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Coskun AK, Aydin A, Tosun S, To U, Rubman S, Schilsky ML, Zimbrean PC. Wilson Disease and the COVID-19 pandemic: exploring patients' mental health and vaccination attitudes in a longitudinal study. Front Psychol 2024; 15:1326802. [PMID: 38803830 PMCID: PMC11129684 DOI: 10.3389/fpsyg.2024.1326802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction The COVID-19 pandemic significantly impacted the mental health of individuals with chronic conditions such as Wilson's Disease (WD). This study investigates stress, anxiety, depression, quality of life, cognitive function, vaccination rates, infection rates, and perceptions related to the pandemic and vaccines among WD patients. Methods The study analyzed COVID-19 perceptions and vaccine attitudes of 62 adult WD patients enrolled in the international multisite WD Registry. A subgroup of 33 participants completed a series of mental health scales. The effect of working essentially, income loss, wellness activity initiation, and infection of COVID-19 during the pandemic was observed. Results Results indicate that, overall, the pandemic did not exacerbate anxiety or cognitive function in WD patients but did lead to increased depression among essential workers. Patients experiencing income loss exhibited higher levels of stress and anxiety. Despite these challenges, WD patients showed high vaccination rates and positive attitudes towards vaccines. Discussion The findings underscore the significant impact of the pandemic on the mental health of WD patients.
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Affiliation(s)
- Ayse K. Coskun
- Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Adem Aydin
- Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Sumeyra Tosun
- Medgar Evers College, CUNY, Brooklyn, NY, United States
| | - Uyen To
- Medicine and Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Susan Rubman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Michael L. Schilsky
- Medicine and Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Paula C. Zimbrean
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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Webber E, Bishop S, Drain PK, Dupuis V, Garza L, Gregor C, Hassell L, Ibarra G, Kessler L, Ko L, Lambert A, Lyon V, Rowe C, Singleton M, Thompson M, Warne T, Westbroek W, Adams A. Critical lessons from a pragmatic randomized trial of home-based COVID-19 testing in rural Native American and Latino communities. J Rural Health 2024. [PMID: 38449317 DOI: 10.1111/jrh.12830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/25/2024] [Accepted: 02/12/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE Native Americans and Latinos have higher COVID-19 infection and mortality rates and may have limited access to diagnostic testing. Home-based testing may improve access to care in rural and underserved populations. This study tests the effect of community health worker (CHW) support on accessibility, feasibility, and completion of COVID-19 home testing among Native American and Latino adults living on the Flathead Reservation in Montana and in Yakima Valley, Washington. METHODS A two-arm, multisite, pragmatic randomized controlled trial was conducted using block randomization stratified by site and participant age. Active arm participants received CHW assistance with online COVID-19 test kit registration and virtual swabbing support. The passive arm participants received standard-of-care support from the kit vendor. Logistic regression modeled the association between study arm and test completion (primary outcome) and between study arm and test completion with return of valid test results (secondary outcome). Responses to posttest surveys and interviews were summarized using deductive thematic analysis. FINDINGS Overall, 63% of participants (n = 268) completed COVID-19 tests, and 50% completed tests yielding a valid result. Active arm participants had higher odds of test completion (odds ratio: 1.66, 95% confidence interval [1.01, 2.75]). Differences were most pronounced among adults ≥60 years. Participants cited ease of use and not having to leave home as positive aspects, and transportation and mailing issues as negative aspects of home-based testing. CONCLUSIONS CHW support led to higher COVID-19 test completion rates, particularly among older adults. Significant testing barriers included language, educational level, rurality, and test kit issues.
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Affiliation(s)
- Eliza Webber
- Center for American Indian and Rural Health Equity, Montana State University, Bozeman, Montana, USA
| | - Sonia Bishop
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Paul K Drain
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Virgil Dupuis
- Extension Office, Salish Kootenai College, Pablo, Montana, USA
| | - Lorenzo Garza
- Family and Community Engagement, Sunnyside School District, Sunnyside, Washington, USA
| | - Charlie Gregor
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Laurie Hassell
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Geno Ibarra
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Larry Kessler
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Linda Ko
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
| | - Alison Lambert
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
- Providence Medical Research Center, Providence Health Care, Spokane, Washington, USA
| | - Victoria Lyon
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Carly Rowe
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Michael Singleton
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Matthew Thompson
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Teresa Warne
- Center for American Indian and Rural Health Equity, Montana State University, Bozeman, Montana, USA
| | - Wendy Westbroek
- Extension Office, Salish Kootenai College, Pablo, Montana, USA
| | - Alexandra Adams
- Center for American Indian and Rural Health Equity, Montana State University, Bozeman, Montana, USA
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Matta S, Chatterjee P, Venkataramani AS. Changes in Health Care Workers' Economic Outcomes Following Medicaid Expansion. JAMA 2024; 331:687-695. [PMID: 38411645 PMCID: PMC10900969 DOI: 10.1001/jama.2023.27014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Importance The extent to which changes in health sector finances impact economic outcomes among health care workers, especially lower-income workers, is not well known. Objective To assess the association between state adoption of the Affordable Care Act's Medicaid expansion-which led to substantial improvements in health care organization finances-and health care workers' annual incomes and benefits, and whether these associations varied across low- and high-wage occupations. Design, Setting, and Participants Difference-in-differences analysis to assess differential changes in health care workers' economic outcomes before and after Medicaid expansion among workers in 30 states that expanded Medicaid relative to workers in 16 states that did not, by examining US individuals aged 18 through 65 years employed in the health care industry surveyed in the 2010-2019 American Community Surveys. Exposure Time-varying state-level adoption of Medicaid expansion. Main Outcomes and Measures Primary outcome was annual earned income; secondary outcomes included receipt of employer-sponsored health insurance, Medicaid, and Supplemental Nutrition Assistance Program benefits. Results The sample included 1 322 263 health care workers from 2010-2019. Health care workers in expansion states were similar to those in nonexpansion states in age, sex, and educational attainment, but those in expansion states were less likely to identify as non-Hispanic Black. Medicaid expansion was associated with a 2.16% increase in annual incomes (95% CI, 0.66%-3.65%; P = .005). This effect was driven by significant increases in annual incomes among the top 2 highest-earning quintiles (β coefficient, 2.91%-3.72%), which includes registered nurses, physicians, and executives. Health care workers in lower-earning quintiles did not experience any significant changes. Medicaid expansion was associated with a 3.15 percentage point increase in the likelihood that a health care worker received Medicaid benefits (95% CI, 2.46 to 3.84; P < .001), with the largest increases among the 2 lowest-earning quintiles, which includes health aides, orderlies, and sanitation workers. There were significant decreases in employer-sponsored health insurance and increases in SNAP following Medicaid expansion. Conclusion and Relevance Medicaid expansion was associated with increases in compensation for health care workers, but only among the highest earners. These findings suggest that improvements in health care sector finances may increase economic inequality among health care workers, with implications for worker health and well-being.
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Affiliation(s)
- Sasmira Matta
- Department of Health Care Management, Wharton School, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Paula Chatterjee
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Atheendar S Venkataramani
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Reveles KR, Strey KA, Abdul-Mutakabbir JC, Mendoza VM, Carreno JJ. Infectious Inequity: How the Gut Microbiome and Social Determinants of Health May Contribute to Clostridioides difficile Infection Among Racial and Ethnic Minorities. Clin Infect Dis 2023; 77:S455-S462. [PMID: 38051968 PMCID: PMC10697666 DOI: 10.1093/cid/ciad586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Infectious diseases are a leading contributor to death in the United States, and racial differences in clinical outcomes have been increasingly reported. Clostridioides difficile infection (CDI) is a growing public health concern, as it causes nearly half a million infections per year and considerable excess hospital costs. Concurrent with other infectious diseases, recent literature denotes racial disparities in CDI incidence rates, mortality, and associated morbidity. Of note, investigations into CDI and causative factors suggest that inequities in health-related social needs and other social determinants of health (SDoH) may cause disruption to the gut microbiome, thereby contributing to the observed deleterious outcomes in racially and ethnically minoritized individuals. Despite these discoveries, there is limited literature that provides context for the recognized racial disparities in CDI, particularly the influence of structural and systemic barriers. Here, we synthesize the available literature describing racial inequities in CDI outcomes and discuss the interrelationship of SDoH on microbiome dysregulation. Finally, we provide actionable considerations for infectious diseases professionals to aid in narrowing CDI equity gaps.
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Affiliation(s)
- Kelly R Reveles
- Pharmacotherapy Division, College of Pharmacy, University of Texas at Austin, Austin, Texas, USA
- Pharmacotherapy Education & Research Center, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Kelsey A Strey
- Pharmacotherapy Division, College of Pharmacy, University of Texas at Austin, Austin, Texas, USA
- Pharmacotherapy Education & Research Center, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Jacinda C Abdul-Mutakabbir
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California–San Diego, La Jolla, California, USA
- Division of the Black Diaspora and African American Studies, University of California–San Diego, La Jolla, California, USA
| | - V Mateo Mendoza
- Pharmacotherapy Division, College of Pharmacy, University of Texas at Austin, Austin, Texas, USA
- Pharmacotherapy Education & Research Center, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Joseph J Carreno
- Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, New York, USA
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Hair NL, Urban C. Association of Severe COVID-19 and Persistent COVID-19 Symptoms With Economic Hardship Among US Families. JAMA Netw Open 2023; 6:e2347318. [PMID: 38085541 PMCID: PMC10716716 DOI: 10.1001/jamanetworkopen.2023.47318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/30/2023] [Indexed: 12/18/2023] Open
Abstract
Importance Little is known about the association of severe COVID-19 and post-COVID-19 conditions with household finances. Objective To examine associations between COVID-19 outcomes, pandemic-related economic hardship, and prepandemic socioeconomic status among families in the US. Design, Setting, and Participants This cohort study used data from the Panel Study of Income Dynamics (PSID), a nationally representative, longitudinal study. Data included 6932 families active in the PSID in both 2019 and 2021. Exposures Ordinal exposure categories were defined based on whether the reference person or spouse or partner reported a positive COVID-19 diagnosis and (1) persistent COVID-19 symptoms, (2) previous severe COVID-19, or (3) previous moderate, mild, or asymptomatic COVID-19. Families with no history of COVID-19 served as the reference group. Main Outcomes and Measures Outcomes included whether a resident family member was laid off or furloughed, lost earnings, or had any financial difficulties due to the COVID-19 pandemic. Results In this cohort study of 6932 families (772 Hispanic families [weighted, 13.5%; 95% CI, 12.4%-14.6%], 2725 non-Hispanic Black families [weighted, 13.1%; 95% CI, 12.3%-14.1%], and 3242 non-Hispanic White families [weighted, 66.8%; 95% CI, 65.2%-68.3%]), close to 1 in 4 (2222 [weighted, 27.0%; 95% CI, 25.6%-28.6%]) reported income below 200% of the US Census Bureau poverty threshold. In survey-weighted regression models adjusted for prepandemic sociodemographic characteristics and experiences of economic hardship, the odds of reporting pandemic-related economic hardship were 2.0 to 3.7 times higher among families headed by an adult with persistent COVID-19 symptoms (laid off or furloughed: adjusted odds ratio [AOR], 1.98 [95% CI, 1.37-2.85]; lost earnings: AOR, 2.86 [95% CI, 2.06-3.97]; financial difficulties: AOR, 3.72 [95% CI, 2.62-5.27]) and 1.7 to 2.0 times higher among families headed by an adult with previous severe COVID-19 (laid off or furloughed: AOR, 1.69 [95% CI, 1.13-2.53]; lost earnings: AOR, 1.99 [95% CI, 1.37-2.90]; financial difficulties: AOR, 1.87 [95% CI, 1.25-2.80]) compared with families with no history of COVID-19. Families headed by an adult with persistent COVID-19 symptoms had increased odds of reporting financial difficulties due to the pandemic regardless of prepandemic socioeconomic status (families with lower income: AOR, 3.71 [95% CI, 1.94-7.10]; families with higher income: AOR, 3.74 [95% CI, 2.48-5.63]). Previous severe COVID-19 was significantly associated with financial difficulties among families with lower income (AOR, 2.59 [95% CI, 1.26-5.31]) but was not significantly associated with financial difficulties among those with high income (OR, 1.56 [95% CI, 0.95-2.56]). Conclusions and Relevance This cohort study suggests that persistent COVID-19 symptoms and, to a lesser extent, previous severe COVID-19 were associated with increased odds of pandemic-related economic hardship in a cohort of US families. The economic consequences of COVID-19 varied according to socioeconomic status; families with lower income before the pandemic were more vulnerable to employment disruptions and earnings losses associated with an adult family member's COVID-19 illness.
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Affiliation(s)
- Nicole L. Hair
- Department of Health Services Policy and Management, University of South Carolina Arnold School of Public Health, Columbia
| | - Carly Urban
- Department of Economics, Montana State University, Bozeman
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Tilhou AS, Saloner B, DeLeire T, Chakraborty S, Dague L. Health and Healthcare Access for Essential, Nonessential, and Nonworkers During the COVID-19 Pandemic. J Occup Environ Med 2023; 65:e703-e709. [PMID: 37641177 DOI: 10.1097/jom.0000000000002953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVE The aim of the study is to describe sociodemographic characteristics, healthcare access, and health status of low-income essential, nonessential, and nonworkers during the COVID-19 pandemic. METHODS Using survey data (2020-2021) from Wisconsin Medicaid enrollees ( N = 2528), we compared sociodemographics, healthcare access, and health status between essential, nonessential, and nonworkers. RESULTS Essential workers had less consistent health insurance coverage and more problems paying medical bills than nonessential and nonworkers. They reported better health than nonessential and nonworkers. They reported fewer work-limiting conditions and less outpatient healthcare utilization than nonworkers but similar rates as nonessential workers. Essential workers reported masking less frequently than nonworkers but similar frequency to nonessential workers, and lower COVID-19 vaccine willingness than nonessential and nonworkers. CONCLUSIONS Essential workers report better health, fewer protective behaviors, and more healthcare barriers than nonessential and nonworkers. Findings indicate essential worker status may be a social determinant of health.
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Affiliation(s)
- Alyssa Shell Tilhou
- From the Department of Family Medicine, Boston University Medical Center, Boston, Massachusetts (A.S.T.); Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland (B.S.); McCourt School of Public Policy, Georgetown University, Washington, DC (T.D.); Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, Texas (S.C.); and Department of Public Service and Administration, The Bush School of Government and Public Service, Texas A&M University, College Station, Texas (L.D.)
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Haro‐Ramos AY, Brown TT, Deardorff J, Aguilera A, Pollack Porter KM, Rodriguez HP. Frontline work and racial disparities in social and economic pandemic stressors during the first COVID-19 surge. Health Serv Res 2023; 58 Suppl 2:186-197. [PMID: 36718961 PMCID: PMC10339174 DOI: 10.1111/1475-6773.14136] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To assess the magnitude of racial-ethnic disparities in pandemic-related social stressors and examine frontline work's moderating relationship on these stressors. DATA SOURCES Employed Californians' responses to the Institute for Governmental Studies (IGS) poll from April 16-20, 2020, were analyzed. The Pandemic Stressor Scale (PSS) assessed the extent to which respondents experienced or anticipated problems resulting from the inability to pay for basic necessities, job instability, lacking paid sick leave, unavailability of childcare, and reduced wages or work hours due to COVID-19. STUDY DESIGN Mixed-effects generalized linear models estimated (1) racial-ethnic disparities in pandemic stressors among workers during the first COVID-19 surge, adjusting for covariates, and (2) tested the interaction between race-ethnicity and frontline worker status, which includes a subset of essential workers who must perform their job on-site, to assess differential associations of frontline work by race-ethnicity. DATA COLLECTION The IGS poll data from employed workers (n = 4795) were linked to the 2018 Centers for Disease Control and Prevention Social Vulnerability Index at the zip code level (N = 1068). PRINCIPAL FINDINGS The average PSS score was 37.34 (SD = 30.49). Whites had the lowest PSS score (29.88, SD = 26.52), and Latinxs had the highest (50.74, SD = 32.61). In adjusted analyses, Black frontline workers reported more pandemic-related stressors than White frontline workers (PSS = 47.73 vs. 36.96, p < 0.001). Latinxs reported more pandemic stressors irrespective of frontline worker status. However, the 5.09-point difference between Latinx frontline and non-frontline workers was not statistically different from the 4.6-point disparity between White frontline and non-frontline workers. CONCLUSION Latinx workers and Black frontline workers disproportionately reported pandemic-related stressors. To reduce stress on frontline workers during crises, worker protections like paid sick leave, universal access to childcare, and improved job security are needed, particularly for those disproportionately affected by structural inequities, such as racially minoritized populations.
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Affiliation(s)
- Alein Y. Haro‐Ramos
- Health Policy and ManagementUniversity of California Berkeley School of Public HealthBerkeleyCaliforniaUSA
| | - Timothy T. Brown
- Health Policy and ManagementUniversity of California Berkeley School of Public HealthBerkeleyCaliforniaUSA
| | - Julianna Deardorff
- Health Policy and ManagementUniversity of California Berkeley School of Public HealthBerkeleyCaliforniaUSA
- Community Health SciencesUniversity of California Berkeley School of Public HealthBerkeleyCaliforniaUSA
| | - Adrian Aguilera
- Health Policy and ManagementUniversity of California Berkeley School of Public HealthBerkeleyCaliforniaUSA
- School of Social Welfare BerkeleyUniversity of California BerkeleyBerkeleyCaliforniaUSA
| | - Keshia M. Pollack Porter
- Department of Health Policy and ManagementJohns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Hector P. Rodriguez
- Health Policy and ManagementUniversity of California Berkeley School of Public HealthBerkeleyCaliforniaUSA
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Vega IE, Ajrouch KJ, Rorai V, Gadwa R, Roberts JS, Nyquist L. Engaging diverse populations in aging research during the COVID-19 pandemic: Lessons learned from four National Institutes of Health funded-Centers. Front Public Health 2023; 11:1062385. [PMID: 37081958 PMCID: PMC10110869 DOI: 10.3389/fpubh.2023.1062385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/16/2023] [Indexed: 04/22/2023] Open
Abstract
Background The COVID-19 pandemic's impact on our personal and professional lives required a rapid adaptation to the evolving health crisis and accumulating social stresses. Established measures to reduce the spread of infection and potential death had a direct effect on ongoing research that involved older adults and underrepresented racial/ethnic groups. Although important to preserve public health, these measures risk further isolation of vulnerable research participant populations and threatened established community partnerships. To address the social and research challenges evolving from the COVID-19 pandemic, four National Institutes of Health funded-Centers that engage with community members to enhance research and advance the science of aging came together to learn from each other's efforts, approaches, and communication with community partners. Methods Monthly meetings served as a venue to discuss the challenges of engagement with research participants and support community partners during the pandemic. The developed learning community also contributed to recognize and address research staff stress and isolation. We describe how these conversations led our Centers to address unprecedented challenges and sustain community engagement within diverse populations, especially Black/African Americans, Latinos, Middle Eastern/Arab Americans and the oldest-old. Results The exchange of information resulted in maintaining long standing community relationships and partnerships in the face of the uncertainties generated by the pandemic. The strategies included adapting education programs to reduce risk of infection, recognizing symptoms, promoting vaccination and understanding of the effect of COVID-19 to the brain. Different strategies were used to address the effects of isolation and maintain community engagement. Although new research participant enrollment was a challenge, telephone and virtual visits allowed research participants to remain active in research. Community members participation in virtual learning events was variable, ranging from a dozen to hundreds of participants. Invitations to organize panels about newly developed topics indicated the need for information from trusted sources. Conclusion In sum, the COVID-19 pandemic re - directed all four Centers' commitment to community service led to developing strategies for social support, which will potentially contribute to transforming public perceptions about research and researchers.
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Affiliation(s)
- Irving E. Vega
- Michigan Center for Contextual Factors in Alzheimer’s Disease, Ann Arbor, MI, United States
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, East Lansing, MI, United States
| | - Kristine J. Ajrouch
- Michigan Center for Contextual Factors in Alzheimer’s Disease, Ann Arbor, MI, United States
- Department of Sociology, Anthropology, and Criminology, Eastern Michigan University, Ypsilanti, MI, United States
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
| | - Vanessa Rorai
- Michigan Center for Urban African American Aging Research, Detroit, MI, United States
- Institute of Gerontology, Wayne State University, Detroit, MI, United States
| | - Renee Gadwa
- Outreach, Recruitment and Engagement Core, Michigan Alzheimer’s Disease Research Center, Ann Arbor, MI, United States
| | - J. Scott Roberts
- Outreach, Recruitment and Engagement Core, Michigan Alzheimer’s Disease Research Center, Ann Arbor, MI, United States
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Linda Nyquist
- Claude D. Pepper Older Americans Independence Center, University of Michigan, Ann Arbor, MI, United States
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Richman I, Tessier-Sherman B, Galusha D, Oladele CR, Wang K. Breast cancer screening during the COVID-19 pandemic: moving from disparities to health equity. J Natl Cancer Inst 2023; 115:139-145. [PMID: 36069622 PMCID: PMC9494402 DOI: 10.1093/jnci/djac172] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/02/2022] [Accepted: 08/29/2022] [Indexed: 11/19/2022] Open
Abstract
The COVID-19 pandemic created unprecedented disruptions to routine health care in the United States. Screening mammography, a cornerstone of breast cancer control and prevention, was completely halted in the spring of 2020, and screening programs have continued to face challenges with subsequent COVID-19 waves. Although screening mammography rates decreased for all women during the pandemic, a number of studies have now clearly documented that reductions in screening have been greater for some populations than others. Specifically, minoritized women have been screened at lower rates than White women across studies, although the specific patterns of disparity vary depending on the populations and communities studied. We posit that these disparities are likely due to a variety of structural and contextual factors, including the differential impact of COVID-19 on communities. We also outline key considerations for closing gaps in screening mammography. First, practices, health systems, and communities must measure screening mammography use to identify whether gaps exist and which populations are most affected. Second, we propose that strategies to close disparities in breast cancer screening must be multifaceted, targeting the health system or practice, but also structural factors at the policy level. Health disparities arise from a complex set of conditions, and multimodal solutions that address the complex, multifactorial conditions that lead to disparities may be more likely to succeed and are necessary for promoting health equity.
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Affiliation(s)
- Ilana Richman
- Correspondence to: Ilana Richman, MD, MHS, Department of Medicine, Yale School of Medicine, 367 Cedar St, Harkness Hall A, Room 301a, New Haven, CT 06510, USA (e-mail: )
| | - Baylah Tessier-Sherman
- Department of Medicine, Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, USA
| | - Deron Galusha
- Department of Medicine, Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, USA
| | - Carol R Oladele
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Medicine, Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, USA
| | - Karen Wang
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Medicine, Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, USA
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Hernandez-Salinas C, Marsiglia FF, Oh H, Campos AP, De La Rosa K. Community Health Workers as Puentes/Bridges to Increase COVID-19 Health Equity in Latinx Communities of the Southwest U.S. J Community Health 2022; 48:398-413. [PMID: 36536085 PMCID: PMC9762869 DOI: 10.1007/s10900-022-01182-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Abstract
This study documents the pivotal role that Community Health Workers (CHW) played while supporting underserved Latinx communities affected by COVID-19-related health inequities. With the support of CHWs' agencies historically serving three Latinx-dense counties in Arizona, we recruited CHWs who participated in a state-wide COVID-19 testing project. Using phenomenology and narrative qualitative research methods, five focus groups were facilitated in Spanish between August and November 2021. Bilingual research team members conducted the analysis of the Spanish verbatim transcripts and CHWs reviewed the results for validity. Three interconnected themes reflected the CHWs experiences: (1) CHWs as puentes/bridges with deep community embeddedness through shared experiences and social/cultural context, (2) CHWs as communication brokers and transformational agents, playing a pivotal role in responding to the health and socioeconomic challenges posed by the COVID-19 pandemic, (3) CHWs satisfaction and frustration due to their dual role as committed community members but unrecognized and undervalued frontline public health workers. These findings emphasize the CHWs' commitment towards supporting their communities, even amidst the stressors of the pandemic. It is important to continue to integrate the role of CHWs into the larger healthcare system as opposed to relegating them to short term engagements as was the case during the COVID-19 pandemic. This article provides a set of practice, policy, and future research recommendations, emphasizing the need to allocate greater budgetary and training resources in support of CHWs.
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Affiliation(s)
- Christopher Hernandez-Salinas
- Global Center for Applied Health Research, School of Social Work, Arizona State University, 411 North Central Avenue, Suite 720, Mail Code 4320, Phoenix, AZ 85004 USA
| | - Flavio F. Marsiglia
- Global Center for Applied Health Research, School of Social Work, Arizona State University, 411 North Central Avenue, Suite 720, Mail Code 4320, Phoenix, AZ 85004 USA
| | - Hyunsung Oh
- Global Center for Applied Health Research, School of Social Work, Arizona State University, 411 North Central Avenue, Suite 720, Mail Code 4320, Phoenix, AZ 85004 USA
| | - Ana Paola Campos
- Global Center for Applied Health Research, School of Social Work, Arizona State University, 411 North Central Avenue, Suite 720, Mail Code 4320, Phoenix, AZ 85004 USA
| | - Kate De La Rosa
- Global Center for Applied Health Research, School of Social Work, Arizona State University, 411 North Central Avenue, Suite 720, Mail Code 4320, Phoenix, AZ 85004 USA
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11
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Sangalang CC. "I'm sick of being called a hero - I want to get paid like one": Filipino American frontline workers' health under conditions of COVID-19 and racial capitalism. Front Public Health 2022; 10:977955. [PMID: 36504981 PMCID: PMC9726904 DOI: 10.3389/fpubh.2022.977955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022] Open
Abstract
Although the era of COVID-19 has reaffirmed the vital role of frontline workers in maintaining a functional society, the ongoing pandemic has taken a devastating toll on their health and well-being. In the United States, Filipino American frontline workers in healthcare and service industries have endured threats to their health, safety, and economic livelihood throughout the pandemic and against the broader backdrop of racialized and xenophobic hate directed toward Asian Americans. Drawing on a qualitative approach, the current study explores work-related health risks and effects of the pandemic for Filipino American frontline workers. Data come from the qualitative arm of a larger mixed-methods study that used a community-based participatory research approach. The current analysis is based on focus group data with thirty-five Filipino American frontline workers, a majority of whom were migrants, that worked across healthcare, caregiving, education, childcare, food services, and retail industries. Situated through the lens of racial capitalism, themes included: (1) work-related stress, tensions, and trauma, (2) anti-Asian racism and intersections with age- and gender-based violence, and (3) working while ill and distressed. Study findings can inform interventions and policies to improve health, occupational environments, and labor conditions in order to support minoritized communities disproportionately affected by COVID-19.
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Affiliation(s)
- Cindy C. Sangalang
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, CA, United States,Asian American Studies Department, Social Sciences Division, University of California, Los Angeles, Los Angeles, CA, United States,*Correspondence: Cindy C. Sangalang
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12
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Gerken J, Zapata D, Kuivinen D, Zapata I. Comorbidities, sociodemographic factors, and determinants of health on COVID-19 fatalities in the United States. Front Public Health 2022; 10:993662. [PMID: 36408029 PMCID: PMC9669977 DOI: 10.3389/fpubh.2022.993662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Previous studies have evaluated comorbidities and sociodemographic factors individually or by type but not comprehensively. This study aims to analyze the influence of a wide variety of factors in a single study to better understand the big picture of their effects on case-fatalities. This cross-sectional study used county-level comorbidities, social determinants of health such as income and race, measures of preventive healthcare, age, education level, average household size, population density, and political voting patterns were all evaluated on a national and regional basis. Analysis was performed through Generalized Additive Models and adjusted by the COVID-19 Community Vulnerability Index (CCVI). Effect estimates of COVID-19 fatality rates for risk factors such as comorbidities, sociodemographic factors and determinant of health. Factors associated with reducing COVID-19 fatality rates were mostly sociodemographic factors such as age, education and income, and preventive health measures. Obesity, minimal leisurely activity, binge drinking, and higher rates of individuals taking high blood pressure medication were associated with increased case fatality rate in a county. Political leaning influenced case case-fatality rates. Regional trends showed contrasting effects where larger household size was protective in the Midwest, yet harmful in Northeast. Notably, higher rates of respiratory comorbidities such as asthma and chronic obstructive pulmonary disease (COPD) diagnosis were associated with reduced case-fatality rates in the Northeast. Increased rates of chronic kidney disease (CKD) within counties were often the strongest predictor of increased case-fatality rates for several regions. Our findings highlight the importance of considering the full context when evaluating contributing factors to case-fatality rates. The spectrum of factors identified in this study must be analyzed in the context of one another and not in isolation.
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13
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van Ingen T, Brown KA, Buchan SA, Akingbola S, Daneman N, Warren CM, Smith BT. Neighbourhood-level socio-demographic characteristics and risk of COVID-19 incidence and mortality in Ontario, Canada: A population-based study. PLoS One 2022; 17:e0276507. [PMID: 36264984 PMCID: PMC9584389 DOI: 10.1371/journal.pone.0276507] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/07/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES We aimed to estimate associations between COVID-19 incidence and mortality with neighbourhood-level immigration, race, housing, and socio-economic characteristics. METHODS We conducted a population-based study of 28,808 COVID-19 cases in the provincial reportable infectious disease surveillance systems (Public Health Case and Contact Management System) which includes all known COVID-19 infections and deaths from Ontario, Canada reported between January 23, 2020 and July 28, 2020. Residents of congregate settings, Indigenous communities living on reserves or small neighbourhoods with populations <1,000 were excluded. Comparing neighbourhoods in the 90th to the 10th percentiles of socio-demographic characteristics, we estimated the associations between 18 neighbourhood-level measures of immigration, race, housing and socio-economic characteristics and COVID-19 incidence and mortality using Poisson generalized linear mixed models. RESULTS Neighbourhoods with the highest proportion of immigrants (relative risk (RR): 4.0, 95%CI:3.5-4.5) and visible minority residents (RR: 3.3, 95%CI:2.9-3.7) showed the strongest association with COVID-19 incidence in adjusted models. Among individual race groups, COVID-19 incidence was highest among neighbourhoods with the high proportions of Black (RR: 2.4, 95%CI:2.2-2.6), South Asian (RR: 1.9, 95%CI:1.8-2.1), Latin American (RR: 1.8, 95%CI:1.6-2.0) and Middle Eastern (RR: 1.2, 95%CI:1.1-1.3) residents. Neighbourhoods with the highest average household size (RR: 1.9, 95%CI:1.7-2.1), proportion of multigenerational families (RR: 1.8, 95%CI:1.7-2.0) and unsuitably crowded housing (RR: 2.1, 95%CI:2.0-2.3) were associated with COVID-19 incidence. Neighbourhoods with the highest proportion of residents with less than high school education (RR: 1.6, 95%CI:1.4-1.8), low income (RR: 1.4, 95%CI:1.2-1.5) and unaffordable housing (RR: 1.6, 95%CI:1.4-1.8) were associated with COVID-19 incidence. Similar inequities were observed across neighbourhood-level sociodemographic characteristics and COVID-19 mortality. CONCLUSIONS Neighbourhood-level inequities in COVID-19 incidence and mortality were observed in Ontario, with excess burden experienced in neighbourhoods with a higher proportion of immigrants, racialized populations, large households and low socio-economic status.
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Affiliation(s)
| | - Kevin A. Brown
- Public Health Ontario, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sarah A. Buchan
- Public Health Ontario, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Nick Daneman
- Public Health Ontario, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Brendan T. Smith
- Public Health Ontario, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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14
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Cohen SE, Stookey J, Anderson N, Morris D, Singzon T, Dann M, Burk K, Chen CC. Using Geocoding to Identify COVID-19 Outbreaks in Congregate Residential Settings: San Francisco's Outbreak Response in Single-Room Occupancy Hotels. Public Health Rep 2022; 138:7-13. [PMID: 36239486 PMCID: PMC9574538 DOI: 10.1177/00333549221128301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
More than 500 single-room occupancy hotels (SROs), a type of low-cost congregate housing with shared bathrooms and kitchens, are available in San Francisco. SRO residents include essential workers, people with disabilities, and multigenerational immigrant families. In March 2020, with increasing concerns about the potential for rapid transmission of COVID-19 among a population with disproportionate rates of comorbidity, poor access to care, and inability to self-isolate, the San Francisco Department of Public Health formed an SRO outbreak response team to identify and contain COVID-19 clusters in this congregate residential setting. Using address-matching geocoding, the team conducted active surveillance to identify new cases and outbreaks of COVID-19 at SROs. An outbreak was defined as 3 separate households in the SRO with a positive test result for COVID-19. From March 2020 through February 2021, the SRO outbreak response team conducted on-site mass testing of all residents at 52 SROs with outbreaks identified through geocoding. The rate of positive COVID-19 tests was significantly higher at SROs with outbreaks than at SROs without outbreaks (12.7% vs 6.4%; P < .001). From March through May 2020, the rate of COVID-19 cases among SRO residents was higher than among residents of other settings (ie, non-SRO residents), before decreasing and remaining at an equal level to non-SRO residents during later periods of 2020. The annual case fatality rate for SRO residents and non-SRO residents was similar (1.8% vs 1.5%). This approach identified outbreaks in a setting at high risk of COVID-19 and facilitated rapid deployment of resources. The geocoding surveillance approach could be used for other diseases and in any setting for which a list of addresses is available.
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Affiliation(s)
- Stephanie E. Cohen
- Disease Prevention and Control Branch, Population Health Division, San Francisco Department of Public Health, San Francisco, CA, USA,COVID Command Center, San Francisco Department of Public Health, San Francisco, CA, USA,Stephanie E. Cohen, MD, MPH, San Francisco Department of Public Health, Disease Prevention and Control Branch, Population Health Division, 356 7th St, San Francisco, CA 94103, USA.
| | - Jodi Stookey
- COVID Command Center, San Francisco Department of Public Health, San Francisco, CA, USA,Maternal, Child & Adolescent Health, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Nora Anderson
- COVID Command Center, San Francisco Department of Public Health, San Francisco, CA, USA,Community Health Equity and Promotion Branch, Population Health Division, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Devan Morris
- COVID Command Center, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Trudy Singzon
- COVID Command Center, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Maggie Dann
- COVID Command Center, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Katie Burk
- COVID Command Center, San Francisco Department of Public Health, San Francisco, CA, USA,Community Health Equity and Promotion Branch, Population Health Division, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Carol C. Chen
- COVID Command Center, San Francisco Department of Public Health, San Francisco, CA, USA,Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, USA
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15
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Martin MA, Lennon RP, Smith RA, Myrick JG, Small ML, Van Scoy LJ. Essential and non-essential US workers' health behaviors during the COVID-19 pandemic. Prev Med Rep 2022; 29:101889. [PMID: 35847125 PMCID: PMC9270843 DOI: 10.1016/j.pmedr.2022.101889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/09/2022] [Accepted: 07/01/2022] [Indexed: 11/26/2022] Open
Abstract
We seek to quantify the relationship between health behaviors and work-related experiences during the COVID-19 pandemic by predicting health behaviors as a function of essential worker status, job loss, change in work hours, and COVID-19 experiences. We use multivariate models and survey data from 913 employed adults in a semi-rural mid-Atlantic US county, and test whether essential worker results vary by gender, parenthood, and/or university employment. Multivariate models indicate that essential workers used tobacco on more days (4.5; p <.01) and were less likely to sleep 8 h (odds ratio [OR] 0.6; p <.01) than non-essential workers. The risk of sleeping less than 8 h is concentrated among essential workers in the service industry (OR 0.5; p <.05) and non-parents (OR 0.5; p <.05). Feminine essential workers exercised on fewer days (-0.8; p <.05) than feminine non-essential workers. Workers with reduced work hours consumed more alcoholic drinks (0.3; p <.05), while workers with increased work hours consumed alcohol (0.3; p <.05) and exercised (0.6; p <.05) on more days. Essential worker status and changes in work hours are correlated with unhealthy behaviors during the COVID-19 pandemic.
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Affiliation(s)
- Molly A Martin
- Department of Sociology and Criminology, Pennsylvania State University, University Park, PA, USA
| | - Robert P Lennon
- Department of Family and Community Medicine, Pennsylvania State College of Medicine, Hershey, PA, USA
| | - Rachel A Smith
- Department of Communication Arts and Sciences, Pennsylvania State University, University Park, PA, USA
| | - Jessica G Myrick
- Donald P. Bellisario College of Communications, Pennsylvania State University, University Park, PA, USA
| | - Meg L Small
- College of Health and Human Development, Pennsylvania State University, University Park, PA, USA
| | - Lauren J Van Scoy
- Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey, PA, USA
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16
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Mullachery PH, Li R, Melly S, Kolker J, Barber S, Diez Roux AV, Bilal U. Inequities in spatial accessibility to COVID-19 testing in 30 large US cities. Soc Sci Med 2022; 310:115307. [PMID: 36049353 PMCID: PMC9420026 DOI: 10.1016/j.socscimed.2022.115307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/16/2022] [Accepted: 08/17/2022] [Indexed: 12/24/2022]
Abstract
Testing for SARS-CoV-2 infection has been a key strategy to mitigate and control the COVID-19 pandemic. Wide spatial and racial/ethnic disparities in COVID-19 outcomes have emerged in US cities. Previous research has highlighted the role of unequal access to testing as a potential driver of these disparities. We described inequities in spatial accessibility to COVID-19 testing locations in 30 large US cities. We used location data from Castlight Health Inc corresponding to October 2021. We created an accessibility metric at the level of the census block group (CBG) based on the number of sites per population in a 15-minute walkshed around the centroid of each CBG. We also calculated spatial accessibility using only testing sites without restrictions, i.e., no requirement for an appointment or a physician order prior to testing. We measured the association between the social vulnerability index (SVI) and spatial accessibility using a multilevel negative binomial model with random city intercepts and random SVI slopes. Among the 27,195 CBG analyzed, 53% had at least one testing site within a 15-minute walkshed, and 36% had at least one site without restrictions. On average, a 1-decile increase in the SVI was associated with a 3% (95% Confidence Interval: 2% - 4%) lower accessibility. Spatial inequities were similar across various components of the SVI and for sites with no restrictions. Despite this general pattern, several cities had inverted inequity, i.e., better accessibility in more vulnerable areas, which indicates that some cities may be on the right track when it comes to promoting equity in COVID-19 testing. Testing is a key component of the strategy to mitigate transmission of SARS-CoV-2 and efforts should be made to improve accessibility to testing, particularly as new and more contagious variants become dominant.
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Affiliation(s)
- Pricila H. Mullachery
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA,Department of Health Services Administration and Policy, Temple University College of Public Health, 1301 Cecil B. Moore Ave, Philadelphia, PA, 19122, USA,Corresponding author. 1301 Cecil B. Moore Ave., 539, Philadelphia, PA, 19122, United States
| | - Ran Li
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA
| | - Steven Melly
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA
| | - Jennifer Kolker
- Department of Health Management and Policy, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Sharrelle Barber
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA,Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA,Ubuntu Center on Racism, Global Movements, and Population Health Equity, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA
| | - Ana V. Diez Roux
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA,Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA,Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA
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17
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Lin J, Zajdel M, Keller KR, Gilpin Macfoy FO, Shaw P, Curtis B, Ungar L, Koehly L. Life under stay-at-home orders: a panel study of change in social interaction and emotional wellbeing among older Americans during COVID-19 pandemic. BMC Public Health 2022; 22:1777. [PMID: 36123662 PMCID: PMC9484850 DOI: 10.1186/s12889-022-14103-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent research has shown the mental health consequence of social distancing during the COVID-19 pandemic, but longitudinal data are relatively scarce. It is unclear whether the pattern of isolation and elevated stress seen at the beginning of the pandemic persists over time. This study evaluates change in social interaction over six months and its impact on emotional wellbeing among older adults. METHODS We drew data from a panel study with six repeated assessments of social interaction and emotional wellbeing conducted monthly May through October 2020. The sample included a total of 380 White, Black and Hispanic participants aged 50 and over, of whom 33% had low income, who residing in fourteen U.S. states with active stay-at-home orders in May 2020. The analysis examined how change in living arrangement, in-person interaction outside the household, quality of relationship with family and friends, and perceived social support affected trajectories of isolation stress, COVID worry and sadness. RESULTS While their living arrangements (Odds Ratio [OR] = 0.95, 95% Confidence Interval [CI] = 0.87, 1.03) and relationship quality (OR = 0.94, 95% CI = 0.82, 1.01) remained stable, older adults experienced fluctuations in perceived social support (linear Slope b = -1.42, s.e. = 0.16, p < .001, quadratic slope b = 0.50, s.e. = 0.08, p < .001, cubic slope b = -0.04, s.e. = 0.01, p < .001) and increases in in-person conversations outside the household (OR = 1.19, 95% CI = 1.09, 1.29). Living with a spouse/partner stabilized isolation stress (change in linear slope b = 1.16, s.e. = 0.48, p < .05, in quadratic slope b = -0.62, s.e. = 0.26, p < .05, and in cubic slope = 0.09, s.e. = 0.04, p < .05) and COVID worry (change in quadratic slope b = -0.66, s.e. = 0.32, p < .05 and in cubic slope = 0.09, s.e. = 0.04, p < .05) over time. Individuals with better relationship quality with friends had decreased sadness over time (OR = 0.90, 95% CI = 0.82, 0.99). Changes in social support were associated with greater fluctuations in isolation stress and COVID worry. CONCLUSIONS During the pandemic, social interactions are protective and lack of stability in feeling supported makes older adults vulnerable to stress. Efforts should focus on (re)building and maintaining companionship and support to mitigate the pandemic's negative impact.
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Affiliation(s)
- Jielu Lin
- Social Network Methods Section, Social and Behavioral Research Branch, National Human Genome Research Institute, 31 Center Drive, Building 31, Room B1B37, Bethesda, MD, 20892, USA.
| | - Melissa Zajdel
- Social Network Methods Section, Social and Behavioral Research Branch, National Human Genome Research Institute, 31 Center Drive, Building 31, Room B1B37, Bethesda, MD, 20892, USA
| | - Krystyna R Keller
- Social Network Methods Section, Social and Behavioral Research Branch, National Human Genome Research Institute, 31 Center Drive, Building 31, Room B1B37, Bethesda, MD, 20892, USA
| | - Fiona O Gilpin Macfoy
- Social Network Methods Section, Social and Behavioral Research Branch, National Human Genome Research Institute, 31 Center Drive, Building 31, Room B1B37, Bethesda, MD, 20892, USA
| | - Philip Shaw
- Neurobehavioral Clinical Research Section, Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, USA
| | - Brenda Curtis
- Technology and Translational Research Unit, Translational Addiction Medicine Branch, National Institute On Drug Abuse, Baltimore, MD, USA
| | - Lyle Ungar
- Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA, USA
| | - Laura Koehly
- Social Network Methods Section, Social and Behavioral Research Branch, National Human Genome Research Institute, 31 Center Drive, Building 31, Room B1B37, Bethesda, MD, 20892, USA
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18
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Prasek SM, Pepper IL, Innes GK, Slinski S, Ruedas M, Sanchez A, Brierley P, Betancourt WQ, Stark ER, Foster AR, Betts-Childress ND, Schmitz BW. Population level SARS-CoV-2 fecal shedding rates determined via wastewater-based epidemiology. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 838:156535. [PMID: 35688254 PMCID: PMC9172256 DOI: 10.1016/j.scitotenv.2022.156535] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/14/2022] [Accepted: 06/03/2022] [Indexed: 05/21/2023]
Abstract
Wastewater-based epidemiology (WBE) has been utilized as an early warning tool to anticipate disease outbreaks, especially during the COVID-19 pandemic. However, COVID-19 disease models built from wastewater-collected data have been limited by the complexities involved in estimating SARS-CoV-2 fecal shedding rates. In this study, wastewater from six municipalities in Arizona and Florida with distinct demographics were monitored for SARS-CoV-2 RNA between September 2020 and December 2021. Virus concentrations with corresponding clinical case counts were utilized to estimate community-wide fecal shedding rates that encompassed all infected individuals. Analyses suggest that average SARS-CoV-2 RNA fecal shedding rates typically occurred within a consistent range (7.53-9.29 log10 gc/g-feces); and yet, were unique to each community and influenced by population demographics. Age, ethnicity, and socio-economic factors may have influenced shedding rates. Interestingly, populations with median age between 30 and 39 had the greatest fecal shedding rates. Additionally, rates remained relatively constant throughout the pandemic provided conditions related to vaccination and variants were unchanged. Rates significantly increased in some communities when the Delta variant became predominant. Findings in this study suggest that community-specific shedding rates may be appropriate in model development relating wastewater virus concentrations to clinical case counts.
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Affiliation(s)
- Sarah M Prasek
- Water & Energy Sustainable Technology (WEST) Center, University of Arizona, 2959 W. Calle Agua Nueva, Tucson, AZ 85745, USA
| | - Ian L Pepper
- Water & Energy Sustainable Technology (WEST) Center, University of Arizona, 2959 W. Calle Agua Nueva, Tucson, AZ 85745, USA
| | - Gabriel K Innes
- Yuma Center of Excellence for Desert Agriculture (YCEDA), University of Arizona, 6425 W. 8(th) St., Yuma, AZ 85364, USA
| | - Stephanie Slinski
- Yuma Center of Excellence for Desert Agriculture (YCEDA), University of Arizona, 6425 W. 8(th) St., Yuma, AZ 85364, USA
| | - Martha Ruedas
- Yuma Center of Excellence for Desert Agriculture (YCEDA), University of Arizona, 6425 W. 8(th) St., Yuma, AZ 85364, USA
| | - Ana Sanchez
- Yuma Center of Excellence for Desert Agriculture (YCEDA), University of Arizona, 6425 W. 8(th) St., Yuma, AZ 85364, USA
| | - Paul Brierley
- Yuma Center of Excellence for Desert Agriculture (YCEDA), University of Arizona, 6425 W. 8(th) St., Yuma, AZ 85364, USA
| | - Walter Q Betancourt
- Water & Energy Sustainable Technology (WEST) Center, University of Arizona, 2959 W. Calle Agua Nueva, Tucson, AZ 85745, USA
| | - Erika R Stark
- Water & Energy Sustainable Technology (WEST) Center, University of Arizona, 2959 W. Calle Agua Nueva, Tucson, AZ 85745, USA
| | - Aidan R Foster
- Water & Energy Sustainable Technology (WEST) Center, University of Arizona, 2959 W. Calle Agua Nueva, Tucson, AZ 85745, USA
| | - Nick D Betts-Childress
- Water & Energy Sustainable Technology (WEST) Center, University of Arizona, 2959 W. Calle Agua Nueva, Tucson, AZ 85745, USA
| | - Bradley W Schmitz
- Yuma Center of Excellence for Desert Agriculture (YCEDA), University of Arizona, 6425 W. 8(th) St., Yuma, AZ 85364, USA.
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19
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Agic B, Fruitman H, Maharaj A, Taylor J, Ashraf A, Henderson J, Ronda N, McKenzie K, Soklaridis S, Sockalingam S. Advancing Curriculum Development and Design in Health Professions Education: A Health Equity and Inclusion Framework for Education Programs. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 43:S4-S8. [PMID: 35940600 DOI: 10.1097/ceh.0000000000000453] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
ABSTRACT The COVID-19 pandemic has exacerbated pre-existing health inequities in vulnerable and marginalized patient populations. Continuing professional development (CPD) can be a critical driver of change to improve quality of care, health inequities, and system change. In order for CPD to address these disparities in care for patient populations most affected in the health care system, CPD programs must first address issues of equity and inclusion in their education development and delivery. Despite the need for equitable and inclusive CPD programs, there remains a paucity of tools and frameworks available in the literature to guide CPD and broader education providers on how best to develop and deliver equitable and inclusive education programs. In this article, we describe the development and application of a Health Equity and Inclusion (HEI) Framework for education and training grounded in the Analyze, Design, Develop, Implement, and Evaluate model for instructional design. Using a case example, specifically a hospital-wide trauma-informed de-escalation for safety program, we demonstrate how the HEI Framework can be applied practically to CPD programs to support equity and inclusion in the planning, development, implementation, and evaluation phases of education program delivery. The case example illustrates how the HEI Framework can be used by CPD providers to respect learner diversity, improve accessibility for all learners, foster inclusion, and address biases and stereotypes. We suggest that the HEI Framework can serve as an educational resource for CPD providers and health professions educators aiming to create equitable and inclusive CPD programs.
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Affiliation(s)
- Branka Agic
- Dr. Agic: Independent Scientist, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Fruitman: Instructional Designer, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Maharaj: Director, Community and Continuing Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Taylor: Editor, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Ashraf: Manager, Health Equity, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Dr. Henderson: Professor and Director, Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health; Senior Scientist, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. Dr. Ronda: Chair, School of Workforce Development, Continuing Education and Online Learning, CAMH, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Dr. McKenzie: Professor, CEO of Wellesley Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. Dr. Soklaridis: Associated Professor, Senior Scientist, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. Dr. Sockalingam: Professor, Vice-President Education & Clinician Scientist, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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20
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Dütsch M. COVID-19 and the labour market: What are the working conditions in critical jobs? JOURNAL FOR LABOUR MARKET RESEARCH 2022; 56:10. [PMID: 35909655 PMCID: PMC9321290 DOI: 10.1186/s12651-022-00315-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
UNLABELLED The COVID-19 pandemic has focused public attention on occupational groups that ensure the maintenance of critical infrastructure, provision of medical care and supply of essential goods. This paper examines the working conditions in critical jobs based on representative data from the German BAuA Working Time Survey 2019. Our analyses reveal that essential workers are more likely to perform unskilled or semiskilled activities and work in cleaning, transport and logistics, health care occupations as well as IT and natural science services. Regarding the working conditions, essential workers are paid comparatively less and are more physically proximate to others at work than nonessential workers. They more often work atypical hours, such as day and night shifts and on weekends, and have less autonomy in their working time. Additionally, critical jobs are characterised by muscular and skeletal strain due to working positions and carrying heavy loads significantly more often. Thus, our findings strongly suggest that work-related risks accumulate in critical jobs. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1186/s12651-022-00315-6.
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Affiliation(s)
- Matthias Dütsch
- Secretariat of the German Minimum Wage Commission, c/o Federal Institute for Occupational Safety and Health (BAuA), Nöldnerstraße 40-42, 10317 Berlin, Germany
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21
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Billock RM, Haring Sweeney M, Steege AL, Michaels R, Luckhaupt SE. Identifying essential critical infrastructure workers during the COVID-19 pandemic using standardized industry codes. Am J Ind Med 2022; 65:548-555. [PMID: 35532007 PMCID: PMC9347652 DOI: 10.1002/ajim.23361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/29/2022] [Accepted: 04/25/2022] [Indexed: 11/09/2022]
Abstract
Background The Cybersecurity and Infrastructure Security Agency (CISA) produced an advisory list identifying essential critical infrastructure workers (ECIW) during the coronavirus disease 2019 (COVID‐19) response. The CISA advisory list is the most common national definition of ECIW but has not been mapped to United States (U.S.) Census industry codes (CICs) to readily identify these worker populations in public health data sources. Methods We identified essential critical infrastructure industry designations corresponding to v4.0 of the CISA advisory list for all six‐digit North American Industry Classification System (NAICS) codes and cross‐walked NAICS codes to CICs. CICs were grouped as essential, non‐essential, or mixed essential/non‐essential according to component NAICS industries. We also obtained national estimated population sizes for NAICS and Census industries and cross‐tabulated Census industry and occupation codes to identify industry‐occupation pairs. Results We produced and made publicly available spreadsheets containing essential industry designations corresponding to v4.0 of the CISA advisory list for NAICS and Census industry titles and codes and population estimates by six‐digit NAICS industry, Census industry, and Census industry‐occupation pair. The CISA advisory list is highly inclusive and contains most industries and U.S. workers; 71.0% of Census industries comprising 80.6% of workers and 80.7% of NAICS industries comprising 87.1% of workers were designated as essential. Conclusions We identified workers in essential critical infrastructure industries as defined by CISA using standardized industry codes. These classifications may support public health interventions and analyses related to the COVID‐19 pandemic and future public health crises.
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Affiliation(s)
- Rachael M. Billock
- Division of Field Studies and Engineering National Institute for Occupational Safety and Health, CDC Cincinnati Ohio USA
| | - Marie Haring Sweeney
- Division of Field Studies and Engineering National Institute for Occupational Safety and Health, CDC Cincinnati Ohio USA
| | - Andrea L. Steege
- Division of Field Studies and Engineering National Institute for Occupational Safety and Health, CDC Cincinnati Ohio USA
| | - Ryan Michaels
- Federal Reserve Bank of Philadelphia Philadelphia Pennsylvania USA
| | - Sara E. Luckhaupt
- Division of Field Studies and Engineering National Institute for Occupational Safety and Health, CDC Cincinnati Ohio USA
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22
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Mullangi S, Aviki EM, Chen Y, Robson M, Hershman DL. Factors Associated With Cancer Treatment Delay Among Patients Diagnosed With COVID-19. JAMA Netw Open 2022; 5:e2224296. [PMID: 35900758 PMCID: PMC9335143 DOI: 10.1001/jamanetworkopen.2022.24296] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE The COVID-19 pandemic led to disruptions in delivery of cancer treatments; factors associated with treatment delay among patients with cancer who contract COVID-19 need further characterization. OBJECTIVE To assess the associations of patient factors, social determinants of health, severity of COVID-19, and timing of COVID-19 diagnosis with the risk of treatment delay. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study was conducted from March 2020 through July 2021 at 60 academic and community medical practices in the United States. Participants included patients with any cancer diagnosis who were scheduled for treatment and contracted COVID-19. Data were analyzed in February 2022. EXPOSURE Positive test result for SARS-CoV-2. MAIN OUTCOMES AND MEASURES The main outcomes were treatment delay, defined as more than 14 days between the date originally planned for treatment and the date of initiation of therapy, or discontinuation of therapy. Multivariable analyses were used to assess outcomes. RESULTS A total of 3028 patients (1470 patients [49%] aged ≥65 years; 1741 [58%] women) were included in the registry. With 962 of 2103 patients (46%) experiencing anticancer drug delay or discontinuation, delays were higher among Black patients compared with White patients (odds ratio [OR], 1.87; 95% CI, 1.40-2.51), Hispanic or Latino patients compared with non-Hispanic or Latino patients (OR, 1.91; 95% CI, 1.34-2.72), patients with 2 or more comorbidities compared with patients with 0 to 1 (OR, 1.23; 95% CI, 1.00-1.53), patients with metastatic disease rather than locoregional disease (OR, 1.63; 95% CI, 1.29-2.05), and patients who experienced COVID-19 complications compared with those who did not (OR, 1.52; 95% CI, 1.24-1.86). Residing in an area with a higher proportion of residents reporting Hispanic or Latino ethnicity (OR, 0.76; 95% CI, 0.60-0.95) and contracting COVID-19 later in the pandemic, compared with those who were infected in March to June 2020, (eg, January to March 2021: OR, 0.38; 95% CI, 0.26-0.53) were associated with lower likelihood of drug therapy delay. A total of 95 of 202 patients (47%) experienced delay or discontinuation of radiation treatment, with having 2 or more comorbidities associated with delay (OR, 2.69; 95% CI, 1.20-6.20). Higher local-area median household income was associated with lower likelihood of radiation treatment delay (OR, 0.41; 95% CI, 0.17-0.94). There were 89 of 125 patients (71%) who experienced surgical treatment delay, and delays were higher among patients in the South compared with those in the Midwest (OR, 9.66; 95% CI, 2.14-52.3). Interestingly, patients with 2 or more comorbidities, compared with those with 0 to 1, experienced lower likelihoods of surgical treatment delay (OR, 0.26; 95% CI, 0.07-0.88). CONCLUSIONS AND RELEVANCE Our findings suggest that individual patient factors, social determinants of health, and COVID-19 severity and diagnosis date were associated with exacerbated health disparities during the pandemic in regards to cancer treatment delay.
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Affiliation(s)
- Samyukta Mullangi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Emeline M. Aviki
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yuan Chen
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark Robson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Dawn L. Hershman
- Department of Medicine, Columbia University Medical Center, New York, New York
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23
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Godefroy R, Lewis J. What explains the socioeconomic status-health gradient? Evidence from workplace COVID-19 infections. SSM Popul Health 2022; 18:101124. [PMID: 35669891 PMCID: PMC9150908 DOI: 10.1016/j.ssmph.2022.101124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 05/04/2022] [Accepted: 05/11/2022] [Indexed: 01/08/2023] Open
Abstract
This paper studies the contribution of the workplace to the SES-health gradient. Our analysis is based on a unique dataset that tracks various health outcomes and workplace risks among healthcare workers during the first four months of the coronavirus 2019 (COVID-19) pandemic. The setting provides an exceptional opportunity to test for work-related disparities in health, while controlling for confounding determinants of the SES-health gradient. We find that low-SES nurses were systematically more likely to contract COVID-19 as a result of workplace exposure. These differentials existed in all healthcare institutions, but were particularly large in non-hospital settings. In contrast, we find no relationship between SES and nonwork-related infection rates. The differences in workplace infection rates are substantially larger than those implied by standard ‘task-based’ indices of transmission risk, and cannot be attributable to easily identifiable metrics of workplace risk. Together, our results show how subtle differences in work conditions or job duties can substantially contribute to the SES-health gradient.
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Affiliation(s)
- Raphael Godefroy
- Department of Economics, Université de Montréal, 3150, Rue Jean-Brillant, Montreal, QC, H3T1N8, Canada
| | - Joshua Lewis
- Department of Economics, Université de Montréal, 3150, Rue Jean-Brillant, Montreal, QC, H3T1N8, Canada
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24
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Cohen JFW, Posluszny H, Falbe J, Mueller MP, Gearhardt AN, Leung CW, Wolfson JA. Restaurant dining during the COVID-19 pandemic among adults with low-income in the United States. Appetite 2022; 173:105976. [PMID: 35245643 PMCID: PMC8885442 DOI: 10.1016/j.appet.2022.105976] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 11/23/2022]
Abstract
The COVID-19 pandemic caused widespread non-essential business closures in the U.S., which may have disproportionately impacted food consumption in lower-income communities, in part due to reduced access to healthy and affordable foods, as well as occupations that may have required working outside the home. The aims of this study were to examine restaurant dining behaviors (including drive-through, takeout, and delivery) at fast-food and non-fast-food (i.e., fast casual and full-service ['other']) restaurants and the impact on diet quality among racially/ethnically diverse low-income adults during the early months of the pandemic. Participants completed an online survey using CloudResearch regarding restaurant dining behaviors in the past week (during June 2020) and during a typical week prior to the pandemic. Diet quality was measured using the Prime Diet Quality Score (PDQS). Surveys from 1,756 low-income adults (incomes <250% of the Federal Poverty Level) were analyzed using chi-squared tests to examine differences in demographic characteristics among those dining at restaurants during the pandemic, as well as to examine differences in dining frequency compared with prior to COVID-19. Negative binomial regressions were used to examine the mean frequency of eating food from fast-food and other restaurants, adjusted for socio-demographic characteristics. This study found reductions in fast-food and other restaurant dining compared with prior to COVID-19, although overall restaurant consumption remained high with over half of participants reporting fast-food consumption in the week prior (average consumption of twice per week). Greater fast-food consumption was associated with poorer diet quality. In conclusion, while fast-food consumption was slightly lower during the pandemic, the overall high levels observed among socioeconomically disadvantaged adults remains concerning, highlighting the continued need for initiatives and policies to encourage greater access to and consumption of affordable and healthier foods.
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Affiliation(s)
- Juliana F W Cohen
- Department of Nutrition and Public Health, Merrimack College, 315 Turnpike Street, North Andover, MA, 01845, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Hannah Posluszny
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Jennifer Falbe
- Department of Human Ecology, University of California Davis, 1 Shields Ave, Davis, CA, 95616, USA.
| | - Megan P Mueller
- Department of Food Science and Human Nutrition, Colorado State University, 1571 Campus Dr, Fort Collins, CO, 80523, USA.
| | - Ashley N Gearhardt
- Department of Psychology, University of Michigan, 530 Church Street, Ann Arbor, MI, 48109, USA.
| | - Cindy W Leung
- Department of Nutritional Sciences, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Julia A Wolfson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
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25
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Torres IR, Shklanko S, Haq C, LeBrón AMW. Occupational health within the bounds of primary care: Factors shaping the health of Latina/o immigrant workers in federally qualified health centers. Am J Ind Med 2022; 65:468-482. [PMID: 35426145 DOI: 10.1002/ajim.23356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/18/2022] [Accepted: 03/25/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Many workers seek care for work-related medical conditions in primary care settings. Additionally, occupational medicine training is not consistently addressed in primary care professional training. These patterns raise concerns about the health outcomes of low-wage Latina/o immigrant workers who make use of primary care settings to obtain care for work-related injuries and illnesses. The objective of this qualitative study was to investigate how primary care clinicians assessed and addressed the role of occupational exposures on the health and well-being of Latina/o immigrant workers. METHODS We conducted semistructured in-depth interviews with 17 primary care clinicians (physicians, resident physicians, and nurse practitioners) employed in an urban federally qualified health center (FQHC) with two sites located in Orange County, CA. RESULTS Using a constructivist grounded theory approach, we determined that primary care clinicians had a general understanding that employment influenced the health and well-being of their Latina/o immigrant patients. Clinicians delivered care to Latina/o immigrant workers who feared reporting their injury to their employer and to Latina/o immigrants whose workers' compensation claim was terminated before making a full recovery. Clinicians were responsive to patients' work-related concerns and leveraged the resources available within the FQHC. Although some clinicians offered suggestions to improve occupational health in the FQHC, a few clinicians raised concerns about the feasibility of additional health screenings and clinic-based interventions, and pointed to the importance of interventions outside of the healthcare system. CONCLUSION This study underscores the complexities of addressing occupational health concerns in urban FQHCs.
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Affiliation(s)
- Ivy R Torres
- Department of Health, Society, and Behavior, Program in Public Health, University of California, Irvine, Irvine, California, USA
| | - Sarah Shklanko
- Department of Population Health and Disease Prevention, Program in Public Health, University of California, Irvine, Irvine, California, USA
| | - Cynthia Haq
- Department of Family Medicine, School of Medicine, University of California, Irvine, Irvine, California, USA
| | - Alana M W LeBrón
- Department of Health, Society, and Behavior, Program in Public Health, University of California, Irvine, Irvine, California, USA
- Department of Chicano/Latino Studies, School of Social Sciences, University of California, Irvine, Irvine, California, USA
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26
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Nguyen KH, Irvine S, Chung M, Yue H, Sheetoh C, Chui K, Allen JD. Prevalence of Previous COVID-19 Infection, COVID-19 Vaccination Receipt, and Intent to Vaccinate Among the US Workforce. Public Health Rep 2022; 137:755-763. [PMID: 35403489 PMCID: PMC9066271 DOI: 10.1177/00333549221085238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: As COVID-19 vaccines become more accessible to all people in the United States, more employees are returning to the workforce or switching to in-person work. However, limited information is available on vaccination coverage and intent among the US workforce. Methods: We used data from the US Census Bureau’s Household Pulse Survey, fielded during April 14–May 24, 2021 (N = 218 787), to examine the prevalence of previous COVID-19 infection, vaccination receipt, and intent to vaccinate by essential worker status and employment type. In addition, we analyzed factors associated with vaccination receipt and reasons for not getting vaccinated. Results: More than 15% of the US workforce had a previous diagnosis of COVID-19, and 73.6% received ≥1 dose of COVID-19 vaccine; however, 12.4% reported that they probably will not or definitely will not get vaccinated. Vaccination coverage (range, 63.8%-78.3%) was lowest and non-intent to get vaccinated (12.9%-21.7%) was highest among self-employed adults across all essential and nonessential worker groups. Factors associated with receipt of vaccination were age, race, Hispanic ethnicity, educational attainment, annual household income, health insurance status, and previous COVID-19 diagnosis. The main reasons for not getting vaccinated were concerns about possible side effects and waiting and seeing if the vaccine is safe. Conclusion: Identifying and addressing disparities in COVID-19 vaccination coverage in the US workforce can protect groups with low vaccine coverage and increase understanding of reasons for vaccine hesitancy. Educating employees about the vaccine and its potential side effects, promoting a culture of health and safety in the workplace, and building social norms around vaccination can help create a safe work environment for all employees and their families.
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Affiliation(s)
- Kimberly H. Nguyen
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Shannon Irvine
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Mei Chung
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Holly Yue
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Cordelia Sheetoh
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Kenneth Chui
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA
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27
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Romero D, Manze M, Goldman D, Johnson G. The Role of COVID-19, Race and Social Factors in Pregnancy Experiences in New York State: The CAP Study. Behav Med 2022; 48:120-132. [PMID: 34743679 DOI: 10.1080/08964289.2021.1997893] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Given that New York State's (NYS) was the first epicenter of the COVID-19 pandemic in the United States (US), we were interested in potential racial/ethnic differences in pregnancy-related experiences among women pregnant during versus prior to the pandemic. We surveyed 1,525 women (18-44 years) proportionate to geographic and sociodemographic distribution between June 9, 20 and July 21, 20. We carried out bivariate analysis of various social and pregnancy-related factors by racial/ethnic identity (White, Black, Hispanic) and binary logistic and linear regression assessing the association between race/ethnicity, pregnancy prior to/during the pandemic, demographic characteristics, health and social wellbeing, and employment as an essential worker with pregnancy-related healthcare delays and changes. Overall, Black and Hispanic women were significantly more likely to experience a host of negative prenatal and postpartum experiences. In general, multivariate analyses revealed that individuals who were pregnant during the pandemic, lived in NYC, participated in social welfare programs, lacked health insurance, and/or were essential workers were more likely to report delays in prenatal and postpartum care and/or more changes/negative experiences. In light of previous evidence of racial disparities in birth experiences, the higher rates of negative pregnancy/birth-care and postpartum/newborn-care experiences among Black and Hispanic women in bivariate analysis warrant further inspection given that their aggregation for multivariate analysis may have obscured differences at the level of individual events. Findings support continued efforts for universal health insurance and improved social welfare programs. Guidelines are needed to protect essential workers' access to health services, particularly related to pregnancy given the time-sensitive nature of this care.Supplemental data for this article is available online at https://doi.org/10.1080/08964289.2021.1997893 .
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Affiliation(s)
- Diana Romero
- Department of Community Health and Social Sciences, City University of New York (CUNY) Graduate School of Public Health and Health Policy
| | - Meredith Manze
- Department of Community Health and Social Sciences, City University of New York (CUNY) Graduate School of Public Health and Health Policy
| | - Dari Goldman
- Department of Community Health and Social Sciences, City University of New York (CUNY) Graduate School of Public Health and Health Policy
| | - Glen Johnson
- Department of Environmental, Occupational, and Geospatial Sciences, City University of New York (CUNY) Graduate School of Public Health and Health Policy
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28
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Moderating Effect of a Cross-Level Social Distancing Policy on the Disparity of COVID-19 Transmission in the United States. ISPRS INTERNATIONAL JOURNAL OF GEO-INFORMATION 2022. [DOI: 10.3390/ijgi11040229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Currently, coronavirus disease 2019 (COVID-19) remains a global pandemic, but the prevention and control of the disease in various countries have also entered the normalization stage. To achieve economic recovery and avoid a waste of resources, different regions have developed prevention and control strategies according to their social, economic, and medical conditions and culture. COVID-19 disparities under the interaction of various factors, including interventions, need to be analyzed in advance for effective and precise prevention and control. Considering the United States as the study case, we investigated statistical and spatial disparities based on the impact of the county-level social vulnerability index (SVI) on the COVID-19 infection rate. The county-level COVID-19 infection rate showed very significant heterogeneity between states, where 67% of county-level disparities in COVID-19 infection rates come from differences between states. A hierarchical linear model (HLM) was adopted to examine the moderating effects of state-level social distancing policies on the influence of the county-level SVI on COVID-19 infection rates, considering the variation in data at a unified level and the interaction of various data at different levels. Although previous studies have shown that various social distancing policies inhibit COVID-19 transmission to varying degrees, this study explored the reasons for the disparities in COVID-19 transmission under various policies. For example, we revealed that the state-level restrictions on the internal movement policy significantly attenuate the positive effect of county-level economic vulnerability indicators on COVID-19 infection rates, indirectly inhibiting COVID-19 transmission. We also found that not all regions are suitable for the strictest social distancing policies. We considered the moderating effect of multilevel covariates on the results, allowing us to identify the causes of significant group differences across regions and to tailor measures of varying intensity more easily. This study is also necessary to accomplish targeted preventative measures and to allocate resources.
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29
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Early Care and Education Workers' Experience and Stress during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052670. [PMID: 35270362 PMCID: PMC8910108 DOI: 10.3390/ijerph19052670] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/18/2022] [Accepted: 02/24/2022] [Indexed: 01/29/2023]
Abstract
Early care and education (ECE) workers experience many job-related stressors. During the COVID-19 pandemic, ECE programs either closed or remained open while workers faced additional demands. We deployed a survey of the center-based ECE workforce in Washington State (United States) one year into the COVID-19 pandemic to assess impacts and workers' perceived stress levels. We describe the prevalence of reported impacts, including workplace closures; job changes; COVID-19 transmission; risk factors for severe COVID-19; the use of social distancing practices; satisfaction with workplace responses; perceptions of worker roles, respect, and influence; and food and financial insecurity. Themes from open-ended responses illustrate how workers' jobs changed and the stressors that workers experienced as a result. Fifty-seven percent of ECE workers reported moderate or high levels of stress. In a regression model assessing unique contributions to stress, work changes that negatively impacted home life contributed most to stress. Feeling respected for one's work and feeling positive about one's role as an "essential worker" contributed to lower levels of stress. Experiencing financial insecurity, caring for school-aged children or children of multiple ages, being younger, and being born in the United States also contributed to higher stress. Findings can inform policies designed to support the workforce.
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30
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Garcia M. This Is America: Systemic Racism and Health Inequities Amidst the COVID-19 Pandemic. SOCIAL WORK IN PUBLIC HEALTH 2022; 37:105-121. [PMID: 34592909 DOI: 10.1080/19371918.2021.1981509] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The Coronavirus 2019 (COVID-19) continues to devastate the world and the United States remains number one of reported COVID-19 cases and deaths. Research demonstrates that Blacks and Hispanics in the United States are disproportionately impacted by COVID-19, especially among highly marginalized people at the intersection of immigration and incarceration. Social distancing is a privilege and contact tracing is a deterrent for historically oppressed populations. Public health professionals have attempted a multicausal approach to prevent the spread of infectious diseases, but they have been unsuccessful in addressing the biological-social impact of highly vulnerable populations. An emphasis is placed on syndemics and social determinants of health to address health inequities associated with COVID-19 due to systemic racism. Implications for social work will reinforce the profession's obligation to address public emergencies through social and political action. Recommendations will be made for social workers to support local, state, and federal level responses of COVID-19.
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Affiliation(s)
- Moctezuma Garcia
- School of Social Work, San Jose State University, San Jose, California, USA
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31
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Teixeira RA, Vasconcelos AMN, Torens A, França EB, Ishitani L, Bierrenbach AL, de Abreu DMX, Marinho F. Excess Mortality due to natural causes among whites and blacks during the COVID-19 pandemic in Brazil. Rev Soc Bras Med Trop 2022; 55:e0283. [PMID: 35107533 PMCID: PMC9009425 DOI: 10.1590/0037-8682-0283-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/09/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Excess Mortality by all causes considers deaths directly related to COVID-19 and those attributed to conditions caused by the pandemic. When stratified by social dimensions, such as race/color, it allows for the evaluation of more vulnerable populations. The study estimated the excess mortality by natural causes, separating the white and black populations in 2020. METHODS Public civil registration data on deaths observed in 2020, corrected for under registration, were used. The expected number of deaths was estimated based on the mortality rates observed in 2019, applied to the estimated population in 2020. The difference between the values expected and observed and the proportion of excess was considered the excess mortality. RESULTS The present study found an excess of 270,321 deaths (22.2% above the expected) in 2020. Every state of Brazil reported deaths above the corresponding expected figure. The excess was higher for men (25.2%) than for women (19.0%). Blacks showed an excess of 27.8%, as compared to whites at 17.6%. In both sexes and all age groups, excess was higher in the black population, especially in the South, Southeast, and Midwest regions. São Paulo, the largest in population number, had twice as much excess death in the black population (25.1%) than in the white population (11.5%). CONCLUSIONS The present study showed racial disparities in excess mortality during the COVID-19 pandemic in Brazil. The higher excess found for the black suggests an intrinsic relationship with the socioeconomic situation, further exposing the Brazilian reality, in which social and structural inequality is evident.
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Affiliation(s)
- Renato Azeredo Teixeira
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Saúde Pública, Belo Horizonte, MG, Brasil
- Vital Strategies, New York, United States of America
| | | | - Ana Torens
- Vital Strategies, New York, United States of America
| | - Elisabeth Barboza França
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Saúde Pública, Belo Horizonte, MG, Brasil
| | - Lenice Ishitani
- Universidade Federal de Minas Gerais, Grupo de Pesquisas em Epidemiologia e Avaliação em Saúde, Belo Horizonte, MG, Brasil
| | | | - Daisy Maria Xavier de Abreu
- Universidade Federal de Minas Gerais, Grupo de Pesquisas em Epidemiologia e Avaliação em Saúde, Belo Horizonte, MG, Brasil
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Upchurch DM, Wong MS, Yuan AH, Haderlein TP, McClendon J, Christy A, Washington DL. COVID-19 Infection in the Veterans Health Administration: Gender-specific Racial and Ethnic Differences. Womens Health Issues 2022; 32:41-50. [PMID: 34702652 PMCID: PMC8486675 DOI: 10.1016/j.whi.2021.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 09/10/2021] [Accepted: 09/27/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Racial/ethnic minoritized groups, women, and economically disadvantaged groups are disproportionately affected by the COVID-19 pandemic. We investigated racial/ethnic differences by gender in correlates of COVID-19 infection among veterans seeking health care services at the Veterans Health Administration. Little is known about gender-specific factors associated with infection among veterans. This study seeks to fill this gap. METHODS The sample was veterans with results from a COVID-19 test (polymerase chain reaction) conducted at Veterans Health Administration facilities between March 1, 2020, and August 5, 2020, and linked to the Centers for Disease Control and Prevention Social Vulnerability Index data (39,223 women and 316,380 men). Bivariate, multivariate logistic, and predicted probability analyses were conducted. All analyses were stratified by gender. RESULTS Similar percentages of women and men tested positive for COVID-19 (9.6% vs. 10.0%). In multivariate analysis, compared with non-Hispanic White women, American Indian/Alaska Native, Black, and Hispanic women all had significantly higher odds of infection. Similar racial/ethnic differences were found for men. Both older men and women (>40 years) had lower odds of infection, but the age cut points differed (40 for women, 55 for men). Men 80 years and older had a higher odds than those aged less than 40 years of age. For men, but not for women, being employed (vs. unemployed) was associated with an increased odds of infection, and having comorbidities was associated with decreased odds. There were significant differences within and across gender-by-race/ethnicity in infection, after adjusting for covariates. CONCLUSIONS American Indian/Alaska Native, Hispanic, and Black women and men veterans are disproportionately impacted by COVID-19 infection. Widespread testing and tracking, education, and outreach regarding COVID-19 mitigation and vaccination efforts are recommended.
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Affiliation(s)
- Dawn M Upchurch
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California.
| | - Michelle S Wong
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Anita H Yuan
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Taona P Haderlein
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Juliette McClendon
- National Center for PTSD, Women's Health Science Division, VA Boston Health Care System, Boston, Massachusetts; Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Alicia Christy
- Women's Health Services, Veterans Health Administration, Washington, District of Columbia
| | - Donna L Washington
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California; Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles Geffen School of Medicine, Los Angeles, California
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van Ingen T, Brown KA, Buchan SA, Akingbola S, Daneman N, Warren CM, Smith BT. Neighbourhood-level socio-demographic characteristics and risk of COVID-19 incidence and mortality in Ontario, Canada: A population-based study. PLoS One 2022; 17:e0276507. [PMID: 36264984 DOI: 10.1101/2021.01.27.21250618] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/07/2022] [Indexed: 05/21/2023] Open
Abstract
OBJECTIVES We aimed to estimate associations between COVID-19 incidence and mortality with neighbourhood-level immigration, race, housing, and socio-economic characteristics. METHODS We conducted a population-based study of 28,808 COVID-19 cases in the provincial reportable infectious disease surveillance systems (Public Health Case and Contact Management System) which includes all known COVID-19 infections and deaths from Ontario, Canada reported between January 23, 2020 and July 28, 2020. Residents of congregate settings, Indigenous communities living on reserves or small neighbourhoods with populations <1,000 were excluded. Comparing neighbourhoods in the 90th to the 10th percentiles of socio-demographic characteristics, we estimated the associations between 18 neighbourhood-level measures of immigration, race, housing and socio-economic characteristics and COVID-19 incidence and mortality using Poisson generalized linear mixed models. RESULTS Neighbourhoods with the highest proportion of immigrants (relative risk (RR): 4.0, 95%CI:3.5-4.5) and visible minority residents (RR: 3.3, 95%CI:2.9-3.7) showed the strongest association with COVID-19 incidence in adjusted models. Among individual race groups, COVID-19 incidence was highest among neighbourhoods with the high proportions of Black (RR: 2.4, 95%CI:2.2-2.6), South Asian (RR: 1.9, 95%CI:1.8-2.1), Latin American (RR: 1.8, 95%CI:1.6-2.0) and Middle Eastern (RR: 1.2, 95%CI:1.1-1.3) residents. Neighbourhoods with the highest average household size (RR: 1.9, 95%CI:1.7-2.1), proportion of multigenerational families (RR: 1.8, 95%CI:1.7-2.0) and unsuitably crowded housing (RR: 2.1, 95%CI:2.0-2.3) were associated with COVID-19 incidence. Neighbourhoods with the highest proportion of residents with less than high school education (RR: 1.6, 95%CI:1.4-1.8), low income (RR: 1.4, 95%CI:1.2-1.5) and unaffordable housing (RR: 1.6, 95%CI:1.4-1.8) were associated with COVID-19 incidence. Similar inequities were observed across neighbourhood-level sociodemographic characteristics and COVID-19 mortality. CONCLUSIONS Neighbourhood-level inequities in COVID-19 incidence and mortality were observed in Ontario, with excess burden experienced in neighbourhoods with a higher proportion of immigrants, racialized populations, large households and low socio-economic status.
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Affiliation(s)
| | - Kevin A Brown
- Public Health Ontario, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sarah A Buchan
- Public Health Ontario, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Nick Daneman
- Public Health Ontario, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Brendan T Smith
- Public Health Ontario, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Lemuel AM, Usman IM, Kasozi KI, Alghamdi S, Aigbogun EO, Archibong V, Ssebuufu R, Kabanyoro A, Ifie JE, Swase DT, Ssempijja F, Ayuba JT, Matama K, Onohuean H, Kembabazi S, Henry R, Odoma S, Yusuf H, Afodun AM, Assaggaf HM, Kairania E, Aslam A, Okon O, El-Saber Batiha G, Welburn SC. COVID-19-Related Mental Health Burdens: Impact of Educational Level and Relationship Status Among Low-Income Earners of Western Uganda. Front Public Health 2021; 9:739270. [PMID: 34900896 PMCID: PMC8663024 DOI: 10.3389/fpubh.2021.739270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/30/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: The study aimed to investigate the relationship between mental health with the level of education, relationship status, and awareness on mental health among low-income earners in Western Uganda. Methods: This was a cross-sectional descriptive study carried out among 253 participants. Anxiety, anger, and depression were assessed using a modified generalized anxiety disorder (GAD-7), Spielberger's State-Trait Anger Expression Inventory-2, and Beck Depression Inventory item tools, respectively. Results: The majority of our respondents were male (n = 150/253, 59.3), had a secondary level of education (104/253, 41.1), and were single (137/253, 54.2). No formal education and primary education (r2 = 47.4% and 6.4%, respectively) had a negative correlation with awareness of mental health care. In addition, no formal education had a positive correlation with anger and depression (r2 = 1.9% and 0.3%, respectively). Singleness in this study had a negative correlation with awareness of mental health care, anger, and depression (r2 = 1.9, 0.8, and 0.3%, respectively), and a positive correlation with anxiety (r2 = 3.9%). Conclusion: It is evident that education and relationship status influenced awareness on mental health care and mental health state among low-income earners in Western Uganda during the first COVID-19 lockdown. Therefore, policymakers should strengthen social transformation through the proper engagement of low-income earners in this COVID-19 era.
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Affiliation(s)
- Ann Monima Lemuel
- Faculty of Biomedical Sciences, Kampala International University Western Campus, Bushenyi, Uganda
| | - Ibe Michael Usman
- Faculty of Biomedical Sciences, Kampala International University Western Campus, Bushenyi, Uganda
| | - Keneth Iceland Kasozi
- Infection Medicine, Deanery of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, United Kingdom.,School of Medicine, Kabale University, Kabale, Uganda
| | - Saad Alghamdi
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Eric Osamudiamwen Aigbogun
- Department of Public Health Science, Faculty of Science and Technology, Cavendish University, Kampala, Uganda
| | - Victor Archibong
- Faculty of Biomedical Sciences, Kampala International University Western Campus, Bushenyi, Uganda
| | | | - Annet Kabanyoro
- School of Nursing, Kampala International University Teaching Hospital, Bushenyi, Uganda
| | - Josiah Eseoghene Ifie
- Faculty of Biomedical Sciences, Kampala International University Western Campus, Bushenyi, Uganda
| | - Dominic Terkimbi Swase
- Faculty of Biomedical Sciences, Kampala International University Western Campus, Bushenyi, Uganda
| | - Fred Ssempijja
- Faculty of Biomedical Sciences, Kampala International University Western Campus, Bushenyi, Uganda
| | - John Tabakwot Ayuba
- Faculty of Biomedical Sciences, Kampala International University Western Campus, Bushenyi, Uganda
| | - Kevin Matama
- Department of Pharmacology and Toxicology, School of Pharmacy, Kampala International University Western Campus, Kampala, Uganda
| | - Hope Onohuean
- Biopharmaceutics Unit, Department of Pharmacology and Toxicology, School of Pharmacy, Kampala International University, Kampala, Uganda
| | - Stellamaris Kembabazi
- Faculty of Biomedical Sciences, Kampala International University Western Campus, Bushenyi, Uganda
| | - Rachael Henry
- Department of Human Anatomy, College of Medicine and Health Science, Ahmadu Bello University, Zaria, Nigeria
| | - Said Odoma
- Department of Pharmacology and Toxicology, International University, Kampala, Uganda.,Department of Pharmacology, College of Health Sciences, Kogi State University, Anyigba, Nigeria
| | - Helen Yusuf
- Department of Human Anatomy, College of Medicine and Health Science, Ahmadu Bello University, Zaria, Nigeria
| | - Adam Moyosore Afodun
- Department of Anatomy and Cell Biology, Faculty of Health Sciences, Busitema University, Tororo, Uganda
| | - Hamza M Assaggaf
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Emmanuel Kairania
- Department of Anatomy and Cell Biology, Faculty of Health Sciences, Busitema University, Tororo, Uganda
| | - Akhmed Aslam
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Owoisinke Okon
- Department of Public Health, University of Calabar, Calabar, Nigeria
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour, Egypt
| | - Susan Christina Welburn
- Infection Medicine, Deanery of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, United Kingdom.,Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Zhejiang University, Haining, China
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35
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Sugg MM, Runkle JD, Andersen L, Weiser J, Michael KD. Crisis response among essential workers and their children during the COVID-19 pandemic. Prev Med 2021; 153:106852. [PMID: 34673081 PMCID: PMC8524246 DOI: 10.1016/j.ypmed.2021.106852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 01/06/2023]
Abstract
Limited research has been conducted on the mental health concerns of frontline and essential workers and their children during the COVID-19 pandemic in the United States (U.S.). This study examined the association between working on the frontlines in the U.S. during the COVID-19 pandemic (March to July 2020) and personal crisis text concerns (e.g., self-harm, suicidal thoughts, anxiety/stress, and substance abuse) for frontline essential workers and the children of frontline workers. We used a novel data set from a crisis texting service, Crisis Text Line (CTL), that is widely used throughout the U.S. Generalized Estimating Equations examined the individual association between eight specific crisis types (Depression, Stress/Anxiety, Self-Harm, Suicidal Thoughts, Substance Abuse, Isolation, Relationship Issues, and Abuse) and being in frontline work or being a child of a frontline worker during the early phase of the pandemic. Using CTL concerns as a proxy for the prevalence of mental health issues, we found that children of workers, specifically the youngest demographic (13 years and under), females, and non-conforming youth had a higher risk of specific crisis events during the COVID-19 pandemic. Additionally, Hispanic children of workers reported higher rates of stress/anxiety, whereas African American children of workers had higher rates of abuse and depression. Frontline workers had a higher risk of suicidal thoughts, and the risk of crisis events was generally highest for non-binary, transgender, and male users. Increases in CTL usage among frontline workers were noted across 7-28 days after spikes in local COVID-19 cases. The research to date has focused on the mental health of frontline essential workers, but our study highlights troubling trends in psychological stress among children of these workers. Supportive interventions and mental health resources are needed not only for frontline essential workers, but for their children too.
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Affiliation(s)
- Margaret M Sugg
- Department of Geography and Planning, Appalachian State University, P.O. Box 32066, Boone, North Carolina 28608, United States.
| | - Jennifer D Runkle
- North Carolina Institute for Climate Studies, North Carolina State University, 151 Patton Avenue, Asheville, NC 28801, United States
| | - Lauren Andersen
- Department of Geography and Planning, Appalachian State University, P.O. Box 32066, Boone, North Carolina 28608, United States
| | - Jaclyn Weiser
- Crisis Text Line, PO Box 1144, New York, NY 10159, United States
| | - Kurt D Michael
- Department of Psychology, Appalachian State University, P.O. Box 32109, Boone, North Carolina 28608, United States
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Whaley CM, Cantor J, Pera MF, Bravata DM. Industry Variation in Risk of Delaying Care During COVID-19. J Gen Intern Med 2021; 36:3621-3624. [PMID: 33772442 PMCID: PMC7997479 DOI: 10.1007/s11606-021-06694-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/28/2021] [Indexed: 12/01/2022]
Affiliation(s)
| | - Jonathan Cantor
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | | | - Dena M Bravata
- Castlight Health, San Francisco, CA, USA.,Center for Primary Care and Outcomes Research, Stanford, CA, USA
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37
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Salgado de Snyder VN, McDaniel M, Padilla AM, Parra-Medina D. Impact of COVID-19 on Latinos: A Social Determinants of Health Model and Scoping Review of the Literature. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2021. [DOI: 10.1177/07399863211041214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this scoping review of the literature was to analyze the impact of the COVID-19 pandemic on the living conditions of Latinos (Hispanics) in the U.S. from a social determinants of health perspective. We developed a conceptual model based on the social determinants of health framework to guide the search, extraction, analysis, and interpretation of the bibliographic material. A systematic review of peer reviewed literature published in 2020 in scientific journals in the social, health, and behavioral sciences was conducted. A total of 37 articles met the selection criteria, 12 were original investigations with primary data collection, and 25 were studies reporting results of secondary data analysis using public or private databases. The representation of Latinos in the study samples ranged from 5% to 40%. The results of our review are compelling in terms of the overrepresentation of Latinos in SARSCoV-2 positivity and COVID-19 morbidity and mortality rates. The risk factors identified include working in a job considered essential, living in a geographic area with a high population density of Latinos and blacks, overcrowded living conditions in the household, limited English proficiency, and being unable to systematically carry out preventive behaviors known to be effective for infection avoidance. Existing national surveys and registries suffer from assumptions and omissions regarding variables relevant to Latinos. New studies must be guided by inquiries on the usual social determinants of health, but also those relevant for Latinos, such as national group, generational status, and language, among others.
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Affiliation(s)
- Velia Nelly Salgado de Snyder
- National Institute of Public Health of Mexico, Cuernavaca, Morelos, México
- The University of Texas at Austin, TX, USA
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38
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Tolchin B, Oladele C, Galusha D, Kashyap N, Showstark M, Bonito J, Salazar MC, Herbst JL, Martino S, Kim N, Nash KA, Nguemeni Tiako MJ, Roy S, Vergara Greeno R, Jubanyik K. Racial disparities in the SOFA score among patients hospitalized with COVID-19. PLoS One 2021; 16:e0257608. [PMID: 34535009 PMCID: PMC8448580 DOI: 10.1371/journal.pone.0257608] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/04/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Sequential Organ Failure Assessment (SOFA) score predicts probability of in-hospital mortality. Many crisis standards of care suggest the use of SOFA scores to allocate medical resources during the COVID-19 pandemic. RESEARCH QUESTION Are SOFA scores elevated among Non-Hispanic Black and Hispanic patients hospitalized with COVID-19, compared to Non-Hispanic White patients? STUDY DESIGN AND METHODS Retrospective cohort study conducted in Yale New Haven Health System, including 5 hospitals with total of 2681 beds. Study population drawn from consecutive patients aged ≥18 admitted with COVID-19 from March 29th to August 1st, 2020. Patients excluded from the analysis if not their first admission with COVID-19, if they did not have SOFA score recorded within 24 hours of admission, if race and ethnicity data were not Non-Hispanic Black, Non-Hispanic White, or Hispanic, or if they had other missing data. The primary outcome was SOFA score, with peak score within 24 hours of admission dichotomized as <6 or ≥6. RESULTS Of 2982 patients admitted with COVID-19, 2320 met inclusion criteria and were analyzed, of whom 1058 (45.6%) were Non-Hispanic White, 645 (27.8%) were Hispanic, and 617 (26.6%) were Non-Hispanic Black. Median age was 65.0 and 1226 (52.8%) were female. In univariate logistic screen and in full multivariate model, Non-Hispanic Black patients but not Hispanic patients had greater odds of an elevated SOFA score ≥6 when compared to Non-Hispanic White patients (OR 1.49, 95%CI 1.11-1.99). INTERPRETATION Given current unequal patterns in social determinants of health, US crisis standards of care utilizing the SOFA score to allocate medical resources would be more likely to deny these resources to Non-Hispanic Black patients.
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Affiliation(s)
- Benjamin Tolchin
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Carol Oladele
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Deron Galusha
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Nitu Kashyap
- Information Technology, Yale New Haven Health, New Haven, Connecticut, United States of America
| | - Mary Showstark
- Yale School of Medicine Physician Assistant Online Program, New Haven, Connecticut, United States of America
| | - Jennifer Bonito
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Michelle C. Salazar
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Jennifer L. Herbst
- Quinnipiac University School of Law, North Haven, Connecticut, United States of America
| | - Steve Martino
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Nancy Kim
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Katherine A. Nash
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Max Jordan Nguemeni Tiako
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Shireen Roy
- Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Rebeca Vergara Greeno
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Karen Jubanyik
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
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Touw S, McCormack G, Himmelstein DU, Woolhandler S, Zallman L. Immigrant Essential Workers Likely Avoided Medicaid And SNAP Because Of A Change To The Public Charge Rule. Health Aff (Millwood) 2021; 40:1090-1098. [PMID: 34228520 DOI: 10.1377/hlthaff.2021.00059] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
During the COVID-19 pandemic in the US, essential workers have provided health care, food, and other necessities, often incurring considerable risk. At the pandemic's start, the federal government was in the process of tightening the "public charge" rule by adding nutrition and health benefits to the cash benefits that, if drawn, could subject immigrants to sanctions (for example, green card denial). Census Bureau data indicate that immigrants accounted for 13.6 percent of the population but 17.8 percent of essential workers in 2019. About 20.0 million immigrants held essential jobs, and more than one-third of these immigrants resided in US states bordering Mexico. Nationwide, 12.3 million essential workers and 18.9 million of their household members were at risk because of the new sanctions. The rule change (which was subsequently revoked) likely caused 2.1 million essential workers and household members to forgo Medicaid and 1.3 million to forgo Supplemental Nutrition Assistance Program assistance on the eve of the pandemic, highlighting the potential of immigration policy changes to exacerbate health risks.
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Affiliation(s)
- Sharon Touw
- Sharon Touw is a researcher at the Institute for Community Health, in Malden, Massachusetts
| | - Grace McCormack
- Grace McCormack is a PhD candidate in the Harvard Kennedy School, Harvard University, in Cambridge, Massachusetts
| | - David U Himmelstein
- David U. Himmelstein is a distinguished professor of public health at Hunter College, City University of New York, in New York, New York, and a lecturer in medicine at Cambridge Health Alliance/Harvard Medical School, in Cambridge, Massachusetts
| | - Steffie Woolhandler
- Steffie Woolhandler is a distinguished professor of public health at Hunter College, City University of New York, and a lecturer in medicine at Cambridge Health Alliance/Harvard Medical School
| | - Leah Zallman
- Leah Zallman, who died in November 2020, was director of research at the Institute for Community Health, an assistant professor of medicine at Harvard Medical School, and a primary care physician at Cambridge Health Alliance, when this research was conducted
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40
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Kouser HN, Barnard-Mayers R, Murray E. Complex systems models for causal inference in social epidemiology. J Epidemiol Community Health 2021; 75:702-708. [PMID: 33172839 PMCID: PMC8849440 DOI: 10.1136/jech-2019-213052] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/24/2020] [Accepted: 10/21/2020] [Indexed: 02/06/2023]
Abstract
Systems models, which by design aim to capture multi-level complexity, are a natural choice of tool for bridging the divide between social epidemiology and causal inference. In this commentary, we discuss the potential uses of complex systems models for improving our understanding of quantitative causal effects in social epidemiology. To put systems models in context, we will describe how this approach could be used to optimise the distribution of COVID-19 response resources to minimise social inequalities during and after the pandemic.
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Affiliation(s)
- Hiba N Kouser
- Epidemiology, Boston University, Boston, Massachusetts, USA
| | | | - Eleanor Murray
- Epidemiology, Boston University, Boston, Massachusetts, USA
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Vilendrer S, Amano A, Brown Johnson CG, Favet M, Safaeinili N, Villasenor J, Shaw JG, Hertelendy AJ, Asch SM, Mahoney M. An App-Based Intervention to Support First Responders and Essential Workers During the COVID-19 Pandemic: Needs Assessment and Mixed Methods Implementation Study. J Med Internet Res 2021; 23:e26573. [PMID: 33878023 PMCID: PMC8139393 DOI: 10.2196/26573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/09/2021] [Accepted: 04/16/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has created unprecedented challenges for first responders (eg, police, fire, and emergency medical services) and nonmedical essential workers (eg, workers in food, transportation, and other industries). Health systems may be uniquely suited to support these workers given their medical expertise, and mobile apps can reach local communities despite social distancing requirements. Formal evaluation of real-world mobile app-based interventions is lacking. OBJECTIVE We aimed to evaluate the adoption, acceptability, and appropriateness of an academic medical center-sponsored app-based intervention (COVID-19 Guide App) designed to support access of first responders and essential workers to COVID-19 information and testing services. We also sought to better understand the COVID-19-related needs of these workers early in the pandemic. METHODS To understand overall community adoption, views and download data of the COVID-19 Guide App were described. To understand the adoption, appropriateness, and acceptability of the app and the unmet needs of workers, semistructured qualitative interviews were conducted by telephone, by video, and in person with first responders and essential workers in the San Francisco Bay Area who were recruited through purposive, convenience, and snowball sampling. Interview transcripts and field notes were qualitatively analyzed and presented using an implementation outcomes framework. RESULTS From its launch in April 2020 to September 2020, the app received 8262 views from unique devices and 6640 downloads (80.4% conversion rate, 0.61% adoption rate across the Bay Area). App acceptability was mixed among the 17 first responders interviewed and high among the 10 essential workers interviewed. Select themes included the need for personalized and accurate information, access to testing, and securing personal safety. First responders faced additional challenges related to interprofessional coordination and a "culture of heroism" that could both protect against and exacerbate health vulnerability. CONCLUSIONS First responders and essential workers both reported challenges related to obtaining accurate information, testing services, and other resources. A mobile app intervention has the potential to combat these challenges through the provision of disease-specific information and access to testing services but may be most effective if delivered as part of a larger ecosystem of support. Differentiated interventions that acknowledge and address the divergent needs between first responders and non-first responder essential workers may optimize acceptance and adoption.
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Affiliation(s)
- Stacie Vilendrer
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States
| | - Alexis Amano
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States
| | - Cati G Brown Johnson
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States
| | - Marissa Favet
- College of Liberal Arts and Sciences, University of Iowa, Iowa City, IA, United States
| | - Nadia Safaeinili
- Health Policy and Management, University of California, Berkeley, Berkeley, CA, United States
| | | | - Jonathan G Shaw
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States
| | - Attila J Hertelendy
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL, United States
- Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Steven M Asch
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States
- Center for Innovation to Implementation, Veterans Affairs, Menlo Park, CA, United States
| | - Megan Mahoney
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States
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Lindau ST, Makelarski JA, Boyd K, Doyle KE, Haider S, Kumar S, Lee NK, Pinkerton E, Tobin M, Vu M, Wroblewski KE, Lengyel E. Change in Health-Related Socioeconomic Risk Factors and Mental Health During the Early Phase of the COVID-19 Pandemic: A National Survey of U.S. Women. J Womens Health (Larchmt) 2021; 30:502-513. [PMID: 33818123 DOI: 10.1089/jwh.2020.8879] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: During a pandemic, women may be especially vulnerable to secondary health problems driven by its social and economic effects. We examined the relationship between changes in health-related socioeconomic risks (HRSRs) and mental health. Materials and Methods: A cross-sectional survey of 3,200 women aged 18-90 years was conducted in April 2020 using a quota-based sample from a national panel (88% cooperation rate). Patterns of change in HRSRs (food insecurity, housing instability, interpersonal violence, and difficulties with utilities and transportation) were described. Weighted, multivariate logistic regression was used to model the odds of depression, anxiety, and traumatic stress symptoms among those with and without incident or worsening HRSRs. Results: More than 40% of women had one or more prepandemic HRSRs. In the early pandemic phase, 49% of all women, including 29% with no prepandemic HRSRs, had experienced incident or worsening HRSRs. By April 2020, the rates of depression and anxiety were twice that of prepandemic benchmarks (29%); 17% of women had symptoms of traumatic stress. The odds of depression, anxiety, and posttraumatic stress symptoms were two to three times higher among women who reported at least one incident or worsening HRSR; this finding was similar for women with and without prepandemic HRSRs. Conclusions: Increased health-related socioeconomic vulnerability among U.S. women early in the coronavirus disease 2019 (COVID-19) pandemic was prevalent and associated with alarmingly high rates of mental health problems. Pandemic-related mental health needs are likely to be much greater than currently available resources, especially for vulnerable women.
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Affiliation(s)
- Stacy Tessler Lindau
- Departments of Obstetrics and Gynecology and Medicine-Geriatrics, The University of Chicago, Chicago, Illinois, USA
| | - Jennifer A Makelarski
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
- Benedictine University, College of Education and Health Services, Lisle, Illinois, USA
| | - Kelly Boyd
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Kate E Doyle
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Sadia Haider
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Shivani Kumar
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
| | - Nita Karnik Lee
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, The University of Chicago, Chicago, Illinois, USA
| | - El Pinkerton
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Marie Tobin
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
| | - Milkie Vu
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Kristen E Wroblewski
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, USA
| | - Ernst Lengyel
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, The University of Chicago, Chicago, Illinois, USA
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Gutin G, Hirano T, Hwang SH, Neary PR, Toda AA. The effect of social distancing on the reach of an epidemic in social networks. JOURNAL OF ECONOMIC INTERACTION AND COORDINATION 2021; 16:629-647. [PMID: 33680208 PMCID: PMC7925813 DOI: 10.1007/s11403-021-00322-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/07/2021] [Indexed: 06/12/2023]
Abstract
How does social distancing affect the reach of an epidemic in social networks? We present Monte Carlo simulation results of a susceptible-infected-removed with social distancing model. The key feature of the model is that individuals are limited in the number of acquaintances that they can interact with, thereby constraining disease transmission to an infectious subnetwork of the original social network. While increased social distancing typically reduces the spread of an infectious disease, the magnitude varies greatly depending on the topology of the network, indicating the need for policies that are network dependent. Our results also reveal the importance of coordinating policies at the 'global' level. In particular, the public health benefits from social distancing to a group (e.g. a country) may be completely undone if that group maintains connections with outside groups that are not following suit.
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Affiliation(s)
- Gregory Gutin
- Computer Science Department, Royal Holloway, University of London, London, UK
| | - Tomohiro Hirano
- Economics Department, Royal Holloway, University of London, London, UK
| | - Sung-Ha Hwang
- College of Business, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
| | - Philip R. Neary
- Economics Department, Royal Holloway, University of London, London, UK
| | - Alexis Akira Toda
- Department of Economics, University of California San Diego, San Diego, USA
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44
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Affiliation(s)
- Leo Lopez
- New York City Health + Hospitals, New York, New York
| | - Louis H Hart
- New York City Health + Hospitals, New York, New York
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45
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Campos-Castillo C, Anthony D. Racial and ethnic differences in self-reported telehealth use during the COVID-19 pandemic: a secondary analysis of a US survey of internet users from late March. J Am Med Inform Assoc 2021; 28:119-125. [PMID: 32894772 PMCID: PMC7499625 DOI: 10.1093/jamia/ocaa221] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/28/2020] [Indexed: 12/15/2022] Open
Abstract
Objective Widespread technological changes, like the rapid uptake of telehealth in the US during the COVID-19 pandemic, risk creating or widening racial/ethnic disparities. We conducted a secondary analysis of a cross-sectional, nationally representative survey of internet users to evaluate whether there were racial/ethnic disparities in self-reported telehealth use early in the pandemic. Materials and Methods The Pew Research Center fielded the survey March 19–24, 2020. Telehealth use because of the pandemic was measured by asking whether respondents (N = 10 624) “used the internet or e-mail to connect with doctors or other medical professionals as a result of the coronavirus outbreak.” We conducted survey-weighted logistic regressions, adjusting for respondents’ socioeconomic characteristics and perceived threat of the pandemic to their own health (eg, no threat, minor, major). Results Approximately 17% of respondents reported using telehealth because of the pandemic, with significantly higher unadjusted odds among Blacks, Latinos, and those identified with other race compared to White respondents. The multivariable logistic regressions and sensitivity analyses show Black respondents were more likely than Whites to report using telehealth because of the pandemic, particularly when perceiving the pandemic as a minor threat to their own health. Discussion Black respondents are most likely to report using telehealth because of the COVID-19 pandemic, particularly when they perceive the pandemic as a minor health threat. Conclusion The systemic racism creating health and health care disparities has likely raised the need for telehealth among Black patients during the pandemic. Findings suggest opportunities to leverage a broadly defined set of telehealth tools to reduce health care disparities postpandemic.
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Affiliation(s)
| | - Denise Anthony
- Department of Health Management & Policy, University of Michigan, Ann Arbor, Michigan, USA
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46
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Gaitens J, Condon M, Fernandes E, McDiarmid M. COVID-19 and Essential Workers: A Narrative Review of Health Outcomes and Moral Injury. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1446. [PMID: 33557075 PMCID: PMC7913818 DOI: 10.3390/ijerph18041446] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 12/27/2022]
Abstract
The COVID-19 pandemic has introduced a number of added obstacles to safe employment for already-challenged essential workers. Essential workers not employed in the health sector generally include racially diverse, low-wage workers whose jobs require close interaction with the public and/or close proximity to their coworkers, placing them at increased risk of infection. A narrative review facilitated the analyses of health outcome data in these workers and contributing factors to illness related to limited workplace protections and a lack of organizational support. Findings suggest that this already marginalized population may also be at increased risk of "moral injury" due to specific work-related factors, such as limited personal protective equipment (PPE) and the failure of the employer, as the safety and health "duty holder," to protect workers. Evidence suggests that ethical and, in some cases, legally required safety protections benefit not only the individual worker, but an employer's enterprise and the larger community which can retain access to resilient, essential services.
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Affiliation(s)
| | - Marian Condon
- School of Medicine, University of Maryland, Baltimore, MD 21204, USA; (J.G.); (E.F.); (M.M.)
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47
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Karmakar M, Lantz PM, Tipirneni R. Association of Social and Demographic Factors With COVID-19 Incidence and Death Rates in the US. JAMA Netw Open 2021; 4:e2036462. [PMID: 33512520 PMCID: PMC7846939 DOI: 10.1001/jamanetworkopen.2020.36462] [Citation(s) in RCA: 324] [Impact Index Per Article: 108.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Descriptive data have revealed significant racial/ethnic disparities in coronavirus disease 2019 (COVID-19) cases in the US, but underlying mechanisms of disparities remain unknown. OBJECTIVE To examine the association between county-level sociodemographic risk factors and US COVID-19 incidence and mortality. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed the association between US county-level sociodemographic risk factors and COVID-19 incidence using mixed-effects negative binomial regression, and COVID-19 mortality using zero-inflated negative binomial regression. Data on COVID-19 incidence and mortality were collected from January 20 to July 29, 2020. The association of social risk factors with weekly cumulative incidence and mortality was also examined by interacting time with the index measures, using a random intercept to account for repeated measures. MAIN OUTCOMES AND MEASURES Sociodemographic data from publicly available data sets, including the US Centers for Disease Control and Prevention's Social Vulnerability Index (SVI), which includes subindices of socioeconomic status, household composition and disability, racial/ethnic minority and English language proficiency status, and housing and transportation. RESULTS As of July 29, 2020, there were a total of 4 289 283 COVID-19 cases and 147 074 COVID-19 deaths in the US. An increase of 0.1 point in SVI score was associated with a 14.3% increase in incidence rate (incidence rate ratio [IRR], 1.14; 95% CI, 1.13-1.16; P < .001) and 13.7% increase in mortality rate (IRR, 1.14; 95% CI, 1.12-1.16; P < .001), or an excess of 87 COVID-19 cases and 3 COVID-19 deaths per 100 000 population for a SVI score change from 0.5 to 0.6 in a midsize metropolitan county; subindices were also associated with both outcomes. A 0.1-point increase in the overall SVI was associated with a 0.9% increase in weekly cumulative increase in incidence rate (IRR, 1.01; 95% CI, 1.01-1.01; P < .001) and 0.5% increase in mortality rate (IRR, 1.01; 95% CI, 1.01-1.01; P < .001). CONCLUSIONS AND RELEVANCE In this cross-sectional study, a wide range of sociodemographic risk factors, including socioeconomic status, racial/ethnic minority status, household composition, and environmental factors, were significantly associated with COVID-19 incidence and mortality. To address inequities in the burden of the COVID-19 pandemic, these social vulnerabilities and their root causes must be addressed.
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Affiliation(s)
- Monita Karmakar
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Paula M. Lantz
- Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Renuka Tipirneni
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
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48
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Abstract
This survey study uses prepandemic data to estimate how many adults at increased risk of severe COVID-19 held essential jobs and could not work at home or lived in households with such workers.
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Affiliation(s)
- Thomas M Selden
- Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland
| | - Terceira A Berdahl
- Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland
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49
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PAGAN LASSALLE P, MEYER ML, CONNERS R, ZIEFF G, ROJAS J, FAGHY MA, ARENA R, VERMEESCH A, JOSEPH RP, STONER L. Targeting Sedentary Behavior in Minority Populations as a Feasible Health Strategy During and Beyond COVID-19: On Behalf of ACSM-EIM and HL-PIVOT. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2021; 6:e000174. [PMID: 34746382 PMCID: PMC8570184 DOI: 10.1249/tjx.0000000000000174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Increased sedentary behavior has been an unintended consequence of social and physical distancing restrictions needed to limit transmission of SARS-CoV-2, the novel coronavirus that causes COVID-19. Sedentary behavior is defined as any waking behavior characterized by an energy expenditure ≤1.5 metabolic equivalents (METs), while in a sitting, reclining, or lying posture. These restrictions negatively impact peoples' cardiometabolic and mental health and disproportionately affect certain sectors of the population, including racial/ethnic minorities. In part, the higher risk for complications of COVID-19 could be the result of increased prevalence of comorbid diseases. Further, regular participation and adherence to current physical activity guidelines, defined as at least 150 minutes per week of moderate intensity physical activity or muscle strengthening activities on 2 or more days a week, is challenging for many and may be especially difficult to achieve during the COVID-19 pandemic. A practical strategy to promote health and well-being during COVID-19 is reducing sedentary behavior. Reducing sedentary behaviors (e.g., breaking up periods of prolonged sitting with light-intensity physical activity) may be more easily achieved than physical activity for all individuals, including individuals of racial/ethnic decent, as it does not require purchasing equipment nor require compromising the physical restrictions necessary to slow the spread of COVID-19. The purpose of this commentary is to argue that sedentary behavior is a feasible, independent target to modify during COVID-19, particularly in minority populations, and to address this behavior we need to consider individual, environmental and policy-level factors.
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Affiliation(s)
- Patricia PAGAN LASSALLE
- Department of Exercise and Sport Science, University of
North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Healthy Living for Pandemic Event Protection (HL - PIVOT)
Network, Chicago, IL, USA
| | - Michelle L. MEYER
- Department of Emergency Medicine, University of North
Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ryan CONNERS
- Department of Kinesiology, The University of Alabama in
Huntsville, Huntsville, AL, USA
| | - Gabriel ZIEFF
- Department of Exercise and Sport Science, University of
North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Healthy Living for Pandemic Event Protection (HL - PIVOT)
Network, Chicago, IL, USA
| | - Jacklyn ROJAS
- Department of Exercise and Sport Science, University of
North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mark A. FAGHY
- Healthy Living for Pandemic Event Protection (HL - PIVOT)
Network, Chicago, IL, USA
- Human Sciences Research Centre, University of Derby, Derby,
UK
| | - Ross ARENA
- Healthy Living for Pandemic Event Protection (HL - PIVOT)
Network, Chicago, IL, USA
- Department of Physical Therapy, College of Applied Health
Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Amber VERMEESCH
- Healthy Living for Pandemic Event Protection (HL - PIVOT)
Network, Chicago, IL, USA
- University of Portland, School of Nursing, Portland, OR,
USA
| | - Rodney P. JOSEPH
- Center for Health Promotion and Disease Prevention, Edson
College of Nursing and Health Innovation, Arizona State University, Phoenix AZ,
USA
| | - Lee STONER
- Department of Exercise and Sport Science, University of
North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Healthy Living for Pandemic Event Protection (HL - PIVOT)
Network, Chicago, IL, USA
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50
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Peek ME, Simons RA, Parker WF, Ansell DA, Rogers SO, Edmonds BT. COVID-19 Among African Americans: An Action Plan for Mitigating Disparities. Am J Public Health 2020; 111:286-292. [PMID: 33351662 DOI: 10.2105/ajph.2020.305990] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
As the COVID-19 pandemic has unfolded across the United States, troubling disparities in mortality have emerged between different racial groups, particularly African Americans and Whites. Media reports, a growing body of COVID-19-related literature, and long-standing knowledge of structural racism and its myriad effects on the African American community provide important lenses for understanding and addressing these disparities.However, troubling gaps in knowledge remain, as does a need to act. Using the best available evidence, we present risk- and place-based recommendations for how to effectively address these disparities in the areas of data collection, COVID-19 exposure and testing, health systems collaboration, human capital repurposing, and scarce resource allocation.Our recommendations are supported by an analysis of relevant bioethical principles and public health practices. Additionally, we provide information on the efforts of Chicago, Illinois' mayoral Racial Equity Rapid Response Team to reduce these disparities in a major urban US setting.
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Affiliation(s)
- Monica E Peek
- Monica E. Peek, Russell A. Simons, William F. Parker, and Selwyn O. Rogers are with the University of Chicago, Chicago, IL. David A. Ansell is with the Department of Medicine, Rush University Medical Center, Chicago. Brownsyne Tucker Edmonds is with the Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis
| | - Russell A Simons
- Monica E. Peek, Russell A. Simons, William F. Parker, and Selwyn O. Rogers are with the University of Chicago, Chicago, IL. David A. Ansell is with the Department of Medicine, Rush University Medical Center, Chicago. Brownsyne Tucker Edmonds is with the Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis
| | - William F Parker
- Monica E. Peek, Russell A. Simons, William F. Parker, and Selwyn O. Rogers are with the University of Chicago, Chicago, IL. David A. Ansell is with the Department of Medicine, Rush University Medical Center, Chicago. Brownsyne Tucker Edmonds is with the Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis
| | - David A Ansell
- Monica E. Peek, Russell A. Simons, William F. Parker, and Selwyn O. Rogers are with the University of Chicago, Chicago, IL. David A. Ansell is with the Department of Medicine, Rush University Medical Center, Chicago. Brownsyne Tucker Edmonds is with the Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis
| | - Selwyn O Rogers
- Monica E. Peek, Russell A. Simons, William F. Parker, and Selwyn O. Rogers are with the University of Chicago, Chicago, IL. David A. Ansell is with the Department of Medicine, Rush University Medical Center, Chicago. Brownsyne Tucker Edmonds is with the Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis
| | - Brownsyne Tucker Edmonds
- Monica E. Peek, Russell A. Simons, William F. Parker, and Selwyn O. Rogers are with the University of Chicago, Chicago, IL. David A. Ansell is with the Department of Medicine, Rush University Medical Center, Chicago. Brownsyne Tucker Edmonds is with the Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis
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