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Objective: Binge drinking and heavy alcohol use are highly prevalent among college students. During the COVID-19 pandemic, due to lockdown restrictions and other challenges, many college students were burdened with loneliness, which can contribute to chronic stress, and substance use. The current study explores the association between loneliness and various levels of alcohol use among college students in the rural, underserved region of Central Appalachia, USA. Methods: Data were collected from a regional sample (n = 320) of college age adults, age 18-25 in the Central Appalachian region. The UCLA-3 item Loneliness Scale (UCLA-3) was used in the study to evaluate loneliness. Logistic regression analysis was conducted to assess the association between levels of loneliness and three separate outcomes, including past year binge drinking, past year heavy alcohol use, and past year weekly alcohol use. Results: Overall, 25.5% of the participants reported severe loneliness, 33.6% reported moderate, and 40.9% reported low levels of loneliness. Results of the adjusted models revealed that severe loneliness was associated with higher odds of heavy alcohol use (AOR = 1.89, 95% CI [1.02, 3.50]) and binge drinking (AOR = 2.96, 95% CI [1.16, 7.51]), and not associated with weekly alcohol use. Conclusion: The study found that higher levels of loneliness were linked to both binged drinking and heavy alcohol use. Further efforts for counseling and treatment among college students who are burdened with severe loneliness should be considered. The chronic stress associated with severe loneliness needs to be further addressed, particularly among emerging adults.
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OBJECTIVES: A large number of people cannot afford healthcare services in the United States. Researchers have studied the impact of lack of affordability of health care on the outcomes of various physical conditions. Mental health disorders have emerged as a major public health challenge during the past decade. The lack of affordability of health care also may contribute to the burden of mental health. This research focuses on the association between financial barriers to health care and mental health outcomes in the US state of Tennessee. METHODS: We used cross-sectional data contained in the 2019 US Behavioral Risk Factor Surveillance System (BRFSS). We extracted data for the state of Tennessee, which included 6242 adults aged 18 years or older. Multinomial regression analyses were conducted to test the association between not being able to see a doctor with the number of mentally unhealthy days during the past month. We coded the outcome as a three-level variable, ≥20 past-month mentally unhealthy days, 1 to 20 past-month mentally unhealthy days, and 0 past-month mentally unhealthy days. The covariates examined included self-reported alcohol use, self-reported marijuana use, and other demographic variables. RESULTS: Overall, 11.0% of participants reported ≥20 past-month mentally unhealthy days and 24.0% reported 1 to 20 past-month mentally unhealthy days. More than 13% of study participants reported they could not see a doctor because of the cost in the past 12 months. The inability to see a doctor because of the cost of care was associated with a higher risk of ≥20 past-month mentally unhealthy days (relative risk ratio 3.18; 95% confidence interval 2.57-3.92, P < 0.001) and 1 to 19 past-month mentally unhealthy days (relative risk ratio 1.94; 95% confidence interval 1.63-2.32, P < 0.001). CONCLUSIONS: Statistically significant associations were observed between the inability to see a doctor when needed because of cost and increased days of poorer mental health outcomes. This research has potential policy implications in the postcoronavirus disease 2019 era with healthcare transformation and significant financial impact.