TITLE: Race, gender, and mental health outcomes in Tennessee AUTHOR INFO Eugene Annor Manik Ahuja PhD, MA1 Author Affiliations: 1College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States Background: Tennessee has been disproportionally burdened with high levels of mental health disorders. Over the last decade, Tennessee has consistently ranked in the bottom 10 U.S. states in prevalence of mental health disorders. While it is known that Tennessee ranks lower in mental health status, less is known of how these differences vary across race. Methods: We used cross-sectional data from the 2019 Behavioral Risk Factor Surveillance System, a nationally representative U.S. telephone-based survey of adults aged 18 years or older for the State of Tennessee (n=6,242). Chi-square tests were conducted to assess differences across race. Logistic regression analyses were conducted to test the association between gender and past month mentally unhealthy days, stratified by race. We coded mentally unhealthy days binary, at 15 or more mentally unhealthy days in the past month, and less than 15 days. We controlled for income, educational attainment, health insurance, and age. Results: Overall, 22.9% of American Indian/Alaska Natives, followed by White (14.8%), Black (13.6%) and Hispanic (12.0%) reported 15 or more mentally unhealthy days in the past month. Among Blacks, there were no significant differences between males (13.2%) and females (13.9%) for 15 or more past month mentally unhealthy days (p=.76), as well as among Hispanics (p=.17) Among Whites, females (16.6) reported a significantly higher (p Conclusions: Our findings reveal that among Blacks and Hispanics in Tennessee, there were no significant gender differences in mental health outcomes. White among Whites and American Indian/Alaska Natives, females reported a significantly higher rate of past month mentally unhealthy days. The current study reports that the gap among males and females in report of poorer mental health has narrowed, particularly among Blacks and Hispanics in Tennessee. Further efforts towards providing equitable access to mental health services across race and gender in Tennessee, is essential.