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Women engaged in sex work (WSW) in China encounter numerous disadvantages (e.g., exposure to violence) and have substantial risk for psychological distress and somatic symptoms. Intervention literature has attended to mindfulness, which is a protective factor for psychological outcomes, and its influences can further improve physical health. However, mindfulness has not been well studied in WSW. We aimed to examine the association among mindfulness, psychological distress, and somatic symptoms among Chinese WSW. Data were collected from 410 WSW in Guangxi, China, using an anonymous, self-administered survey evaluating demographics, mindfulness, psychological distress (i.e., depression, loneliness, and perceived stress), and somatic symptoms (i.e., pain, cardiopulmonary, and gastrointestinal/fatigue symptoms). Structural equation modeling was utilized for data analyses. Mindfulness was negatively associated with psychological distress and somatic symptoms. Psychological distress was positively associated with somatic symptoms. Psychological distress mediated the association between mindfulness and somatic symptoms. Mindfulness appears to be a protective factor for psychological distress among WSW, and such an effect is further influential to their somatic symptoms. Our findings add to the growing literature on mindfulness, suggesting that mindfulness-based interventions could be beneficial for WSW. Future research should explore other cognitive factors underlying the psychosomatic mechanism of mindfulness.

Dual epidemics of coronavirus disease 2019 (COVID-19) and HIV cause burnout among HIV health care workers. Guided by a socioecological framework, we investigated risk and protective factors of their burnout in Guangxi, China based on an online survey (N = 1,029) from April to May 2020. Descriptive and bivariate analyses and hierarchical regression were conducted. COVID-19-related stressors (B = 0.648 [0.482-0.816], p.001), challenges while delivering HIV services (B = 0.236 [0.174-0.298], p.001), and working in province/city-level institutes (B = 2.302, [0.828-3.776], p =.002) were risk factors. Protective factors were resilience (B = -0.596 [-0.687 to -0.504], p.001), workplace social support (B = -0.410 [-0.717 to -0.044], p =.03), and institutional responsiveness to COVID-19 (B = -0.138 [-0.205 to -0.071], p.001), respectively. Burnout-related interventions may benefit from promoting resilience, creating a supportive work environment, and strengthening institutional response to public health emergencies.

College students are vulnerable to psychological distress during COVID-19 due to pandemic-related stressors. In response to psychological distress, college students engage in various coping behaviors, such as self-care behaviors and substance use. The transactional model of stress and coping depicts a cognitive appraisal process in the stress-coping association. Psychological resilience is an essential factor for the cognitive appraisal. This study aimed to investigate the mediation effects of resilience on psycho-behavioral health in response to COVID-19 stressors.Longitudinal data were collected from 1,225 Chinese college students via web-based anonymous surveys at wave 1 (T1, between Jan 31 and Feb 11, 2020) and wave 2 (T2, between Mar 20 and Apr 3, 2020).Participants reported their COVID-19 stressors (T1), resilience (T1), psychological distress (depression and anxiety; T2), and coping behaviors (self-care behaviors, drinking, and smoking; T2). Path analysis was used for data analyses.Resilience mediated the association between COVID-19 stressors and psychological distress. Resilience together with psychological distress mediated the association of COVID-19 stressors with self-care behaviors or drinking.Resilience appears to offer protection that promotes psycho-behavioral health in college students in the face of COVID-19 stressors. Interventions for college students should attend to resilience.

During the COVID-19 pandemic, HIV-related services have been unavoidably disrupted and impacted. However, the nature and scope of HIV service disruptions due to COVID-19 has rarely been characterized in China. A cross-sectional online survey was conducted among 1029 HIV healthcare providers in Guangxi, China, from April to May 2020. Latent class analysis (LCA) was first used to identify HIV service disruption levels, then hierarchical multilevel logistic regression was conducted to analyze the relationships of COVID-19 challenges, institutional responses, and HIV service disruption levels adjusting for the clustering effect of institutional ownership levels. Four classes of HIV service disruption were identified, with 22.0% complete disruption, 15.4% moderate disruption, 21.9% minor disruption, and 40.7% almost no disruption. COVID-19 challenges were positively associated with the probabilities of service disruption levels. Institutional responses were negatively associated with the probabilities of being classified as "minor disruption" and moderated the association of COVID-19 challenges with complete and moderate disruptions compared with no disruption group. To maintain continuity of core HIV services in face of a pandemic, building a resilient health care system with adequate preparedness is necessary.

BackgroundSubstance use has become a critical health concern during the COVID-19 pandemic, and emerging attention has been paid to people with the persistent symptoms of COVID-19 (COVID-19 long haulers) due to their high vulnerability. However, scant research has investigated their substance use and relevant psychosocial factors. The current study was to (1) examine substance use behaviors (i.e., legal drug use, illicit drug use, and non-medical use of prescription drugs); and (2) assessed their associations with psychiatric symptoms (i.e., depression, anxiety, and post-traumatic stress disorder) and psychosocial factors (i.e., personal mastery and social support) among COVID-19 long haulers.MethodsIn January – March 2022, 460 COVID-19 long haulers (50% female), with an average age of 32, completed online surveys regarding their demographics, substance use, psychiatric symptoms, and psychosocial factors.ResultsIn the past three months, the most commonly used or non-medically used substances were tobacco (82%) for legal drugs, cocaine (53%) for illicit drugs, and prescription opioids (67%) for prescription drugs. Structural equation modeling suggested that psychiatric symptoms were positively associated with substance use behaviors (βs = .38 to .68,ps < .001), while psychosocial factors were negatively associated with substance use behaviors (βs = -.61 to -.43,ps < .001).ConclusionSubstance use is common in COVID-19 long haulers and psychiatric symptoms are the risk factors. Personal mastery and social support appear to offer protection offsetting the psychiatric influences. Substance use prevention and mental health services for COVID-19 long haulers should attend to personal mastery and social support.

BACKGROUND Suicide has been particularly concerning in the United States (US), but the risk assessment has been challenging because of its dependence on psychometric evaluations at the clinics. Growing attention has been paid to the role of social media since existing literature indicates that social media users disclose their suicide ideation and seek help online. Artificial neural networks (ANNs) have been proven as promising for sematic analysis of psychiatric health Internet contents. ANNs may also be applicable for the suicide risk assessment on social media, such as Twitter. OBJECTIVE This study aimed to explore the feasibility of using three widely used ANNs, including Convolutional Neural Network (CNN), Long Short-Term Memory (LSTM), and Bidirectional Encoder Representations from Transformers (BERT), to identify suicide-risk contents on Twitter in the US. METHODS Three ANNs were trained and tested using a training dataset of 9,900 tweets developed through a human-in-the-loop approach. The performance of the models was tested using several statistical indicators, including precision, recall, and F-1 scores. AUC-ROC and PR-AUC were also calculated. The ANN with the best performance was applied to classify suicide-risk contents in the pool of 3.2 million historical tweets (2010 to 2021) filtered by expert-determined keywords. RESULTS Compared to CNN and LSTM, BERT showed a higher precision, recall, and F-1 score on the classification of suicide-risk tweets. BERT had greater AUC-ROC and PR-AUC than the other two ANNs. The trained BERT was then used for the classification among historical tweets, and results suggested that the ratio of Twitter users who posted such contents increased (year 2011 to 2014) and then gradually decreased (2014 to 2021). CONCLUSIONS BERT appears to outperform CNN and LSTM in classifying suicide-risk tweets. Its classification results for past-decade historical tweets were aligned with the national survey data on suicide-related psychiatric symptoms (i.e., depression). Future suicide prevention would benefit from applying ANNs to identify users with suicide risks on social media and offer timely online interventions.

BackgroundArtificial-Intelligence (AI)-based chatbots can offer personalized, engaging, and on-demand health-promotion interventions. This systematic review evaluates the feasibility, efficacy, and intervention characteristics of AI-chatbots in promoting health-behavior change.MethodsA comprehensive search was conducted in seven bibliographic databases (PubMed, IEEE Xplore, ACM Digital Library, PsychoINFO, Web of Science, EMBASE, and JMIR publications) for empirical articles published from 1980 to 2022 that evaluated feasibility and/or efficacy of AI-chatbots for behavioral change. The screening, extraction, and analyses of identified articles followed the PRISMA guidelines.ResultsOf the 15 included studies, majority studies (n=11) reported high usability, acceptability and engagement, and some evidence on feasibility of AI-chatbots. Selected studies demonstrated high efficacy in promoting healthy lifestyles (n=6), smoking cessation (n=4), treatment/medication adherence (n=2), and reduction in substance misuse (n=1). Behavioral change theories and/or expert consultation were used to develop behavioral change strategies of AI-chatbots, including goal setting, monitoring, real-time reinforcement/feedback, and on- demand support. Real-time user-chatbot interaction data, such as user preferences and behavioral performance, were collected on the chatbot platform to identify ways of providing personalized services. The AI-chatbots demonstrated potential for scalability by deployment through accessible devices and platforms (e.g., smartphones and messenger). Participants also reported that AI-chatbots offered a non-judgmental space for communicating sensitive information. However, the reported results need to be interpreted with caution because of moderate to high risk of internal validity, insufficient description of AI-techniques, and limitation for generalizability.ConclusionAI-chatbots have demonstrated efficacy of health-behavior change interventions among large and diverse population; however, future studies need to adopt robust RCTs to establish definitive conclusions.

BACKGROUND Artificial intelligence (AI)–based chatbots can offer personalized, engaging, and on-demand health promotion interventions. OBJECTIVE The aim of this systematic review was to evaluate the feasibility, efficacy, and intervention characteristics of AI chatbots for promoting health behavior change. METHODS A comprehensive search was conducted in 7 bibliographic databases (PubMed, IEEE Xplore, ACM Digital Library, PsycINFO, Web of Science, Embase, and JMIR publications) for empirical articles published from 1980 to 2022 that evaluated the feasibility or efficacy of AI chatbots for behavior change. The screening, extraction, and analysis of the identified articles were performed by following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS Of the 15 included studies, several demonstrated the high efficacy of AI chatbots in promoting healthy lifestyles (n=6, 40%), smoking cessation (n=4, 27%), treatment or medication adherence (n=2, 13%), and reduction in substance misuse (n=1, 7%). However, there were mixed results regarding feasibility, acceptability, and usability. Selected behavior change theories and expert consultation were used to develop the behavior change strategies of AI chatbots, including goal setting, monitoring, real-time reinforcement or feedback, and on-demand support. Real-time user-chatbot interaction data, such as user preferences and behavioral performance, were collected on the chatbot platform to identify ways of providing personalized services. The AI chatbots demonstrated potential for scalability by deployment through accessible devices and platforms (eg, smartphones and Facebook Messenger). The participants also reported that AI chatbots offered a nonjudgmental space for communicating sensitive information. However, the reported results need to be interpreted with caution because of the moderate to high risk of internal validity, insufficient description of AI techniques, and limitation for generalizability. CONCLUSIONS AI chatbots have demonstrated the efficacy of health behavior change interventions among large and diverse populations; however, future studies need to adopt robust randomized control trials to establish definitive conclusions.

Peer victimization is detrimental to child mental health. Research has indicated a reciprocal relationship between peer victimization and mental health problems. Yet limited evidence was from children and adolescents in China. The present study used the random intercepts cross-lagged panel model (RI-CLPM) to examine both between-person and within-person associations between peer victimization and depressive symptoms among Chinese children and adolescents. Participants were 1205 Chinese students (M

Psychological distress among healthcare providers is concerning during COVID-19 pandemic due to extreme stress at healthcare facilities, including HIV clinics in China. The socioecological model suggests that psychological distress could be influenced by multi-level factors. However, limited COVID-19 research examined the mechanisms of psychological distress among HIV healthcare providers. This study examined organizational and intrapersonal factors contributing to psychological health during COVID-19 pandemic. Data were collected via online anonymous surveys from 1029 HIV healthcare providers in Guangxi, China during April–May 2020. Path analysis was utilized to test a mediation model among COVID-19 stressors, institutional support, resilience, and psychological distress (PHQ-4). Thirty-eight percent of the providers experienced psychological distress (PHQ-4 score > 3). Institutional support and resilience mediated the relationship between COVID-19 stressors and psychological distress. Psychological distress was common among Chinese HIV healthcare providers during COVID-19 pandemic. Psychological health intervention should attend to institutional support and resilience.

HIV healthcare providers might be vulnerable to mental health problems during the COVID-19 pandemic. Guided by the stress and coping paradigm, the current study aimed at examining the interactive effects of COVID-19-related stressors and coping on mental health problems. A cross-sectional online survey was conducted among 1029 HIV healthcare providers in Guangxi, China. The prevalence of depression and anxiety in the current study was 13.31% and 6.61%, respectively. Results from path analyses revealed that the main effects of COVID-19-related stressors and coping were significant on both depression and anxiety. The interaction of coping and COVID-19-related stressors had significant effects on depression and anxiety. Simple slope tests revealed that more coping behaviors buffered against the negative effect of COVID-19-related stressors on mental health problems. Coping acted as a protective factor that alleviated the harm of COVID-19-related stressors on mental health. Intervention targeting coping management might benefit the mental health of HIV healthcare providers.

Objectives: Non-medical use of prescription drugs (NMUPD) has become a threat to public health. In the United States, NMUPD is especially common in young adults (aged 18-25). Self-esteem is a robust psychosocial factor of substance use. The substance use literature also documents that self-esteem is associated with alcohol use through other cognitive factors, such as coping. Given the important role of coping in substance use intervention, it is important to understand how coping alters mechanisms underlying the effects of self-esteem on NMUPD. However, little research has explored mediational mechanisms among self-esteem, coping, and NMUPD. The current study sought to examine a hypothesized mediation model among self-esteem, coping, and NMUPD in college students. Methods: Data were collected online from 1052 undergraduates (aged 18 to 25; 723 females) in a large public university in Virginia. Participants reported their past-three-month NMUPD (i.e. opioids, sedatives, anxiolytics, and stimulants), self-esteem, and coping (13 domains; e.g. active coping and self-blame). Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to identify the factorial structure of coping. Structural equation modeling (SEM) was employed for examining the hypothesized mediation model. Results: EFA and CFA identified a two-factor structure of coping (i.e. adaptive coping and maladaptive coping). SEM suggested that adaptive coping together with maladaptive coping completely mediated the relationship between self-esteem and NMUPD. The goodness-of-fit indicators suggest a good model fit (RMSEA = .04; CFI = .95; TLI = .93; WRMR = 1.11). Conclusion: Self-esteem appears to be a protective factor for NMUPD in college students, and its relationship with NMUPD is mediated by two types of coping. Future interventions targetting NMUPD among college students should attend to self-esteem and coping.

Introduction: Persistent COVID-19 symptoms (long COVID) may bring numerous challenges to long haulers' social lives. Women may have to endure more profound impacts given their social roles and existing structural inequality. This study aims to explore the impacts of long COVID on various aspects of social life among female long haulers.Methods: We conducted 15 semi-structured interviews with female long haulers in the United States purposely recruited from Facebook groups, Slack group, and organization websites. The interviews were audio recorded after appropriate consent and transcribed verbatim. Inductive approach was applied in thematic analysis, which consists of six stages: becoming familiar with data, developing initial codes, extracting themes, refining themes, labeling themes, and reporting. The MAXQDA software was used in data analysis.Results: Participants reported persistent symptoms that negatively affected their social lives in many ways. The main impacts included physical limitation, financial hardship, social relationship, conflict of social roles, and social stigma. Negative effects of long COVID hindered female long haulers’ recovery process. Social isolation, COVID-19 associated stigma, and conflicts of social roles cause tremendous stress. Employers’ support and social media usage may play positive role in their coping with impacts of long COVID on their social life.Conclusion: Existing policies and intervention programs need to be adapted to address the challenges and barriers that long haulers face in returning to normal social life, especially for females. Tailored social life-related recommendations and social support are needed for female long haulers.

IntroductionPersistent COVID-19 symptoms (long COVID) may bring numerous challenges to long haulers’ social lives. Women may have to endure more profound impacts given their social roles and existing structural inequality. This study aims to explore the impacts of long COVID on various aspects of social life among female long haulers.MethodsWe conducted 15 semi-structured interviews with female long haulers in the United States purposely recruited from Facebook groups, Slack groups, and organization websites. The interviews were audio recorded after appropriate consent and transcribed verbatim. Inductive approach was applied in thematic analysis, which consists of six stages: becoming familiar with data, developing initial codes, extracting themes, refining themes, labeling themes, and reporting. The MAXQDA software was used in data analysis.ResultsPersistent COVID-19 symptoms negatively affected female long haulers’ social lives in many aspects including physical function, financial security, social relationship, conflict of social roles, and social stigma. Physical limitations changed their body image. Social isolation and work-family conflicts caused huge stress. They experienced internalization of stigma and job insecurities. Shifting to new methods of communication, especially social media may buffer the negative effects of social isolation because of long COVID.ConclusionExisting policies and intervention programs need to be adapted to address the challenges and barriers that long haulers face in returning to normal social life, especially for females. Tailored social life-related recommendations and social support are needed for female long haulers.

Background The current study evaluated the preliminary efficacy of a pilot trial of a resilience-based intervention programme designed to decrease depression symptoms and improve protective factors (e.g. personal assets, social resources, cultural adaptation self-efficacy, interpreting adversity, and self-esteem) among rural-to-urban migrant children in China. Methods Participants were 285 fourth and fifth graders from two migrant children schools in Beijing. One school was cluster-randomly assigned as the intervention group (n = 127) and the other was assigned as the wait-list control group (n = 158). Data were collected at baseline and post-intervention with a follow-up rate of 96.8 per cent. Results Multivariate analyses found significantly greater increases in social resources, cultural adaptation self-efficacy, and making positive sense of adversity in the intervention group than in the control group. In the intervention group, migrant children who had moved more often reported a higher increase in personal assets than those who had fewer mobility experience. Conclusion The findings suggest that the resilience-based intervention can be efficacious in improving resilience among migrant children in China.

Before herd immunity is reached, preventive practices still play an important role in controlling the COVID-19 pandemic. Adherence to preventive behaviors could be determined by individuals' health beliefs, which would be influenced by antecedent factors such as previous exposure to pandemic stressors. Applying the health belief model (HBM), this study aims to examine the mediation association among COVID-19 stressors, HBM constructs, and preventive behaviors. Longitudinal data were collected from 1225 Chinese college students using web-based surveys at wave 1 (w1; between January 31 and February 11, 2020) and wave 2 (w2; between March 20 and April 3, 2020). Participants reported their COVID-19 stressors (w1), five HBM constructs (w2), and preventive behaviors (w1 and w2). Paired t-tests suggested that social distancing and self-quarantine behaviors decreased while precautionary behaviors increased from w1 to w2. Path analysis indicated that two HBM constructs (perceived barriers and self-efficacy) mediated the association between COVID-19 stressors and precautionary behaviors. These findings suggested that tailored prevention intervention for college students should attend to perceived barriers and self-efficacy. Individuals who exposed to multiple pandemic stressors merit particular attention and intervention should account for their early pandemic stress experiences.

Background: Nonmedical use of prescription drugs (NMPUD) has become a critical public health concern. Chinese literature has paid growing attention to NMUPD, but scarce research has focused on fema...

BackgroundThe healthcare system in China was largely overwhelmed during the unprecedented pandemic of coronavirus disease (COVID-19). HIV-related services have been unavoidably interrupted and impacted. However, the nature and scope of HIV service interruptions due to COVID-19 has rarely been characterized in China and how HIV service challenges affect the service interruptions are also unclear. The current study aimed at characterize HIV service interruption levels and analyzed its associated factors related to service challenges and institutional response from HIV healthcare providers’ viewpoint.MethodsA cross-sectional online survey was conducted among 1,029 HIV healthcare providers in Guangxi, China, from April to May 2020. Latent class analysis (LCA) was first used to identify HIV service interruption levels. Then hierarchical multinomial logistic regression was conducted to analyze the relationships of HIV care service challenges and institutional response with HIV service interruption levels. Simple slope analysis was employed to examine interaction effects between HIV service challenges and institutional response to COVID-19.ResultsFour classes of HIV service interruption were identified using LCA, with 22.0% complete interruption (class 1), 15.4% moderate interruption (class 2), 21.9% minor interruption (class 3) and 40.7% almost no interruption (class 4). Using class 4 as a reference group, HIV care service challenges were positively associated with the probabilities of service interruptions (Class 1: AOR=1.23, 95%CI: 1.19∼1.26; Class 2: AOR= 1.10, 95%CI: 1.08∼1.13; Class 3: AOR= 1.10, 95%CI: 1.08∼1.12). Institutional response to HIV healthcare delivery was negatively associated with the probabilities of being classified into Class 1 (“Complete interruption”) (AOR=0.97, 95%CI: 0.93∼1.00) and Class 3 (“minor interruption [Outreach service]”) (AOR=0.96, 95%CI: 0.93∼0.99) as compared to Class 4 (“almost no interruption”). Institutional response to HIV healthcare delivery moderated the association of HIV service challenges with complete interruption, but not with the moderate or minor interruption when comparing with no interruption group.ConclusionsA substantial HIV service interruptions occurs due to the COVID-19 pandemic, particularly services that require face-to-face interactions, such as VCT counselling, follow up and outreach services. HIV service challenges largely hinder the HIV service delivery. Institutional response to HIV healthcare delivery could marginally buffer the negative effect of service challenges on complete HIV service interruptions. To maintain continuity of core HIV services in face of a pandemic, build a resilient health care system with adequate preparedness is necessary.

BackgroundTo control the COVID-19 pandemic, governments need to ensure a successful large-scale administration of COVID-19 vaccines when safe and efficacious vaccines become available. Vaccine acceptance could be a critical factor influencing vaccine uptake. Health information has been associated with vaccine acceptance. For college students who are embracing a digital era and being exposed to multimedia, the sources of COVID-19 vaccine information and their trust in these sources may play an important role in shaping their acceptance of vaccine uptake.MethodsIn September 2020, we conducted an online survey among 1062 college students in South Carolina to understand their perceptions and attitudes toward COVID-19 vaccination. Descriptive analysis and linear regression analysis were used to investigate vaccine information sources among college students and examine how COVID-19 vaccine acceptance was associated with information source and trust level in each source.ResultsThe top three sources of COVID-19 vaccine information were health agencies (57.7%), mass media (49.5%), and personal social networks (40.5%). About 83.1% of the participants largely or always trusted scientists, 73.9% trusted healthcare providers, and 70.2% trusted health agencies. After controlling for key demographics, vaccine acceptance was positively associated with scientists as information sources but negatively associated with pharmaceutical companies as sources. Higher trust levels in mass media, health agencies, scientists, and pharmaceutical companies was significantly associated with higher COVID-19 vaccine acceptance. However, trust in social media was negatively associated with vaccine acceptance.DiscussionCollege students use multiple sources to learn about upcoming COVID-19 vaccines including health agencies, personal networks, and social media. The level of trust in these information sources play a critical role in predicting vaccine acceptance. Trust in health authorities and scientists rather than social media is related to higher level vaccine acceptance. Our findings echo the call for restoring trust in government, healthcare system, scientists, and pharmaceutical industries in the COVID-19 era and highlight the urgency to dispel misinformation in social media. Effective strategies are needed to disseminate accurate information about COVID-19 vaccine from health authorities and scientific research to improve vaccine communication to the public and promote COVID-19 vaccine uptake.

BackgroundCOVID-19 vaccination could be a promising approach in controlling the pandemic, but its success strongly relies on the acceptance of vaccines among various populations including young adults who are especially vulnerable to COVID-19 due to their active lifestyle and perception of invulnerability. Vaccine acceptance decisions can be influenced by multiple factors and people may weigh these factors differently in their decision making. The current study aims to explore COVID-19 vaccine acceptance among college students in South Carolina and examine how they weigh these factors according to their levels of COVID-19 vaccine acceptance (i.e., acceptance, hesitance, refusal).MethodsOnline survey data were collected from 1062 college students in South Carolina between September and October 2020. Multivariate analysis of covariance was used to compare perceived importance of 12 factors affecting levels of vaccine acceptance, controlling for key demographic variables.ResultsAbout 60.6% of the college students reported they would definitely or likely take COVID-19 vaccine when available. Duration of vaccine protection, vaccine accessibility, and authoritative advice (e.g., if vaccination is recommended by school, government, or doctors) were considered important among the acceptance group; Negative consequences of vaccination and vaccine characteristics (i.e., ways the vaccine will be administered, and where the vaccine is made) were considered important by the refusal group; The hesitance group considered the same factors important as the refusal group did but also considered duration of vaccine protection and recommendation by school or doctors important.ConclusionOur findings suggest relatively low vaccine acceptance among college students in South Carolina and different factors that play a role in their vaccine uptake decision according to their levels of acceptance. Tailored vaccine promotion messages should address specific concerns among the refusal and hesitancy groups. School could play a positive role in vaccine campaign since the reluctancy group considered that recommendation by their school was important in their decision making. Health educators also need to pay particular attention to the refusal group who do not value duration of protection or authoritative advice as much as their counterparts in their vaccine decision making.

Purpose: The current study investigated how risk exposures, risk perceptions of COVID-19, and negative attitudes toward general vaccination were related to COVID vaccine acceptance among college students. Design: Cross-sectional study. Setting: Data was collected by online survey using RedCap among college students in South Carolina between September 2020 and October 2020. Sample: 1062 college students in South Carolina. Measures: risk exposures to COVID-19, perceived severity of COVID-19, perceived susceptibility of COVID-19, negative attitude toward general vaccination, vaccine acceptance of COVID-19. Analysis: Hierarchical linear regression was used to examine the association of these factors with COVID-19 vaccine acceptance controlling for key demographics. Results: Perceived severity of COVID-19 was positively associated with vaccine acceptance (ß = 0.19, p < 0.001). Higher level of risk exposures (ß = −0.08, p = 0.007) and negative attitude toward general vaccination (ß = −0.38, p < 0.001) were associated with low vaccine acceptance. Conclusion: We need tailored education messages for college students to emphasize the severity of COVID-19, address the concerns of side effects of general vaccines by dispelling the misconception, and target the most vulnerable subgroups who reported high level of risk exposures while showed low intention to take the vaccine.

Background Prescription opioid misuse (POM) has become a critical public health issue in the United States (US), with veteran and military population being especially vulnerable to POM. However, limited behavioral interventions have been developed for veterans and military to reduce POM risk due to the lack of an adequate understanding of POM andrelated factors among veterans and military. The current study aims to review and synthesize empirical findings regarding POM and its correlates among US veterans and military. Methods We conducted a systematic review of 17 empirical studies (16 quantitative studies and one qualitative study) from 1980 to 2019 that reported POM statistics (e.g., prevalence) and examined correlates of POM in veterans and military. Results The prevalence of POM in veterans and military ranged from 6.9%–77.9% varying by study samples, individual POM behaviors, and recalled time periods. Several factors were identified to be associated with POM in veterans and military. These factors included socio-demographic factors (age, race/ethnicity, education, relationship status, and military status), pain-related factors (pain symptoms, severity, interference, and cognitions), other physical factors (e.g., common illness), opioid-medication-related factors (receipt of opioid medications and quantity of opioid medications), behavioral factors (substance use disorder, alcohol use, cigarette use, and other prescription drug use), and psychological factors (psychiatric symptoms and cognitive factors). Conclusions POM was prevalent in veterans and military and could be potentially influenced by multiple psycho-behavioral factors. Future research guided by a theoretical framework is warranted to examine psycho-behavioral influences on POM and their mechanisms and to inform effective psychosocial POM interventions in veterans and military.

Due to a dramatic increase in the past 20 years, the non-medical use of prescription drugs (NMUPD) has become a global public health issue. College students have high prevalence of NMUPD in the United States. However, limited studies have been conducted among Chinese students. The purposes of this study were to examine the prevalence of NMUPD among college students in two urban centers (Beijing and Macau) in China and assess its relationships with cultural orientation (collectivism - primary focus on the group and individualism - primary focus on the individual).In January-April 2017, 849 undergraduates (72.2% female) from Beijing and Macau, with an average age of 20 completed online surveys about their demographics, NMUPD, and cultural orientation.Overall, 62.9% (lifetime) and 33.4% (past three-months) of students in Beijing reported NMUPD, while 35.9% (lifetime) and 21.8% (past three-months) of students in Macau reported NMUPD. The most commonly non-medically used class of medicine (lifetime) was analgesics (62.9% Beijing; 35.5% Macau), followed by sedatives (4.0% Beijing; 0.9% Macau), anxiolytics (2.7% Beijing; 0.6% Macau), and stimulants (1.0% Beijing; 0.2% Macau). Multivariate analyses suggested a positive association of individualism with lifetime NMUPD (OR = 1.78, 95% CI = 1.15, 2.75, p .01 in Beijing; OR = 1.53, 95% CI = 1.16, 2.02, p .01 in Macau).NMUPD in Chinese college students appears to be common. More discussion is needed in China about regulation of prescription drugs. Future culturally-tailored NMUPD-risk reduction intervention programs may be beneficial to Chinese college students.

The current study aims to investigate the mediating effect of perceived control over the future and the moderating effect of empathy on the association between stressful experiences and PTSD symptoms among college students in China in response to COVID-19. A sample of 1,225 college students (70.69% were female, M age = 20.22 years, SD = 2.02) were recruited using web-based surveys at wave 1 (W1) and wave 2 (W2) longitudinally. Results showed that COVID-19-related stressful experiences were significantly associated with PTSD symptoms. Perceived control over the future partially mediated the relationship between these two variables ( indirect effect size = 0.09, p < 0.01). Empathy significantly moderated the path from perceived control over the future to PTSD symptoms, suggesting that the association was stronger for individuals with higher levels of empathy. Findings suggest a protective effect of perceived control over the future on college students’ PTSD symptoms during the COVID-19 pandemic. Such a protective effect was intensified by empathy. Future intervention to manage PTSD symptoms should be tailored to positive future expectations and empathy.

Background: Due to the high prevalence of non-medical use of prescription drugs (NMUPD; i.e., use of these drugs without a doctor’s prescription) among college students, it is important to identify psychosocial factors relevant to NMUPD. Prior research shows a link between perceived stress, psychiatric symptoms and NMUPD. Resilience is an essential concept in adaptive coping that emphasizes that resilience protects people against stress. Substantial evidence shows the mediation effect of resilience on the relationship between stress, psychiatric symptoms, and substance use. However, scant literature has examined associations between resilience and NMUPD. Objectives: The current study explored the relationship among perceived stress, psychiatric symptoms, resilience, and NMUPD in college students. Methods: Online data were collected from 1,052 undergraduates (68.7% females) with an average age of 19.8 years in 2016 in Virginia, United States, using anonymous surveys assessing perceived stress, psychiatric symptoms (i.e., depression and social anxiety), resilience (i.e., tenacity, tolerance, acceptance, control, and spirituality), and past-three-month NMUPD (i.e., opioids, sedatives, anxiolytics, and stimulants). Structural equation modeling was employed for data analysis. Results: Resilience together with psychiatric symptoms completely mediated the effects of perceived stress on NMUPD. Resilience completely mediated the relationship between perceived stress and psychiatric symptoms. The goodness-of-fit indicators suggested a good fit of data (RMSEA = .04; CFI = .97; TLI = .96; WRMR = 1.37). Conclusions: Resilience appears to offer protection that can mitigate the effects of perceived stress and psychiatric symptoms on NMUPD. Future interventions related to NMUPD among college students should attend to resilience.

Social stigma has deleterious effects on psychological well-being. Emerging empirical evidences suggest that resilience is an adaptive mindset that generally enables people to survive and thrive in adversity. The current study used a three-wave longitudinal data to examine the potential bidirectional association between perceived stigmatization and resilience. Children of parents living with HIV (n = 195) were assessed at the baseline and followed up for 12 months with 6-month intervals. Cross-lagged panel analyses were performed in the study. The findings showed that the autoregressive effects were stable for perceived stigmatization and resilience, suggesting stable individual differences over time. The cross-lagged effects indicated that perceived stigmatization negatively predicted the level of resilience. However, resilience did not predict perceived stigmatization during the study time. The study suggests a robust longitudinal effect of perceived stigmatization on resilience. The potential bidirectional association between perceived stigmatization and resilience should be examined in the future studies.

Background: The global literature has revealed that cultural orientation, adaptation and social capital may influence HIV-related sexual behaviours among migrants. However, whether cultural orientations influence adaptation and social capital and thereby affect sexual behaviour is not well understood. Method: This study examined whether individualistic and collectivistic orientations, adaptation and social capital have direct and indirect effects on condom use among rural-to-urban migrants in China. We collected data from 641 migrants aged 17 to 30 years, in Beijing, China. Participants completed scales on individualistic orientation, collectivistic orientation, adaptation, social capital and condom use. Structural equation modelling was used for model testing. Results: Condom use was positively associated with an individualistic orientation and social capital. An individualistic orientation had an indirect effect on condom use via social capital. Women reported higher levels of condom use than men. Conclusion: Future sexual risk prevention and intervention programmes to improve sexual health should pay more attention to building social capital and engaging with relevant cultural factors.

Parental illness and death due to human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) impose challenges to children's psychological adjustment. Positive psychology emphasizes individual's resilience in the face of adversity, trauma, and tragedy. Limited data are available regarding the factors that can cultivate resilience of children affected by HIV/AIDS. This study aims to examine the role of extracurricular interest in strengthening resilience among children affected by HIV/AIDS. Participants included 755 children orphaned by parental HIV/AIDS, 466 vulnerable children living with HIV-positive parent(s), and 404 comparison children from HIV-free families in the same community in rural China. The measures include extracurricular interest (i.e., reading, sports, music, painting, science, and playing chess) and indicators of psychological adjustment (i.e., depression, loneliness, and self-esteem). Having extracurricular interest was positively associated with self-esteem and negatively associated with depression and loneliness. Having extracurricular interest attenuated the negative effect of parental HIV/AIDS on children's self-esteem and loneliness, after controlling for children's age, gender, and family socioeconomic status. The findings underscore the importance of nurturing extracurricular interest and make available of such activities to promote resilience for children affected by HIV/AIDS in resource-limited settings.

Previous literature has suggested high rates of HIV/STIs among Chinese FSWs. However, limited data were available regarding HIV-related risks among Vietnamese FSWs - a rapidly increasing, vulnerable population in southwest China. The current study examined the demographic and behavioral factors associated with the infection rates of HIV, syphilis, and Hepatitis C (HCV) among Vietnamese FSWs in Guangxi, China. We conducted a secondary data analysis of a cumulative sample of 1026 Vietnamese FSWs (aged 14-66) recruited over five years (2010-2014) from 35 National Sentinel Surveillance sites in Guangxi. Analyses included Fisher's exact chi-square test, t-test, and binary logistic regression. The overall prevalence of HIV, syphilis, and HCV infections among the cross-border women were 3.2%, 6.9%, and 2.6%, respectively. Multivariate analysis showed that greater lengths of sex work and low paying work venues were significant risk factors for HIV infection; for syphilis infection, older age, drug use experience, and forgoing condom use were significant risk factors; for HCV infection, drug use experience was the only significant risk factor. Our findings suggest that elevated HIV-related risks among the Vietnamese FSWs are closely related to their financial disadvantages and that drug use is a prominent risk factor for cross-border women in the sex trade. Furthermore, culturally tailored and linguistically accessible HIV prevention and intervention initiatives that target cross-border FSWs, with a close international collaboration between China and Vietnam, are urgently needed.

Parental illness imposes great challenges to children's life and mental health. Having a parent infected by HIV may further challenge children's psychological well-being. Existing studies have demonstrated a negative impact of caregiver's distress on children's well-being. Limited studies examined the potential pathways of the link. This study aims to examine whether parenting stress, parenting competence and parental responsiveness can explain the relationship between caregivers' distress and children's well-being. A community sample of children of parents living with HIV and their current caregivers (n = 754 dyads) was recruited in rural central China. Children completed the measures on their psychological well-being and perceived parental responsiveness of their caregivers. Caregivers reported on their psychological well-being, parenting stress, and parenting competence. Structural equation modeling analysis showed that caregivers' distress indirectly affect children's well-being through parenting stress, parenting competence and parental responsiveness. Parenting stress explained the impact of caregiver's distress on parental responsiveness and showed pervasive effects on parenting competence. Our findings lend credence to family-based intervention for children affected by HIV and affirm the importance of incorporating the cognitive, emotional and behavioral components of parenting practices in such intervention.

The current study examined the longitudinal relationship of collectivistic orientation and depression and the mediating effects of acculturative stress and cultural self-efficacy between collectivistic orientation and depression. We expect that collectivistic orientation would decrease acculturative stress and increase cultural self-efficacy, and in turn, improve depression. Using data from 641 Chinese internal migrants during a one-year period, the results supported the hypothesis that collectivistic orientation predicted decreased depression. Moreover, collectivistic orientation alleviated depression through reducing acculturative stress. Although cultural self-efficacy was also a significant mediator, collectivistic orientation relieved depression through decreasing cultural self-efficacy. Implications for future research directions and counseling are discussed.

Objectives: The global literature has revealed potential negative impacts of migration and discrimination on individual's psychological adjustments. However, the psychological adjustments among internal migrant children in developing countries are rarely assessed. This study simultaneously examines perceived discrimination and schooling arrangements in relation to psychological adjustments among rural-to-urban migrant children in China. Methods: A sample of 657 migrant children was recruited in Beijing, China. Cross-sectional associations of self-reported perceived discrimination and schooling arrangements (i.e. public school and migrant children school (MCS)) with psychological adjustment outcomes (i.e. social anxiety, depression and loneliness) were examined by general linear model. Results: (1) Compared with migrant children in public school, migrant children in MCS had lower family incomes, and their parents had received less education. (2) Migrant children in MCS reported higher levels of social anxiety, depression and loneliness than did their counterparts. Children who reported high level of perceived discrimination also reported the highest level of social anxiety, depression and loneliness. (3) Perceived discrimination had main effects on social anxiety and depression after controlling for the covariates. A significant interaction between perceived discrimination and schooling arrangements on loneliness was found. Specifically, the migrant children in MCS reported higher loneliness scores than did migrant children in public school only at low level of perceived discrimination; however, schooling arrangements was unrelated to loneliness at medium and high levels of discrimination. Conclusions: These results indicate that migration-related perceived discrimination is negatively associated with migrant children's psychological adjustments. These findings suggest that effective interventions should be developed to improve migrant children's capacities to cope with migration-related discrimination and improve their psychological adjustments, especially in terms of loneliness.

The current study aimed to investigate the impact of individualism, collectivism, and hopelessness on substance use. Hopelessness was hypothesized as a mediator between individualism and substance use, and between collectivism and substance use. We tested the hypothesis using a survey of 641 young rural-to-urban migrants in China. Consistent with our hypotheses, individualistic orientation predicted increased hopelessness and subsequently predicted more substance use, whereas collectivistic orientation was associated with decreased hopelessness and subsequently predicted less substance use. Hopelessness fully mediated the relations between individualism and substance use and between collectivism and substance use. The theoretical and practical implications of these findings were discussed.

Our objective was to evaluate the efficacy of a cultural adaptation of a social cognitive theory-based HIV behavioral prevention program among young rural-to-urban migrants in China. The intervention design and assessment were guided by the Protection Motivation Theory (PMT). The intervention was evaluated through a randomized controlled trial with 6-month and 12-month follow-ups. The primary behavioral outcome was the use of condoms. Other outcome measures include HIV knowledge, condom use knowledge, HIV-related perceptions (PMT constructs), and intention to use condom. The mixed-effects regression models for condom use with regular partners indicated that overall frequency of condom use, condom use in last three sexual acts and proper condom use increased over time for the participants but the increases were significantly greater among the intervention group than the control group at 6-month and 12-month follow-ups. The mixed-effects models for HIV-related perceptions indicated that extrinsic rewards, intrinsic rewards, and response costs decreased while vulnerability, severity, response efficacy, and self-efficacy increased over time for the intervention group. The increases in HIV knowledge, condom use knowledge, and intention to use condom were also significantly greater among the intervention group than the control group. The data in the current study suggested efficacy of a social cognitive theory-based behavioral intervention in increasing condom use among young migrants in China. The intervention also increased protective perceptions and decreased risk perception posited by the theory (i.e., PMT).