians were associated with weight gain. Conclusions: Risk factors of weight gain differ across racial and ethnic groups during the COVID-19 pandemic. Tailored intervention strategies are warranted to address specific risk behaviors within each racial and ethnic group.

Telehealth is an important source of health care during the COVID-19 pandemic. Evidence is scarce regarding disparities in telehealth utilization in the United States. We aimed to investigate the prevalence and factors associated with telehealth utilization among US adults. Our data came from the Health, Ethnicity, and Pandemic Study, a nationally representative survey conducted in October 2020, with 2554 adults ≥ 18 and an oversample of racial/ethnic minorities. Telehealth utilization was measured as self-reported teleconsultation with providers via email, text message, phone, video, and remote patient monitoring during the pandemic. Logistic regressions were performed to examine the association between telehealth use and factors at the individual, household, and community levels. Overall, 43% of the sample reported having used telehealth, representing 114.5 million adults in the nation. East and Southeast Asians used telehealth less than non-Hispanic Whites (OR = 0.5, 95% CI: 0.3-0.8). Being uninsured (compared with private insurance: OR = 0.4, 95% CI: 0.2-0.8), and those with limited broadband coverage in the community (OR = 0.5, 95% CI: 0.3-0.8) were less likely to use telehealth. There is a need to develop and implement more equitable policies and interventions at both the individual and community levels to improve access to telehealth services and reduce related disparities.

Objective: Concurrent with a substantial surge in gun purchases among Americans during COVID-19, there was an escalation of racism and hate crimes in the United States. Despite this disturbing trend, little is known about whether and the extent to which racism experience is linked to gun purchase during the pandemic. This study aims to examine the association between experience of racial discrimination and gun purchase among Americans during COVID-19. Methods: Based on data from the Health, Ethnicity, and Pandemic Survey (n = 2,584), a national survey conducted in the U.S. in October 2020, chi-square tests and logistic regressions were estimated to examine the association between racism experience and gun purchase during COVID-19 with and without controlling for selected covariates. Results: About 6.9 % of the sample reported gun purchases during COVID-19. Among respondents who reported experience of racism, 18.3 % purchased a gun as compared to 5.8 % among those who did not report experience of racism. Relative to respondents with no experience of racism, the odds of gun purchase for those who reported racism experience became 257 % as much (AOR = 2.57, 95 % CI: 1.63, 4.04) after controlling for other covariates in the analysis. Non-Hispanic Blacks were more likely to report gun purchases than non-Hispanic Whites (AOR = 1.80, 95 % CI: 1.04, 3.10). Conclusions: Americans who reported experience of racism during COVID-19 were far more likely to purchase a gun than those otherwise. These findings elevate the need for addressing racism as an important risk factor of firearm violence.

Chinese young adults (CYA), who are at an increasing risk of developing nonalcoholic fatty liver disease (NAFLD), which in turn increases the risk of liver cancer, are an ideal target population to deliver educational interventions to improve their awareness and knowledge of NAFLD and consequently reduce their risk of developing NAFLD. The purpose of this study was to determine the efficacy of two interventions to improve awareness and knowledge of NAFLD among CYA for the prevention of liver cancer. Between May and July 2021, 1373 undergraduate students aged 18 to 25 years in one university in China completed a web-based, self-administered survey distributed through WeChat app. One week after completion of the baseline survey, all eligible participants were randomly assigned to a pamphlet, a video intervention, or no intervention (control group), with follow-up assessments immediately and 1-month post-intervention. The 7-page pamphlet or 6.5-min video had information on NAFLD. Self-assessments included NAFLD awareness, lean NAFLD awareness, and knowledge scores of NAFLD. About 26

Historical narratives and the "model minority" myth have obscured the realities of anti-Asian racism in the United States. The escalation of prejudice and hate crimes against Asian Americans during the COVID-19 pandemic further underscored the need for robust measures to quantify this phenomenon. This study proposes a novel county-level index specifically designed to capture the multifaceted nature of anti-Asian racism. The index integrates a diverse data set including geotagged Twitter data assessing public attitudes and potential hate speech directed toward Asian Americans, anti-Asian hate crime records from the Federal Bureau of Investigation’s Uniform Crime Reporting System, Google Search Trends data about anti-Asian stereotypes and narratives, and alien land bills denoting context for discriminatory policies against Asian immigrants at the state level. We employed Principal Component Analysis to combine these data sources into a single, composite index. A validation of the index using nationally representative survey data indicates that two of the three identified principal components significantly predict area racism against Asian respondents. This study offers a nuanced understanding of anti-Asian racism and has the potential to inform targeted interventions, the allocation of resources for community support and educational initiatives, and can be instrumental for policymakers in identifying areas with heightened anti-Asian bias. Additionally, the index serves as a foundation for future research, facilitating the exploration of correlations between anti-Asian racism and various health and social outcomes. While limitations exist regarding data subjectivity and availability, this index represents a significant advancement in measuring anti-Asian racism at the county level. It paves the way for a more comprehensive understanding of this critical issue and the development of effective strategies to combat racial injustice and address related geographic disparities.

Background Previous studies have demonstrated the association between food security and cardiometabolic diseases (CMDs), yet none have investigated trends in prevalence of CMDs by food security status in the United States (US). Methods Serial cross-sectional analysis of the US nationally representative data from National Health and Nutrition Examination Survey (1999–2018) was conducted among adults aged 20 years or older. Food security status was defined by the US Household Food Security Survey Module (full, marginal, low, and very low food security). We estimated the age-adjusted prevalence of CMDs including obesity, hypertension, diabetes, and coronary heart disease by food security status. Racial and ethnic disparities in age-adjusted prevalence of CMDs by food security status were also assessed. Results A total of 49,738 participants were included in this analysis (weighted mean age 47.3 years; 51.3% women). From 1999 to 2018, the age-adjusted prevalence of CMDs was lower in full food secure group as compared with other groups. For example, trends in hypertension decreased from 49.7% (47.5-51.8%) to 45.9% (43.8-48.0%) ( P -trend = 0.002) among the full and from 54.2% (49.9-58.5%) to 49.7% (46.8-52.6%) ( P -trend = 0.02) among the marginal but remained stable among the low at 49.7% (47.9-51.6%) and among the very low at 51.1% (48.9-53.3%) ( P -interaction = 0.02). Prevalence of diabetes increased from 8.85% (8.15-9.60%) to 12.2% (11.1-13.5%) among the full ( P -trend < 0.001), from 16.5% (13.2-20.4%) to 20.9% (18.6-23.5%) ( P -trend = 0.045) among the marginal and from 14.6% (11.1-19.0%) to 20.9% (18.8-23.3%) ( P -trend = 0.001) among the low but remained stable at 18.8% (17.0-20.9) among the very low ( P -trend = 0.35) ( P -interaction = 0.03). Racial and ethnic differences in prevalence of CMD by food security status were observed. For example, among individuals with full food secure status, the prevalence of diabetes was 9.08% (95% CI, 8.60-9.59%) for non-Hispanic whites, 17.3% (95% CI, 16.4-18.2%) for non-Hispanic blacks, 16.1% (95% CI, 15.0-17.4%) for Hispanics and 14.9% (95% CI, 13.3-16.7%) for others. Conclusions and relevance Prevalence of CMDs was greatest among those experiencing food insecurity, and food insecurity disproportionately affected racial/ethnic minorities. Disparities in CMD prevalence by food security status persisted or worsened, especially among racial/ethnic minorities.

Attention-deficit hyperactivity disorder is a common disorder that affects both children and adults. However, for adults, little is known about ADHD-attributable medical expenditures. To estimate the medical expenditures associated with ADHD, stratified by age, in the US adult population. Using a two-part model, we analyzed data from Medical Expenditure Panel Survey for 2015 to 2019. The first part of the model predicts the probability that individuals incurred any medical costs during the calendar year using a logit model. The second part of the model estimates the medical expenditures for individuals who incurred any medical expenses in the calendar year using a generalized linear model. Covariates included age, sex, race/ethnicity, geographic region, Charlson comorbidity index, insurance, asthma, anxiety, and mood disorders. Adults (18 +) who participated in the Medical Expenditure Panel Survey from 2015 to 2019 (N = 83,776). Overall and service specific direct ADHD-attributable medical expenditures. A total of 1206 participants (1.44%) were classified as having ADHD. The estimated incremental costs of ADHD in adults were $2591.06 per person, amounting to $8.29 billion nationally. Significant adjusted incremental costs were prescription medication ($1347.06; 95% CI: $990.69–$1625.93), which accounted for the largest portion of total costs, and office-based visits ($724.86; 95% CI: $177.75–$1528.62). The adjusted incremental costs for outpatient visits, inpatient visits, emergency room visits, and home health visits were not significantly different. Among older adults (31 +), the incremental cost of ADHD was $2623.48, while in young adults (18–30), the incremental cost was $1856.66. The average medical expenditures for adults with ADHD in the US were substantially higher than those without ADHD and the incremental costs were higher in older adults (31 +) than younger adults (18–30). Future research is needed to understand the increasing trend in ADHD attributable cost.

Parenting programs are an important tool that can provide support for parents and families and improve family functioning. This concurrent nested QUANT + qual mixed methods study sought to better understand parenting education program participation and examine format, delivery, and content preferences for parenting programs among Latino parents in Nebraska. Results from a statewide survey (N = 173) indicated that 31.4% of parents in the sample had participated in a parenting program. Significant predictors of participation in parenting education programs included being unmarried, not working full-time, having a higher income, and having excellent or very good health. Major barriers to participation included lack of information about available programs and logistical concerns. Focus group participants discussed key program design concerns which included: (1) cultural clashes related to acculturation gaps between parents and children; (2) cultural relevance of programming; (3) logistical considerations; and (4) the inclusion of technology to enhance parenting. Overall, participants were particularly interested in group-based learning, flexible scheduling, and improving the cultural relevance of programs. Implications for program design and outreach to improve Latino parents' access and willingness to participate in parenting education programs are presented. Future research should explore the effectiveness of parenting program implementation and dissemination with Latino parents in rural communities, if there are differences in the benefits of parenting programs by Latino subgroup or level of acculturation, and assess the impact of near-peers in the delivery of parenting programs with Latinos.

BackgroundGiven the observed within-Asian disparity in COVID-19 incidence, we aimed to explore the differential preventive behaviors among Asian subgroups in the United States.MethodsBased on data from the Asian subsample (N = 982) of the 2020 Health, Ethnicity, and Pandemic survey, we estimated the weighted proportion of noncompliance with Centers for Disease Control and Prevention (CDC) guidelines on preventive behaviors and COVID-19 testing by Asian subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Other Asian). We examined these subgroup differences after adjusting for demographic factors and state-level clustering.ResultsFilipinos demonstrated the lowest rate of noncompliance for mask-wearing, social distancing, and handwashing. As compared with the Filipinos, our logistic models showed that the Chinese and the 'other Asians' subgroup had significantly higher risk of noncompliance with mask-wearing, while the Japanese, the Vietnamese, and other Asians were significantly more likely to report noncompliance with social distancing.ConclusionsThe significant variation of preventive behavior across Asian subgroups signals the necessity of data disaggregation when it comes to understanding the health behavior of Asian Americans, which is critical for future pandemic preparedness. The excess behavioral risk among certain Asian subgroups (especially those 'other Asians') warrants further investigation and interventions about the driving forces behind these disparities.

Objective: The purpose of this research is to qualitatively identify perceived concerns about mental disorders among children and related screening practices for mental illness among early childcare and education providers. Design: Qualitative research design with a phenomenological approach was used. Sample: 53 early childcare and education providers from Nebraska participated in semi-structured interviews focused on mental disorders and related screening practices among children. Methods: The recorded interviews were transcribed, coded, and systematically analyzed through thematic content analysis. Results: The analysis identified two themes concerning pediatric mental health disorders and screening practices. The first theme, mental health concerns, includes three categories: perceived level of mental disorder (n=39; 74 %), most common (attention-deficit disorder [n=28; 53.8 %] and anxiety [n=13; 25.6 %]), and least common (mood disorders [n=5; 10.2 %] and substance abuse [n=8; 15.4 %]). The second theme, screening practices, reflects the use of screening tools and their implication to screen mental disorders and suggested one category: screening measure usage (Ages and Stages and the Modified Checklist for Autism in Toddlers). Conclusion: Among the 53 participants, 39 or 74 % of them stated their concern about pediatric mental health disorders in their organization, with some of the most commonly reported disorders including attention-deficit/hyperactivity disorder (ADHD) (53.8 %), anxiety (25.6 %), depression (17.9 %), and substance use (15.4 %). Participants were also concerned about the lack of standard screening instruments for mental health issues among children of ages 0 to 5. There is a need for early childcare organizations, healthcare providers, and educational organizations to collaborate and implement a coordinated approach to improving Nebraska's pediatric mental health.

Background Research on mental health disparities by race-ethnicity in the United States (US) during COVID-19 is limited and has generated mixed results. Few studies have included Asian Americans as a whole or by subgroups in the analysis. Methods Data came from the 2020 Health, Ethnicity, and Pandemic Study, based on a nationally representative sample of 2,709 community-dwelling adults in the US with minorities oversampled. The outcome was psychological distress. The exposure variable was race-ethnicity, including four major racial-ethnic groups and several Asian ethnic subgroups in the US. The mediators included experienced discrimination and perceived racial bias toward one’s racial-ethnic group. Weighted linear regressions and mediation analyses were performed. Results Among the four major racial-ethnic groups, Hispanics (22%) had the highest prevalence of severe distress, followed by Asians (18%) and Blacks (16%), with Whites (14%) having the lowest prevalence. Hispanics’ poorer mental health was largely due to their socioeconomic disadvantages. Within Asians, Southeast Asians (29%), Koreans (27%), and South Asians (22%) exhibited the highest prevalence of severe distress. Their worse mental health was mainly mediated by experienced discrimination and perceived racial bias. Conclusions Purposefully tackling racial prejudice and discrimination is necessary to alleviate the disproportionate psychological distress burden in racial-ethnic minority groups.

The recent escalation of racism in the U.S. during the COVID-19 pandemic points to the importance of examining the association between experienced racism and sexual health. Based on data from a nationally representative survey conducted in the U.S. in October 2020 (n = 1,915), Chi-square tests and multivariable logistic regressions were estimated to examine the association between experience of racism and changes in sex life during the pandemic. We further performed a causal mediation analysis using the bootstrap technique to assess the mediating role of psychological distress in the observed association between the experience of racism and changes in sex life. Among the respondents, the proportions reporting better, worse, or no change in sex life were, respectively, 15%, 21%, and 64%. Experiencing racial discrimination during COVID-19 was significantly associated with worsening sex life (adjusted odd ratio [AOR] = 1.53; 95% confidence interval [CI] = 1.04, 2.25). Respondents with experienced racism were also more likely to report psychological distress (AOR = 1.68; 95% CI = 1.09, 2.59). About one-third (32.66%) of the observed association between experienced racism and worsening sex life was mediated through psychological distress. Addressing racism and its association with psychological distress has the potential to improve sexual health and reduce related racial and ethnic disparities.

This study compares and contrasts how key factors influence Americans' trust in different types of media (broadcast, print, and social) as COVID-19 information sources and how people's media trust is associated with their adoption of preventive measures. Our results from a national survey (sample = 2571) showed that age, political party affiliation, and race and ethnicity and income level were significantly associated with people's trust in different media types as COVID information sources. Elder adults trusted print and broadcast media more, while younger adults trusted social media more. Democrats and Lean Democrats had more trust in all three forms of media than Republicans and Lean Republicans. Asians had the highest levels of trust in all three media types, while Whites had the lowest level of trust in broadcast and social media. Trust in broadcast media was found to be associated with facial mask wearing, but trust in social media, however, did not contribute to the adoption of any COVID-19 preventive measures. This study contributes to a general understanding of media trust and mediated health communication and provides nuanced understanding of how demographic factors shape media trust and the consequence of media trust during a historical pandemic.