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hysical distancing has been the primary strategy to limit the spread of COVID-19 in the United States. Physical distancing (also called 'social distancing') entails reducing contacts between non-household members to reduce opportunities for transmission from infected to susceptible individuals. To promote physical distancing, most US states closed schools, mandated business closures, and issued 'stay-at-home' orders directing residents to avoid unnecessary trips. These measures have been essential to prevent worst-case scenarios involving millions of deaths 1-3. Although there is evidence that new cases of COVID-19 declined as people stayed home 2 , evidence suggests unequal declines in the burden of COVID-19. While case data disaggregated by income are not available, COVID-19 case and death rates have risen fastest in low-income communities 4,5. An association between lower neighbourhood income and COVID-19 risk is also consistent with data showing higher COVID-19 mortality among racial and ethnic minorities 6 , whose socioeconomic position is systematically lower, on average, than that of white Americans and who disproportionately reside in low-income neighbourhoods due to a long history of discriminatory housing policy 7,8. Financial constraints to physical distancing may have been an important factor contributing to higher COVID-19 burden among economically marginalized populations 4. At businesses that have remained open during the pandemic, low-income workers have reported less ability to work from home relative to higher wage earners 9. At these workplaces, most workers were not eligible for unemployment insurance unless they could document a COVID-19 diagnosis or exposure 10. Although many states began closing businesses and ordering residents to stay home in the second half of March, businesses deemed essential remained open, and staffed predominantly by low-wage workers 11,12. It was not until mid-April that some states began requiring people to wear masks in public spaces to reduce COVID-19 transmission, and some states still have not done so 10. In this context, low-income workers have had to choose between staying home and losing their income or going to work and risking exposure to COVID-19 for themselves and their households and neighbours. Given that those in low-income households typically have little savings 13 , losing income could bring other health and safety risks, including homelessness and food insecurity. Previous work 14 has found that residents of low-income neighbourhoods were less likely than residents of higher-income neighbourhoods to stay home in response to COVID-19. In this article, we test two main hypotheses. First, we proposed that this gap in physical distancing was explained by work-related demands (hypothesis 1a) and not by visits to places other than work (hypothesis 1b). Second, we proposed that state policies that ordered non-essential businesses to close, and for residents to stay at home, increased the gap in physical distancing between low-and high-income neighbourhoo...

IMPORTANCE Suicide is the second leading cause of death among adolescents between the ages of 15 and 24 years. Adolescents who are sexual minorities experience elevated rates of suicide attempts.OBJECTIVE To evaluate the association between state same-sex marriage policies and adolescent suicide attempts. DESIGN, SETTING, AND PARTICIPANTSThis study used state-level Youth Risk Behavior Surveillance System (YRBSS) data from January 1, 1999, to December 31, 2015, which are weighted to be representative of each state that has participation in the survey greater than 60%. A difference-in-differences analysis compared changes in suicide attempts among all public high school students before and after implementation of state policies in 32 states permitting same-sex marriage with year-to-year changes in suicide attempts among high school students in 15 states without policies permitting same-sex marriage. Linear regression was used to control for state, age, sex, race/ethnicity, and year, with Taylor series linearized standard errors clustered by state and classroom. In a secondary analysis among students who are sexual minorities, we included an interaction between sexual minority identity and living in a state that had implemented same-sex marriage policies.INTERVENTIONS Implementation of state policies permitting same-sex marriage during the full period of YRBSS data collection.MAIN OUTCOMES AND MEASURES Self-report of 1 or more suicide attempts within the past 12 months. RESULTS Among the 762 678 students (mean [SD] age, 16.0 [1.2] years; 366 063 males and 396 615 females) who participated in the YRBSS between 1999 and 2015, a weighted 8.6% of all high school students and 28.5% of students who identified as sexual minorities reported suicide attempts before implementation of same-sex marriage policies. Same-sex marriage policies were associated with a 0.6-percentage point (95% CI, -1.2 to -0.01 percentage points) reduction in suicide attempts, representing a 7% relative reduction in the proportion of high school students attempting suicide owing to same-sex marriage implementation. The association was concentrated among students who were sexual minorities.CONCLUSIONS AND RELEVANCE State same-sex marriage policies were associated with a reduction in the proportion of high school students reporting suicide attempts, providing empirical evidence for an association between same-sex marriage policies and mental health outcomes.

Key Points Question Was the receipt of unemployment insurance and a $600/wk federal supplement to unemployment insurance associated with reduced food insecurity among people in low- and middle-income households who lost work during the coronavirus disease 2019 (COVID-19) pandemic? Findings In this cohort study of 1119 adults who lost work during the COVID-19 pandemic, unemployment insurance was associated with a 35% relative decline in food insecurity and a 48% relative decline in eating less due to financial constraints. The $600/wk federal supplement was associated with additional reductions in food insecurity. Meaning These findings suggest that expanding the amount and duration of unemployment insurance may be an effective approach to reducing food insecurity.

Key Points Question Was the introduction of advance payments for the Child Tax Credit associated with food insufficiency in US households? Findings In this cross-sectional study using repeated surveys of a nationally representative sample of US households, the introduction of advance payments for the Child Tax Credit was associated with a significant reduction in household food insufficiency of approximately 26%. Meaning This study suggests that the Child Tax Credit advance payments acted as a buffer against food insufficiency among households with children.

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Laws permitting denial of services to same-sex couples, which exist in 12 states and are under consideration by the US Supreme Court, are associated with a 46% increase in sexual minority adults experiencing mental distress.

Background Pre-exposure prophylaxis (PrEP) is efficacious in preventing HIV among men who have sex with men (MSM). We assessed PrEP uptake among MSM presenting for services at a sexually transmitted diseases (STD) clinic. Methods MSM presenting to the Rhode Island STD Clinic between October 2013 and November 2014 were educated about, and offered, PrEP. We categorized PrEP engagement using an implementation cascade to describe gaps in uptake which described MSM who: 1) were educated about PrEP, 2) indicated interest, 3) successfully received follow-up contact, 4) scheduled an appointment, 5) attended an appointment, and 6) initiated PrEP (i.e., received a prescription). Bivariate and multivariable logistic regression models were used to examine predictors of PrEP initiation. Results A total of 234 MSM were educated about PrEP; of these, 56% expressed interest. Common reasons for lack of interest were low HIV risk perception (37%), wanting more time to consider (10%), concern about side effects (7%), and financial barriers (3%). Among those interested, 53% followed up. Of those, 51% scheduled an appointment. The most common reason patients did not schedule an appointment was low HIV risk perception (38%). Seventy-seven percent of those with an appointment attended the appointment; of those, 93% initiated PrEP. Patients with higher HIV risk perception (aOR=2.17, 95% CI 1.29-3.64) and a history of sex with an HIV-positive partner (aOR=7.08, 95% CI 2.35-21.34) had significantly higher odds of initiating PrEP. Conclusions Low HIV risk perception was the most significant barrier to PrEP uptake among MSM attending a public STD clinic.