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The COVID-19 vaccine was initially offered to frontline health care workers (HCWs), due to the high risk of contracting COVID-19 through occupational exposure to patients. Low HCW vaccine uptake can impact overall community-level vaccine uptake. This study used the Diffusion of Innovation (DOI) Theory to understand factors related to COVID-19 vaccine uptake in HCWs. We surveyed Pennsylvanian HCWs (excluding Philadelphia) from August 2022 to February 2023. Survey questions inquired about demographics, COVID-19 vaccination status, reasons for receiving/declining the COVID-19 vaccine, and sources of information about the vaccine. Participants (n = 3,490) were 85% female, 89% White, and 93% (n = 3,255) reported receiving at least one dose of a COVID-19 vaccine. HCWs were categorized into adopter categories of the DOI Theory: innovators (56%), early adopters (9%), early majority (11%), late majority (7%), and laggards (17%). The major reason that prompted participants to get the vaccine was to protect them against COVID-19 infection (78%), while the major reason for declining the vaccine was due to concern about possible side effects from the vaccine (78%). We applied the DOI Theory to characterize adopters and identify factors related to COVID-19 vaccine uptake in HCWs. As updated COVID-19 vaccines are approved for the United States market, our findings may be used to improve vaccine education and communication among HCWs to support vaccine uptake. • The Diffusion of Innovation Theory was used to characterize COVID-19 vaccine uptake. • Most health care workers were categorized as innovators and early adopters. • Factors related to COVID-19 vaccine uptake vary by category of adoption. [ABSTRACT FROM AUTHOR]

This cross-sectional study examines differences in the prevalence of suicidal thoughts and behaviors across intersectional combinations of gender, sexual orientation, race and ethnicity, and rurality among US adults. Key Points: Question: Does the prevalence of suicide ideation, plan, and attempt vary across intersectional combinations of gender, sexual orientation, race and ethnicity, and rurality? Findings: In this cross-sectional study of 189 800 adults based on 5 years of data from an annual population-based US survey, prevalence of suicide ideation, plan, and attempt were highest among Hispanic and non-Hispanic Black bisexual women living in nonmetropolitan counties. Meaning: The findings suggest that Hispanic and non-Hispanic Black bisexual women living in nonmetropolitan counties may experience high prevalence of suicide ideation, plan, and attempt, possibly due to experiencing compounding forms of structural discrimination. Importance: Suicidal thoughts and behaviors (STBs) are major public health problems, and some social groups experience disproportionate STB burden. Studies assessing STB inequities for single identities (eg, gender or sexual orientation) cannot evaluate intersectional differences and do not reflect that the causes of inequities are due to structural-level (vs individual-level) processes. Objective: To examine differences in STB prevalence at the intersection of gender, sexual orientation, race and ethnicity, and rurality. Design, Setting, and Participants: This cross-sectional study used adult data from the 2015-2019 National Survey on Drug Use and Health (NSDUH), a population-based sample of noninstitutionalized US civilians. Data were analyzed from July 2022 to March 2023. Main Outcomes and Measures: Outcomes included past-year suicide ideation, plan, and attempt, each assessed with a single question developed for the NSDUH. Intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) models were estimated, in which participants were nested within social strata defined by all combinations of gender, sexual orientation, race and ethnicity, and rurality; outcome prevalence estimates were obtained for each social stratum. Social strata were conceptualized as proxies for exposure to structural forms of discrimination that contribute to health advantages or disadvantages (eg, sexism, racism). Results: The analytic sample included 189 800 adults, of whom 46.5% were men; 53.5%, women; 4.8%, bisexual; 93.0%, heterosexual; 2.2%, lesbian or gay; 18.8%, Hispanic; 13.9%, non-Hispanic Black; and 67.2%, non-Hispanic White. A total of 44.6% were from large metropolitan counties; 35.5%, small metropolitan counties; and 19.9%, nonmetropolitan counties. There was a complex social patterning of STB prevalence that varied across social strata and was indicative of a disproportionate STB burden among multiply marginalized participants. Specifically, the highest estimated STB prevalence was observed among Hispanic (suicide ideation: 18.1%; 95% credible interval [CrI], 13.5%-24.3%) and non-Hispanic Black (suicide plan: 7.9% [95% CrI, 4.5%-12.1%]; suicide attempt: 3.3% [95% CrI, 1.4%-6.2%]) bisexual women in nonmetropolitan counties. Conclusions and Relevance: In this cross-sectional study, intersectional exploratory analyses revealed that STB prevalence was highest among social strata including multiply marginalized individuals (eg, Hispanic and non-Hispanic Black bisexual women) residing in more rural counties. The findings suggest that considering and intervening in both individual-level (eg, psychiatric disorders) and structural-level (eg, structural discrimination) processes may enhance suicide prevention and equity efforts. [ABSTRACT FROM AUTHOR]

Background: Compared to their cisgender counterparts, genderqueer adults have significantly higher rates of sexually transmitted infections (STIs). Screening guidelines suggest that sexually active genderqueer adults should be screened for STIs annually, yet those living in rural or under resourced areas may be less likely to do so. Methods: Using social media, 438 genderqueer adults were recruited from a five-state region in the mid-Atlantic United States. To participate, adults were required to be 18+ and identify as transgender, genderqueer, nonbinary, or as a gender different than their assigned sex at birth. Via an online survey in REDCap, participants were asked about their history of STI testing and access to routine healthcare. Using log binomial regression, we evaluated the relationship between access to routine healthcare and STI testing. Results: Among participants who had ever had sex (n=354), 50% lived in a rural county, the majority (84%) were aged 18-34, 74% identified as White, and 21% identified as Black. 39% reported being tested for STIs in the past year. 14% reported having no routine care provider, 8% reported having to travel 50+ miles to receive routine care, 13% reported travelling 25-49 miles, and 49% reported < 25 miles. Unadjusted and adjusted log binomial regression revealed that those without a routine care provider were significantly less likely to report STI testing compared to those who travel less than 25 miles. However, those who travel further (25-49,50+ miles) were not significantly different than those reporting a < 25-mile distance. Conclusion: Only participants who reported not having a routine healthcare provider were significantly less likely to have been tested for STIs, while distance to provider was not a significant predictor. These findings suggest that connecting genderqueer populations to routine healthcare providers is of critical importance, regardless of distance. Given the shortage of healthcare providers cognizant of transgender-specific needs in many areas, immediate efforts can be made to ensure that genderqueer adults are connected to healthcare in neighboring communities and regions. [ABSTRACT FROM AUTHOR]

Background: Poverty and rural residency status have long been associated with higher rates of sexually transmitted infections (STI) due to fewer sexual health and medical resources. The continuing increase in STIs across the nation requires nuanced understanding of interacting or compounding roles of these disparities. Persistent poverty counties, those counties who have had >20% of the population at or below the national poverty level for at least 30 consecutive years, are predominately rural, and have higher rates of poor outcomes from other health conditions such as cancer. Despite this evidence, no published literature exists that examines the association between these persistent poverty counties and STI rates in the US. Methods: Drawing on data from the National Electronic Database Surveillance System (NEDSS), American Community Survey (ACS), and County Health Rankings we conducted unadjusted and adjusted binomial regressions, including generalized estimating equations, to examine potential relationships between persistent poverty, as defined by the U.S. Department of Agriculture Economic Research, and STI rates. Results: Of the 3,143 counties or county-level equivalents in the US, 353 (11.2%) are designated as persistent poverty, of which 63.5% are rural. Positive relationships between persistent poverty and gonorrhea (p=0.0023) and chlamydia (p< 0.001) incidence at the county level were observed. When controlling for rurality, sex education policies, and other factors, persistent poverty remained positively associated with STI incidence. Conclusion: These findings provide a more nuanced understanding of the growing literature surrounding the relationship between poverty and negative sexual health outcomes by demonstrating a positive relationship between county-level persistent poverty status with gonorrhea and chlamydia incidence. Negative social determinants may be exacerbated within these communities, which warrants further exploration to help inform community-based interventions. [ABSTRACT FROM AUTHOR]

• Health professional students can effectively implement a contact tracing initiative • A replicable workflow and onboarding system aids in efficient contact tracing • Testing capacity, community buy-in, and sparse resources can impact contact tracing The Centers for Disease Control and Prevention recommends aggressive contact tracing to control the COVID-19 pandemic. In this work, we (1) describe the development of a COVID-19 contact tracing initiative that includes medical, nursing, and public health students, and is led by clinicians and infectious disease epidemiologists within our health system, and, (2) articulate process steps for contact tracing including workflows and telephone scripts, and, (3) highlight the key challenges and strategies to overcome these challenges. A single academic institution-based contact tracing initiative was rapidly scaled to 110 health professional students, four physicians, two epidemiologists, and a research team. Following training, students called patients who were COVID-19 positive and the individuals they were in contact with to ensure proper isolation and quarantine measures. Students also assisted those who faced barriers to quarantine. In total, between March 24 and May 28 – this initiative completed contact tracing for 536 confirmed cases, which resulted in the identification of 953 contacts. We aim to disseminate this process, including telephone scripts and workflow, to other health systems for use in their initiatives to respond to the COVID-19 pandemic and future public health emergencies. [ABSTRACT FROM AUTHOR]

Introduction: Sexual orientation‒related disparities in alcohol use disorder are well-established. Yet, the degree to which sexual orientation differences in alcohol use disorder vary across the life course is poorly understood. There is also a limited understanding of how exposure to minority stressors and their relationship with alcohol use disorder vary as a function of age.Methods: Using nationally representative data collected in 2012-2013, authors used sex-stratified time-varying effect models to estimate age-specific prevalence rates of alcohol use disorder among heterosexual and sexual minority adults aged 18-60 years (N=28,090). Among sexual minority adults (n=1,050), authors also assessed age-specific associations between exposure to lesbian, gay, and bisexual‒related discrimination and alcohol use disorder. Analyses were conducted in 2019.Results: Gay and bisexual male participants aged 18-45 years demonstrated the highest prevalence rates of alcohol use disorder (e.g., >45% at age 25 years), whereas lesbian, gay, and bisexual female participants were most likely to meet the criteria for alcohol use disorder between ages 45 and 55 years. Sexual minority adults who experienced discrimination in the past year had greater odds of alcohol use disorder between ages 23 and 34 years and again from ages 42 to 53 years; the association between discrimination and alcohol use disorder was strongest among sexual minority men.Conclusions: Sexual orientation-related disparities in alcohol use disorder are dynamic across the life course and point to critical times for screening and intervention. Developmental perspectives of sexual minority health inequities demand focused research attention as findings will help to identify strategies for promoting sexual minority health at distinct points in the life course. [ABSTRACT FROM AUTHOR]

• A 2017 mumps outbreak on a college campus triggered a test, trace, and isolate response. • Response teams documented average contacts per case and compliance with quarantine and isolation protocols. • We identify strategies to increase compliance with contact tracing efforts and quarantine and isolation protocols to reduce pathogen transmission on campus. • Lessons learned from the outbreak can applied to future outbreak management on college campuses, including SARS-CoV-2. In 2017, Penn State University's campus experienced a mumps outbreak that coincided with unrelated restrictions on social gatherings. University Health Services implemented testing, contact tracing, and quarantine and isolation protocols. Approximately half of the supplied contact tracing information was usable, ∼70% of identified contacts were reached, and <50% of those contacted complied with quarantine protocol. Students with confirmed mumps reported ∼7.4 (1-35) contacts on average. Findings from this outbreak can inform future outbreak management on college campuses, including COVID-19, by estimating average contacts per case, planning capacity for testing and quarantine/isolation, and strategically increasing compliance with suggested interventions. [ABSTRACT FROM AUTHOR]

Objective: Transdermal alcohol concentration (TAC) sensors capture aspects of drinking events that self-reports cannot. The multidimensional nature of TAC data allows novel classification of drinking days and identification of associated behavioral and contextual risks. We used multilevel latent profile analysis (MLPA) to create day-level profiles of TAC features and test their associations with (a) daily behaviors and contexts and (b) risk for alcohol use disorders at baseline., Method: Two hundred twenty-two regularly heavy-drinking young adults ( M age = 22.3) completed the Alcohol Use Disorders Identification Test (AUDIT) at baseline and then responded to mobile phone surveys and wore TAC sensors for six consecutive days. MLPA identified day-level profiles using four TAC features (peak, rise rate, fall rate, and duration). TAC profiles were tested as correlates of daily drinking behaviors, contexts, and baseline AUDIT., Results: Four profiles emerged: (a) high-fast (8.5% of days), (b) moderate-fast (12.8%), (c) low-slow (20.4%), and (d) little-to-no drinking days (58.2%). Profiles differed in the odds of risky drinking behaviors and contexts. The highest risk occurred on high-fast days, followed by moderate-fast, low-slow, and little-to-no drinking days. Higher baseline AUDIT predicted higher odds of high-fast and moderate-fast days., Conclusions: Days with high and fast intoxication are reflective of high-risk drinking behaviors and were most frequent among those at risk for alcohol use disorders. TAC research using MLPA may offer novel and important insights to intervention efforts. (PsycInfo Database Record (c) 2024 APA, all rights reserved).