The Disparities on Loss of Employment Income by US Households During the COVID-19 Pandemic

Health Insurance Coverage Among Adolescent and Young Adult Cancer Survivors Receiving Health Care before and During the COVID-19 Pandemic

We investigated insurance coverage among adolescents and young adults (AYA) with cancer before and during the COVID-19 pandemic. AYAs diagnosed with cancer 15-39 years of age were identified using Utah Cancer Registry records and linked with University of Utah electronic health records. Poisson models calculated incidence rate ratios (IRRs) of health insurance coverage during pre-pandemic (11/4/2017-3/5/2020; n = 2,140) and pandemic (3/6/2020-7/6/2022; n = 1,894) periods. Prior to the pandemic, insurance gaps were higher (pre-pandemic = 16.40%, pandemic = 13.73%; IRR = 0.84, 95%CI = 0.71-0.98); more AYAs had continuous public insurance during the pandemic (pre-pandemic = 8.60%, pandemic = 10.98%; IRR = 1.28, 95%CI = 1.05-1.56). Research is needed on the durability of pandemic relief programs on insurance coverage among AYA cancer survivors.

Economic insecurity during the COVID-19 pandemic among healthcare workers by educational attainment

Prior to the COVID-19 pandemic, healthcare workers with less formal education (eg, nursing assistants and home care aides) vs more formal education (eg, physicians and nurses) were more likely to experience economic insecurity, the real and/or perceived risk of financial losses. Given the unprecedented impact of COVID-19 on healthcare workers, we sought to describe economic insecurity among these workers during the pandemic. Using data from the U.S. Census Bureau's Household Pulse Survey from July 2021 to July 2023, we examined economic insecurity among healthcare workers by educational attainment. Higher proportions of healthcare workers with an associate degree or below reported difficulty paying usual expenses, food insufficiency, and being behind on rent/mortgage payments compared to healthcare workers with a bachelor's degree or higher. Accounting for other sociodemographic characteristics, higher educational attainment was associated with significantly lower odds of economic insecurity. Since the public health emergency has ended and temporary policies to support low-wage workers during the pandemic have sunsetted, targeted policies to promote economic security among financially vulnerable low-wage workers are critical to enable recruitment and retention of these essential healthcare workers.

Gap in protective behaviors between Han and minority ethnicities during COVID-19 pandemic in rural western China: A decomposition analysis

Understanding the ethnic gap in protective behavior and its explanatory factors is a promising step for reducing pandemic-induced disparities. However, no studies have endeavored to identify the factors contributing to a gap in protective behaviors between Han and minority ethnicities during COVID-19 pandemic in rural China. We aimed to analyze the gap in protective behaviors between Han and minority residents in rural China. We conducted cross-sectional studies in multi-ethnic rural China in 2020. A total of 1640 participants from Han and minority groups were invited to participate. The decomposition method was applied to analyze the gap in protective behaviors and its associated factors between the Han and minority groups. Participants in the Han group had a higher protective behavioral score (9.26 ± 1.20) than the minority group (8.97 ± 1.50), yielding a significant gap in protective behaviors between Han and minority ethnicities of 0.29. Socio-demographic characteristics, health status, the degree of knowledge held about COVID-19, and psychological responses to COVID-19 explained 79.3 % (0.23/0.29) of the behavioral gap between the Han and minority groups. The difference in household asset levels was the largest explained contributor to the behavioral gap (52.17 %) (0.12/0.23), followed by fear felt for COVID-19 (-21.74 %) (-0.05/0.23). Differences in educational attainment, degree of knowledge held about COVID-19, and self-efficacy in response to COVID-19 each explained 17.4 % (0.04/0.23) of the behavioral gap. In conclusion, Han group show greater protective behaviors than minority ethnic groups. To drive better protective behavior in the most vulnerable communities, targeted, group-specific COVID-19 preventative messages deployed in public health communication strategies is suggested to enhance individual confidence in coping with the pandemic while creating a healthy amount of fear for public health crisis.

The Psychosocial Impact of the COVID-19 Pandemic on Families of Youth of Color: A Prospective Cohort Study

OBJECTIVE

Prospectively examine racial and ethnic disparities in exposure to COVID-19-related stressors and their impact on families.

METHODS

A racially, ethnically, and socioeconomically diverse cohort of caregivers of youth (n = 1,581) representative of the population served by a pediatric healthcare system completed the COVID-19 Exposure and Family Impact Scales in Oct/Nov 2020 and March/April 2021. Linear mixed-effects models were used to examine exposure to COVID-19-related events (Exposure), impact of the pandemic on family functioning and well-being (Impact), and child and parent distress (Distress) across time and as a function of race and ethnicity, adjusting for other sociodemographic variables.

RESULTS

Exposure and Distress increased over time for all participants. After adjusting for sociodemographic factors, caregivers of Black and Hispanic youth reported greater Exposure than caregivers of White youth and caregivers of Black youth had a greater increase in Exposure over time than caregivers of White youth. Caregivers of White youth reported greater Impact than caregivers of Black and Other race youth.

CONCLUSIONS

Exposure to and impact of the COVID-19 pandemic on family psychosocial functioning varied by race and ethnicity. Although exposure to COVID-19-related events was greater among Hispanic and non-Hispanic Black families, those of marginalized races reported less family impact than non-Hispanic White families, suggesting resiliency to the pandemic. Research should examine such responses to public health crises in communities of color, with a focus on understanding protective factors. These findings suggest the importance of culturally tailored interventions and policies that support universal psychosocial screenings during times of public health crises.

Environmental equity and COVID-19 experiences in the United States: Results from three survey waves of a nationally representative study conducted between 2020-2022

Certain environmental exposures, such as air pollution, are associated with COVID-19 incidence and mortality. To determine whether environmental context is associated with other COVID-19 experiences, we used data from the nationally representative Tufts Equity in Health, Wealth, and Civic Engagement Study data (n=1785; three survey waves 2020-2022). Environmental context was assessed using self-reported climate stress and county-level air pollution, greenness, toxic release inventory site, and heatwave data. Self-reported COVID-19 experiences included willingness to vaccinate against COVID-19, health impacts from COVID-19, receiving assistance for COVID-19, and provisioning assistance for COVID-19. Self-reported climate stress in 2020 or 2021 was associated with increased COVID-19 vaccination willingness by 2022 (odds ratio [OR] = 2.35; 95% confidence interval [CI] = 1.47, 3.76), even after adjusting for political affiliation (OR = 1.79; 95% CI = 1.09, 2.93). Self-reported climate stress in 2020 was also associated with increased likelihood of receiving COVID-19 assistance by 2021 (OR = 1.89; 95% CI = 1.29, 2.78). County-level exposures (i.e., less greenness, more toxic release inventory sites, more heatwaves) were associated with increased vaccination willingness. Air pollution exposure in 2020 was positively associated with likelihood of provisioning COVID-19 assistance in 2020 (OR = 1.16 per μg/m3; 95% CI = 1.02, 1.32). Associations between certain environmental exposures and certain COVID-19 outcomes were stronger among those who identify as a race/ethnicity other than non-Hispanic White and among those who reported experiencing discrimination; however, these trends were not consistent. A latent variable representing a summary construct for environmental context was associated with COVID-19 vaccination willingness. Our results add to the growing body of literature suggesting that intersectional equity issues affecting likelihood of exposure to adverse environmental conditions are also associated with health-related outcomes.

Changes in Health Care Access by Race, Income, and Medicaid Expansion During the COVID-19 Pandemic

BACKGROUND

The intersecting crises of the COVID-19 pandemic, job losses, and concomitant loss of employer-sponsored health insurance may have disproportionately affected health care access within minorized and lower-socioeconomic status communities.

OBJECTIVE

To describe changes in access to care during the COVID-19 pandemic, stratified by race/ethnicity, household income, and state Medicaid expansion status.

RESEARCH DESIGN

We used interrupted time series and difference-in-differences regression models, controlling for respondent characteristics and preexisting trends.

SUBJECTS

Data were extracted for all adults aged 18-64 surveyed in the 2015-2020 Behavioral Risk Factor Surveillance System (N=1,731,699) from all 50 states and the District of Columbia.

MEASURES

Our outcomes included indicators for whether respondents had any health insurance coverage or avoided seeking care because of cost within the prior year. The primary exposure was the onset of the COVID-19 pandemic in the United States in March 2020.

RESULTS

The pandemic was associated with a 1.2 percentage point (pp) decline in uninsurance for Medicaid expansion states (95% CI, -1.8, -0.6); these reductions were concentrated among respondents who were Black, multiracial, or low income. The rates of uninsurance were generally stable in nonexpansion states. The rates of avoided care because of cost fell by 3.5 pp in Medicaid expansion states (95% CI, -3.9, -3.1), and by 3.6 pp (95% CI, 4.3-2.9) in nonexpansion states. These declines were concentrated among respondents who were Hispanic, Other Race, or low income.

CONCLUSIONS

Our findings reinforce the value of Medicaid expansion as one tool to improve access to health insurance and care for marginalized and vulnerable populations.

Racial and ethnic disparities in who receives unemployment benefits during COVID-19

The impact of COVID-19 on job displacement in the United States has been unevenly experienced by race, ethnicity, and the socioeconomically disadvantaged. Although unemployment benefits may mitigate the effects of job displacement, this social safety net is also unevenly distributed across workers. We examine racial/ethnic differences in receiving unemployment benefits among workers displaced by the pandemic. We use data from the US Census Household Pulse Survey (HPS), which is specifically designed to capture the real time effects of the pandemic across a wide spectrum of social issues. (US Census, 2020) Unlike the Current Population Survey (CPS) data used in the monthly unemployment rate calculations, the HPS data allow us to identify workers directly displaced from their jobs by the pandemic. We analyze over 1.3 million HPS interviews from the first stage of the pandemic when the disruptions to the labor market were the most severe, covering the period from June 11, 2020 to December 22, 2020. We contribute to the literature on the labor market effects of the pandemic in two ways. One, the HPS data allow us to identify workers who directly experienced job loss as a result of the disruptions created by COVID-19 and to determine who did not receive unemployment insurance. Two, we present both bivariate and multivariate analyses to examine racial/ethnic disparities for five groups: non-Hispanic whites, Blacks, Hispanic, Asian, and non-Hispanic Other workers. We find that Black and Hispanic workers are more likely to be unemployed without Unemployment Insurance (UI). Black workers are 12.0% of the employed but 17.5% of displaced workers without UI. Hispanic workers are even more affected. Hispanic workers are 15.6% of the employed, but are 23.4% of all displaced workers without UI. Although there are limitations to using the HPS data—the survey was administered online in only English and Spanish and occupational and industry data are not available for displaced workers, the results still provide valuable insights informing the current policy debate about the effects of expanding UI.