Rural Adolescent Health: The Importance of Prevention Services in the Rural Community

Context: Adolescence is a pivotal developmental period for the establishment of positive health and health practices. However, developmentally propelled risk behaviors coinciding with barriers to health services may increase the propensity for untoward health outcomes in adolescence. In addition, the sociocultural context of the rural environment can present challenges to the health of adolescents. Limited data on rural adolescent health, particularly among population subgroups, hinder the ability to adequately advocate for adolescent health prevention services. Methods: A secondary analysis of the 2005 California Health Interview Survey Adolescent questionnaire was conducted. Selected survey items corresponding to the Healthy Youth 2010 objectives were analyzed for 663 adolescents aged 12‐17 residing in rural regions of California. Adolescent subgroup analysis included race/ethnicity, age, and poverty level. Findings: Adolescent health issues of particular concern in this study include sexual health, substance use, mental health, and risk factors for obesity. Predictably, risk behaviors increase with the age of the adolescent. Minority and poor youth demonstrate the greatest vulnerability to untoward health outcomes. Conclusion: Significant risk behaviors and health concerns exist among the rural adolescent population, particularly among poor and minority youth, arguing for the creation and preservation of prevention services for youth in the rural community. Future research using alternative sampling methodologies may be necessary to adequately represent the higher‐risk adolescent in the rural community. More data are needed on vulnerable adolescent populations in the rural community in order to adequately advocate for prevention services.     

Implications of Comprehensive Mental Health Services Embedded in an Adolescent Obstetric Medical Home

Purpose Mental health issues in perinatal adolescents are well documented and studies have shown high rates of depressive disorders among this population. Treatment is challenging because pregnant adolescents are poorly adherent with mental health services. We describe a novel integrated mental health care program for pregnant and parenting adolescent mothers and their children. Methods The Colorado Adolescent Maternity Program (CAMP) is a comprehensive, multidisciplinary teen pregnancy and parenting medical home program serving an ethnically diverse and low socioeconomic status population in the Denver metro area. We describe the Healthy Expectations Adolescent Response Team (HEART), an embedded mental health care program focused on improving identification of mental health symptoms and increasing rates mental health treatment in adolescent mothers. Results From January 1, 2011–January 16 2014, 894 pregnant adolescents were enrolled in CAMP and 885 patients were screened for mental health issues. Prior to HEART’s inception, 20 % of patients were identified as having mood symptoms in the postpartum period. Successful referrals to community mental health facilities occurred in only 5 % of identified patients. Following the creation of HEART, 41 % of patients were identified as needing mental health services. Nearly half of the identified patients (47 %) engaged in mental health treatment with the psychologist. Demographic factors including age, parity, ethnicity, and parent and partner involvement did not have a significant impact on treatment engagement. Trauma history was associated with lower treatment engagement. Conclusion Our findings suggest that an embedded mental health program in an adolescent obstetric and pediatric medical home is successful in improving identification and engagement in mental health treatment. Key components of the program include universal screening, intensive social work and case management involvement, and ready access to onsite mental health care providers. Limitations of the program are discussed as well directions for future research.     

Using the Clinical Prevention and Population Health Curriculum Framework to encourage curricular change

The Healthy People Curriculum Task Force was established in 2002 to encourage implementation of Healthy People 2010 Objective 1.7: "To increase the proportion of schools of medicine, schools of nursing and health professional training schools whose basic curriculum for healthcare providers includes the core competencies in health promotion and disease prevention." In 2004, the Task Force published a Clinical Prevention and Population Health Curriculum Framework ("Framework") to help each profession assess and develop more robust approaches to this content in their training. During the 6 years since the publication of the Framework, the Task Force members introduced and disseminated it to constituents, facilitated its implementation at member schools, integrated it into initiatives that would influence training across schools, and adapted and applied the Framework to meet the data needs of the Healthy People 2010 Objective 1.7. The Framework has been incorporated into initiatives that help promote curricular change, such as accreditation standards and national board examination content, and efforts to disseminate the experiences of peers, expert recommendations, and activities to monitor and update curricular content. The publication of the revised Framework and the release of Healthy People 2020 (and the associated Education for Health Framework) provide an opportunity to review the efforts of the health professions groups to advance the kind of curricular change recommended in Healthy People 2010 and Healthy People 2020 and to appreciate the many strategies required to influence health professions curricula.     

Ethnic minority status and adolescent mental health services utilization

Adolescents who are members of ethnic minority groups constitute a large and ever increasing proportion of the population. While the information base regarding mental health problems and mental health services utilization in adolescents in general is slowly increasing, relatively little knowledge has accumulated about the particular needs and practices of youth of color. The purpose of this article is to review the available literature about adolescent mental health needs and service utilization as well as literature regarding adult ethnicity and mental health service utilization. The conclusion of this review is that significant gaps exist in our knowledge base regarding ethnicity in adolescents and its implications for the utilization of mental health services. The limited data available suggest that significant numbers of adolescents of color have multiple needs for mental health care and that a complex set of barriers exists to prevent them from obtaining appropriate servicies. A variety of suggestions are offered to improve the opportunities for and the quality of mental health services for ethnic minority adolescents. This research was supported by Grant MH 47786 from the National Institute of Mental Health.     

Health reform and Healthy People initiative

The passage of the Affordable Care Act builds on and strengthens the foundation for prevention and wellness that Healthy People--the nation's health promotion and disease prevention aspirations for a healthier nation--established. The Affordable Care Act reaffirms the themes of Healthy People by promoting population-based prevention and sets the stage for Healthy People 2020. The heart of Healthy People 2010 lies in its leading health indicators, reflecting high-priority health issues for the nation. National progress requires broad application of the ecological health model. We reviewed the status of each Healthy People 2010 indicator and noted how the Affordable Care Act drives future positive health outcomes using the ecological model of health as a prism for viewing health improvement.     

Physical activity levels of high school students --- United States, 2010

Healthy People 2020 (HP 2020), released in December 2010, outlines numerous public health objectives, including objectives for youth physical activity participation (1). HP 2020 includes three objectives for meeting current federal physical activity guidelines for 1) aerobic physical activity (participation in ≥60 minutes of aerobic activity per day, 7 days per week) (PA 3.1); 2) muscle-strengthening activity (muscle-strengthening activities on ≥3 days per week) (PA 3.2); and 3) aerobic physical activity and muscle-strengthening activity combined (PA 3.3) (1,2). The HP 2020 target for PA 3.1 is 20.2%; targets for PA 3.2 and PA 3.3 are not set because baseline data are not available. To meet the HP 2020 targets for physical activity, promotion of physical activity among female high school students (3), high school students in upper grades (3), and youths with obesity (4) might be warranted, given that these subpopulations are at risk for low levels of physical activity. To determine the proportion of U.S. youths who meet these HP 2020 objectives, CDC analyzed data from the 2010 National Youth Physical Activity and Nutrition Study (NYPANS), a school-based study conducted by CDC that included height and weight measurements and a survey that measured physical activity and dietary behaviors among a nationally representative sample of students in grades 9--12. This report summarizes the results of that analysis, which indicated that among students nationwide in grades 9--12, 15.3% met the aerobic objective, 51.0% met the muscle-strengthening objective, and 12.2% met the objective for both aerobic and muscle-strengthening activities. To improve youth physical activity participation, efforts are needed among CDC, state and local public health agencies, schools, and other public health partners that promote physical activity.     

A National Study of Lesbian,Gay, Bisexual (LGB), and Non-LGB Youth Sexual Behavior Online and In-Person

Online and in-person sexual behaviors of cisgender lesbian, gay, queer, bisexual, heterosexual, questioning, unsure, and youth of other sexual identities were examined using data from the Teen Health and Technology study. Data were collected online between August 2010 and January 2011 from 5,078 youth 13–18 years old. Results suggested that, depending on sexual identity, between 4–35 % of youth had sexual conversations and 2–24 % shared sexual photos with someone online in the past year. Among the 22 % of youth who had oral, vaginal, and/or anal sex, between 5–30 % met one of their two most recent sexual partners online. Inconsistent condom use was associated with increased odds of meeting one’s most recent partner online for heterosexual adolescent men. For gay and queer adolescent men, having an older partner, a partner with a lifetime history of sexually transmitted infections (STI), and concurrent sex partners were each significantly associated with increased odds of having met one’s most recent sex partner online. None of the examined characteristics significantly predicted meeting one’s most recent sexual partner online versus in-person for heterosexual; bisexual; or gay, lesbian, and queer women. The Internet is not replacing in-person exploration and expression of one’s sexuality and meeting sexual partners online appears to be uncommon in adolescence across sexual identities. Healthy sexuality programming that acknowledges some youth are meeting partners online is warranted, but this should not be a main focal point. Instead, inclusive STI prevention programming that provides skills to reduce risk when engaging in all types of sex is critical.     

Fruit and vegetable intake: Few adolescent girls meet national guidelines

OBJECTIVE: To examine longitudinal changes in daily fruit and vegetable consumption among black and white adolescent girls and calculate the percent of girls who met the Healthy People 2010 recommendations. METHODS: Girls (1186 black and 1126 white) who participated in the National Heart, Lung, and Blood Institute Growth Health Study (NGHS) were included if they had completed a 3-day food diary for at least one of six annual assessments visits, beginning at ages 11 or 12. Mixed models estimated the association of visit and race with (a) average daily consumption of fruits and vegetables and (b) the probability of meeting intake recommendations on one or more out of 3 days. RESULTS: For girls of both races, fruit and vegetable consumption increased with age; white girls showed a greater increase in fruit and nutrient-rich vegetable intake than black girls. Across visits, girls consumed considerably fewer than the recommended daily servings of fruits (1.0-1.5), vegetables (1.7-2.5), or nutrient-rich vegetables (0.25). Most girls (95%) failed to meet Healthy People 2010 recommendations. CONCLUSIONS: Public health efforts are needed to meet Healthy People 2010 objectives.     

Modeling Minority Stress Effects on Homelessness and Health Disparities among Young Men Who Have Sex with Men

Sexual minority youth are more likely to experience homelessness, and homeless sexual minority youth report greater risk for mental health and substance abuse symptoms than homeless heterosexual youth, yet few studies have assessed determinants that help explain the disparities. Minority stress theory proposes that physical and mental health disparities among sexual minority populations may be explained by the stress produced by living in heterosexist social environments characterized by stigma and discrimination directed toward sexual minority persons. We used data from a sample of 200 young men who have sex with men (YMSM) (38 % African American, 26.5 % Latino/Hispanic, 23.5 % White, 12 % multiracial/other) to develop an exploratory path model measuring the effects of experience and internalization of sexual orientation stigma on depression and substance use via being kicked out of home due to sexual orientation and current homelessness. Direct significant paths were found from experience of sexual orientation-related stigma to internalization of sexual orientation-related stigma, having been kicked out of one’s home, experiencing homelessness during the past year, and major depressive symptoms during the past week. Having been kicked out of one’s home had a direct significant effect on experiencing homelessness during the past 12 months and on daily marijuana use. Internalization of sexual orientation-related stigma and experiencing homelessness during the past 12 months partially mediated the direct effect of experience of sexual orientation-related stigma on major depressive symptoms. Our empirical testing of the effects of minority stress on health of YMSM advances minority stress theory as a framework for investigating health disparities among this population.     

Sleep and Mental Health in the General Population of Elderly Women

Sleep and mental health complaints are prevalent in the elderly and share common risk factors. We assessed the relationship between sleep and mental health in three representative samples of elderly women while controlling for multiple risk factors common to both. We performed this cross sectional secondary data analysis in 2015 using 2013 data from the Behavioral Risk Factor Surveillance System (BRFSS) for females ages 65 years and older from California (N = 1912), Florida (N = 9120), and Pennsylvania (N = 2429). We conducted multiple logistic regression analysis to assess the relationship between sleep duration group (short, moderate/reference, or long) and mental health issues in the past 30 days (yes or no) in elderly females, while controlling for multiple covariates. About 25% of the elderly females reported mental health issues and 20% reported short or long sleep durations. In adjusted analysis, compared to the elderly females in the moderate sleep duration group (averaging 6–8 h of sleep per day), those in the short and long sleep duration groups had increased prevalence of mental health issues by 66% and 26%, respectively. Mental health was also related to physical health issues including general health status, activity limitations, and chronic health conditions. Overall, sleep was related to mental health in representative samples of elderly females even after controlling for risk factors common to both. Even though we could not determine the direction of influence, the findings indicate a need for clinicians to screen their elderly female patients for both sleep and mental health issues, especially in those with physical health comorbidities.     

Self-Reported Dietary Intake of Youth with Recent Onset of Type 2 Diabetes: Results from the TODAY Study

Despite the widely recognized importance of diet in managing diabetes, few studies have documented usual dietary intake in young people with type 2 diabetes. The objectives of our study were to assess dietary intake among a large, ethnically diverse cohort of young people with type 2 diabetes and compare intake to current recommendations. The Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study is a multicenter randomized clinical trial of 699 youth aged 10 to 17 years. At baseline, following a run-in period that included standard diabetes education, diet was assessed using a food frequency questionnaire between 2004 and 2009. Analysis of variance and nonparametric tests were used to compare mean and median nutrient intakes; logistic regression was used to compare the odds of meeting predefined dietary intake recommendation cutpoints between subgroups of age, sex, and race–ethnicity. Percent of energy from saturated fat was consistently 13% to 14% across all subgroups—substantially exceeding national recommendations. Overall, only 12% of youth met Healthy People 2010 guidelines for intake of <10% of energy from saturated fat and only 1% of youth met American Diabetes Association recommendations for intake of <7% of energy from saturated fat. Dietary intake fell substantially below other Healthy People 2010 targets; only 3% met calcium intake goals, 11% met fruit consumption goals, 5% met vegetable consumption goals, and 67% met grain intake goals. Overall, dietary intake in this large cohort of young people with type 2 diabetes fell substantially short of recommendations, in ways that were consistent by sex, age, and race–ethnicity. The data suggest a critical need for better approaches to improve dietary intake of these young people.     

Evidence-based health promotion programs for schools and communities

Healthy People 2020 includes an objective to increase the proportion of elementary, middle, and senior high schools that provide comprehensive school health education to prevent health problems in the following areas: unintentional injury; violence; suicide; tobacco use and addiction; alcohol or other drug use; unintended pregnancy, HIV/AIDS, and sexually transmitted infections (STI); unhealthy dietary patterns; and inadequate physical activity. These specific goals are part of the efforts of Healthy People 2020 to increase the proportion of elementary, middle, and senior high schools that have health education goals or objectives that address the knowledge and skills articulated in the National Health Education Standards. A focus on Pre-K through 12 health education is a prerequisite for the implementation of a coordinated, seamless approach to health education as advocated by the Healthy People Curriculum Task Force and incorporated into the Education for Health framework. To help accomplish these goals, this article views the role of education as part of the broader socioecologic model of health. A comprehensive literature review was undertaken to identify evidence-based, peer-reviewed programs, strategies, and resources. The results of this review are presented organized as sexual health, mental and emotional health, injury prevention, tobacco and substance abuse, and exercise and healthy eating. Evidence-based implementation strategies, often considered the missing link, are recommended to help achieve the Healthy People 2020 objective of increasing the prevalence of comprehensive school health education programs designed to reduce health risks for children.     

A comprehensive review of the Healthy People 2020 Occupational Safety And Health Objectives: Part 1. Tools for the occupational health nurse in goal attainment

This is the first part of a two-part series introducing Healthy People 2020 and the foundational categories that are linked to overarching goals and corresponding measures for progress within the Healthy People 2020 initiative. The two articles together will review the 10 objectives for occupational safety and health within the American workplace, provide a resource guide for occupational health nurses, and discuss MAP-IT, the suggested implementation format to reach the Healthy People 2020 goals. The articles are intended to inform occupational health nurses about the current agenda for safety and health of the U.S. work force as articulated in Healthy People 2020 and provide a foundation for better understanding the requirements of a safe work environment in 2020 and beyond.     

Health access and status of adolescents and young adults using youth employment and training programs in an urban environment.

PURPOSE: To describe the health status and access to healthcare of adolescents and young adults disconnected from traditional education and work settings. The health status of these disconnected youth is largely unknown, although it is suspected to be quite poor. Most information about the health of youth in the United States relies on school-based samples. METHOD: In-person interviews with 1037 adolescents and young adults (aged 16-24 years) enrolled in an employment and training program in Baltimore were used to measure access to health services and health status in four domains: violent behavior, mental health, substance use, and reproductive health. Differences in healthcare access and health status by age and gender were examined. In addition, youth in the employment and training sample are compared with Baltimore youth in school and of comparable ages, as measured by the Youth Risk Behavior Surveillance System. RESULTS: Nearly 50% of young adults in the employment and training program were found to lack health insurance, and about 20% reported a time when they needed medical care but did not receive it. Youth in the program exhibited notable health status concerns, often exceeding the risk prevalence of students in school. In particular, adolescents and young adults disconnected from traditional employment and work settings were more likely to be in physical fights, to smoke cigarettes, and to use marijuana than their in-school counterparts. In-school youth were more likely to have considered harming themselves and to have made a suicide plan in the last year. CONCLUSIONS: Given high levels of health risk among youth disconnected from traditional education and work settings, adolescent health providers must increasingly pay attention to integrating health promotion and disease prevention strategies into youth employment and training programs, where sizable numbers of these youth can be reached.     

Lessons Learned About Adolescent Nutrition from the Minnesota Adolescent Health Survey

In 1986–1987, more than 30,000 adolescents completed the Minnesota Adolescent Health Survey, a comprehensive assessment of adolescent health status, health behaviors, and psychosocial factors. Although the survey included relatively few items on nutrition-related issues, a wealth of knowledge about adolescent nutrition was gained. Lessons learned from a decade of subsequent analyses of data collected in the survey and implications for working with youth are summarized in this article. Major concerns identified included high prevalence rates of inadequate intake of fruits, vegetables, and dairy products; unhealthful weight-control practices; and overweight status. For example, inadequate fruit intake was reported by 28% of the adolescents and inadequate vegetable intake was reported by 36%. Among female adolescents, 12% reported chronic dieting, 30% reported binge eating, 12% reported self-induced vomiting, and 2% reported using diuretics or laxatives. Some of the risk factors for inadequate food intake patterns or unhealthful weight-control practices included low socioeconomic status, minority status, chronic illness, poor school achievement, low family connectedness, weight dissatisfaction, overweight, homosexual orientation among male adolescents, and use of health-compromising behaviors. To improve adolescent eating behaviors, the results suggest a need for innovative outreach strategies that include educational and environmental approaches. Dietitians play a key role in developing interventions and promoting research in the field of adolescent nutrition. J Am Diet Assoc. 1998;98:1449–1456.     

Mental Health Status of Double Minority Adolescents: Findings from National Cross-Sectional Health Surveys

Little population-based work has been published about the mental health of adolescents with both sexual/gender (SG) and ethnic minority (i.e. double minority) status. This study aimed to provide an overview on their mental health. Analysis of data from a total of 17,607 high school students from New Zealand’s 2007 and 2012 cross-sectional nationally representative Adolescent Health Surveys, including a total of 1306 (7.4%) SG minority participants, of whom 581 (3.3%) were also an ethnic minority. SG minority status, minority ethnicity, and female sex were associated with higher mental distress and poorer well-being. Generally speaking, double minority students reported poorer mental health than SG majority students of the same ethnicity, but reported better mental health than SG minority New Zealand European students. Explanations and future directions for research were suggested to further explore how double minority students negotiate mental health in the context of their communities/cultures in New Zealand.     

A 1993 Status Report on the Health Status of Asian Pacific Islander Americans: Comparisons with Healthy People 2000 Objectives

PURPOSE OF THE PAPER: The purpose of this paper is to offer a current assessment of the health status of Asian Pacific Islander Americans (APIAs) with respect to relevant Healthy People 2000 objectives and an assessment of Federal resource allocations targeted at APIAs. SUMMARY OF METHODS UTILIZED: The author reviewed documents from the relevant progress reports made to the Assistant Secretary on Health on Healthy People 2000 objectives, other Federal documents, and a review of the literature. PRINCIPAL FINDINGS: Adequate progress has been made on only one of the eight objectives targeted at APIAs; progress on the remaining objectives is either "not on target," require more data to evaluate, or inappropriate for APIAs at this time. Examples of APIA health problems not included in Healthy People 2000 objectives were documented. Illustrations of inadequate allocations of Federal health resources were cited. CONCLUSIONS: APIAs have been among the most neglected minority group with regards to health status surveillance, health services, and have been the most overlooked in Federal resource allocations. However, as greater awareness of data deficits and health status is presented, policy makers have the opportunity to improve the situation. A policy to improve the health status of APIAs must be multifaceted and minimally include the facets of data needs, intervention approaches, a research agenda, and advocacy. RELEVANCE TO ASIAN PACIFIC ISLANDER AMERICAN POPULATIONS: A 1993 review of the health status of APIAs with regards to the eight Healthy People 2000 and areas not covered by Healthy People 2000 were reviewed. KEY WORDS: Asian Americans, health status, health policy, health planning, tobacco, diet, diseases     

Racial differences in the mental health needs and service utilization of youth in the juvenile justice system

Mental health placement rates by the juvenile justice system differ by race. However, it is unknown whether mental health needs differ by race. This study attempted to investigate potential differences in mental health needs and service utilization among Caucasian, African American, and Hispanic juvenile justice involved youth. A stratified random sample of 473 youth petitioned, adjudicated, and incarcerated from 1995–1996 was examined using a standard chart review protocol and the Childhood Severity of Psychiatric Illness measure for mental health needs. Significant and unique mental health needs were demonstrated for all racial groups. African American youth demonstrated the greatest level of needs. Minority status indicated significantly lower rates of mental health service utilization. Minority youth in the juvenile justice system are most at risk for underserved mental health needs. Based on the current data, it can be inferred that the first contact with the state's child and adolescent serving system, which includes the juvenile justice and mental health sectors, appears to be through the juvenile justice sector for many minority youth with delinquency problems.     

Reproductive Health Decision-Making in Perinatally HIV-Infected Adolescents and Young Adults

With widespread access to antiretroviral therapy in the United States, many perinatally HIV-infected (PHIV+) children are surviving into adolescence and adulthood, becoming sexually active and making decisions about their reproductive health. The literature focusing on the reproductive decisions of individuals behaviorally infected with HIV can serve as a springboard for understanding the decision-making process of PHIV+ youth. Yet, there are many differences that critically distinguish reproductive health and related decision-making of PHIV+ youth. Given the potential public health implications of their reproductive decisions, better understanding of factors influencing the decision-making process is needed to help inform the development of salient treatment and prevention interventions. To begin addressing this understudied area, a “think tank” session, comprised of clinicians, medical providers, and researchers with expertise in the area of adolescent HIV, was held in Bethesda, MD, on September 21, 2011. The focus was to explore what is known about factors that influence the reproductive decision-making of PHIV+ adolescents and young adults, determine what important data are needed in order to develop appropriate intervention for PHIV+ youth having children, and to recommend future directions for the field in terms of designing and carrying out collaborative studies. In this report, we summarize the findings from this meeting. The paper is organized around the key themes that emerged, including utilizing a developmental perspective to create an operational definition of reproductive decision-making, integration of psychosocial services with medical management, and how to design future research studies. Case examples are presented and model program components proposed.     

The Effect of COVID-19 Endemicity on the Mental Health of Health Workers

ObjectivesA major surge in COVID-19 cases despite Singapore's high vaccination has strained the health care system in October 2021. Our aim was to assess and compare Healthcare Worker (HCW) mental well-being in 2021 against a previously published cohort in 2020.DesignCross-sectional survey study.Setting and ParticipantsHCWs from 4 public hospitals and a primary health care system over a 4-week duration in 2021 coinciding with a major surge compared with a similar period in 2020.MethodsA survey comprising of the Oldenburg Burnout Inventory (OLBI), Hospital Anxiety and Depression Scale (HADS), and Safety Attitudes Questionnaire (SAQ) was distributed via email. Primary endpoints were the proportion meeting OLBI thresholds for both disengagement and exhaustion and being at risk for both Anxiety and Depression using HADS. Multivariate analysis identified significant predictors among demographic, workplace, and SAQ data. Subgroup analysis of overseas HCWs was performed.ResultsWe surveyed 1475 HCWs. Significantly more HCWs met primary outcomes using OLBI and HADS than in 2020 (84.1% and 39.6% vs 68.2% and 23.3%, respectively; P < .001). Burnout levels were uniformly high. A HADS score ≥8 in either subscale was significantly associated with meeting burnout thresholds (P < .001). Overseas HCWs (P = .002), South Asian ethnicity (P = .004), preuniversity educational qualifications (P = .026), and longer shift workhours of 8 to <12 (P = .015) and ≥12 (P = .001) were significantly associated with meeting HADS thresholds. Among overseas HCWs (n=407), seeing family more than a year ago was significantly associated with worse OLBI disengagement scores and a greater proportion meeting HADS thresholds vs seeing them within a year or being local HCWs (47.2% vs 37.2% and 35.6%, respectively; P = .001).Conclusions and ImplicationsHCW mental health has objectively worsened between 2020 and 2021 in the pandemic’s second year. Avoiding prolonged shifts, adopting preventive mental health strategies, improving patient safety, and attention to HCWs of minority ethnicity, from overseas, and with preuniversity education may help.