Psychiatric illness confers significant risk for severe COVID-19 morbidity and mortality; identifying psychiatric risk factors for vaccine hesitancy is critical to mitigating risk in this population. This study examined the prevalence of vaccine hesitancy among those with psychiatric illness and the associations between psychiatric morbidity and vaccine hesitancy. Data came from electronic health records and a patient survey obtained from 14,365 patients at a group medical practice between February and May, 2021. Logistic regression was used to calculate odds for vaccine hesitancy adjusted for sociodemographic characteristics and physical comorbidity. Of 14,365 participants 1,761 (12.3%) participants reported vaccine hesitancy. Vaccine hesitancy was significantly more prevalent among participants with substance use (29.6%), attention deficit and hyperactivity (23.3%), posttraumatic stress (23.1%), bipolar (18.0%), generalized anxiety (16.5%), major depressive (16.1%), other anxiety (15.5%), and tobacco use disorders (18.6%), and those previously infected with COVID-19 (19.8%) compared to participants without these disorders. After adjusting for sociodemographic characteristics and physical comorbidities, substance use disorders and tobacco use were significantly associated with increased odds for vaccine hesitancy and bipolar disorder was significantly inversely associated with vaccine hesitancy. Interventions to improve uptake in these populations may be warranted.

This study tested the Wellness Enhancing Physical Activity in Young Children (WE PLAY) program, a 4-week online preschool teacher training, on children's moderate-to-vigorous physical activity (MVPA). In this cluster RCT, six Head Start preschools were randomized to an intervention and comparison group. Children's MVPA was measured using accelerometers at pre-and posttest. The magnitude of the difference in MVPA between groups at posttest was small, but in the expected direction: ⌬ min/hour ϭ 1.60, 95% CI [Ϫ0.97, 4.18], p ϭ .22, Cohen's d ϭ 0.32. We observed a pre/post within group increase in average minutes per hour of MVPA in school with a medium effect size for the intervention group: ⌬ mean min/hour ϭ 2.09, 95% CI [0.51, 3.67], p ϭ .0096, Cohen's d ϭ 0.42. An increase was not seen for the comparison group: ⌬ mean min/hour ϭ 0.44, 95% CI [Ϫ0.70, 1.59], p ϭ .45, Cohen's d ϭ 0.07. WE PLAY children in 6 hr/day programs gained 63 min of MVPA per week in school, providing preliminary evidence of the benefits of WE PLAY on children's physical activity levels. WE PLAY deserves further testing with larger groups of children and teachers. Impact and ImplicationsPhysical activity is critical for children's physical and emotional well-being and cognitive functioning, yet many children need help from adults to be more active. The Wellness Enhancing Physical Activity for Young Children (WE PLAY) online teacher professional development program was developed to support the knowledge, confidence, and skills of early childhood educators so they can lead active play every day with their students. This study found that children whose teachers completed WE PLAY training engaged in higher levels of moderateto-vigorous physical activity at posttest relative to pretest, and those changes were not observed in a comparison group.

BackgroundStrong and consistent associations between access to firearms and suicide have been found in ecologic and individual-level observational studies. For adolescents, a seminal case–control study estimated that living in a home with (vs without) a firearm was associated with a fourfold increase in the risk of death by suicide.MethodsWe use data from a nationally representative study of 10 123 US adolescents aged 13–18 years to (1) measure how much adolescents who live in a home with a firearm differ from those who do not in ways related to their risk of suicide, and (2) incorporate these differences into an updated effect estimate of the risk of adolescent suicide attributable to living in a home with firearms.ResultsAlmost one-third (30.7%) of adolescents reported living in a home with firearms. Relative to those who did not, adolescents reporting living in a home with a firearm were slightly more likely to be male, older and reside in the South and rural areas, but few differences were identified for mental health characteristics. The effect size found by Brent and colleagues appeared robust to sources of possible residual confounding: updated relative risks remained above 4.0 across most sensitivity analyses and at least 3.1 in even the most conservative estimates.ConclusionsAlthough unmeasured confounding and other biases may nonetheless remain, our updated estimates reinforce the suggestion that adolescents’ risk of suicide was increased threefold to fourfold if they had lived in homes with a firearm compared with if they had not.