People who inject drugs (PWID) are a population that disproportionately struggles with economic and mental health challenges. However, despite numerous reports of people globally experiencing new or exacerbated economic and/or mental health challenges during the COVID-19 pandemic, the literature on the effect of the pandemic on PWID and their risk for harm (e.g., overdose) remains sparse. The present study will describe reported changes during the pandemic in risk factors for drug overdose (including changes in mental health symptoms and care access) among PWID in Chicago, and it will examine associations between such risk factor changes and the experience of economic challenges during the pandemic. Participants from an ongoing longitudinal study of young PWID from the Chicago suburbs and their injection risk network members (N = 138; mean age = 28.7 years) were interviewed about changes in their experiences, substance use behavior, and mental health since the start of the COVID-19 pandemic. Bivariate cross tabulations were computed of each “overdose risk factor” with experiences of economic challenges during the pandemic. Fisher’s Exact Tests were used to assess statistical significance. Adjusted logistic regression models were also conducted that controlled for sociodemographic characteristics, for time elapsed since the start of the pandemic, and for pre-pandemic income, homelessness, and injection frequency. Over half of our sample reported using alone more than usual during the pandemic, and over 40% reported using more than usual and/or buying drugs that were of a decreased purity or quality. Additionally, a large proportion of our sample (52.5% of those asked) reported more difficulty than usual accessing mental health care. Experiencing loss of a source of income during the pandemic was associated with using more drugs, using alone more, using a larger amount of drugs while using alone, wanting to stop using but being unable, and difficulty accessing mental health care. The preliminary associations found by the present study suggest that economic challenges or disruptions experienced during the pandemic are likely to increase risk for overdose among PWID experiencing such challenges, via changes in the above behaviors and/or conditions that are associated with risk for overdose. Intervention efforts should therefore be focused not only directly on overdose prevention, but also on assisting PWID with their economic challenges and helping them regain economic stability and access to services that may have been impeded by financial difficulty.

COVID-19 vaccination is an important public health intervention to curb the pandemic's magnitude and spread, and racial discrimination is a key predictor of COVID-19 preventive behavior, vaccine hesitancy, and uptake. This study evaluated the association of vaccine hesitancy with various modes of information on COVID-19 (i.e., online, social media) and the moderating role of cyberbullying among Asian Americans. The authors used population-weighted data from the nationwide Asian American and Native Hawaiian/Pacific Islander COVID-19 Needs Assessment Survey, which was conducted from January 2021 to April, 2021 (unweighted N=3,127). The association between various modes of COVID-19 information and vaccine hesitancy, moderated by exposure to cyberbullying, were examined. In general, 16% of Asian Americans reported vaccine hesitancy; 26% reported experiencing cyberbullying. Asian Americans reported receiving most COVID-19 information from online sources (75%) and social media (52%). In unadjusted models, receiving information via online (OR=0.46; 95% CI=0.33, 0.62; p<0.001), social media (OR=0.80; 95% CI=0.52, 0.93; p<0.05), and broadcast (OR=0.60; 95% CI=0.44, 0.81; p<0.001) were significantly associated with a lower vaccine hesitancy. However, reporting any cyberbullying was associated with increased vaccine hesitancy (OR=1.39; 95% CI=1.02, 1.90; p<0.05). The protective effects for COVID-19 information modes remained when accounting for health and sociodemographic factors, whereas the effect of cyberbullying was no longer statistically significant. Cyberbullying moderated the protective effect of broadcast information only, so those who received information via broadcast and reported experiencing cyberbullying had similar odds of vaccine hesitancy compared with those who did not receive information via broadcast. Online, social media, and broadcast remain important sources of information about COVID-19 for Asian Americans; however, experiencing cyberbullying can reduce the effectiveness of these sources in the uptake of the vaccine. COVID-19 information promotion strategies for Asian Americans must account for the role of cyberbullying in social media campaigns.

Latinx people who inject drugs (PWID) are less likely to engage in injection equipment sharing, but are more vulnerable to injection drug use (IDU)-related morbidity and mortality than Whites. Identifying subgroups of Latinx PWID who do engage in equipment sharing and likely bear the brunt of this health burden is a priority. Ethnic disparities may reflect contextual drivers, including injection networks. Latinx PWID with low ethnic homophily (the proportion of individuals with the same ethnic background) may be more likely to share equipment due to forced distancing from health-protective ethnocultural resources and power imbalances within injection networks. The current study offers a framework and examines how associations between network ethnic homophily and injection equipment sharing differ among 74 Latinx and 170 non-Latinx White PWID in the Chicagoland area (N = 244). Latinx had less homophilous than non-Latinx Whites (p <.001). Ethnic homophily was protective for equipment sharing among Latinx (OR = 0.17, 95%CI [0.77, 0.04], p = .02), but not non-Latinx Whites (OR = 1.66, 95%CI [0.40, 6.93], p = .49). Our findings implicate the need for targeted cultured interventions that focus on Latinx PWID who are more vulnerable to morbidity and mortality, potentially due to less access to ethnic peers.

The increasing rates of cancer incidence are disproportionately borne by populations that are ineligible for screening and historically marginalized populations. To address this need, our community-centered model seeks to catalyze the widespread diffusion of evidence-based information and resources (e.g., community-based organizations, federally qualified health centers) to reduce the risks of cancer, chronic disease, and other conditions. In this study, we tested whether improving personal health literacy (i.e., confidence in seeking information) and enabling successful information transfer (i.e., intention to share the specific information learned through the program) among community residents could contribute to greater diffusion intention (i.e., number of network members with whom residents plan to share information and resources). The current study used post-intervention surveys, which were administered to Chicago residents who were 18 years or older and had participated in the program. Among the 1499 diverse Chicago residents, improved personal health literacy was associated with greater diffusion intention (ORs = 2.00–2.68, 95% CI [1.27–4.39], p ≤ 0.003). Successful information transfer was associated with greater diffusion, especially for cancer and other chronic disease risk reductions (ORs = 3.43–3.73, 95% CI [1.95–6.68], p < 0.001). The findings highlight the potential gains for health equity through sustainable, scalable, multi-sectoral partnerships.

Objective: To examine the association between sleep quality and psychological resilience in a Chinese community-based cohort and assess the consistency of this association across two sleep measures. Design: Cross-sectional analysis of baseline data. Setting: Community-based cohort in Hangzhou, China (2016–2019). Participants: 10 268 adults aged 18–80 years enrolled via quota sampling stratified by sex and age group. After excluding participants with missing data, analytic samples were 9781 (single-item measure) and 9780 (Pittsburgh Sleep Quality Index (PSQI)), owing to one additional missing response. Primary outcome measure: Low psychological resilience, defined by a median split on a 9-item scale adapted from the Brief Resilience Scale and Connor–Davidson Resilience Scale. Results: Poor sleep quality was associated with higher odds of low resilience across both measures (single-item measure, adjusted OR=1.5, 95% CI 1.3 to 1.6; PSQI, adjusted OR=1.5, 95% CI 1.4 to 1.7), after adjustment for demographic factors, socio-economic factors, mental health indicators and health behaviours. Interaction tests showed no evidence of effect modification by sex, age group, loneliness or depression history for the single-item measure (p>0.05). For the PSQI, the association differed by loneliness (p<0.05), with a larger magnitude of association among lonely participants (adjusted OR=2.1, 95% CI 1.6 to 2.7) than non-lonely participants (adjusted OR=1.5, 95% CI 1.3 to 1.6). Conclusions: Poor sleep quality was consistently associated with low resilience across both measures. Because the design was cross-sectional, temporal direction cannot be established. Longitudinal and interventional studies are needed to establish temporal ordering, and intervention studies are needed to determine whether improving sleep increases resilience.