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Greene LK, Song G, Palma AV, Santarelli C, Wetzel C, Spillane J, Nielsen VM. A Case Series Study Assessing an Equity-Focused Implementation of Self-Monitoring Blood Pressure Programs Using Telehealth. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:S71-S79. [PMID: 38870363 PMCID: PMC11178246 DOI: 10.1097/phh.0000000000001897] [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: 06/15/2024]
Abstract
CONTEXT Self-monitoring blood pressure (SMBP) programs are an evidence-based hypertension management intervention facilitated through telehealth. SMBP programs can provide a continuum of care beyond a clinical setting by facilitating hypertension management at home; however, equitable access to SMBP is a concern. OBJECTIVES To evaluate the implementation of telehealth SMBP programs using an equity lens in 5 federally qualified health centers (FQHCs) in Massachusetts (MA). DESIGN A prospective case series study. SETTING Five FQHCs. PARTICIPANTS The MA Department of Public Health (MDPH) selected 5 FQHCs to implement SMBP programs using telehealth. FQHCs were selected if their patient population experiences inequities due to social determinants of health and has higher rates of cardiovascular disease. Each of the 5 FQHCs reported data on patients enrolled in their SMBP programs totaling 241 patients examined in this study. INTERVENTION SMBP programs implemented through telehealth. MAIN OUTCOME MEASURE Systolic blood pressure and diastolic blood pressure. RESULTS Approximately 53.5% of SMBP participants experienced a decrease in blood pressure. The average blood pressure decreased from 146/87 to 136/81 mm Hg. Among all patients across the 5 FQHCs, the average blood pressure decreased by 10.06/5.34 mm Hg (P < .001). Blood pressure improved in all racial, ethnic, and language subgroups. CONCLUSIONS Five MA FQHCs successfully implemented equitable telehealth SMBP programs. SMBP participants enrolled in the programs demonstrated notable improvements in their blood pressure at the conclusion of the program. A flexible, pragmatic study design that was adjusted to meet unique patient needs; engaging nonphysician team members, particularly community health workers; adapting health information technology; and partnerships with community-based organizations were critical facilitators to program success.
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Affiliation(s)
- Leah K. Greene
- Massachusetts Department of Public Health, Office of Statistics and Evaluation, Bureau of Community Health and Prevention
| | - Glory Song
- Massachusetts Department of Public Health, Office of Statistics and Evaluation, Bureau of Community Health and Prevention
| | - Ana V. Palma
- Massachusetts Department of Public Health, Office of Statistics and Evaluation, Bureau of Community Health and Prevention
| | - Claire Santarelli
- Massachusetts Department of Public Health, Division of Health Promotion and Protection, Bureau of Community Health and Prevention
| | - Caroline Wetzel
- Massachusetts Department of Public Health, Division of Health Promotion and Protection, Bureau of Community Health and Prevention
| | - Janet Spillane
- Massachusetts Department of Public Health, Division of Health Promotion and Protection, Bureau of Community Health and Prevention
| | - Victoria M. Nielsen
- Massachusetts Department of Public Health, Office of Statistics and Evaluation, Bureau of Community Health and Prevention
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Sauer SM, Fulcher IR, Matias WR, Paxton R, Elnaiem A, Gonsalves S, Zhu J, Guillaume Y, Franke M, Ivers LC. Missing data and missed infections: investigating racial and ethnic disparities in SARS-CoV-2 testing and infection rates in Holyoke, Massachusetts. Am J Epidemiol 2024; 193:908-916. [PMID: 38422371 PMCID: PMC11145903 DOI: 10.1093/aje/kwae011] [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: 12/07/2022] [Revised: 02/01/2024] [Indexed: 03/02/2024] Open
Abstract
Routinely collected testing data have been a vital resource for public health response during the COVID-19 pandemic and have revealed the extent to which Black and Hispanic persons have borne a disproportionate burden of SARS-CoV-2 infections and hospitalizations in the United States. However, missing race and ethnicity data and missed infections due to testing disparities limit the interpretation of testing data and obscure the true toll of the pandemic. We investigated potential bias arising from these 2 types of missing data through a case study carried out in Holyoke, Massachusetts, during the prevaccination phase of the pandemic. First, we estimated SARS-CoV-2 testing and case rates by race and ethnicity, imputing missing data using a joint modeling approach. We then investigated disparities in SARS-CoV-2 reported case rates and missed infections by comparing case rate estimates with estimates derived from a COVID-19 seroprevalence survey. Compared with the non-Hispanic White population, we found that the Hispanic population had similar testing rates (476 tested per 1000 vs 480 per 1000) but twice the case rate (8.1% vs 3.7%). We found evidence of inequitable testing, with a higher rate of missed infections in the Hispanic population than in the non-Hispanic White population (79 infections missed per 1000 vs 60 missed per 1000).
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Affiliation(s)
- Sara M Sauer
- Corresponding author: Sara M. Sauer, Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 ()S.M.S., I.R.F., and W.R.M. contributed equally to this work
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Knauft K, Zilioli S, Tarraf W, Rorai V, Perry TE, Lichtenberg PA. Social connectedness in older Urban African-American adults during the COVID-19 pandemic: the roles of education and partnership. Aging Ment Health 2024; 28:874-881. [PMID: 37986033 PMCID: PMC11102929 DOI: 10.1080/13607863.2023.2282682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE This study examined education, partnership status, and the moderating role of the lockdown period on social connectedness during the COVID-19 pandemic in a sample of urban African-American older adults. METHODS Five hundred thirty-four African-American adults living in Detroit (91.0% female, Mage = 74.53) reported demographic information pre-pandemic and answered one social connectedness questionnaire between April and December 2020. RESULTS Participants interviewed after the lockdown (post-June 2020) reported more loneliness than those interviewed during the lockdown (April-June, 2020). Married/partnered participants reported less loneliness and social isolation. Loneliness did not differ between those with high education levels interviewed during the lockdown compared to post-lockdown. However, among individuals with low education levels, those interviewed after the lockdown reported more loneliness than those interviewed during the lockdown period. CONCLUSION Our findings suggest partnership status is associated with more social connectedness during the pandemic and education accentuates the effects of forced isolation related to loneliness among urban African-American older adults.
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Affiliation(s)
| | - Samuele Zilioli
- Department of Psychology, Wayne State University
- Department of Family Medicine and Public Health Sciences, Wayne State University
| | | | | | - Tam E. Perry
- Institute of Gerontology, Wayne State University
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Rusk SA, DiBari J, Mason DM, Li M, Hong X, Wang G, Pearson C, Mirolli G, Cheng TL, Kogan MD, Zuckerman B, Wang X. The impact of COVID-19 on psychiatric clinical encounters among low-income racially-diverse children. J Child Psychol Psychiatry 2024; 65:631-643. [PMID: 37088737 PMCID: PMC10590822 DOI: 10.1111/jcpp.13809] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND There is a lack of longitudinal data to examine the impact of COVID-19 on all types of clinical encounters among United States, underrepresented BIPOC (Black, Indigenous, and people of color), children. This study aims to examine the changes in all the outpatient clinical encounters during the pandemic compared to the baseline, with particular attention to psychiatric encounters and diagnoses. METHOD This study analyzed 3-year (January 2019 to December 2021) longitudinal clinical encounter data from 3,394 children in the Boston Birth Cohort, a US urban, predominantly low-income, Black and Hispanic children. Outcomes of interest were completed outpatient clinical encounters and their modalities (telemedicine vs. in person), including psychiatric care and diagnoses, primary care, emergency department (ED), and developmental and behavioral pediatrics (DBP). RESULTS The study children's mean (SD) age is 13.9 (4.0) years. Compared to 2019, psychiatric encounters increased by 38% in 2020, most notably for diagnoses of adjustment disorders, depression, and post-traumatic stress disorders (PTSD). In contrast, primary care encounters decreased by 33%, ED encounters decreased by 55%, and DBP care decreased by 16% in 2020. Telemedicine was utilized the most for psychiatric and DBP encounters and the least for primary care encounters in 2020. A remarkable change in 2021 was the return of primary care encounters to the 2019 level, but psychiatric encounters fluctuated with spikes in COVID-19 case numbers. CONCLUSIONS Among this sample of US BIPOC children, compared to the 2019 baseline, psychiatric encounters increased by 38% during 2020, most notably for the new diagnoses of adjustment disorder, depression, and PTSD. The 2021 data showed a full recovery of primary care encounters to the baseline level but psychiatric encounters remained sensitive to the pandemic spikes. The long-term impact of the pandemic on children's mental health warrants further investigation.
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Affiliation(s)
- Serena A. Rusk
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health
| | - Jessica DiBari
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services
| | - Dana M. Mason
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services
| | - Mengmeng Li
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health
| | - Xiumei Hong
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health
| | - Guoying Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health
| | - Colleen Pearson
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center
| | - Gabrielle Mirolli
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center
| | - Tina L. Cheng
- Department of Pediatrics, Cincinnati Children’s Hospital and University of Cincinnati
| | - Michael D. Kogan
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services
| | - Barry Zuckerman
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health
- Department of Pediatrics, Johns Hopkins University School of Medicine
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Mckinney J, Salmanian B, Grace R, Moufarrij S, Sangi-Haghpeykar H, Eppes C, Gandhi M. Social Drivers of COVID-19 Disease Severity in Pregnant Patients. Am J Perinatol 2024; 41:e2269-e2278. [PMID: 37311541 DOI: 10.1055/a-2109-3876] [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: 06/15/2023]
Abstract
OBJECTIVE While coronavirus disease 2019 (COVID-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has had global impact in all populations, certain groups of patients have experienced disproportionate rates of morbidity and mortality. The purpose of this study was to assess the relationship between COVID-19 disease severity, demographic variables, race and ethnicity, and social determinants of health among pregnant patients in a diverse urban population. STUDY DESIGN A retrospective analysis was performed of all pregnant patients diagnosed with COVID-19 at two urban tertiary care centers in Houston, TX between March and August 2020. Maternal demographic, COVID-19 illness criteria, and delivery characteristics were collected. The Centers for Disease Control and Prevention Social Vulnerability Index (SVI) and COVID-19 Community Vulnerability Index (CCVI) were obtained based on a patients' census tract of residence. Analyses compared persons with asymptomatic, mild, or severe-critical disease at diagnosis. RESULTS A total of 317 persons tested positive for COVID-19 during this time period. Asymptomatic persons were more likely to be diagnosed at later gestational ages, but there were no other differences in baseline maternal characteristics. Persons with more severe disease had greater social vulnerability specifically for housing and transportation than those with mild disease (mean SVI [standard error]: 0.72 [0.06] vs. 0.58 [0.2], p = 0.03). Total SVI, total CCVI, and other themed SVI and CCVI indices were not significantly different between groups. CONCLUSION In this cohort of pregnant persons infected with SARS-CoV-2, an association was shown between disease severity and increased vulnerability in living conditions and transportation. Drivers of the pandemic and COVID-19 outcomes are complex and multifactorial, and likely change over time. However, continued efforts to accurately identify and measure social determinants of health in medicine will likely help identify geographic areas and patient populations that are at risk of higher disease burden. This could facilitate preventative and mitigation measures in these areas in future disaster or pandemic situations. KEY POINTS · SVI and CCVI estimate social determinants of health.. · COVID-19 is associated with housing and transportation vulnerability.. · Social determinants contribute to disease burden in pregnancy..
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Affiliation(s)
- Jennifer Mckinney
- Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, Texas
- Department of Obstetrics and Gynecology, Harris Health System, Houston, Texas
| | - Bahram Salmanian
- Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, Texas
| | - Rebecca Grace
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Sara Moufarrij
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | | | - Catherine Eppes
- Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, Texas
- Department of Obstetrics and Gynecology, Harris Health System, Houston, Texas
| | - Manisha Gandhi
- Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, Texas
- Division of Maternal Fetal Medicine, Texas Children's Hospital Pavilion for Women, Houston, Texas
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Traver J, Yeaman S, Arenas CA, Daugherty J, Davidson JE. Organizational Climate for Inclusion Among Nurses: A Mixed-Methods Analysis. J Nurs Adm 2024; 54:292-298. [PMID: 38648363 DOI: 10.1097/nna.0000000000001426] [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: 04/25/2024]
Abstract
OBJECTIVE The aim of this study was to answer the research question: What factors predict sense of belonging among nurses?The connection between inclusion (an element of diversity and equity) and a nurse's sense of belonging is poorly understood. METHODS In this mixed-methods research, regression analysis of Climate for Inclusion Scale subscales and Sense of Belonging score plus thematic content analysis of questions assessing sense of belonging were conducted. Nurses (n = 131) attending a research conference in June to July 2022 were invited to participate; 131 (72%) participated. RESULTS Climate for Inclusion Scale was positively associated with and predictive of sense of belonging (F3,113 = 71.7, P < 0.001). Themes reflecting actions to enhance sense of belonging were as follows: authentic leadership, embracing social justice, team unification, feeling heard, being seen, professional development, developing a healthier work environment, and integration of differences. CONCLUSIONS Leaders can promote a sense of belonging among nurses by focusing on actions reflected in the themes.
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Affiliation(s)
- Jodi Traver
- Authors Affiliation: Clinical Nurse Educator (Dr Traver), Clinical Nurse (Yeaman), Nurse Practitioner (Dr Arenas), Resuscitation Instructor (Dr Daugherty), and Nurse Scientist (Dr Davidson), University of California San Diego Health
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Ryan SC, Sugg MM, Runkle JD, Wertis L, Singh D, Green S. Short-term changes in mental health help-seeking behaviors following exposure to multiple social stressors and a natural disaster. Soc Sci Med 2024; 348:116843. [PMID: 38603916 PMCID: PMC11134597 DOI: 10.1016/j.socscimed.2024.116843] [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: 09/22/2023] [Revised: 02/23/2024] [Accepted: 03/26/2024] [Indexed: 04/13/2024]
Abstract
In 2020, unprecedented circumstances led to significant mental health consequences. Individuals faced mental health stressors that extended beyond the devastating impact of the COVID-19 pandemic, including widespread social unrest following the murder of George Floyd, an intense hurricane season in the Atlantic, and the politically divisive 2020 election. The objective of this analysis was to consider changes in help-seeking behavior following exposure to multiple social stressors and a natural disaster. Data from Crisis Text Line (CTL), a national text-based mental health crisis counseling service, was used to determine how help-seeking behavior changed in the wake of each event. Wilcoxon rank sum tests assessed changes in help-seeking behavior for each event in 2020 as compared to the same period in 2019. AutoRegressive Integrated Moving Average (ARIMA) models examined if changes in crisis conversation volumes following each event differed. Higher median conversation volumes noted for the COVID-19 pandemic (+1 to +5 conversations), Hurricane Laura (+1 to +7 conversations) and the 2020 Election (+1 to +26 conversations). ARIMA models show substantial increases in help-seeking behavior following the declaration of a national emergency for the COVID-19 pandemic (+4.3 to +38.2%) and following the 2020 election (+3 to +24.44%). Our analysis found that the mental health response following social stressors may be distinct from natural events, especially when natural disasters occur in the context of multiple social stressors. This analysis adds to the growing body of literature considering the mental health impact of exposure to multiple co-occurring societal stressors, like police violence and a global pandemic.
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Affiliation(s)
- Sophia C Ryan
- Department of Geography and Planning, Appalachian State University, Boone NC, 28607, USA.
| | - Margaret M Sugg
- Department of Geography and Planning, Appalachian State University, Boone NC, 28607, USA
| | - Jennifer D Runkle
- North Carolina Institute for Climate Studies, North Carolina State University, Raleigh NC, 27695, USA
| | - Luke Wertis
- Department of Geography and Planning, Appalachian State University, Boone NC, 28607, USA
| | - Devyani Singh
- Data Team, Crisis Text Line, New York City, New York, USA
| | - Shannon Green
- Data Team, Crisis Text Line, New York City, New York, USA
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Mac C, Cheung K, Alzoubi T, Atacan C, Sehar H, Liyanage S, AlShurman BA, Butt ZA. The Impact of Comorbidities among Ethnic Minorities on COVID-19 Severity and Mortality in Canada and the USA: A Scoping Review. Infect Dis Rep 2024; 16:407-422. [PMID: 38804440 PMCID: PMC11130838 DOI: 10.3390/idr16030030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 05/29/2024] Open
Abstract
(1) Current literature on ethnic minorities, comorbidities, and COVID-19 tends to investigate these factors separately, leaving gaps in our understanding about their interactions. Our review seeks to identify a relationship between ethnicity, comorbidities, and severe COVID-19 outcomes (ICU admission and mortality). We hope to enhance our understanding of the various factors that exacerbate COVID-19 severity and mortality in ethnic minorities in Canada and the USA. (2) All articles were received from PubMed, Scopus, CINAHL, and Ovid EMBASE from November 2020 to June 2022. Included articles contain information regarding comorbidities among ethnic minorities in relation to COVID-19 severity and mortality. (3) A total of 59 articles were included that examined various ethnic groups, including Black/African American, Asian, Hispanic, White/Caucasian, and Indigenous people. We found that the most examined comorbidities were diabetes, hypertension, obesity, and chronic kidney disease. A total of 76.9% of the articles (40 out of 52) found a significant association between different races and COVID-19 mortality, whereas 21.2% of the articles (11 out of 52) did not. (4) COVID-19 ICU admissions and mortality affect various ethnic groups differently, with Black patients generally having the most adverse outcomes. These outcomes may also interact with sex and age, though more research is needed assessing these variables together with ethnicity.
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Affiliation(s)
- Christina Mac
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (C.M.); (T.A.); (C.A.); (H.S.); (S.L.); (B.A.A.)
| | - Kylem Cheung
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON L8N 3Z5, Canada;
| | - Tala Alzoubi
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (C.M.); (T.A.); (C.A.); (H.S.); (S.L.); (B.A.A.)
| | - Can Atacan
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (C.M.); (T.A.); (C.A.); (H.S.); (S.L.); (B.A.A.)
| | - Hibah Sehar
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (C.M.); (T.A.); (C.A.); (H.S.); (S.L.); (B.A.A.)
| | - Shefali Liyanage
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (C.M.); (T.A.); (C.A.); (H.S.); (S.L.); (B.A.A.)
| | - Bara’ Abdallah AlShurman
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (C.M.); (T.A.); (C.A.); (H.S.); (S.L.); (B.A.A.)
| | - Zahid Ahmad Butt
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (C.M.); (T.A.); (C.A.); (H.S.); (S.L.); (B.A.A.)
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Whitfield C, Liu Y, Anwar M. Impact of COVID-19 Pandemic on Social Determinants of Health Issues of Marginalized Black and Asian Communities: A Social Media Analysis Empowered by Natural Language Processing. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01996-0. [PMID: 38625665 DOI: 10.1007/s40615-024-01996-0] [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: 12/02/2023] [Revised: 04/02/2024] [Accepted: 04/07/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE This study aims to understand the impact of the COVID-19 pandemic on social determinants of health (SDOH) of marginalized racial/ethnic US population groups, specifically African Americans and Asians, by leveraging natural language processing (NLP) and machine learning (ML) techniques on race-related spatiotemporal social media text data. Specifically, this study establishes the extent to which Latent Dirichlet Allocation (LDA) and Gibbs Sampling Dirichlet Multinomial Mixture (GSDMM)-based topic modeling determines social determinants of health (SDOH) categories, and how adequately custom named-entity recognition (NER) detects key SDOH factors from a race/ethnicity-related Reddit data corpus. METHODS In this study, we collected race/ethnicity-specific data from 5 location subreddits including New York City, NY; Los Angeles, CA; Chicago, IL; Philadelphia, PA; and Houston, TX from March to December 2019 (before COVID-19 pandemic) and from March to December 2020 (during COVID-19 pandemic). Next, we applied methods from natural language processing and machine learning to analyze SDOH issues from extracted Reddit comments and conversation threads using feature engineering, topic modeling, and custom named-entity recognition (NER). RESULTS Topic modeling identified 35 SDOH-related topics. The SDOH-based custom NER analyses revealed that the COVID-19 pandemic significantly impacted SDOH issues of marginalized Black and Asian communities. On average, the Social and Community Context (SCC) category of SDOH had the highest percent increase (366%) from the pre-pandemic period to the pandemic period across all locations and population groups. Some of the detected SCC issues were racism, protests, arrests, immigration, police brutality, hate crime, white supremacy, and discrimination. CONCLUSION Reddit social media platform can be an alternative source to assess the SDOH issues of marginalized Black and Asian communities during the COVID-19 pandemic. By employing NLP/ML techniques such as LDA/GSDMM-based topic modeling and custom NER on a race/ethnicity-specific Reddit corpus, we uncovered various SDOH issues affecting marginalized Black and Asian communities that were significantly worsened during the COVID-19 pandemic. As a result of conducting this research, we recommend that researchers, healthcare providers, and governments utilize social media and collaboratively formulate responses and policies that will address SDOH issues during public health crises.
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Affiliation(s)
| | - Yang Liu
- North Carolina A&T State University, Greensboro, NC, 27411, USA
| | - Mohd Anwar
- North Carolina A&T State University, Greensboro, NC, 27411, USA.
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Kibbey MM, DiBello AM, Fedorenko EJ, Farris SG. Testing a brief, self-guided values affirmation for behavioral activation intervention during COVID-19. Cogn Behav Ther 2024:1-17. [PMID: 38593029 DOI: 10.1080/16506073.2024.2339315] [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: 08/24/2023] [Accepted: 04/01/2024] [Indexed: 04/11/2024]
Abstract
This pilot study tested a single-session digital values affirmation for behavioral activation (VABA) intervention. Hypotheses predicted the VABA intervention would be more effective than an active control condition in improving mood, decreasing COVID-19 fear/worry and depressive symptoms, and promoting positively reinforcing behaviors during early weeks of the COVID-19 pandemic. Participants were a diverse sample of undergraduate students (N = 296) under a state-wide lockdown. Students were randomized to either VABA, a 10-min values clarification and affirmation task, or Control, a time- and attention-matched task. Positive and negative affects were assessed pre- and post-intervention. At next-day follow-up, positive and negative affects were reassessed, as well as past 24-h behavioral activation and depressive symptoms. Within-group increases in positive affect were observed in both conditions (VABA d = 0.39; Control d = 0.19). However, VABA produced a significantly larger increase than Control (F[2] = 3.856, p = .022, d = 0.22). At 24-h follow-up, behavioral activation, which was significantly higher in VABA versus Control (t[294] = -5.584, p < .001, d = 0.65), predicted fewer depressive symptoms (R2 change = .019, β = -.134, p = .003). VABA is an ultra-brief intervention that appears to have acute effects on mood-enhancement and behavioral activation.
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Affiliation(s)
- Mindy M Kibbey
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Angelo M DiBello
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Erick J Fedorenko
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Samantha G Farris
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
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Whittington BJ, Buttazzoni G, Patel A, Power LE, McKane P, Fleischer NL, Hirschtick JL. Disparities in COVID-19 Hospitalization at the Intersection of Race and Ethnicity and Income. J Racial Ethn Health Disparities 2024; 11:1116-1123. [PMID: 37058202 PMCID: PMC10103660 DOI: 10.1007/s40615-023-01591-9] [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: 10/17/2022] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Existing studies have elucidated racial and ethnic disparities in COVID-19 hospitalizations, but few have examined disparities at the intersection of race and ethnicity and income. METHODS We used a population-based probability survey of non-institutionalized adults in Michigan with a polymerase chain reaction-positive SARS-CoV-2 test before November 16, 2020. We categorized respondents by race and ethnicity and annual household income: low-income (< $50,000) Non-Hispanic (NH) Black, high-income (≥ $50,000) NH Black, low-income Hispanic, high-income Hispanic, low-income NH White, and high-income NH White. We used modified Poisson regression models, adjusting for sex, age group, survey mode, and sample wave, to estimate COVID-19 hospitalization prevalence ratios by race and ethnicity and income. RESULTS Over half of the analytic sample (n = 1593) was female (54.9%) and age 45 or older (52.5%), with 14.5% hospitalized for COVID-19. Hospitalization was most prevalent among low-income (32.9%) and high-income (31.2%) Non-Hispanic (NH) Black adults, followed by low-income NH White (15.3%), low-income Hispanic (12.9%), high-income NH White (9.6%), and high-income Hispanic adults (8.8%). In adjusted models, NH Black adults, regardless of income (low-income prevalence ratio [PR]: 1.86, 95% CI: 1.36-2.54; high-income PR: 1.57, 95% CI: 1.07-2.31), and low-income NH White adults (PR: 1.52, 95% CI: 1.12-2.07), had higher prevalence of hospitalization compared to high-income NH White adults. We observed no significant difference in the prevalence of hospitalization among Hispanic adults relative to high-income NH White adults. CONCLUSIONS We observed disparities in COVID-19 hospitalization at the intersection of race and ethnicity and income for NH Black adults and low-income NH White adults relative to high-income NH White adults, but not for Hispanic adults.
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Affiliation(s)
- Blair J Whittington
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, USA.
| | - Giovanna Buttazzoni
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Akash Patel
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Laura E Power
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Patricia McKane
- Lifecourse Epidemiology and Genomics Division, Michigan Department of Health and Human Services, Lansing, MI, USA
- Animal Industry Division, Michigan Department of Agriculture and Rural Development, Lansing, MI, USA
| | - Nancy L Fleischer
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Jana L Hirschtick
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, USA
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12
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Ban A, Shrestha A, Van den Berk-Clark C, Ballard J, Logan R, Logan T, Francioni A, Murray M, Baker EA. Through the eyes of community health workers: what was needed to increase COVID-19 vaccine uptake in the Missouri Southeast region. Front Public Health 2024; 12:1286177. [PMID: 38601509 PMCID: PMC11004485 DOI: 10.3389/fpubh.2024.1286177] [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: 08/31/2023] [Accepted: 03/04/2024] [Indexed: 04/12/2024] Open
Abstract
Public health emergencies, such as the COVID-19 pandemic, elucidate the strengths, weaknesses, and significant gaps in infrastructure, compatibility and consistency in communication systems, as well as the quality of collaborative relationships, and provider and workforce capacity. They also expose longstanding patterns of mistrust in the government and healthcare systems, and inadequacy in socio-economic infrastructures. These issues resulted in higher COVID-19 infection and mortality rates, and lower vaccination rates in many rural counties across the nation, including Missouri. In response to these challenges, the COVID-19 Response Network was formed in the Southeast corner of the state. The Network was a community-academic partnership that brought together community and faith-based leaders, academicians, healthcare providers and administrators, public health practitioners, and pharmacists to facilitate collaboration on education and outreach efforts aimed at reducing vaccine inequity in the 16-county project area. Importantly, the Network also included Community Health Workers (CHWs) who worked with these different agencies and organizations and were at the heart of implementing Network activities. The intent of this study was to assess their perspectives on the factors that influenced community engagement and communication strategies, and increased vaccine uptake in rural Missouri. Qualitative methods, including in-depth interviews, were used to explore the professional and personal experiences of CHWs working at the grassroots level during an ongoing pandemic. Narrative analysis revealed effective communication and engagement strategies for increasing vaccine uptake in rural communities. For instance, fear-based messaging was perceived as coercive and met with resistance. In contrast, messages that shared personal experiences and catered to the human need to protect their loved ones were more effective. Trust in the source of information was critical. This study highlights the significance of exploring and leveraging the capacities of trusted community members like CHWs to increase the effectiveness of public health interventions in rural communities.
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Affiliation(s)
- Anusha Ban
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States
| | - Ashish Shrestha
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States
| | | | | | | | - Tripp Logan
- L and S Pharmacy, Charleston, MO, United States
| | | | - Megan Murray
- Southeastern Missouri Area Health Education Center, Poplar Bluff, MO, United States
| | - Elizabeth A. Baker
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States
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13
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Zhao MY, Lei YY, Aaronson MRM, De Silva SR, Badiee J, May FP. Colorectal Cancer Screening Rates at Federally Qualified Health Centers From 2014 to 2022: Incomplete Recovery From COVID-19 and Worsening Disparities. Am J Gastroenterol 2024:00000434-990000000-01024. [PMID: 38529856 DOI: 10.14309/ajg.0000000000002706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/15/2024] [Indexed: 03/27/2024]
Abstract
INTRODUCTION Federally Qualified Health Centers (FQHC) provide preventive health services such as colorectal cancer (CRC) screening to low-income and underinsured individuals. Overall CRC screening participation in the United States declined during the COVID-19 pandemic and recovered by 2021; however, trends in underresourced settings are unknown. METHODS Using Uniform Data System data from 2014 to 2022, we assessed trends in FQHC CRC screening rates nationally, in California, and in Los Angeles County and determined clinic-level factors associated with recent screening rate changes. For each FQHC, we calculated the screening rate change from 2019 to 2020, 2020 to 2021, and 2020 to 2022. We used mixed-effects linear regression to determine clinic-level characteristics associated with each screening rate change. RESULTS Across all FQHC (n = 1,281), 7,016,181 patients were eligible for CRC screening in 2022. Across the United States and in California, median screening rates increased from 2014 to 2019, severely declined in 2020, and failed to return to prepandemic levels by 2022. Both nationally and in California, CRC screening declined most dramatically from 2019 to 2020 in FQHC serving majority Hispanic/Latino patients or a high proportion of patients experiencing homelessness. From 2020 to 2022, screening rates did not recover completely in US FQHC, with disproportionate recovery among FQHC serving majority non-Hispanic Black patients. DISCUSSION CRC screening rates at FQHC did not return to prepandemic levels by 2022, and recovery varied by FQHC patient characteristics. Tailored interventions addressing low and decreasing CRC screening rates in FQHC are urgently needed to mitigate worsening CRC disparities.
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Affiliation(s)
- Matthew Y Zhao
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Yvonne Y Lei
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Megan R M Aaronson
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Sadie R De Silva
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Jayraan Badiee
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Folasade P May
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
- Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California, USA
- UCLA Kaiser Permanente Center for Health Equity, Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, California, USA
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14
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Willie TC, Sharpless L, Katague M, Kershaw T. A Mixed-Methods Analysis of Coercive Control and COVID-19 Stress Among Black Women Experiencing Intimate Partner Violence During the COVID-19 Pandemic. Public Health Rep 2024:333549241238895. [PMID: 38519862 DOI: 10.1177/00333549241238895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024] Open
Abstract
OBJECTIVE During times of crises, women are at elevated risk for intimate partner violence (IPV), but extant discourse fails to consider how this landscape amplifies disparities for Black women. This study examined the prevalence and associations of COVID-19 pandemic-specific coercive control and COVID-19-related stress among Black women experiencing IPV. METHODS Fifty-five Black women reporting past-year IPV participated in a prospective cohort study in 2020 and completed surveys on pandemic-specific coercive control, COVID-19-related stress, and sociodemographic characteristics. A subset of 15 participants completed semi-structured interviews in 2021. We conducted multivariable regression analyses to examine associations between coercive control and stress. We used interpretive phenomenological analysis to contextualize women's experiences of coercive control and stress during the pandemic. RESULTS In the past 3 months, 76% (42 of 55) of women had a partner blame them for exposing them to COVID-19, 74% (41 of 55) had a partner minimize their pandemic concerns, and 52% (29 of 55) had a partner prevent them from getting a COVID-19 test. A higher average of pandemic-specific coercive control was associated with greater severity of COVID-19-related traumatic stress (b [SE] = 0.033 [0.009]; P = .001) and socioeconomic consequences related to COVID-19 (b [SE] = 0.019 [0.008]; P = .03). We identified 3 superordinate themes that illustrated Black women's experiences: (1) coercive control, (2) pandemic-driven shifts in relational context, and (3) women's structural and psychosocial stressors. CONCLUSIONS Experiencing coercive control during the pandemic interfered with Black women's engagement in preventive behaviors, which exacerbated distress. Intersectional public health efforts should address sociostructural and relational factors to prevent coercive control and stress among Black women experiencing IPV.
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Affiliation(s)
- Tiara C Willie
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laurel Sharpless
- Department of Health Behavior, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marina Katague
- San Diego State University and University of California, San Diego, San Diego, CA, USA
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
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15
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Del Fiol G, Orleans B, Kuzmenko TV, Chipman J, Greene T, Martinez A, Wirth J, Meads R, Kaphingst KK, Gibson B, Kawamoto K, King AJ, Siaperas T, Hughes S, Pruhs A, Pariera Dinkins C, Lam CY, Pierce JH, Benson R, Borsato EP, Cornia R, Stevens L, Bradshaw RL, Schlechter CR, Wetter DW. SCALE-UP II: protocol for a pragmatic randomised trial examining population health management interventions to increase the uptake of at-home COVID-19 testing in community health centres. BMJ Open 2024; 14:e081455. [PMID: 38508633 PMCID: PMC10961568 DOI: 10.1136/bmjopen-2023-081455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/23/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION SCALE-UP II aims to investigate the effectiveness of population health management interventions using text messaging (TM), chatbots and patient navigation (PN) in increasing the uptake of at-home COVID-19 testing among patients in historically marginalised communities, specifically, those receiving care at community health centres (CHCs). METHODS AND ANALYSIS The trial is a multisite, randomised pragmatic clinical trial. Eligible patients are >18 years old with a primary care visit in the last 3 years at one of the participating CHCs. Demographic data will be obtained from CHC electronic health records. Patients will be randomised to one of two factorial designs based on smartphone ownership. Patients who self-report replying to a text message that they have a smartphone will be randomised in a 2×2×2 factorial fashion to receive (1) chatbot or TM; (2) PN (yes or no); and (3) repeated offers to interact with the interventions every 10 or 30 days. Participants who do not self-report as having a smartphone will be randomised in a 2×2 factorial fashion to receive (1) TM with or without PN; and (2) repeated offers every 10 or 30 days. The interventions will be sent in English or Spanish, with an option to request at-home COVID-19 test kits. The primary outcome is the proportion of participants using at-home COVID-19 tests during a 90-day follow-up. The study will evaluate the main effects and interactions among interventions, implementation outcomes and predictors and moderators of study outcomes. Statistical analyses will include logistic regression, stratified subgroup analyses and adjustment for stratification factors. ETHICS AND DISSEMINATION The protocol was approved by the University of Utah Institutional Review Board. On completion, study data will be made available in compliance with National Institutes of Health data sharing policies. Results will be disseminated through study partners and peer-reviewed publications. TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT05533918 and NCT05533359.
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Affiliation(s)
- Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Brian Orleans
- Center for Health Outcomes and Population Equity, University of Utah Health Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Tatyana V Kuzmenko
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Jonathan Chipman
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Tom Greene
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Anna Martinez
- Center for Health Outcomes and Population Equity, University of Utah Health Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Jennifer Wirth
- Center for Health Outcomes and Population Equity, University of Utah Health Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Ray Meads
- Center for Health Outcomes and Population Equity, University of Utah Health Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | | | - Bryan Gibson
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Andy J King
- Department of Communication, University of Utah, Salt Lake City, Utah, USA
| | - Tracey Siaperas
- Association for Utah Community Health, Salt Lake City, Utah, USA
| | - Shlisa Hughes
- Association for Utah Community Health, Salt Lake City, Utah, USA
| | - Alan Pruhs
- Association for Utah Community Health, Salt Lake City, Utah, USA
| | | | - Cho Y Lam
- Center for Health Outcomes and Population Equity, University of Utah Health Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Joni H Pierce
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Ryzen Benson
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Emerson P Borsato
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Ryan Cornia
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Leticia Stevens
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Richard L Bradshaw
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Chelsey R Schlechter
- Center for Health Outcomes and Population Equity, University of Utah Health Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - David W Wetter
- Center for Health Outcomes and Population Equity, University of Utah Health Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
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16
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Koku EF, Johnson-Yengbeh N, Muhr A. Addressing COVID-19 Vaccine Hesitancy and Uptake Among African Immigrants: Lessons from a Community-Based Outreach Program. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01947-9. [PMID: 38443740 DOI: 10.1007/s40615-024-01947-9] [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: 11/13/2023] [Revised: 02/07/2024] [Accepted: 02/13/2024] [Indexed: 03/07/2024]
Abstract
In 2021, the African Cultural Alliance of North America (ACANA) implemented a community-based vaccine education and outreach program to decrease hesitancy and increase COVID-19 vaccine uptake among African immigrants in Philadelphia. The program had three components: (1) tailored messaging on the benefits of vaccines by trusted community health navigators in familiar languages/dialects, (2) use of educational/tabling events, and (3) establishment of a vaccine clinic in community settings. Using secondary data analysis, in-depth interviews, focus group discussions and a self-administered survey, we explored (i) the impact and effectiveness of the outreach program and extent of vaccine uptake, (ii) African immigrants' beliefs about the COVID-19 pandemic and the vaccine, and (iii) barriers and facilitators of vaccine knowledge, uptake, and hesitancy. Our analysis showed that ACANA's outreach program was effective in addressing several cultural, logistic, and systematic barriers to vaccine uptake. The program distributed 2000 educational/informational flyers, reached 3000 community members via social media campaigns, and an additional 2320 through other person-to-person outreach events. The program was effective and resulted in the vaccination of 1265 community members over the course of the outreach. The impact of this outreach underscores the critical role of community-based organizations in addressing COVID-19 vaccine hesitancy and increasing vaccine uptake in underserved and minority communities. The paper concludes with suggestions and recommendations for using community-based outreach programs to increase COVID-19 vaccine uptake and decrease hesitancy.
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Affiliation(s)
- Emmanuel F Koku
- Department of Sociology, Drexel University, 3201 Arch Street, Room 288, Philadelphia, PA, 19104, USA.
| | - Nettie Johnson-Yengbeh
- Health Department, African Cultural Alliance of North America (ACANA), 5530 Chester Ave, Philadelphia, PA, 19143, USA
| | - Ava Muhr
- Health Department, African Cultural Alliance of North America (ACANA), 5530 Chester Ave, Philadelphia, PA, 19143, USA
- School of Social and Political Science, University of Edinburgh, 15a George Square, EH8 9LD, Edinburgh, UK
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17
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Olanlesi-Aliu A, Kemei J, Alaazi D, Tunde-Byass M, Renzaho A, Sekyi-Out A, Mullings DV, Osei-Tutu K, Salami B. COVID-19 among Black people in Canada: a scoping review. Health Promot Chronic Dis Prev Can 2024; 44:112-125. [PMID: 38501682 PMCID: PMC11092311 DOI: 10.24095/hpcdp.44.3.05] [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] [Indexed: 03/20/2024]
Abstract
INTRODUCTION The COVID-19 pandemic exacerbated health inequities worldwide. Research conducted in Canada shows that Black populations were disproportionately exposed to COVID-19 and more likely than other ethnoracial groups to be infected and hospitalized. This scoping review sought to map out the nature and extent of current research on COVID-19 among Black people in Canada. METHODS Following a five-stage methodological framework for conducting scoping reviews, studies exploring the effects of the COVID-19 pandemic on Black people in Canada, published up to May 2023, were retrieved through a systematic search of seven databases. Of 457 identified records, 124 duplicates and 279 additional records were excluded after title and abstract screening. Of the remaining 54 articles, 39 were excluded after full-text screening; 2 articles were manually picked from the reference lists of the included articles. In total, 17 articles were included in this review. RESULTS Our review found higher rates of COVID-19 infections and lower rates of COVID-19 screening and vaccine uptake among Black Canadians due to pre-COVID-19 experiences of institutional and structural racism, health inequities and a mistrust of health care professionals that further impeded access to health care. Misinformation about COVID-19 exacerbated mental health issues among Black Canadians. CONCLUSIONS Our findings suggest the need to address social inequities experienced by Black Canadians, particularly those related to unequal access to employment and health care. Collecting race-based data on COVID-19 could inform policy formulation to address racial discrimination in access to health care, quality housing and employment, resolve inequities and improve the health and well-being of Black people in Canada.
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Affiliation(s)
| | - Janet Kemei
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Dominic Alaazi
- Health and Immigration Policies and Practices Research Program (HIPP), University of Alberta, Edmonton, Alberta, Canada
| | - Modupe Tunde-Byass
- Black Physicians of Ontario, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Ontario, Toronto, Ontario, Canada
| | - Andre Renzaho
- Translational Health Research Institute, School of Medicine, Campbell Town Campus, Western Sydney University, Australia
| | | | - Delores V Mullings
- School of Social Work, Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Kannin Osei-Tutu
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bukola Salami
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Health and Immigration Policies and Practices Research Program (HIPP), University of Alberta, Edmonton, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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18
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Araújo MVRD, Pereira-Borges RC. Racism, health and pandemic: a narrative review of the relationship between black population and COVID-19 events in 2020. CIENCIA & SAUDE COLETIVA 2024; 29:e11072023. [PMID: 38451653 DOI: 10.1590/1413-81232024293.11072023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/20/2023] [Indexed: 03/08/2024] Open
Abstract
This study aimed to analyze how scientific publications described and interpreted findings about the relationship between the Black population and events linked to COVID-19 in 2020. Narrative review with systematic search, in which a survey was conducted on articles published in 2020 in the Scopus, Medline/PubMed, and Web of Science databases. Initially, 665 articles were found, and after reading and applying the eligible criteria, the final number of 45 articles was reached. Epidemiological, observational studies, secondary data and developed in the United States predominated. Four groupings and respective findings emerged from the synthesis of information extracted: Main events in the Black population - high number of deaths and mortality rate; Direct relationships - poor health, housing, and work conditions; Intermediate relationships - low income and anti-Black prejudice; Comprehensive relationships - structural racism and social determinants of health. The identification of racial health disparities is an important finding about the dynamics of the pandemic among the Black population. However, multicausal explanations were limited. It is necessary to mobilize critical theoretical resources from ethnic and health studies to qualify research in order to support global actions to combat the SARS-CoV-2 epidemic in this group.
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Affiliation(s)
- Marcos Vinícius Ribeiro de Araújo
- Instituto Multidisciplinar de Reabilitação e Saúde, Universidade Federal da Bahia. R. Padre Feijó 312, casas 47 e 49, Canela. 40.110-170 Salvador BA Brasil.
| | - Ruan Carlos Pereira-Borges
- Programa de Residência Multiprofissional Hospital Metropolitano Odilon Behrens, Secretaria Municipal de Saúde de Belo Horizonte. Belo Horizonte MG Brasil
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19
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Dyar C, Crosby S, Newcomb ME, Mustanski B, Kaysen D. Doomscrolling: Prospective associations between daily COVID news exposure, internalizing symptoms, and substance use among sexual and gender minority individuals assigned female at birth. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2024; 11:139-152. [PMID: 38737889 PMCID: PMC11081596 DOI: 10.1037/sgd0000585] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Cross-sectional studies have demonstrated associations between COVID news exposure, anxiety, and depression. However, longitudinal research examining the directionality of these associations is extremely limited. Further, most studies have focused on the general population and neglected sexual and gender minority individuals (SGM), a population disproportionately impacted by the pandemic. To address these limitations, the current study utilized data from a 30-day diary study of SGM assigned female at birth (N = 429). We examined concurrent and prospective associations between COVID news exposure, depressed and anxious affect, COVID distress, substance use, and motives for use. Further, we examined associations between cumulative COVID news exposure across the diary period and prospective changes in anxiety, depression, and COVID distress. When participants were exposed to more COVID news, they experienced more depressed and anxious affect, more COVID distress, less positive affect, and were more likely to use alcohol and cannabis to cope. Further, when participants were exposed to more COVID news, they experienced subsequent increases in depressed affect, decreases in positive affect, and increases in the likelihood of using cannabis to cope. Findings also provided evidence of bi-directional prospective associations between COVID news exposure and COVID distress and of a cumulative impact of COVID news exposure on anxiety, depression, and COVID distress. Findings suggest that individuals should balance the need to remain informed about the pandemic and their own mental health when considering how much COVID news to consume.
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Affiliation(s)
| | | | - Michael E. Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
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20
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Adinkrah EK, Bazargan S, Cobb S, Kibe LW, Vargas R, Waller J, Sanchez H, Bazargan M. Mobilizing faith-based COVID-19 health ambassadors to address COVID-19 health disparities among African American older adults in under-resourced communities: A hybrid, community-based participatory intervention. PLoS One 2024; 19:e0285963. [PMID: 38358995 PMCID: PMC10868749 DOI: 10.1371/journal.pone.0285963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 01/26/2024] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic disproportionately affected older adults, particularly those with pre-existing chronic health conditions. To address the health disparity and challenges faced by under-resourced African American older adults in South Los Angeles during this period, we implemented a hybrid (virtual/in-person), pre-post, community-based participatory intervention research project utilizing a faith-based lay health advisor model (COVID-19 Health Ambassador Program (CHAP)). We recruited COVID-19 Health Ambassadors (CHAs) and African American older adults (participants) from faith-based organizations who partook in CHA-led meetings and follow-ups that educated and supported the participants. This paper seeks to evaluate this intervention's implementation using the Consolidated Framework for Implementation Research (CFIR) as a reporting tool with an emphasis on fidelity, challenges, and adaptations based on data collected via stakeholder interviews and surveys. RESULTS CHAP was delivered to 152 participants by 19 CHAs from 17 faith-based organizations. CHAs assisted with chronic disease management, resolved medication-related challenges, encouraged COVID-19 vaccination, reduced psychological stress and addressed healthcare avoidance behaviors such as COVID-19 vaccine hesitancy among the participants. Challenges encountered include ensuring participant engagement and retention in the virtual format and addressing technological barriers for CHAs and participants. Adaptations made to better suit the needs of participants included providing communication tools and additional training to CHAs to improve their proficiency in using virtual platforms in addition to adapting scientific/educational materials to suit our participants' diverse cultural and linguistic needs. CONCLUSION The community-centered hybrid approach in addition to our partnership with faith-based organizations and their respective COVID-19 health ambassadors proved to be essential in assisting underserved African American older adults manage chronic health conditions and address community-wide health disparities during the COVID-19 pandemic. Adaptability, cultural sensitivity, and teamwork are key to implementing health interventions especially in underserved populations.
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Affiliation(s)
- Edward K. Adinkrah
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, United States of America
| | - Shahrzad Bazargan
- Departments of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, California, United States of America
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California, United States of America
| | - Sharon Cobb
- Mervyn M. Dymally College of Nursing, Charles R. Drew University of Medicine and Science, Los Angeles, California, United States of America
| | - Lucy W. Kibe
- Physician Associate Program, Charles R. Drew University of Medicine and Science, Los Angeles, California, United States of America
| | - Roberto Vargas
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, United States of America
| | - Joe Waller
- Office of Research, Charles R. Drew University of Medicine and Science, Los Angeles, California, United States of America
| | - Humberto Sanchez
- Office of Research, Charles R. Drew University of Medicine and Science, Los Angeles, California, United States of America
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, United States of America
- Department of Family Medicine, University of California Los Angeles, Los Angeles, California, United States of America
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21
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Russ S, Bennett N, van Wijngaarden E, Hill E, Liu Y. Influence of Community Determinants on Barriers and Facilitators to COVID-19 Vaccine Uptake: Regional Stakeholders' Perspectives. Vaccine 2024; 42:1160-1167. [PMID: 38272763 DOI: 10.1016/j.vaccine.2024.01.039] [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: 06/27/2023] [Revised: 10/29/2023] [Accepted: 01/13/2024] [Indexed: 01/27/2024]
Abstract
Our study objective was to explore possible pathways by which neighborhood-level characteristics drive COVID-19 vaccination among communities experiencing health inequity and disparities. To do so, we conducted semi-structured qualitative interviews with stakeholders in the Finger Lakes region of New York between November 2022 through January 2023. Using a pre-developed interview guide informed by the Health Belief Model, we elicited county health commissioner, medical professional and community-health partner's perspectives regarding the impact community determinants have on shaping barriers to and facilitators of COVID-19 vaccine uptake, as well as recommended solutions for ensuring health equity in future vaccination efforts. Fifteen stakeholders were interviewed, of which 40% were county health commissioners, 27% hospital executives and 33% community-health organization partners. We identified diverse perceived and logistical barriers to COVID-19 vaccination that emerged as sub-themes including perceived risks outweighing the benefits of vaccination, concerns of vaccine safety, distrust stemming from changing scientific knowledge surrounding the vaccines, mistrust of the medical system, and challenges with transportation to and registering for vaccine appointments. Stakeholders reported these barriers were linked to the racial diversity, poverty, political conservatism, and availability of health care of the communities where they reported these were experienced. Notable solutions for improving equitable vaccination included facilitating structural access to vaccination and engaging community trusted messengers. Perceived and experienced barriers to COVID-19 vaccination may differ based upon the social, racial and economic composition of neighboring communities. Strategies for ensuring health equity in future vaccination campaigns should specifically target prevalent barriers based upon the community composition.
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Affiliation(s)
- Savanah Russ
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, 265 Crittenden Boulevard, Rochester, NY 14642, United States; Center for Community Health and Prevention, University of Rochester School of Medicine and Dentistry, 46 Prince Street, Rochester, NY 14607, United States.
| | - Nancy Bennett
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, 265 Crittenden Boulevard, Rochester, NY 14642, United States; Center for Community Health and Prevention, University of Rochester School of Medicine and Dentistry, 46 Prince Street, Rochester, NY 14607, United States
| | - Edwin van Wijngaarden
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, 265 Crittenden Boulevard, Rochester, NY 14642, United States
| | - Elaine Hill
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, 265 Crittenden Boulevard, Rochester, NY 14642, United States
| | - Yu Liu
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, 265 Crittenden Boulevard, Rochester, NY 14642, United States
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22
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Strozza C, Vigezzi S, Callaway J, Aburto JM. The impact of COVID-19 on life expectancy across socioeconomic groups in Denmark. Popul Health Metr 2024; 22:3. [PMID: 38321440 PMCID: PMC10848407 DOI: 10.1186/s12963-024-00323-3] [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: 09/17/2023] [Accepted: 01/29/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Denmark was one of the few countries that experienced an increase in life expectancy in 2020, and one of the few to see a decrease in 2021. Because COVID-19 mortality is associated with socioeconomic status (SES), we hypothesize that certain subgroups of the Danish population experienced changes in life expectancy in 2020 and 2021 that differed from the country overall. We aim to quantify life expectancy in Denmark in 2020 and 2021 by SES and compare this to recent trends in life expectancy (2014-2019). METHODS We used Danish registry data from 2014 to 2021 for all individuals aged 30+. We classified the study population into SES groups using income quartiles and calculated life expectancy at age 30 by year, sex, and SES, and the differences in life expectancy from 2019 to 2020 and 2020 to 2021. We compared these changes to the average 1-year changes from 2014 to 2019 with 95% confidence intervals. Lastly, we decomposed these changes by age and cause of death distinguishing seven causes, including COVID-19, and a residual category. RESULTS We observed a mortality gradient in life expectancy changes across SES groups in both pandemic years. Among women, those of higher SES experienced a larger increase in life expectancy in 2020 and a smaller decrease in 2021 compared to those of lower SES. Among men, those of higher SES experienced an increase in life expectancy in both 2020 and 2021, while those of lower SES experienced a decrease in 2021. The impact of COVID-19 mortality on changes in life expectancy in 2020 was counterbalanced by improvements in non-COVID-19 mortality, especially driven by cancer and cardiovascular mortality. However, in 2021, non-COVID-19 mortality contributed negatively even for causes as cardiovascular mortality that has generally a positive impact on life expectancy changes, resulting in declines for most SES groups. CONCLUSIONS COVID-19 mortality disproportionally affected those of lower SES and exacerbated existing social inequalities in Denmark. We conclude that in health emergencies, particular attention should be paid to those who are least socially advantaged to avoid widening the already existing mortality gap with those of higher SES. This research contributes to the discussion on social inequalities in mortality in high-income countries.
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Affiliation(s)
- Cosmo Strozza
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark.
| | - Serena Vigezzi
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
| | - Julia Callaway
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
| | - José Manuel Aburto
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Sociology, University of Oxford, Oxford, UK
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23
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Paglino E, Lundberg DJ, Wrigley-Field E, Zhou Z, Wasserman JA, Raquib R, Chen YH, Hempstead K, Preston SH, Elo IT, Glymour MM, Stokes AC. Excess natural-cause mortality in US counties and its association with reported COVID-19 deaths. Proc Natl Acad Sci U S A 2024; 121:e2313661121. [PMID: 38300867 PMCID: PMC10861891 DOI: 10.1073/pnas.2313661121] [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: 08/11/2023] [Accepted: 12/06/2023] [Indexed: 02/03/2024] Open
Abstract
In the United States, estimates of excess deaths attributable to the COVID-19 pandemic have consistently surpassed reported COVID-19 death counts. Excess deaths reported to non-COVID-19 natural causes may represent unrecognized COVID-19 deaths, deaths caused by pandemic health care interruptions, and/or deaths from the pandemic's socioeconomic impacts. The geographic and temporal distribution of these deaths may help to evaluate which explanation is most plausible. We developed a Bayesian hierarchical model to produce monthly estimates of excess natural-cause mortality for US counties over the first 30 mo of the pandemic. From March 2020 through August 2022, 1,194,610 excess natural-cause deaths occurred nationally [90% PI (Posterior Interval): 1,046,000 to 1,340,204]. A total of 162,886 of these excess natural-cause deaths (90% PI: 14,276 to 308,480) were not reported to COVID-19. Overall, 15.8 excess deaths were reported to non-COVID-19 natural causes for every 100 reported COVID-19 deaths. This number was greater in nonmetropolitan counties (36.0 deaths), the West (Rocky Mountain states: 31.6 deaths; Pacific states: 25.5 deaths), and the South (East South Central states: 26.0 deaths; South Atlantic states: 25.0 deaths; West South Central states: 24.2 deaths). In contrast, reported COVID-19 death counts surpassed estimates of excess natural-cause deaths in metropolitan counties in the New England and Middle Atlantic states. Increases in reported COVID-19 deaths correlated temporally with increases in excess deaths reported to non-COVID-19 natural causes in the same and/or prior month. This suggests that many excess deaths reported to non-COVID-19 natural causes during the first 30 mo of the pandemic in the United States were unrecognized COVID-19 deaths.
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Affiliation(s)
- Eugenio Paglino
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA19104
| | - Dielle J. Lundberg
- Department of Global Health, Boston University School of Public Health, Boston, MA02118
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA98195
| | - Elizabeth Wrigley-Field
- Department of Sociology and Minnesota Population Center, University of Minnesota, Minneapolis, MN55455
| | - Zhenwei Zhou
- Department of Biostatistics, Boston University School of Public Health, Boston, MA02118
| | | | - Rafeya Raquib
- Department of Global Health, Boston University School of Public Health, Boston, MA02118
| | - Yea-Hung Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA94158
| | | | - Samuel H. Preston
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA19104
| | - Irma T. Elo
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA19104
| | - M. Maria Glymour
- Department of Epidemiology, Boston University School of Public Health, Boston, MA02118
| | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health, Boston, MA02118
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24
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Burton WM, Mumba MN. Race as a Structural Determinant of Mental Health. J Psychosoc Nurs Ment Health Serv 2024; 62:3-5. [PMID: 38315974 DOI: 10.3928/02793695-20240109-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Affiliation(s)
| | - Mercy Ngosa Mumba
- Center for Substance Use Research and Related Conditions, Capstone College of Nursing, The University of Alabama, Tuscaloosa, Alabama
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25
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Wippold GM, Tucker CM, Farishta A, Kim E, Hill R, Burwell A, Sapia P. An in-person and technology-implemented holistic health promotion program for older Black adults in low-income communities. J Natl Med Assoc 2024; 116:83-92. [PMID: 38172041 PMCID: PMC10922434 DOI: 10.1016/j.jnma.2023.12.008] [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: 10/10/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
The COVID-19 pandemic halted many in-person programs of research and required researchers to pivot to technology-enhanced approaches. To date, there are no examples or guidelines on how to use technology to implement health promotion programs rooted in the community-based participatory research (CBPR) model among low-income older Black adults. The aims of this paper are (a) to describe and report on the health-related outcomes of an in-person CBPR model-based health promotion intervention program for older Black adults in a low-income community, and (b) to describe the process of adapting this program to a technology-enhanced and Zoom-delivered format and provide preliminary evidence on the health-related outcomes and acceptability of this program. This paper highlights the potential benefits of a technology-enhanced and Zoom-delivered health promotion program among low-income older Black adults and provides recommendations to optimize such efforts to foster these benefits. These recommendations are aligned with the four domains of the CBPR model (i.e., contexts, partnership processes, intervention and research, and outcomes). We conclude that CBPR model-based, technology implemented health promotion interventions for low-income older Black adults are acceptable to such adults and should attend to the values, perspectives, and preferences of these individuals. The information in this manuscript is relevant to health promotion specialists at this seemingly ongoing though post-pandemic era because technology-enhanced interventions are scalable and cost-effective and those anchored in CBPR are well-positioned to promote health equity.
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Affiliation(s)
| | | | | | - Erin Kim
- University of Florida, Gainesville, FL, USA
| | - Rhonda Hill
- UF College of Community Health and Family Medicine (Jacksonville), Jacksonville, FL, USA
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26
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LeMasters K, Krajewski T, Dong K, Brinkley-Rubinstein L. Documenting Competing Needs to Well-Being Among Those on Community Supervision in the South. JOURNAL OF CORRECTIONAL HEALTH CARE 2024; 30:14-21. [PMID: 38150566 DOI: 10.1089/jchc.23.04.0027] [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] [Indexed: 12/29/2023]
Abstract
Although the harms of incarceration on health are well known, little is known about individuals' competing priorities to maintaining their health while on probation and parole after release from incarceration. We explored individuals' competing needs on probation and parole (lack of health insurance/access, hazardous alcohol use, substance use, food insecurity, un/underemployment, housing insecurity, lack of social support, length of recent incarceration, prohibitive monthly fees, criminal legal discrimination) to achieving well-being. We explored overlap between competing needs and overall well-being. This descriptive, cross-sectional analysis assesses the relationship between competing needs and current well-being of participants in The Southern Pre-Exposure Prophylaxis Study. Of 364 enrolled participants, 48% were thriving. The most common competing need was substance use (73%). Of the 10 competing needs, participants experienced a median 4 (interquartile range [IQR] 3-6). Those considered to be thriving experienced a median 4 (IQR 3-5) competing needs while those not thriving experienced a median 5 (IQR 4-6; p < .001). People on probation and parole experience competing needs to achieving health and well-being. To improve well-being among this population, programs and policies must focus on not only the health of those exiting incarceration but also the multiple competing needs that they face.
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Affiliation(s)
- Katherine LeMasters
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Taylor Krajewski
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Center for AIDS Research, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kimberly Dong
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
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27
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Ong JCL, Seng BJJ, Law JZF, Low LL, Kwa ALH, Giacomini KM, Ting DSW. Artificial intelligence, ChatGPT, and other large language models for social determinants of health: Current state and future directions. Cell Rep Med 2024; 5:101356. [PMID: 38232690 PMCID: PMC10829781 DOI: 10.1016/j.xcrm.2023.101356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 10/12/2023] [Accepted: 12/10/2023] [Indexed: 01/19/2024]
Abstract
This perspective highlights the importance of addressing social determinants of health (SDOH) in patient health outcomes and health inequity, a global problem exacerbated by the COVID-19 pandemic. We provide a broad discussion on current developments in digital health and artificial intelligence (AI), including large language models (LLMs), as transformative tools in addressing SDOH factors, offering new capabilities for disease surveillance and patient care. Simultaneously, we bring attention to challenges, such as data standardization, infrastructure limitations, digital literacy, and algorithmic bias, that could hinder equitable access to AI benefits. For LLMs, we highlight potential unique challenges and risks including environmental impact, unfair labor practices, inadvertent disinformation or "hallucinations," proliferation of bias, and infringement of copyrights. We propose the need for a multitiered approach to digital inclusion as an SDOH and the development of ethical and responsible AI practice frameworks globally and provide suggestions on bridging the gap from development to implementation of equitable AI technologies.
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Affiliation(s)
- Jasmine Chiat Ling Ong
- Division of Pharmacy, Singapore General Hospital, Singapore, Singapore; SingHealth Duke-NUS Medicine Academic Clinical Programme, Singapore, Singapore
| | - Benjamin Jun Jie Seng
- MOHH Holdings (Singapore) Pte., Ltd., Singapore, Singapore; SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
| | | | - Lian Leng Low
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore, Singapore; Population Health and Integrated Care Office, Singapore General Hospital, Singapore, Singapore; Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore; Outram Community Hospital, SingHealth Community Hospitals, Singapore, Singapore
| | - Andrea Lay Hoon Kwa
- Division of Pharmacy, Singapore General Hospital, Singapore, Singapore; SingHealth Duke-NUS Medicine Academic Clinical Programme, Singapore, Singapore; Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | - Kathleen M Giacomini
- Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel Shu Wei Ting
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research, Singapore, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore, Singapore; Byers Eye Institute, Stanford University, Stanford, CA, USA.
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28
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Myruski S, Pérez-Edgar K, Buss KA. Adolescent coping and social media use moderated anxiety change during the COVID-19 pandemic. J Adolesc 2024; 96:177-195. [PMID: 37919867 PMCID: PMC10842370 DOI: 10.1002/jad.12267] [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: 02/28/2023] [Revised: 10/04/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION Adolescence is a sensitive period during which stressors and social disruptions uniquely contribute to anxiety symptoms. Adolescent's coping strategies (i.e., avoidance and approach) during the coronavirus disease 2019 (COVID-19) pandemic may be differentially related to anxiety symptom changes. Further, social media use (SMU) is ubiquitous and may serve as an avenue to deploy avoidant and/or approach coping. METHOD Participants included 265 adolescents (ages 12-20 years; 55.8% female, 43.8% male) and one parent per adolescent. At two time points separated by ~6 months, adolescents reported on SMU and coping strategies, and parents and adolescents reported demographic information and adolescents' anxiety symptoms. Data were collected online in the United States, from summer 2020 through spring 2021. RESULTS Increases in avoidant coping predicted increasing anxiety, particularly when approach coping decreased. Decreases in both avoidant coping and SMU coincided with decreasing anxiety. Older adolescents showed decreasing anxiety when avoidant coping declined and SMU increased. CONCLUSION Coping strategies and SMU predicted patterns of adolescent anxiety symptom change across 6 months during the COVID-19 pandemic. Results highlight that coping and SMU should be contextualized within the time course of stressors.
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Affiliation(s)
- Sarah Myruski
- Department of Psychology, The Pennsylvania State University, State College, Pennsylvania, USA
| | - Koraly Pérez-Edgar
- Department of Psychology, The Pennsylvania State University, State College, Pennsylvania, USA
| | - Kristin A Buss
- Department of Psychology, The Pennsylvania State University, State College, Pennsylvania, USA
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29
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Mutiso F, Li H, Pearce JL, Benjamin-Neelon SE, Mueller NT, Neelon B. Bayesian kernel machine regression for count data: modelling the association between social vulnerability and COVID-19 deaths in South Carolina. J R Stat Soc Ser C Appl Stat 2024; 73:257-274. [PMID: 38222066 PMCID: PMC10782459 DOI: 10.1093/jrsssc/qlad094] [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: 07/21/2022] [Revised: 04/24/2023] [Accepted: 09/19/2023] [Indexed: 01/16/2024]
Abstract
The COVID-19 pandemic created an unprecedented global health crisis. Recent studies suggest that socially vulnerable communities were disproportionately impacted, although findings are mixed. To quantify social vulnerability in the US, many studies rely on the Social Vulnerability Index (SVI), a county-level measure comprising 15 census variables. Typically, the SVI is modelled in an additive manner, which may obscure non-linear or interactive associations, further contributing to inconsistent findings. As a more robust alternative, we propose a negative binomial Bayesian kernel machine regression (BKMR) model to investigate dynamic associations between social vulnerability and COVID-19 death rates, thus extending BKMR to the count data setting. The model produces a 'vulnerability effect' that quantifies the impact of vulnerability on COVID-19 death rates in each county. The method can also identify the relative importance of various SVI variables and make future predictions as county vulnerability profiles evolve. To capture spatio-temporal heterogeneity, the model incorporates spatial effects, county-level covariates, and smooth temporal functions. For Bayesian computation, we propose a tractable data-augmented Gibbs sampler. We conduct a simulation study to highlight the approach and apply the method to a study of COVID-19 deaths in the US state of South Carolina during the 2021 calendar year.
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Affiliation(s)
- Fedelis Mutiso
- Division of Biostatistics, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Hong Li
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
| | - John L Pearce
- Division of Environmental Health, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Sara E Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Noel T Mueller
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Brian Neelon
- Division of Biostatistics, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
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30
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Zang X, Walley AY, Chatterjee A, Kimmel SD, Morgan JR, Murphy SM, Linas BP, Nolen S, Reilly B, Urquhart C, Schackman BR, Marshall BDL. Changes to opioid overdose deaths and community naloxone access among Black, Hispanic and White people from 2016 to 2021 with the onset of the COVID-19 pandemic: An interrupted time-series analysis in Massachusetts, USA. Addiction 2023; 118:2413-2423. [PMID: 37640687 PMCID: PMC10986189 DOI: 10.1111/add.16324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 07/07/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND AND AIMS The onset of the coronavirus disease 2019 (COVID-19) pandemic was associated with a surge in opioid overdose deaths in Massachusetts, particularly affecting racial and ethnic minority communities. We aimed to compare the impact of the pandemic on opioid overdose fatalities and naloxone distribution from community-based programs across racial and ethnic groups in Massachusetts. DESIGN Interrupted time-series. SETTING AND CASES Opioid overdose deaths (OODs) among non-Hispanic White, non-Hispanic Black, Hispanic and non-Hispanic other race people in Massachusetts, USA (January 2016 to June 2021). MEASUREMENTS Rate of OODs per 100 000 people, rate of naloxone kits distributed per 100 000 people and ratio of naloxone kits per opioid overdose death as a measure of naloxone availability. We applied five imputation strategies using complete data in different periods to account for missingness of race and ethnicity for naloxone data. FINDINGS Before COVID-19 (January 2016 to February 2020), the rate of OODs declined among non-Hispanic White people [0.2% monthly reduction (95% confidence interval = 0.0-0.4%)], yet was relatively constant among all other population groups. The rate of naloxone kits increased across all groups (0.8-1.2% monthly increase) and the ratio of naloxone kits per OOD death among non-Hispanic White was 1.1% (0.8-1.4%) and among Hispanic people was 1.0% (0.2-1.8%). After the onset of the pandemic (March 2020+), non-Hispanic Black people experienced an immediate increase in the rate of OODs [63.6% (16.4-130%)], whereas rates among other groups remained similar. Trends in naloxone rescue kit distribution did not substantively change among any groups, and the ratio of naloxone kits per OOD death for non-Hispanic Black people did not compensate for the surge in OODs deaths in this group. CONCLUSIONS With the onset of the COVID-19 pandemic, there was a surge in opioid overdose deaths among non-Hispanic Black people in Massachusetts, USA with no compensatory increase in naloxone rescue kit distribution. For non-Hispanic White and Hispanic people, opioid overdose deaths remained stable and naloxone kit distribution continued to increase.
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Affiliation(s)
- Xiao Zang
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Alexander Y Walley
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Avik Chatterjee
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Simeon D Kimmel
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA
| | - Jake R Morgan
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, NY, USA
| | - Benjamin P Linas
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Shayla Nolen
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Brittni Reilly
- Massachusetts Department of Public Health, Boston, MA, USA
| | | | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, NY, USA
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
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31
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Oppelt TF, Polsonetti B, Caron MF, Collins-Carriveau C, Fischer N, Gofman L, Ghazipura M. Patient Perceptions of their COVID-19 Inpatient Hospital Experience: a Survey Exploring Inequities in Healthcare Delivery. J Racial Ethn Health Disparities 2023; 10:2775-2782. [PMID: 36417149 PMCID: PMC9684944 DOI: 10.1007/s40615-022-01454-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/14/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Compared with White patients, Black and Latinx patients have higher infection, hospitalization, and mortality rates from COVID-19; yet, little is known about their perspective before, during, and after a COVID-19 hospitalization. The objective of this study conducted in White, Black, and Latinx patients was to assess perceptions of their COVID-19-related hospitalization from onset of symptoms through the post-discharge period to identify disparities in their perceived care. METHODS A cross-sectional observational study using an online survey from May 19 to June 23, 2021, was conducted by The Harris Poll in 200 White, 200 Black, and 201 Latinx patients hospitalized for COVID-19 in the US. Main measures obtained included baseline demographic variables, socioeconomic status, and social determinants of health. Survey questions were specific to key aspects of the patient experience before, during, and after a COVID-19-related hospitalization. RESULTS Compared with White patients, Latinx and Black patients faced unique challenges in their healthcare journey including higher likelihood of delaying their hospitalization (10% Black vs. 4% White patients, respectively, P = 0.025), lower perceived satisfaction with care (82% Latinx vs 91% White patients, P = 0.002), and lower trust in providers following their hospitalization (85% White vs. 65% Latinx [P = 0.027] and 73% Black [P = 0.050] patients). CONCLUSIONS Patient perceptions of their COVID-19 hospitalization experience revealed disparities in perceived quality of care among minority groups. These findings offer insights that health inequities still exist, and strategies need to be taken to make health care delivery more equitable.
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Singh P, Nawaz S, Seiber EE, Bryant I, Moon K, Wastler H, Breitborde NJ. ED Visits for Schizophrenia Spectrum Disorders During the COVID-19 Pandemic at 5 Campus Health Systems. JAMA Netw Open 2023; 6:e2349305. [PMID: 38150255 PMCID: PMC10753394 DOI: 10.1001/jamanetworkopen.2023.49305] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/10/2023] [Indexed: 12/28/2023] Open
Abstract
Importance Although substantial research has reported grave population-level psychiatric sequelae of the COVID-19 pandemic, evidence pertaining to temporal changes in schizophrenia spectrum disorders in the US following the pandemic remains limited. Objective To examine the monthly patterns of emergency department (ED) visits for schizophrenia spectrum disorders after the onset of the COVID-19 pandemic. Design, Setting, and Participants This observational cohort study used time-series analyses to examine whether monthly counts of ED visits for schizophrenia spectrum disorders across 5 University of California (UC) campus health systems increased beyond expected levels during the COVID-19 pandemic. Data included ED visits reported by the 5 UC campuses from 2016 to 2021. Participants included persons who accessed UC Health System EDs had a diagnosis of a psychiatric condition. Data analysis was performed from March to June 2023. Exposures The exposures were binary indicators of initial (March to May 2020) and extended (March to December 2020) phases of the COVID-19 pandemic. Main Outcomes and Measures The primary outcome was monthly counts of ED visits for schizophrenia spectrum disorders. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes, categorized within Clinical Classification Software groups, were used to identify ED visits for schizophrenia spectrum disorders and all other psychiatric ED visits, from the University of California Health Data Warehouse database, from January 2016 to December 2021. Time-series analyses controlled for autocorrelation, seasonality, and concurrent trends in ED visits for all other psychiatric conditions. Results The study data comprised a total of 377 872 psychiatric ED visits, with 37 815 visits for schizophrenia spectrum disorders. The prepandemic monthly mean (SD) number of ED visits for schizophrenia spectrum disorders was 519.9 (38.1), which increased to 558.4 (47.6) following the onset of the COVID-19 pandemic. Results from time series analyses, controlling for monthly counts of ED visits for all other psychiatric conditions, indicated 70.5 additional ED visits (95% CI, 11.7-129.3 additional visits; P = .02) for schizophrenia spectrum disorders at 1 month and 74.9 additional visits (95% CI, 24.0-126.0 visits; P = .005) at 3 months following the initial phase of the COVID-19 pandemic in California. Conclusions and Relevance This study found a 15% increase in ED visits for schizophrenia spectrum disorders within 3 months after the initial phase of the pandemic in California across 5 UC campus health systems, underscoring the importance of social policies related to future emergency preparedness and the need to strengthen mental health care systems.
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Affiliation(s)
- Parvati Singh
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus
| | - Saira Nawaz
- Center for Health Outcomes and Policy Evaluation Studies, College of Public Health, The Ohio State University, Columbus
| | - Eric E. Seiber
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus
| | - Ian Bryant
- Department of Economics, University of Cincinnati, Cincinnati, Ohio
| | - Kyle Moon
- Center for Health Outcomes and Policy Evaluation Studies, College of Public Health, The Ohio State University, Columbus
| | - Heather Wastler
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, College of Medicine, The Ohio State University, Columbus
| | - Nicholas J. Breitborde
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, College of Medicine, The Ohio State University, Columbus
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Ramos SD, Kannout L, Khan H, Klasko-Foster L, Chronister BN, Du Bois S. A Neighborhood-level analysis of mental health distress and income inequality as quasi-longitudinal risk of reported COVID-19 infection and mortality outcomes in Chicago. DIALOGUES IN HEALTH 2023; 2:100091. [PMID: 36530218 PMCID: PMC9731648 DOI: 10.1016/j.dialog.2022.100091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 12/02/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022]
Abstract
Extant literature investigates the impact of COVID-19 on mental health outcomes, however there is a paucity of work examining mental health distress as a risk factor for COVID-19 outcomes. While systemic variables like income inequality relate to both mental health and COVID-19, more work is needed to test theoretically informed models including such variables. Using a social-ecological framework, we aimed to address these gaps in the literature by conducting a neighborhood-level analysis of potential mental health distress and systemic- (income inequality) level predictors of reported COVID-19 infection and mortality over time in Chicago. Neighborhood-level comparisons revealed differences in mental health distress, income inequality, and reported COVID-19 mortality, but not reported COVID-19 infection. Specifically, Westside and Southside neighborhoods generally reported higher levels of mental health distress and greater concentration of poverty. The Central neighborhood showed a decline in reported mortality rates over time. Multi-level negative binomial models established that Zip-codes with greater mental health distress were at increased reported COVID-19 infection risk, yet lower mortality risk; Zip-codes with more poverty were at increased reported COVID-19 infection risk, yet lower mortality risk; and Zip-codes with the highest percentage of People of Color were at decreased risk of reported COVID-19 mortality. Taken together, these findings substantiate Chicago neighborhood-level disparities in mental health distress, income inequality, and reported COVID-19 mortality; identify unique differential associations of mental health distress and income inequality to reported COVID-19 infection and reported mortality risk; and, offer an alternative lens towards understanding COVID-19 outcomes in terms of race/ethnicity.
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Affiliation(s)
- Stephen D. Ramos
- University of California San Diego, Division of Infectious Diseases and Global Public Health, Department of Medicine, San Diego, CA 92093, USA
- San Diego State University, SDSU Research Foundation, San Diego, CA 92120, USA
| | - Lynn Kannout
- Illinois Institute of Technology, Department of Psychology, Chicago, IL 60616, USA
| | - Humza Khan
- Illinois Institute of Technology, Department of Psychology, Chicago, IL 60616, USA
| | - Lynne Klasko-Foster
- Brown University, Department of Psychiatry and Human Behavior, Providence, RH 02912, USA
| | - Briana N.C. Chronister
- Herbert Wertheim School of Public Health, University of California San Diego, San Diego, CA 92093, USA
- School of Public Health, San Diego State University, San Diego, CA 92182, USA
| | - Steff Du Bois
- Illinois Institute of Technology, Department of Psychology, Chicago, IL 60616, USA
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Goldstein FC, Hajjar I, Summers A, Truong AD, Lee FFEH, Han JE, Walker TA. Frequency and correlates of subjective cognitive complaints and objective cognitive screening results in African American adults following COVID-19 infection. Brain Behav Immun Health 2023; 34:100691. [PMID: 37842136 PMCID: PMC10569942 DOI: 10.1016/j.bbih.2023.100691] [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: 03/01/2023] [Revised: 07/24/2023] [Accepted: 09/30/2023] [Indexed: 10/17/2023] Open
Abstract
Background Subjective cognitive complaints are frequent following COVID-19 infection, but assessment of whether these complaints map onto objective cognitive findings may not be routine in busy clinical settings. Consequently, opportunities to confirm these complaints and to provide follow-up referrals and appropriate care may be missed, thereby impacting patients' functional independence and quality of life. African Americans are vulnerable to poor outcomes from COVID-19, and thus represent a minority group in whom subjective concerns are especially important to investigate. Towards this end, we examined the frequency and correlates of subjective complaints and objective screening results of African American patients referred to the Post-Acute Sequelae of SARS-CoV-2 (PASC) Clinic at Grady Memorial Hospital, a large county teaching hospital in Atlanta, Georgia. Methods Eighty seven African American patients (mean age = 52.5, SD = 10.5, range = 30-73) were evaluated between January 28, 2021-October 14, 2021 in the Grady PASC clinic. They ranged from 1 to 17 months post positive SARS-COV-2 antigen testing. Patients were administered a subjective cognitive complaint questionnaire (PROMIS Cognitive Function Scale Short Form 8a) as well as cognitive screening measures including the Mini-Cog (3 item recall, clock) and the Digit Symbol Substitution Test (timed visuomotor sequencing). Mood was assessed via the Patient Health Questionnaire-9, and anxiety via the Generalized Anxiety Disorders Scale. Published norms were used to identify clinically elevated scores. Results Sixty six (76%) patients denied experiencing meaningful cognitive concerns, and of these, 25 (38%) had positive cognitive screens indicating impaired performance on objective testing. Of 21 patients with subjectively elevated cognitive concerns, 17 (81%) also had positive cognitive screens. There were no significant differences in sociodemographic factors (p values = .07-.71), days post-acute positive SARS-COV-2 Antigen Test (p = .99), disease severity (p values = .67-.75), or COVID-19 comorbidity indices (medical conditions (p values = .20-.77), substance abuse (p = .79), psychiatric history (p values = .11-.99) in those with or without subjective complaints and objective cognitive findings. However, patients with subjective complaints and objective cognitive findings reported more post-COVID-19 anxiety (p = .02) and depression (p = .001). Conclusions Findings indicate a high concordance between subjective complaints on the PROMIS Cognitive Scale and objectively confirmed cognitive impairments in African Americans. Further, almost 40% who reported no cognitive complaints screened positive for cognitive impairment. Although depression and anxiety are associated with subjective complaints, they do not account for positive cognitive screening results, as those patients without depressive complaints also had similar rates of positive objective screens. The findings suggest that cognitive screening using assessment tools should be routinely performed in African Americans, especially those reporting cognitive symptoms on outcome scales. While future studies are needed to assess long-term outcomes, we highly recommend follow-ups in those with positive screens to characterize the specific domains that are impacted and that could affect activities of daily living and quality of life.
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Affiliation(s)
| | - Ihab Hajjar
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology, University of Texas Southwestern, Dallas, TX, USA
| | - Aerica Summers
- Grady Post-COVID Clinic, Grady Memorial Hospital, Atlanta, GA, USA
| | - Alexander D. Truong
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - F. Frances Eun-Hyung Lee
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jenny E. Han
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Tiffany A. Walker
- Grady Post-COVID Clinic, Grady Memorial Hospital, Atlanta, GA, USA
- Department of Medicine, Division of General Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Aamir Shahzad M, Wang L, Qin S, Zhou S. COVID-19 incidence of poverty: How has disease affected the cost of purchasing food in Pakistan. Prev Med Rep 2023; 36:102477. [PMID: 37869539 PMCID: PMC10587723 DOI: 10.1016/j.pmedr.2023.102477] [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: 05/30/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/24/2023] Open
Abstract
COVID-19 harms health and income generation activities. The pandemic caused poverty, and food crisis in the most vulnerable and underprivileged segments. Economic turbulence and massive poverty during epidemic period probably resulted in short-term food insecurity and low food consumption. Based on these concerns, the current study examined how COVID-19 has impacted Pakistan's cost of purchasing food. The study surveyed total 1067 Punjab and Sindh residents in Pakistan, from July to October 2021. A structural equation model was used to examine the interrelationship among food intake, food purchasing cost, and health effects. We investigated whether people experienced substantial effects from the loss of a source of income, work hours, debt burden, and food inflation on their food intake. These circumstances all negatively affected food intake, reducing food consumption. Besides COVID-19's effects on direct income, 41% more people fall into poverty and 23% can't afford healthy food. People's socioeconomic circumstances affects poverty levels and affordable healthy food costs. The cost of purchasing food is significantly correlated with health outcomes. A significant and positive correlation between COVID-19 and income effects, and a negative correlation between food consumption and adverse income effects was explored. In addition, people increased their demand for food assistance during COVID-19 to mitigate negative income shocks. People who cannot afford minimal food costs should be offered food through mobile vehicles or delivery channels in the short term. Cash transfers or subsidies could also be provided to the needy during crisis time.
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Affiliation(s)
- Muhammad Aamir Shahzad
- School of Economics and Trade, Hunan University, Shi Jiachong, Yuelu District, Changsha City, Hunan Province 410079, China
| | - Lianfen Wang
- School of Economics and Trade, Hunan University, Shi Jiachong, Yuelu District, Changsha City, Hunan Province 410079, China
| | - Shengze Qin
- School of Tourism Management, Wuhan Business University, Wuhan Economic and Technological Development Zone, 430056 Wuhan, China
| | - Sha Zhou
- School of Economics and Trade, Hunan University, Shi Jiachong, Yuelu District, Changsha City, Hunan Province 410079, China
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Fern SE, Kimbro RT, Hill ME, Hughes CC. Emergency Food Support Preference and Usage During COVID-19: A Neighborhood Study of Low-Income Black Mothers? Use of School-Based Food Distribution and P-EBT. Am J Public Health 2023; 113:S227-S230. [PMID: 38118086 PMCID: PMC10733869 DOI: 10.2105/ajph.2023.307458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 12/22/2023]
Abstract
COVID-19 disrupted families' food supply. Based on in-depth interviews with 45 Black low-income mothers of young children in an underserved Houston, Texas, neighborhood from April 2020 to June 2021, we compared two aid programs-Pandemic Electronic Benefits Transfer cash assistance and in-kind food distributions. We found that mothers preferred cash assistance for boosting existing food strategies, while food distributions presented new challenges for already burdened families. We argue that food assistance interventions can be more successful and equitable by integrating service user context, needs, and preferences. (Am J Public Health. 2023;113(S3):S227-S230. https://doi.org/10.2105/AJPH.2023.307458).
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Affiliation(s)
- Simon E Fern
- Simon E. Fern and Rachel T. Kimbro are with the Department of Sociology, Rice University, Houston, TX. Marbella Eboni Hill is with the Department of Sociology and Anthropology, North Carolina State University, Raleigh. Cayce C. Hughes is with the Department of Sociology, Colorado College, Colorado Springs
| | - Rachel T Kimbro
- Simon E. Fern and Rachel T. Kimbro are with the Department of Sociology, Rice University, Houston, TX. Marbella Eboni Hill is with the Department of Sociology and Anthropology, North Carolina State University, Raleigh. Cayce C. Hughes is with the Department of Sociology, Colorado College, Colorado Springs
| | - Marbella Eboni Hill
- Simon E. Fern and Rachel T. Kimbro are with the Department of Sociology, Rice University, Houston, TX. Marbella Eboni Hill is with the Department of Sociology and Anthropology, North Carolina State University, Raleigh. Cayce C. Hughes is with the Department of Sociology, Colorado College, Colorado Springs
| | - Cayce C Hughes
- Simon E. Fern and Rachel T. Kimbro are with the Department of Sociology, Rice University, Houston, TX. Marbella Eboni Hill is with the Department of Sociology and Anthropology, North Carolina State University, Raleigh. Cayce C. Hughes is with the Department of Sociology, Colorado College, Colorado Springs
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Celermajer D, McKibbin P. Reimagining Relationships: Multispecies Justice as a Frame for the COVID-19 Pandemic. JOURNAL OF BIOETHICAL INQUIRY 2023; 20:657-666. [PMID: 37624548 PMCID: PMC10942882 DOI: 10.1007/s11673-023-10280-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/31/2023] [Indexed: 08/26/2023]
Abstract
COVID-19 catalyzed a renewed focus on the interconnected nature of human health. Together with the climate crisis, it highlighted not only intra-human connections but the entanglement of human health with the health of non-human animals, plants, and ecological systems more broadly. In this article, we challenge the persistent notion that humans are ontologically distinct from the rest of nature and the ethics that flow from this understanding. Imposing this privileged view of humans has devastating consequences for beings other than humans and for humans and impedes effective responses to crises. We situate the COVID-19 pandemic within the "polycrisis," and argue that one component of addressing multidimensional crises must involve fully embracing a relational ontology and ethics. We discuss two approaches to relationality, one articulated by ecofeminists and the second inhering in an Indigenous Māori worldview. Two dominant approaches, One Health and Planetary Health, purport to take account of relational ontologies in their approaches to health, but, we argue, persist in casting the more-than-human world in an instrumental role to secure human health. We suggest that Multispecies Justice, which draws on ecofeminist and Indigenous approaches, affords a fully relational approach to health and well-being. We explore the implications of relationality, and suggest fresh ways of understanding humans' connections with the more-than-human world.
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Affiliation(s)
- Danielle Celermajer
- Sydney Environment Institute, Discipline of Sociology and Criminology, University of Sydney, Room 350 Social Sciences, A02, University of Sydney, Sydney, NSW, 2006, Australia.
| | - Philip McKibbin
- Sydney Environment Institute, Discipline of Sociology and Criminology, University of Sydney, Room 350 Social Sciences, A02, University of Sydney, Sydney, NSW, 2006, Australia
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Ngamasana EL, Zarwell M, Gunn LH. Physical and mental health of informal caregivers before and during the COVID-19 pandemic in the United States. BMC Public Health 2023; 23:2349. [PMID: 38012592 PMCID: PMC10683238 DOI: 10.1186/s12889-023-17164-8] [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: 02/03/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Informal caregiving, a common form of social support, can be a chronic stressor with health consequences for caregivers. It is unclear how varying restrictions during the COVID-19 pandemic affected caregivers' physical and mental health. This study explores pre-post March 2020 differences in reported days of poor physical and mental health among informal caregivers. METHODS Data from the 2019/2020 Behavioral Risk Factor Surveillance System survey were used to match, via propensity scores, informal caregivers who provided care during COVID-19 restrictions to those who provided care before the pandemic. Negative binomial weighted regression models estimated incidence rate ratios (IRRs) and differences by demographics of reporting days of poor physical and mental health. A sensitivity analysis including multiple imputation was also performed. RESULTS The sample included 9,240 informal caregivers, of whom 861 provided care during the COVID-19 pandemic. The incidence rate for days of poor physical health was 26% lower (p = 0.001) for those who provided care during the COVID-19 pandemic, though the incidence rates for days of poor mental health were not statistically different between groups. Informal caregivers with low educational attainment experienced significantly higher IRRs for days of poor physical and mental health. Younger informal caregivers had a significantly lower IRR for days of poor physical health, but higher IRR for days of poor mental health. CONCLUSIONS This study contends that the physical and mental health burden associated with informal caregiving in a period of great uncertainty may be heightened among certain populations. Policymakers should consider expanding access to resources through institutional mechanisms for informal caregivers, who may be likely to incur a higher physical and mental health burden during public health emergencies, especially those identified as higher risk.
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Affiliation(s)
- Emery L Ngamasana
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA.
| | - Meagan Zarwell
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Laura H Gunn
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
- School of Data Science, University of North Carolina at Charlotte, Charlotte, NC, USA
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Brown J, Xia C, Tazelaar H, Crow J, Telionis A, Anson-Dwamena R, Landen M. COVID-19 Case, Death, and Vaccination Rate Disparities by Race and Ethnicity in Virginia. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01856-3. [PMID: 38012433 DOI: 10.1007/s40615-023-01856-3] [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: 08/03/2023] [Revised: 10/18/2023] [Accepted: 10/29/2023] [Indexed: 11/29/2023]
Abstract
This paper tracks trends in COVID-19 case, death, and vaccination rate disparities by race and ethnicity in Virginia during the COVID-19 pandemic. COVID-19 case, death, and vaccination rates were obtained from electronic state health department records from March 2020 to February 2022. Rate ratios were then utilized to quantify racial and ethnic disparities for several time periods during the pandemic. The Hispanic population had the highest COVID-19 case and age-adjusted death rates, and the lowest vaccination rates at the beginning of the pandemic in Virginia. These disparities resolved later in the pandemic. COVID-19 case and death rates among the Black population were also higher than those of the White population and these disparities remained throughout the pandemic. Racial and ethnic disparities changed over time in Virginia as vaccination coverage and public health policies evolved. Year 2 of the analysis saw lower case and death rates, and higher vaccination rates for non-White populations in Virginia. Public health strategies need to be addressed during the pandemic and developed before the next pandemic to ensure that large racial and ethnic disparities are not again present at the outset.
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Affiliation(s)
- Juwairiyah Brown
- Office of Health Equity, Virginia Department of Health, Richmond, VA, USA.
| | - Chenyang Xia
- Office of Health Equity, Virginia Department of Health, Richmond, VA, USA
| | - Helen Tazelaar
- Office of Information Management, Virginia Department of Health, Richmond, VA, USA
| | - Justin Crow
- Office of Emergency Preparedness, Virginia Department of Health, Richmond, VA, USA
| | - Alex Telionis
- Office of Emergency Preparedness, Virginia Department of Health, Richmond, VA, USA
| | | | - Michael Landen
- Office of Epidemiology, Virginia Department of Health, Richmond, VA, USA
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Abraham C, Garabedian LF, LeCates RF, Galbraith AA. Vaccine Mandates and Influenza Vaccination During the Pandemic. Pediatrics 2023; 152:e2023061545. [PMID: 37814817 PMCID: PMC10691407 DOI: 10.1542/peds.2023-061545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 10/11/2023] Open
Abstract
OBJECTIVES To determine whether a state influenza vaccine mandate and elevated community coronavirus disease 2019 (COVID-19) severity affected a child's probability of receiving an influenza vaccine during the 2020-2021 influenza season, given the child's previous vaccination history. METHODS Longitudinal cohort study using enrollment and claims data of 71 333 children aged 6 months to 18 years living in Massachusetts, New Hampshire, and Maine, from a regional insurer. Schoolchildren in Massachusetts were exposed to a new influenza vaccine mandate in the 2020-2021 season. Community COVID-19 severity was measured using county-level total cumulative confirmed case counts between March 2020 and August 2020 and linked by zip codes. The primary outcome of interest was a claim for any influenza vaccine in the 2020-2021 season. RESULTS Children living in a state with a vaccine mandate during the 2020-2021 influenza season had a higher predicted probability of receiving an influenza vaccine than those living in states without a mandate (47.7%, confidence interval 46.4%-49.0%, vs 21.2%, confidence interval 18.8%-23.6%, respectively, for previous nonvaccinators, and 78.2%, confidence interval 77.4%-79.0%, vs 58.2%, confidence interval 54.7%-61.7%, for previous vaccinators); the difference was 6.5 percentage points greater among previous nonvaccinators (confidence interval 1.3%-11.7%). Previously vaccinated children had a lower predicted probability of receiving an influenza vaccine if they lived in a county with the highest COVID-19 severity compared with a county with low COVID-19 severity (72.1%, confidence interval 70.5%-73.7%, vs 77.3%, confidence interval 74.7%-79.9%). CONCLUSIONS Strategies to improve uptake of influenza vaccination may have differential impact based on previous vaccination status and should account for community factors.
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Affiliation(s)
- Claire Abraham
- Division of General Pediatrics, Harvard Medical School, Boston, MA
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Laura F. Garabedian
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Robert F. LeCates
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Alison A. Galbraith
- Department of Pediatrics, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA
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Douglas MD, Li C, Josiah Willock R, Baltrus P, Caplan L, Immergluck L, McKinney T, Hopkins J, Mack D, Gaglioti AH. Population-Level Disparities in Exposure to COVID-19 Mitigation Policies, April 2020-April 2021. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:874-881. [PMID: 37498523 PMCID: PMC10549887 DOI: 10.1097/phh.0000000000001777] [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] [Indexed: 07/28/2023]
Abstract
CONTEXT Studies have found that COVID-19 stay-at-home orders (SHOs) and face mask policies (FMPs) were associated with reduced COVID-19 transmission and deaths. But it is unknown whether exposure to these policies varied by sociodemographic characteristics across the US population. OBJECTIVE The goal of this study was to quantify and characterize the sociodemographic characteristics and geographic distribution of populations exposed to evidence-based COVID-19 mitigation policies. DESIGN We obtained statewide SHOs and FMPs for all US counties from April 10, 2020, to April 10, 2021, calculated median policy lengths, and categorized counties into 4 groups based on length of policy exposure: low SHO-low FMP, high SHO-low FMP, low SHO-high FMP, and high SHO-high FMP. We described exposure groups by COVID-19 cumulative case/death and vaccination rates and county sociodemographic characteristics. SETTING In total, 3142 counties from all 50 states and Washington, District of Columbia, were included in the analysis. MAIN OUTCOME MEASURES County-level sociodemographic factors and county cumulative rates for COVID-19 cases, deaths, and vaccinations. RESULTS The largest percentage of the US population lived in counties with high exposure to SHOs and FMPs. However, populations living in high SHO-high FMP counties had the lowest percent non-Hispanic Black (NHB) and highest percent non-Hispanic White (NHW) populations. Populations living in high SHO-low FMP counties had the highest percent NHB and Hispanic populations and the lowest percent NHW population. CONCLUSION This study identified county-level racial, ethnic, and sociodemographic disparities in exposure to evidence-based statewide COVID-19 mitigation policies. POLICY IMPLICATIONS Exposure to evidence-based policies is an important consideration for studies evaluating the root causes of health inequities.
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Affiliation(s)
- Megan D. Douglas
- National Center for Primary Care (Drs Douglas, Baltrus, Mack, and Gaglioti and Mr Li), Department of Community Health and Preventive Medicine (Drs Douglas, Josiah Willock, Baltrus, Caplan, and Hopkins), Department of Microbiology, Biochemistry & Immunology (Dr Immergluck), Satcher Health Leadership Institute (Drs McKinney and Hopkins), and Department of Family Medicine (Dr Mack), Morehouse School of Medicine, Atlanta, Georgia; and Population Health Research Institute at MetroHealth and Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio (Dr Gaglioti)
| | - Chaohua Li
- National Center for Primary Care (Drs Douglas, Baltrus, Mack, and Gaglioti and Mr Li), Department of Community Health and Preventive Medicine (Drs Douglas, Josiah Willock, Baltrus, Caplan, and Hopkins), Department of Microbiology, Biochemistry & Immunology (Dr Immergluck), Satcher Health Leadership Institute (Drs McKinney and Hopkins), and Department of Family Medicine (Dr Mack), Morehouse School of Medicine, Atlanta, Georgia; and Population Health Research Institute at MetroHealth and Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio (Dr Gaglioti)
| | - Robina Josiah Willock
- National Center for Primary Care (Drs Douglas, Baltrus, Mack, and Gaglioti and Mr Li), Department of Community Health and Preventive Medicine (Drs Douglas, Josiah Willock, Baltrus, Caplan, and Hopkins), Department of Microbiology, Biochemistry & Immunology (Dr Immergluck), Satcher Health Leadership Institute (Drs McKinney and Hopkins), and Department of Family Medicine (Dr Mack), Morehouse School of Medicine, Atlanta, Georgia; and Population Health Research Institute at MetroHealth and Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio (Dr Gaglioti)
| | - Peter Baltrus
- National Center for Primary Care (Drs Douglas, Baltrus, Mack, and Gaglioti and Mr Li), Department of Community Health and Preventive Medicine (Drs Douglas, Josiah Willock, Baltrus, Caplan, and Hopkins), Department of Microbiology, Biochemistry & Immunology (Dr Immergluck), Satcher Health Leadership Institute (Drs McKinney and Hopkins), and Department of Family Medicine (Dr Mack), Morehouse School of Medicine, Atlanta, Georgia; and Population Health Research Institute at MetroHealth and Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio (Dr Gaglioti)
| | - Lee Caplan
- National Center for Primary Care (Drs Douglas, Baltrus, Mack, and Gaglioti and Mr Li), Department of Community Health and Preventive Medicine (Drs Douglas, Josiah Willock, Baltrus, Caplan, and Hopkins), Department of Microbiology, Biochemistry & Immunology (Dr Immergluck), Satcher Health Leadership Institute (Drs McKinney and Hopkins), and Department of Family Medicine (Dr Mack), Morehouse School of Medicine, Atlanta, Georgia; and Population Health Research Institute at MetroHealth and Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio (Dr Gaglioti)
| | - Lilly Immergluck
- National Center for Primary Care (Drs Douglas, Baltrus, Mack, and Gaglioti and Mr Li), Department of Community Health and Preventive Medicine (Drs Douglas, Josiah Willock, Baltrus, Caplan, and Hopkins), Department of Microbiology, Biochemistry & Immunology (Dr Immergluck), Satcher Health Leadership Institute (Drs McKinney and Hopkins), and Department of Family Medicine (Dr Mack), Morehouse School of Medicine, Atlanta, Georgia; and Population Health Research Institute at MetroHealth and Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio (Dr Gaglioti)
| | - Tonyka McKinney
- National Center for Primary Care (Drs Douglas, Baltrus, Mack, and Gaglioti and Mr Li), Department of Community Health and Preventive Medicine (Drs Douglas, Josiah Willock, Baltrus, Caplan, and Hopkins), Department of Microbiology, Biochemistry & Immunology (Dr Immergluck), Satcher Health Leadership Institute (Drs McKinney and Hopkins), and Department of Family Medicine (Dr Mack), Morehouse School of Medicine, Atlanta, Georgia; and Population Health Research Institute at MetroHealth and Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio (Dr Gaglioti)
| | - Jammie Hopkins
- National Center for Primary Care (Drs Douglas, Baltrus, Mack, and Gaglioti and Mr Li), Department of Community Health and Preventive Medicine (Drs Douglas, Josiah Willock, Baltrus, Caplan, and Hopkins), Department of Microbiology, Biochemistry & Immunology (Dr Immergluck), Satcher Health Leadership Institute (Drs McKinney and Hopkins), and Department of Family Medicine (Dr Mack), Morehouse School of Medicine, Atlanta, Georgia; and Population Health Research Institute at MetroHealth and Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio (Dr Gaglioti)
| | - Dominic Mack
- National Center for Primary Care (Drs Douglas, Baltrus, Mack, and Gaglioti and Mr Li), Department of Community Health and Preventive Medicine (Drs Douglas, Josiah Willock, Baltrus, Caplan, and Hopkins), Department of Microbiology, Biochemistry & Immunology (Dr Immergluck), Satcher Health Leadership Institute (Drs McKinney and Hopkins), and Department of Family Medicine (Dr Mack), Morehouse School of Medicine, Atlanta, Georgia; and Population Health Research Institute at MetroHealth and Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio (Dr Gaglioti)
| | - Anne H. Gaglioti
- National Center for Primary Care (Drs Douglas, Baltrus, Mack, and Gaglioti and Mr Li), Department of Community Health and Preventive Medicine (Drs Douglas, Josiah Willock, Baltrus, Caplan, and Hopkins), Department of Microbiology, Biochemistry & Immunology (Dr Immergluck), Satcher Health Leadership Institute (Drs McKinney and Hopkins), and Department of Family Medicine (Dr Mack), Morehouse School of Medicine, Atlanta, Georgia; and Population Health Research Institute at MetroHealth and Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio (Dr Gaglioti)
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Oyeyemi DM, Lin IF, Wang H, Gan D, Brown MJ, Freedman VA, Manning M. Changes in late-life assistance networks for Black and White older adults during the COVID-19 pandemic. J Am Geriatr Soc 2023; 71:3574-3583. [PMID: 37587898 DOI: 10.1111/jgs.18547] [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: 03/07/2023] [Revised: 07/02/2023] [Accepted: 07/19/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND The COVID-19 pandemic has disproportionately impacted older Black Americans. Given that assistance networks play a crucial role in older adults' ability to respond to challenges, we sought to investigate whether older adults' assistance network size changed during the COVID-19 pandemic and differed by race. METHODS We analyzed data from the 2018-2020 rounds of the U.S. National Health and Aging Trends Study for Black and White adults aged 70 and older receiving help in the community or residential care settings. We used ordinary least squares regression to compare changes in assistance network size in the 2 years pre-COVID-19 (2018-2019, N = 3438) to changes in size at the onset of COVID-19 (2019-2020, N = 3185). RESULTS Black older adults had larger assistance networks with a greater number of family helpers before and during the pandemic compared to their White counterparts. Assistance network size for older adults increased before but not during the pandemic mostly due to declines in unpaid nonrelative helpers and lack of increase in paid helpers. These effects did not differ by race. CONCLUSIONS Black and White older adults experienced similarly sized reductions in their assistance networks as a consequence of the COVID-19 pandemic. Future research should investigate the relationship between these network changes and the unmet needs of older adults.
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Affiliation(s)
- Deborah M Oyeyemi
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- National Clinician Scholars Program, University of California, Los Angeles, California, USA
| | - I-Fen Lin
- Department of Sociology, Bowling Green State University, Bowling Green, Ohio, USA
| | - Haowei Wang
- Department of Sociology, Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, New York, USA
| | - Daniel Gan
- Department of Psychology, Trinity Western University, Langley, British Columbia, Canada
| | - Monique J Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Vicki A Freedman
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark Manning
- Department of Psychology, Oakland University, Rochester, Michigan, USA
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Quinn KG, Hunt B, Jacobs J, Valencia J, Hirschtick J, Walsh JL. Community Cohesion, Social Support, and Mental Health among Black Individuals in Chicago: A Cross-Sectional Examination of the Effects on COVID-19 Vaccination. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01837-6. [PMID: 37872464 DOI: 10.1007/s40615-023-01837-6] [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: 08/04/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023]
Abstract
The COVID-19 pandemic put a significant strain on communities, social resources, and personal relationships, disproportionately impacting Black and low-income communities in the United States. Community cohesion and social support are positively associated with numerous health outcomes and preventive health measures, yet were strained during the pandemic due to COVID mitigation measures. This study examined the relationships between social cohesion, social support, mental health, and COVID-19 vaccination to understand whether community cohesion and social support were associated with increased likelihood of receiving a COVID-19 vaccination. Data are from a cross-sectional survey of 537 Black Chicagoans that was disseminated between September 2021 and March 2022. Structural equation modeling was used to test associations between community cohesion, social support, loneliness, anxiety, stress, and having received a COVID-19 vaccination. Results demonstrated that social support mediated associations between community cohesion and loneliness, anxiety, and stress, but was not associated with COVID-19 vaccination. These results demonstrate the importance of community cohesion and social support on mental health and suggest there are other potential pathways that may link community cohesion and vaccination.
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Affiliation(s)
- Katherine G Quinn
- Medical College of Wisconsin, Center for AIDS Intervention Research, Milwaukee, WI, 53202, USA.
| | - Bijou Hunt
- Sinai Health System, Sinai Urban Health Institute, Chicago, IL, USA
| | - Jacquelyn Jacobs
- Sinai Health System, Sinai Urban Health Institute, Chicago, IL, USA
| | - Jesus Valencia
- Sinai Health System, Sinai Urban Health Institute, Chicago, IL, USA
| | | | - Jennifer L Walsh
- Medical College of Wisconsin, Center for AIDS Intervention Research, Milwaukee, WI, 53202, USA
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Gunness H, Jacob E, Bhuiyan J, Hilas O. Pandemic Readiness: Disparities Among New York City Residents Living in the Epicenter of the COVID-19 Outbreak. Disaster Med Public Health Prep 2023; 17:e513. [PMID: 37859421 DOI: 10.1017/dmp.2023.175] [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] [Indexed: 10/21/2023]
Abstract
BACKGROUND Queens County was identified as the epicenter of the coronavirus disease 2019 (COVID-19) outbreak in United States, representing a significant proportion of racial and ethnic minorities. As the pandemic surged and new variants emerged, one factor that has not been explored is the level of pandemic readiness (preparedness) in urban communities. METHODS This was a cross-sectional study using a survey to assess pandemic readiness among residents in Queens County, New York, which was disseminated online by means of elected officials. The survey included basic demographics, health status, essential supplies (such as food, water, and prescription medication), social support, spatial capacity, and access to COVID-19 health information. RESULTS A total of 306 participants completed the survey (59% response rate). Eighty-two percent of participants were not pandemic ready with only 11.4% at beginner-level and 7% advanced-level readiness. Beginner- and advanced-level readiness was more common among participants with college experience. Regarding employment, 85% of participants who were employed were not ready for the pandemic, compared with 68% of those who were not employed. More strikingly, over 60% of participants learned something new by completing the survey. CONCLUSIONS This study adds to the existing literature on pandemic preparedness and highlights the need for greater outreach and education among racial and ethnic minorities.
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Affiliation(s)
- Harlem Gunness
- Department of Pharmacy Administration and Public Health, St. John's College of Pharmacy & Health Sciences, Queens, NY, USA
| | - Elsen Jacob
- Department of Clinical Health Professions, St. John's College of Pharmacy & Health Sciences, Queens, NY, USA
| | - Jennifer Bhuiyan
- Department of Clinical Health Professions, St. John's College of Pharmacy & Health Sciences, Queens, NY, USA
| | - Olga Hilas
- Department of Clinical Health Professions, St. John's College of Pharmacy & Health Sciences, Queens, NY, USA
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Nagaraj G, Vinayak S, Khaki AR, Sun T, Kuderer NM, Aboulafia DM, Acoba JD, Awosika J, Bakouny Z, Balmaceda NB, Bao T, Bashir B, Berg S, Bilen MA, Bindal P, Blau S, Bodin BE, Borno HT, Castellano C, Choi H, Deeken J, Desai A, Edwin N, Feldman LE, Flora DB, Friese CR, Galsky MD, Gonzalez CJ, Grivas P, Gupta S, Haynam M, Heilman H, Hershman DL, Hwang C, Jani C, Jhawar SR, Joshi M, Kaklamani V, Klein EJ, Knox N, Koshkin VS, Kulkarni AA, Kwon DH, Labaki C, Lammers PE, Lathrop KI, Lewis MA, Li X, Lopes GDL, Lyman GH, Makower DF, Mansoor AH, Markham MJ, Mashru SH, McKay RR, Messing I, Mico V, Nadkarni R, Namburi S, Nguyen RH, Nonato TK, O'Connor TL, Panagiotou OA, Park K, Patel JM, Patel KG, Peppercorn J, Polimera H, Puc M, Rao YJ, Razavi P, Reid SA, Riess JW, Rivera DR, Robson M, Rose SJ, Russ AD, Schapira L, Shah PK, Shanahan MK, Shapiro LC, Smits M, Stover DG, Streckfuss M, Tachiki L, Thompson MA, Tolaney SM, Weissmann LB, Wilson G, Wotman MT, Wulff-Burchfield EM, Mishra S, French B, Warner JL, Lustberg MB, Accordino MK, Shah DP. Clinical characteristics, racial inequities, and outcomes in patients with breast cancer and COVID-19: A COVID-19 and cancer consortium (CCC19) cohort study. eLife 2023; 12:e82618. [PMID: 37846664 PMCID: PMC10637772 DOI: 10.7554/elife.82618] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/18/2023] [Indexed: 10/18/2023] Open
Abstract
Background Limited information is available for patients with breast cancer (BC) and coronavirus disease 2019 (COVID-19), especially among underrepresented racial/ethnic populations. Methods This is a COVID-19 and Cancer Consortium (CCC19) registry-based retrospective cohort study of females with active or history of BC and laboratory-confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection diagnosed between March 2020 and June 2021 in the US. Primary outcome was COVID-19 severity measured on a five-level ordinal scale, including none of the following complications, hospitalization, intensive care unit admission, mechanical ventilation, and all-cause mortality. Multivariable ordinal logistic regression model identified characteristics associated with COVID-19 severity. Results 1383 female patient records with BC and COVID-19 were included in the analysis, the median age was 61 years, and median follow-up was 90 days. Multivariable analysis revealed higher odds of COVID-19 severity for older age (aOR per decade, 1.48 [95% CI, 1.32-1.67]); Black patients (aOR 1.74; 95 CI 1.24-2.45), Asian Americans and Pacific Islander patients (aOR 3.40; 95 CI 1.70-6.79) and Other (aOR 2.97; 95 CI 1.71-5.17) racial/ethnic groups; worse ECOG performance status (ECOG PS ≥2: aOR, 7.78 [95% CI, 4.83-12.5]); pre-existing cardiovascular (aOR, 2.26 [95% CI, 1.63-3.15])/pulmonary comorbidities (aOR, 1.65 [95% CI, 1.20-2.29]); diabetes mellitus (aOR, 2.25 [95% CI, 1.66-3.04]); and active and progressing cancer (aOR, 12.5 [95% CI, 6.89-22.6]). Hispanic ethnicity, timing, and type of anti-cancer therapy modalities were not significantly associated with worse COVID-19 outcomes. The total all-cause mortality and hospitalization rate for the entire cohort was 9% and 37%, respectively however, it varied according to the BC disease status. Conclusions Using one of the largest registries on cancer and COVID-19, we identified patient and BC-related factors associated with worse COVID-19 outcomes. After adjusting for baseline characteristics, underrepresented racial/ethnic patients experienced worse outcomes compared to non-Hispanic White patients. Funding This study was partly supported by National Cancer Institute grant number P30 CA068485 to Tianyi Sun, Sanjay Mishra, Benjamin French, Jeremy L Warner; P30-CA046592 to Christopher R Friese; P30 CA023100 for Rana R McKay; P30-CA054174 for Pankil K Shah and Dimpy P Shah; KL2 TR002646 for Pankil Shah and the American Cancer Society and Hope Foundation for Cancer Research (MRSG-16-152-01-CCE) and P30-CA054174 for Dimpy P Shah. REDCap is developed and supported by Vanderbilt Institute for Clinical and Translational Research grant support (UL1 TR000445 from NCATS/NIH). The funding sources had no role in the writing of the manuscript or the decision to submit it for publication. Clinical trial number CCC19 registry is registered on ClinicalTrials.gov, NCT04354701.
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Affiliation(s)
| | - Shaveta Vinayak
- Fred Hutchinson Cancer Research CenterSeattleUnited States
- University of WashingtonSeattleUnited States
- Seattle Cancer Care AllianceSeattleUnited States
| | | | - Tianyi Sun
- Vanderbilt University Medical CenterNashvilleUnited States
| | - Nicole M Kuderer
- University of WashingtonSeattleUnited States
- Advanced Cancer Research GroupKirklandUnited States
| | | | - Jared D Acoba
- University of Hawaii Cancer CenterHonoluluUnited States
| | - Joy Awosika
- University of Cincinnati Cancer CenterCincinnatiUnited States
| | | | | | - Ting Bao
- Memorial Sloan Kettering Cancer CenterNew YorkUnited States
| | - Babar Bashir
- Sidney Kimmel Comprehensive Cancer Center, Thomas Jefferson UniversityPhiladelphiaUnited States
| | | | - Mehmet A Bilen
- Winship Cancer Institute, Emory UniversityAtlantaUnited States
| | - Poorva Bindal
- Beth Israel Deaconess Medical CenterBostonUnited States
| | - Sibel Blau
- Northwest Medical SpecialtiesTacomaUnited States
| | - Brianne E Bodin
- Herbert Irving Comprehensive Cancer Center, Columbia UniversityNew YorkUnited States
| | - Hala T Borno
- Helen Diller Family Comprehensive Cancer Center, University of California, San FranciscoSan FranciscoUnited States
| | | | - Horyun Choi
- University of Hawaii Cancer CenterHonoluluUnited States
| | - John Deeken
- Inova Schar Cancer InstituteFairfaxUnited States
| | | | | | - Lawrence E Feldman
- University of Illinois Hospital & Health Sciences SystemChicagoUnited States
| | | | | | - Matthew D Galsky
- Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkUnited States
| | - Cyndi J Gonzalez
- Rogel Cancer Center, University of Michigan-Ann ArborAnn ArborUnited States
| | - Petros Grivas
- Fred Hutchinson Cancer Research CenterSeattleUnited States
- University of WashingtonSeattleUnited States
- Seattle Cancer Care AllianceSeattleUnited States
| | | | - Marcy Haynam
- The Ohio State University Comprehensive Cancer CenterColumbusUnited States
| | - Hannah Heilman
- University of Cincinnati Cancer CenterCincinnatiUnited States
| | - Dawn L Hershman
- Herbert Irving Comprehensive Cancer Center, Columbia UniversityNew YorkUnited States
| | - Clara Hwang
- Henry Ford Cancer Institute, Henry Ford HospitalDetroitUnited States
| | | | - Sachin R Jhawar
- The Ohio State University Comprehensive Cancer CenterColumbusUnited States
| | - Monika Joshi
- Penn State Health St Joseph Cancer CenterReadingUnited States
| | - Virginia Kaklamani
- Mays Cancer Center, The University of Texas Health San Antonio MD Anderson Cancer CenterSan AntonioUnited States
| | | | - Natalie Knox
- Stritch School of Medicine, Loyola UniversityMaywoodUnited States
| | - Vadim S Koshkin
- Helen Diller Family Comprehensive Cancer Center, University of California, San FranciscoSan FranciscoUnited States
| | - Amit A Kulkarni
- Masonic Cancer Center, University of MinnesotaMinneapolisUnited States
| | - Daniel H Kwon
- Helen Diller Family Comprehensive Cancer Center, University of California, San FranciscoSan FranciscoUnited States
| | | | | | - Kate I Lathrop
- Mays Cancer Center, The University of Texas Health San Antonio MD Anderson Cancer CenterSan AntonioUnited States
| | - Mark A Lewis
- Intermountain HealthcareSalt Lake CityUnited States
| | - Xuanyi Li
- Vanderbilt University Medical CenterNashvilleUnited States
| | - Gilbert de Lima Lopes
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of MedicineMiamiUnited States
| | - Gary H Lyman
- Fred Hutchinson Cancer Research CenterSeattleUnited States
- University of WashingtonSeattleUnited States
- Seattle Cancer Care AllianceSeattleUnited States
| | - Della F Makower
- Montefiore Medical Center, Albert Einstein College of MedicineBronxUnited States
| | | | - Merry-Jennifer Markham
- Division of Hematology and Oncology, University of Florida Health Cancer CenterGainesvilleUnited States
| | | | - Rana R McKay
- Moores Cancer Center, University of California, San DiegoSan DiegoUnited States
| | - Ian Messing
- Division of Radiation Oncology, George Washington UniversityWashingtonUnited States
| | - Vasil Mico
- Sidney Kimmel Comprehensive Cancer Center, Thomas Jefferson UniversityPhiladelphiaUnited States
| | | | | | - Ryan H Nguyen
- University of Illinois Hospital & Health Sciences SystemChicagoUnited States
| | | | | | | | - Kyu Park
- Loma Linda University Cancer CenterLoma LindaUnited States
| | | | | | | | - Hyma Polimera
- Penn State Health St Joseph Cancer CenterReadingUnited States
| | | | - Yuan James Rao
- Division of Radiation Oncology, George Washington UniversityWashingtonUnited States
| | - Pedram Razavi
- Moores Cancer Center, University of California, San DiegoSan DiegoUnited States
| | - Sonya A Reid
- Vanderbilt University Medical CenterNashvilleUnited States
| | - Jonathan W Riess
- UC Davis Comprehensive Cancer Center, University of California, DavisDavisUnited States
| | - Donna R Rivera
- Division of Cancer Control and Population Sciences, National Cancer InstituteRockvilleUnited States
| | - Mark Robson
- Memorial Sloan Kettering Cancer CenterNew YorkUnited States
| | - Suzanne J Rose
- Carl & Dorothy Bennett Cancer Center, Stamford HospitalStamfordUnited States
| | - Atlantis D Russ
- Division of Hematology and Oncology, University of Florida Health Cancer CenterGainesvilleUnited States
| | | | - Pankil K Shah
- Mays Cancer Center, The University of Texas Health San Antonio MD Anderson Cancer CenterSan AntonioUnited States
| | | | - Lauren C Shapiro
- Montefiore Medical Center, Albert Einstein College of MedicineBronxUnited States
| | | | - Daniel G Stover
- The Ohio State University Comprehensive Cancer CenterColumbusUnited States
| | | | - Lisa Tachiki
- Fred Hutchinson Cancer Research CenterSeattleUnited States
- University of WashingtonSeattleUnited States
- Seattle Cancer Care AllianceSeattleUnited States
| | | | | | | | - Grace Wilson
- Masonic Cancer Center, University of MinnesotaMinneapolisUnited States
| | - Michael T Wotman
- Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkUnited States
| | | | - Sanjay Mishra
- Vanderbilt University Medical CenterNashvilleUnited States
| | | | | | - Maryam B Lustberg
- Yale Cancer Center, Yale University School of MedicineNew HavenUnited States
| | - Melissa K Accordino
- Herbert Irving Comprehensive Cancer Center, Columbia UniversityNew YorkUnited States
| | - Dimpy P Shah
- Mays Cancer Center, The University of Texas Health San Antonio MD Anderson Cancer CenterSan AntonioUnited States
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Lang S, Silveira L, Smith C, Abuogi L, DeCamp LR. Variation over Time in Child and Neighborhood Characteristics Associated with COVID-19. Health Equity 2023; 7:676-684. [PMID: 37908402 PMCID: PMC10615088 DOI: 10.1089/heq.2022.0213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 11/02/2023] Open
Abstract
Introduction To examine the associations between child and neighborhood characteristics and incidence of COVID-19 infection during the first 19 months of the pandemic. Study Design We utilized individual electronic health record data and corresponding census tract characteristics for pediatric SARS-CoV-2 cases (age <18 years) from March 23, 2020 to September 30, 2021 with molecular tests resulted at a children's health system in Colorado. We compared associations between individual SARS-CoV-2 cases and census tract SARS-CoV-2 positivity rates over three time periods (TP1: March-September 2020; TP2: October 2020-March 2021; TP3: April-September 2021) using multinomial logistic regression for individual associations and negative binomial regression for census tract associations. Results We included 7498 pediatric SARS-CoV-2 cases and data from 711 corresponding census tracts. Spanish preferred health care language was associated with SARS-CoV-2 positivity for TP1 (odds ratio [OR] 4.9, 95% confidence interval [CI] 3.7-6.5) and TP2 (OR 2.01, 95% CI 1.6-2.6) compared with TP3. Other non-English preferred health care language was associated with SARS-CoV-2 positivity in TP1 (OR 2.4, 95% CI 1.4-4.2). Increasing percentage internationally born in a census tract was associated with SARS-CoV-2 positivity for TP1 (multivariable incident rate ratio [IRR]=1.040, p<0.0001), TP2 (multivariable IRR=1.028, p<0.0001), and in all TP combined (multivariable IRR=1.024, p<0.0001). Discussion Our study is notable for the identification of COVID-19 disparities among children in immigrant families and communities, particularly early in the pandemic. Addressing disparities for immigrant communities requires targeted investments in public health infrastructure.
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Affiliation(s)
- Sean Lang
- Department of Pediatrics, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
- Children's Hospital Immunodeficiency Program (CHiP), Children's Hospital Colorado, Aurora, Colorado, USA
| | - Lori Silveira
- Department of Pediatrics, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Christiana Smith
- Department of Pediatrics, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
- Children's Hospital Immunodeficiency Program (CHiP), Children's Hospital Colorado, Aurora, Colorado, USA
| | - Lisa Abuogi
- Department of Pediatrics, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
- Children's Hospital Immunodeficiency Program (CHiP), Children's Hospital Colorado, Aurora, Colorado, USA
| | - Lisa Ross DeCamp
- Department of Pediatrics, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), Aurora, Colorado, USA
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Bagasra A, Allen CT, Doan S. Perceived Effectiveness of COVID-19 Preventive Practices and Behavioral Intention: Survey of a Representative Adult Sample in the United States. JMIR Hum Factors 2023; 10:e39919. [PMID: 37815862 PMCID: PMC10566581 DOI: 10.2196/39919] [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: 06/02/2022] [Revised: 03/03/2023] [Accepted: 07/22/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Using existing models of behavioral health promotion, specifically the Extended Parallel Process Model, previous research has identified factors that may impact engagement in preventive health behaviors during the COVID-19 pandemic such as perceived threat, perceived susceptibility to the threat, perceived severity, and perceived efficacy. OBJECTIVE This study aims to examine the role of perceived effectiveness of COVID-19 preventive behaviors, perceived susceptibility, perceived threat, and perceived severity of COVID-19 in participants' intentions to engage in Centers for Disease Control (CDC)-recommended individual health behaviors in the first year of the pandemic. METHODS In October 2020, a representative sample of 506 US adults completed a web-based survey through the RAND American Life Panel. RESULTS The study primarily found that participants who perceived that CDC-recommended health practices were effective had stronger intentions to engage in those practices. The second strongest correlate was participants' perceived severity of COVID-19 across the United States. Perceived effectiveness of recommended practices accounted for the largest variance in behavioral intention. However, analysis of individual behaviors indicated a mismatch in the behaviors perceived to be the most effective (avoiding sick people and mask-wearing) and those participants indicated intention to engage in (throwing away used tissues, avoiding sick people, and coughing into their elbows) in the next 30 days. CONCLUSIONS The authors recommend tailoring public health messaging to address the perceived threat of COVID-19 and self-efficacy. Thus, health promotion efforts should emphasize the effectiveness of CDC-recommended practices while highlighting the pandemic's severity. Additionally, rebuilding trust in public health messaging and messengers is necessary to increase perceived self-efficacy. As the COVID-19 pandemic continues, health messaging must continue to promote and build trust in CDC-recommended health practices and educate regarding the efficacy of vaccination and other preventive behaviors.
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Affiliation(s)
- Anisah Bagasra
- Department of Psychological Science, Kennesaw State University, Kennesaw, GA, United States
| | | | - Sara Doan
- Department of Writing, Rhetoric and Cultures, Michigan State University, East Lansing, MI, United States
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Klopack ET. Chronic Stress and Latent Virus Reactivation: Effects on Immune Aging, Chronic Disease Morbidity, and Mortality. J Gerontol B Psychol Sci Soc Sci 2023; 78:1707-1716. [PMID: 37294880 PMCID: PMC10561893 DOI: 10.1093/geronb/gbad087] [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: 11/07/2022] [Indexed: 06/11/2023] Open
Abstract
OBJECTIVES Social stress has been shown to affect immune functioning. Past research has found that chronic social stress and latent viral infections accelerate immune aging, leading to chronic disease morbidity and mortality. Chronic stress may also reactivate latent viral infections, like cytomegalovirus (CMV), accelerating the aging of the immune system. METHOD Utilizing panel survey data from 8,995 U.S. adults aged 56 or older from the Health and Retirement Study, this study investigates whether chronic stress interacts with CMV positivity to drive aging of the immune system, multimorbidity, and mortality. RESULTS Results of moderated mediation analysis indicate that the effect of CMV positivity on morbidity and mortality as mediated by immune aging indicators is amplified by chronic stress. DISCUSSION These findings suggest that immune aging is a biological pathway underlying the stress process and help explain past findings in the literature on stress and health.
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Affiliation(s)
- Eric T Klopack
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
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49
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Purvis SJ, Soltoff A, Isaacson MJ, Duran T, Johnson G, LaPlante JR, Tobey M, Armstrong K. COVID-19 Testing Factors Among Great Plains American Indians. J Racial Ethn Health Disparities 2023; 10:2528-2539. [PMID: 36271192 PMCID: PMC9589717 DOI: 10.1007/s40615-022-01433-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/07/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND COVID-19 created unparalleled challenges for vulnerable communities, especially among American Indians and Alaska Natives. An effective COVID-19 response requires a tribally driven effort to understand the perspectives of Tribal members on testing and to ensure that delivery strategies are grounded in the cultural values, traditions, and experiences of the Tribes. METHODS We conducted a cross-sectional, anonymous survey in October 2021 using established methods to reach Tribal members residing in three Reservations in the Great Plains (N = 679). Multivariate analyses were conducted using logistic regression to assess the association between independent variables and COVID-19 testing uptake after adjusting for confounding. RESULTS After multivariate adjustment, a respondent's employment status, ability to isolate if diagnosed with COVID-19, and endorsing that COVID-19 testing is only needed if one has symptoms were significantly correlated with having been previously tested for COVID-19. Participants without a full-time job were about half as likely to have been tested for COVID-19 compared to those with full-time jobs. Participants who reported not being able to isolate if they tested positive for COVID-19 and participants who did not think testing was needed if asymptomatic were also half as likely to be tested. CONCLUSIONS Ensuring that everyone has the ability to isolate, that people who are not working have easy access to testing, and that everyone understands the value of testing after exposure are key steps to maximizing testing uptake. Efforts will only be successful if there is continued investment in programs that provide free testing access for everyone on Reservations.
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Affiliation(s)
- Sara J Purvis
- Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA, 02114, USA.
| | - Alexander Soltoff
- Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA, 02114, USA
| | - Mary J Isaacson
- College of Nursing South, Dakota State University, Rapid City, SD, USA
| | - Tinka Duran
- Great Plains Tribal Epidemiology Center, Great Plains Trifbal Leaders' Health Board, Rapid City, SD, USA
| | - Gina Johnson
- Community Health Prevention Programs, Great Plains Tribal Leaders' Health Board, Rapid City, SD, USA
| | - J R LaPlante
- American Indian Health Initiative, Avera Health, Sioux Falls, SD, USA
| | - Matthew Tobey
- Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA, 02114, USA
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Chavanne D, Ahluwalia JS, Goodyear K. The effects of race and class on community-level stigmatization of opioid use and policy preferences. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 120:104147. [PMID: 37639913 DOI: 10.1016/j.drugpo.2023.104147] [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: 03/14/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND With opioid use and overdose rates continuing to plague minority communities in the U.S., we explored whether a geographic community's racial composition and social class affect how opioid use in the community is stigmatized and what policy preferences arise in response. METHODS We use case vignettes in a randomized, between-subjects study (N = 1478) with a nation-wide survey. The vignettes describe a community where opioids are harmfully used, varying whether the community was (1) wealthy or poor, (2) predominantly Black or White and (3) facing prevalent use of painkillers or heroin. We tested how these variables affect public stigmatization of opioid use (measured with ratings of responsibility, dangerousness, sympathy, concern, anger, and disappointment) preferred levels of social distance from communities with opioid use (measured with responses to questions about living, working, and interacting in the community), and policy preferences for responding to opioid use (measured with levels of support for providing a safe-consumption site in the community, treating drug use in the community punitively, treating drug use in the community as an illness, and funding drug treatment in the community through income redistribution). RESULTS Compared to wealthy communities with opioid use, poor communities with opioid use were less stigmatized in terms of responsibility, sympathy, concern, anger, and disappointment; they were also met with less support for punitiveness, more support for treating drug use as an illness, and preferences for greater social distance. Compared to White communities with opioid use, Black communities with opioid use were less stigmatized in terms of responsibility, and they were met with stronger preferences to not live and work there and with reduced support for using income redistribution to provide drug treatment for people in the community. Poor-Black communities with opioid use were also perceived to be more dangerous than both poor-White and wealthy-Black communities with opioid use. CONCLUSION These results point to class- and race-based territorial stigma affecting how communities with opioid use are judged and whether policies for providing communities with treatment are supported.
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Affiliation(s)
- David Chavanne
- Department of Economics, Connecticut College, New London, CT, USA.
| | - Jasjit S Ahluwalia
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | - Kimberly Goodyear
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA; Center for Alcohol and Addiction Studies, Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
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