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Boakye PN, Prendergast N, Bailey A. Challenging anti-racism in nursing education: A moral and professional call to action. NURSE EDUCATION TODAY 2024; 141:106305. [PMID: 39002415 DOI: 10.1016/j.nedt.2024.106305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 05/28/2024] [Accepted: 07/09/2024] [Indexed: 07/15/2024]
Abstract
The call to implement anti-racism pedagogy in nursing education and practice is reverberating globally. Racist ideologies are foundational to systems of health inequity. An antiracist approach is critical to dismantling systemic racism and promoting optimal health outcomes in the quest for health equity. Therefore, employing an anti-racist pedagogy within nursing education that allows students and teachers to reflect on their roles in dismantling racist structures and transforming equity outcomes in practice and society, is a moral undertaking. However, for nursing education to make significant inroads in health equity, it cannot be guided by the same Eurocentric motives and value systems that continue to shape health inequities. We must transcend the boundaries of Eurocentric knowledge construction to intentionally shift how nurses think and practice within systems of inequities. Alongside the pressing and growing call for radical transformation of students and teachers through anti-racist pedagogy, we also provide directions to teaching strategies that support the uptake of anti-racism in nursing curricula and classroom engagement.
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Affiliation(s)
- Priscilla N Boakye
- Toronto Metropolitan University, 288 Church St, Toronto, ON M5B 1Z5, Canada.
| | - Nadia Prendergast
- Toronto Metropolitan University, 288 Church St, Toronto, ON M5B 1Z5, Canada
| | - Annette Bailey
- Toronto Metropolitan University, 288 Church St, Toronto, ON M5B 1Z5, Canada
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O'Connor Á, Resendiz E, Nason L, Eyler AA, Brownson RC, Reis RS, Banchoff A, King AC, Salvo D. Who Benefits? A Mixed Methods Study Assessing Community Use of a Major Metropolitan Park During the COVID-19 Pandemic. J Urban Health 2024; 101:827-844. [PMID: 39023683 PMCID: PMC11329476 DOI: 10.1007/s11524-024-00886-4] [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] [Accepted: 05/14/2024] [Indexed: 07/20/2024]
Abstract
By providing spaces for recreation, physical activity, social gatherings, and time in nature, urban parks offer physical, mental, and social benefits to users. However, many urban residents face barriers to park use. The COVID-19 pandemic introduced new potential barriers to urban park access and use, including changes to daily life and employment, closure of park amenities and restrictions to public movement, and risk from the coronavirus itself. The mixed-methods PARCS study measured use and perceptions of a large urban park in St. Louis, Missouri before, during, and after local COVID-19 contingency measures and restrictions. We examine data from 1,157 direct observation assessments of park usership, an online survey of park users (n=561), interviews with key stakeholders (n=27), four focus groups (n=30), and a community-based participatory research sub-study (n=66) to comprehensively characterize the effects of the COVID-19 pandemic on park use. Park users who felt unsafe from the coronavirus experienced 2.65 higher odds of reducing park use. However, estimated park visits during COVID-19 contingency measures (n=5,023,759) were twice as high as post-contingency (n=2,277,496). Participants reported using the park for physical activity, recreation, time in nature, and socializing during the contingency period. Black, Hispanic/Latino, and young people were less likely to visit the park than others, suggesting an additional, disproportionate impact of the pandemic on minoritized and socioeconomically disadvantaged communities. This study highlights the role of public spaces like parks as resources for health and sites where urban health inequities can be alleviated in times of public crisis.
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Affiliation(s)
- Áine O'Connor
- People, Health, and Place Unit, Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, Austin, TX, USA
| | - Eugen Resendiz
- People, Health, and Place Lab, Department of Kinesiology and Health Education, The University of Texas in Austin, Austin, TX, USA
| | - Leah Nason
- People, Health, and Place Unit, Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, Austin, TX, USA
| | - Amy A Eyler
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
- Center for Diabetes Translation Research (WU-CDTR), Washington University in St. Louis, St. Louis, MO, USA
| | - Rodrigo S Reis
- People, Health, and Place Unit, Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, Austin, TX, USA
| | - Ann Banchoff
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Abby C King
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Deborah Salvo
- People, Health, and Place Lab, Department of Kinesiology and Health Education, The University of Texas in Austin, Austin, TX, USA.
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA.
- Center for Diabetes Translation Research (WU-CDTR), Washington University in St. Louis, St. Louis, MO, USA.
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Spence EH, Niles MT, Bertmann F, Mares T, Belarmino EH. Higher rates of food insecurity and stress experienced by food systems workers during the first year of the COVID-19 pandemic. Front Nutr 2024; 11:1274656. [PMID: 38774263 PMCID: PMC11106489 DOI: 10.3389/fnut.2024.1274656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 04/09/2024] [Indexed: 05/24/2024] Open
Abstract
Introduction The present study examined the prevalence of food insecurity and perceived stress among food system workers relative to other members of the population during the first year of the COVID-19 pandemic. It also explored perspectives on the role of food system workers during the pandemic and their experiences working during this time. Methods Data were collected via an online survey in spring 2021. The sample was comprised of 441 residents of Vermont, United States, including 41 food system workers. Results Regression models identified higher rates of food insecurity and perceived stress among food system workers during the first year of the pandemic. However, these relationships were not maintained when the models were adjusted for income and job disruption, suggesting that the associations were primarily due to the economic vulnerability of food system workers. Most respondents indicated concern for the health and well-being of food system workers, felt that food system workers were undervalued, and agreed that the well-being of food system workers should be prioritized. However, opinions were split regarding whether it was worth the health risk to require farms and food processing plants to stay open to maintain the food supply. Half of food system workers believed that their work had compromised their well-being during the pandemic, although several also identified their jobs as pathways for accessing food. Discussion The findings provide valuable information for decision-makers seeking to increase the resilience of the food supply and the food system workforce.
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Affiliation(s)
- Emma H. Spence
- Food Systems Program, University of Vermont, Burlington, VT, United States
| | - Meredith T. Niles
- Food Systems Program, University of Vermont, Burlington, VT, United States
- Department of Nutrition and Food Sciences, University of Vermont, Burlington, VT, United States
- Gund Institute for Environment, University of Vermont, Burlington, VT, United States
| | - Farryl Bertmann
- Food Systems Program, University of Vermont, Burlington, VT, United States
- Department of Nutrition and Food Sciences, University of Vermont, Burlington, VT, United States
| | - Teresa Mares
- Food Systems Program, University of Vermont, Burlington, VT, United States
- Department of Anthropology, University of Vermont, Burlington, VT, United States
| | - Emily H. Belarmino
- Food Systems Program, University of Vermont, Burlington, VT, United States
- Department of Nutrition and Food Sciences, University of Vermont, Burlington, VT, United States
- Gund Institute for Environment, University of Vermont, Burlington, VT, United States
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Constantin AM, Noertjojo K, Sommer I, Pizarro AB, Persad E, Durao S, Nussbaumer-Streit B, McElvenny DM, Rhodes S, Martin C, Sampson O, Jørgensen KJ, Bruschettini M. Workplace interventions to reduce the risk of SARS-CoV-2 infection outside of healthcare settings. Cochrane Database Syst Rev 2024; 4:CD015112. [PMID: 38597249 PMCID: PMC11005086 DOI: 10.1002/14651858.cd015112.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
BACKGROUND Although many people infected with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) experience no or mild symptoms, some individuals can develop severe illness and may die, particularly older people and those with underlying medical problems. Providing evidence-based interventions to prevent SARS-CoV-2 infection has become more urgent with the potential psychological toll imposed by the coronavirus disease 2019 (COVID-19) pandemic. Controlling exposures to occupational hazards is the fundamental method of protecting workers. When it comes to the transmission of viruses, workplaces should first consider control measures that can potentially have the most significant impact. According to the hierarchy of controls, one should first consider elimination (and substitution), then engineering controls, administrative controls, and lastly, personal protective equipment. This is the first update of a Cochrane review published 6 May 2022, with one new study added. OBJECTIVES To assess the benefits and harms of interventions in non-healthcare-related workplaces aimed at reducing the risk of SARS-CoV-2 infection compared to other interventions or no intervention. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Web of Science Core Collections, Cochrane COVID-19 Study Register, World Health Organization (WHO) COVID-19 Global literature on coronavirus disease, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform, and medRxiv to 13 April 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) and non-randomised studies of interventions. We included adult workers, both those who come into close contact with clients or customers (e.g. public-facing employees, such as cashiers or taxi drivers), and those who do not, but who could be infected by coworkers. We excluded studies involving healthcare workers. We included any intervention to prevent or reduce workers' exposure to SARS-CoV-2 in the workplace, defining categories of intervention according to the hierarchy of hazard controls (i.e. elimination; engineering controls; administrative controls; personal protective equipment). DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were incidence rate of SARS-CoV-2 infection (or other respiratory viruses), SARS-CoV-2-related mortality, adverse events, and absenteeism from work. Our secondary outcomes were all-cause mortality, quality of life, hospitalisation, and uptake, acceptability, or adherence to strategies. We used the Cochrane RoB 2 tool to assess risk of bias, and GRADE methods to evaluate the certainty of evidence for each outcome. MAIN RESULTS We identified 2 studies including a total of 16,014 participants. Elimination-of-exposure interventions We included one study examining an intervention that focused on elimination of hazards, which was an open-label, cluster-randomised, non-inferiority trial, conducted in England in 2021. The study compared standard 10-day self-isolation after contact with an infected person to a new strategy of daily rapid antigen testing and staying at work if the test is negative (test-based attendance). The trialists hypothesised that this would lead to a similar rate of infections, but lower COVID-related absence. Staff (N = 11,798) working at 76 schools were assigned to standard isolation, and staff (N = 12,229) working at 86 schools were assigned to the test-based attendance strategy. The results between test-based attendance and standard 10-day self-isolation were inconclusive for the rate of symptomatic polymerase chain reaction (PCR)-positive SARS-CoV-2 infection (rate ratio (RR) 1.28, 95% confidence interval (CI) 0.74 to 2.21; 1 study; very low-certainty evidence). The results between test-based attendance and standard 10-day self-isolation were inconclusive for the rate of any PCR-positive SARS-CoV-2 infection (RR 1.35, 95% CI 0.82 to 2.21; 1 study; very low-certainty evidence). COVID-related absenteeism rates were 3704 absence days in 566,502 days-at-risk (6.5 per 1000 working days) in the control group and 2932 per 539,805 days-at-risk (5.4 per 1000 working days) in the intervention group (RR 0.83, 95% CI 0.55 to 1.25). We downgraded the certainty of the evidence to low due to imprecision. Uptake of the intervention was 71% in the intervention group, but not reported for the control intervention. The trial did not measure our other outcomes of SARS-CoV-2-related mortality, adverse events, all-cause mortality, quality of life, or hospitalisation. We found seven ongoing studies using elimination-of-hazard strategies, six RCTs and one non-randomised trial. Administrative control interventions We found one ongoing RCT that aims to evaluate the efficacy of the Bacillus Calmette-Guérin (BCG) vaccine in preventing COVID-19 infection and reducing disease severity. Combinations of eligible interventions We included one non-randomised study examining a combination of elimination of hazards, administrative controls, and personal protective equipment. The study was conducted in two large retail companies in Italy in 2020. The study compared a safety operating protocol, measurement of body temperature and oxygen saturation upon entry, and a SARS-CoV-2 test strategy with a minimum activity protocol. Both groups received protective equipment. All employees working at the companies during the study period were included: 1987 in the intervention company and 1798 in the control company. The study did not report an outcome of interest for this systematic review. Other intervention categories We did not find any studies in this category. AUTHORS' CONCLUSIONS We are uncertain whether a test-based attendance policy affects rates of PCR-positive SARS-CoV-2 infection (any infection; symptomatic infection) compared to standard 10-day self-isolation amongst school and college staff. A test-based attendance policy may result in little to no difference in absenteeism rates compared to standard 10-day self-isolation. The non-randomised study included in our updated search did not report any outcome of interest for this Cochrane review. As a large part of the population is exposed in the case of a pandemic, an apparently small relative effect that would not be worthwhile from the individual perspective may still affect many people, and thus become an important absolute effect from the enterprise or societal perspective. The included RCT did not report on any of our other primary outcomes (i.e. SARS-CoV-2-related mortality and adverse events). We identified no completed studies on any other interventions specified in this review; however, eight eligible studies are ongoing. More controlled studies are needed on testing and isolation strategies, and working from home, as these have important implications for work organisations.
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Affiliation(s)
- Alexandru Marian Constantin
- Department of Internal Medicine Clinical Hospital Colentina, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | | | - Isolde Sommer
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Krems, Austria
| | | | - Emma Persad
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Krems, Austria
- Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Solange Durao
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Barbara Nussbaumer-Streit
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Krems, Austria
| | - Damien M McElvenny
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
- Institute of Occupational Medicine, Edinburgh, UK
| | - Sarah Rhodes
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | | | | | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Matteo Bruschettini
- Cochrane Sweden, Department of Research and Education, Lund University, Skåne University Hospital, Lund, Sweden
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
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5
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Lam T, Saso A, Torres Ortiz A, Hatcher J, Woodman M, Chandran S, Thistlethwayte R, Best T, Johnson M, Wagstaffe H, Mai A, Buckland M, Gilmour K, Goldblatt D, Grandjean L. Socioeconomic and Demographic Risk Factors for SARS-CoV-2 Seropositivity Among Healthcare Workers in a UK Hospital: A Prospective Cohort Study. Clin Infect Dis 2024; 78:594-602. [PMID: 37647517 PMCID: PMC10954340 DOI: 10.1093/cid/ciad522] [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: 05/08/2023] [Revised: 07/26/2023] [Accepted: 08/29/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND To protect healthcare workers (HCWs) from the consequences of disease due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), it is necessary to understand the risk factors that drive exposure and infection within hospitals. Insufficient consideration of key socioeconomic variables is a limitation of existing studies that can lead to bias and residual confounding of proposed risk factors for infection. METHODS The Co-STARs study prospectively enrolled 3679 HCWs between April 2020 and September 2020. We used multivariate logistic regression to comprehensively characterize the demographic, occupational, socioeconomic, and environmental risk factors for SARS-CoV-2 seropositivity. RESULTS After adjusting for key confounders, relative household overcrowding (odds ratio [OR], 1.4 [95% confidence interval {CI}, 1.1-1.9]; P = .006), Black, Black British, Caribbean, or African ethnicity (OR, 1.7 [95% CI, 1.2-2.3]; P = .003), increasing age (ages 50-60 years: OR, 1.8 [95% CI, 1.3-2.4]; P < .001), lack of access to sick pay (OR, 1.8 [95% CI, 1.3-2.4]; P < .001). CONCLUSIONS Socioeconomic and demographic factors outside the hospital were the main drivers of infection and exposure to SARS-CoV-2 during the first wave of the pandemic in an urban pediatric referral hospital. Overcrowding and out-of-hospital SARS-CoV-2 contact are less amenable to intervention. However, lack of access to sick pay among externally contracted staff is more easily rectifiable. Our findings suggest that providing easier access to sick pay would lead to a decrease in SARS-CoV-2 transmission and potentially that of other infectious diseases in hospital settings. CLINICAL TRIALS REGISTRATION NCT04380896.
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Affiliation(s)
- Tanya Lam
- Department of Infectious Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Anja Saso
- Department of Infectious Diseases, Great Ormond Street Hospital, London, United Kingdom
- Department of Tropical and Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Medical Research Council Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Arturo Torres Ortiz
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
- Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, United Kingdom
| | - James Hatcher
- Department of Microbiology, Great Ormond Street Hospital, London, United Kingdom
| | - Marc Woodman
- Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, United Kingdom
| | - Shruthi Chandran
- Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, United Kingdom
| | | | - Timothy Best
- Department of Microbiology, Great Ormond Street Hospital, London, United Kingdom
| | - Marina Johnson
- Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, United Kingdom
| | - Helen Wagstaffe
- Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, United Kingdom
| | - Annabelle Mai
- Clinical Immunology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, United Kingdom
| | - Matthew Buckland
- Clinical Immunology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, United Kingdom
| | - Kimberly Gilmour
- Clinical Immunology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, United Kingdom
| | - David Goldblatt
- Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, United Kingdom
| | - Louis Grandjean
- Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, United Kingdom
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Worku F, Bennett F, Wheeler S, Siddiqi A, Papadakos J. Exploring the COVID-19 Knowledge, Attitudes, and Practices (KAPs) in the Black Community: a Scoping Review. J Racial Ethn Health Disparities 2024; 11:273-299. [PMID: 36757610 PMCID: PMC9910259 DOI: 10.1007/s40615-023-01518-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/06/2023] [Accepted: 01/16/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION AND BACKGROUND Racial minorities have been the focal point of media coverage, attributing the disproportionate impact of COVID-19 to their individual actions; however, the ability to engage in preventative practices can also depend on one's social determinants of health. Individual actions can include knowledge, attitudes, and practices (KAPs). Since Black communities are among those disproportionately affected by COVID-19, this scoping review explores what is known about COVID-19 KAPs among Black populations. METHODS A comprehensive literature search was conducted in 2020 for articles written in English from the Medline, Embase, and PsycInfo databases. Reviews, experimental research, and observational studies were included if they investigated at least one of COVID-19 KAP in relation to the pandemic and Black communities in OECD peer countries including Canada, the United States, and the United Kingdom. RESULTS AND ANALYSIS Thirty-one articles were included for analysis, and all employed observational designs were from the United States. The following KAPs were examined: 6 (18.8%) knowledge, 21 (65.6%) attitudes, and 22 (68.8%) practices. Black communities demonstrated high levels of adherence to preventative measures (e.g., lockdowns) and practices (e.g., mask wearing), despite a strong proportion of participants believing they were less likely to become infected with the virus, and having lower levels of COVID-19 knowledge, than other racial groups. CONCLUSIONS AND IMPLICATIONS The findings from this review support that Black communities highly engage in COVID-19 preventative practices within their realm of control such as mask-wearing and hand washing and suggest that low knowledge does not predict low practice scores among this population.
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Affiliation(s)
- Fiqir Worku
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Avenue, Toronto, ON, M5T 3M7, Canada.
| | - Falan Bennett
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sarah Wheeler
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Avenue, Toronto, ON, M5T 3M7, Canada
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Janet Papadakos
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Avenue, Toronto, ON, M5T 3M7, Canada
- Cancer Health Literacy Research Centre, Princess Margaret Cancer Centre, Toronto, Canada
- The Institute for Education Research (TIER), University Health Network, Toronto, Canada
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7
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Haley BM, Patil P, Levy JI, Spangler KR, Tieskens KF, Carnes F, Peng X, Klevens RM, Troppy TS, Fabian MP, Lane KJ, Leibler JH. Evaluating COVID-19 Risk to Essential Workers by Occupational Group: A Case Study in Massachusetts. J Community Health 2024; 49:91-99. [PMID: 37507525 PMCID: PMC10823035 DOI: 10.1007/s10900-023-01249-x] [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] [Accepted: 06/23/2023] [Indexed: 07/30/2023]
Abstract
Occupational exposure to SARS-CoV-2 varies by profession, but "essential workers" are often considered in aggregate in COVID-19 models. This aggregation complicates efforts to understand risks to specific types of workers or industries and target interventions, specifically towards non-healthcare workers. We used census tract-resolution American Community Survey data to develop novel essential worker categories among the occupations designated as COVID-19 Essential Services in Massachusetts. Census tract-resolution COVID-19 cases and deaths were provided by the Massachusetts Department of Public Health. We evaluated the association between essential worker categories and cases and deaths over two phases of the pandemic from March 2020 to February 2021 using adjusted mixed-effects negative binomial regression, controlling for other sociodemographic risk factors. We observed elevated COVID-19 case incidence in census tracts in the highest tertile of workers in construction/transportation/buildings maintenance (Phase 1: IRR 1.32 [95% CI 1.22, 1.42]; Phase 2: IRR: 1.19 [1.13, 1.25]), production (Phase 1: IRR: 1.23 [1.15, 1.33]; Phase 2: 1.18 [1.12, 1.24]), and public-facing sales and services occupations (Phase 1: IRR: 1.14 [1.07, 1.21]; Phase 2: IRR: 1.10 [1.06, 1.15]). We found reduced case incidence associated with greater percentage of essential workers able to work from home (Phase 1: IRR: 0.85 [0.78, 0.94]; Phase 2: IRR: 0.83 [0.77, 0.88]). Similar trends exist in the associations between essential worker categories and deaths, though attenuated. Estimating industry-specific risk for essential workers is important in targeting interventions for COVID-19 and other diseases and our categories provide a reproducible and straightforward way to support such efforts.
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Affiliation(s)
- Beth M Haley
- Department of Environmental Health, School of Public Health, Boston University, 715 Albany St, Boston, MA, 02118, USA
| | - Prasad Patil
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Jonathan I Levy
- Department of Environmental Health, School of Public Health, Boston University, 715 Albany St, Boston, MA, 02118, USA
| | - Keith R Spangler
- Department of Environmental Health, School of Public Health, Boston University, 715 Albany St, Boston, MA, 02118, USA
| | - Koen F Tieskens
- Department of Environmental Health, School of Public Health, Boston University, 715 Albany St, Boston, MA, 02118, USA
| | - Fei Carnes
- Department of Environmental Health, School of Public Health, Boston University, 715 Albany St, Boston, MA, 02118, USA
| | - Xiaojing Peng
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - R Monina Klevens
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, USA
| | - T Scott Troppy
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, USA
| | - M Patricia Fabian
- Department of Environmental Health, School of Public Health, Boston University, 715 Albany St, Boston, MA, 02118, USA
| | - Kevin J Lane
- Department of Environmental Health, School of Public Health, Boston University, 715 Albany St, Boston, MA, 02118, USA
| | - Jessica H Leibler
- Department of Environmental Health, School of Public Health, Boston University, 715 Albany St, Boston, MA, 02118, USA.
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8
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Moss J, Alexander L, Barré I, Parham I, Gillyard T, Davis J, Cunningham-Erves J. Understanding Physical Distancing and Face Mask Use Across High-Risk African American Subgroups During the COVID-19 Pandemic: Application of Health Belief Model. Health Promot Pract 2024; 25:49-59. [PMID: 36710489 PMCID: PMC9902790 DOI: 10.1177/15248399221151176] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Physical distancing and face masks remain frontline prevention strategies due to suboptimal vaccine uptake and the highly infectious COVID-19 variants. Communities of color are disproportionately impacted by a chronic disease burden that places them at higher risk of severe COVID-19 disease. Therefore, they can greatly benefit from face mask use and physical distancing, especially if the individual(s) have not received the vaccine. We applied the Health Belief Model to explore barriers and motivators influencing physical distancing and face mask use among high-risk, Black American subgroups during the early COVID-19 pandemic stages. We conducted 62 semi-structured interviews among four Black American subgroups: young adults, individuals with underlying medical conditions, essential workers, and parents. Thematic analysis, guided by the Health Belief Model, yielded six themes: (1) Knowledge on Face Mask Use and Physical Distancing, (2) Perceived Susceptibility and Severity Varies by Subgroup, (3) Experience with and Perceived Self-Efficacy to Engage in Preventive Behavior, (4) Perceived Benefits to engaging in preventive behaviors, (5) Perceived Barriers to engage in preventive behaviors, and (6) Cues to action to increase participation. Each subgroup's unique experience informed multilevel, tailored approaches that can be used by health promotion practitioners to improve face mask use and physical distancing among uniquely vulnerable Black American subgroups in the current and future pandemic.
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Affiliation(s)
- Jamal Moss
- Meharry Medical College, Nashville, TN, USA
| | | | - Iman Barré
- Meharry Medical College, Nashville, TN, USA
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Carlos Chavez FL, Sanchez D, Capielo Rosario C, Han S, Cerezo A, Cadenas GA. COVID-19 Economic and Academic Stress on Mexican American Adolescents' Psychological Distress: Parents as Essential Workers. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:37-51. [PMID: 37036440 DOI: 10.1080/15374416.2023.2191283] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
OBJECTIVES In a sample of Mexican American adolescents (N = 398; 51% females; aged 13-17), we examined the associations between psychological distress, COVID-19 household economic stress, COVID-19 academic stress, and whether these associations varied by adolescents' gender and by parents/caregivers' essential worker status. METHOD First, linear regression models assessed the main effects of household economic and academic stress on psychological distress. Second, the moderating effects of gender and parents/caregivers' essential worker status on the association between household economic and academic stress, and psychological distress were examined. Third, the three-way interaction effect of household economic stress, gender, and parents/caregivers' essential worker status on psychological distress as well as the three-way interaction effect of academic stress, gender, and parents/caregivers' essential worker status on psychological distress were calculated. RESULTS Household economic and academic stress were associated with psychological distress. However, these associations did not vary based on adolescents' gender or parents/caregivers' essential worker status. The three-way interaction for household economic stress, parents/caregivers' essential worker status, and gender for psychological distress was significant. Specifically, the effects of household economic stress on psychological distress was worse for boys than girls whose parents/caregivers were essential workers. Furthermore, the three-way interaction among academic stress, parents/caregivers' essential worker status, and gender was significant. Particularly, the effects of academic stress when grades were worse on adolescents' psychological distress was worse for boys than girls whose parents/caregivers were essential workers. CONCLUSION Parents/caregivers' essential worker status was salient among Mexican American adolescents' mental health outcomes during COVID-19, particularly for adolescent boys.
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Affiliation(s)
- Fiorella L Carlos Chavez
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University
| | - Delida Sanchez
- Department of Counseling, Higher Education, and Special Education, University of Maryland
| | | | - SeungYong Han
- Research Initiatives, Support & Engagement (R.I.S.E.). Edson College of Nursing and Health Innovation, Arizona State University
| | - Alison Cerezo
- Department of Counseling, Clinical, and School Psychology, University of California Santa Barbara
| | - German A Cadenas
- Department of Education & Human Services, College of Education, Lehigh University
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Hoerger M, Kim S, Mossman B, Alonzi S, Xu K, Coward JC, Whalen K, Nauman E, Miller J, De La Cerda T, Peyser T, Dunn A, Zapolin D, Rivera D, Murugesan N, Baker CN. Cultivating community-based participatory research (CBPR) to respond to the COVID-19 pandemic: an illustrative example of partnership and topic prioritization in the food services industry. BMC Public Health 2023; 23:1939. [PMID: 37803311 PMCID: PMC10559526 DOI: 10.1186/s12889-023-16787-1] [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: 06/22/2023] [Accepted: 09/18/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND As an illustrative example of COVID-19 pandemic community-based participatory research (CBPR), we describe a community-academic partnership to prioritize future research most important to people experiencing high occupational exposure to COVID-19 - food service workers. Food service workers face key challenges surrounding (1) health and safety precautions, (2) stress and mental health, and (3) the long-term pandemic impact. METHOD Using CBPR methodologies, academic scientists partnered with community stakeholders to develop the research aims, methods, and measures, and interpret and disseminate results. We conducted a survey, three focus groups, and a rapid qualitative assessment to understand the three areas of concern and prioritize future research. RESULTS The survey showed that food service employers mainly supported basic droplet protections (soap, hand sanitizer, gloves), rather than comprehensive airborne protections (high-quality masks, air quality monitoring, air cleaning). Food service workers faced challenging decisions surrounding isolation, quarantine, testing, masking, vaccines, and in-home transmission, described anxiety, depression, and substance use as top mental health concerns, and described long-term physical and financial concerns. Focus groups provided qualitative examples of concerns experienced by food service workers and narrowed topic prioritization. The rapid qualitative assessment identified key needs and opportunities, with help reducing in-home COVID-19 transmission identified as a top priority. COVID-19 mitigation scientists offered recommendations for reducing in-home transmission. CONCLUSIONS The COVID-19 pandemic has forced food service workers to experience complex decisions about health and safety, stress and mental health concerns, and longer-term concerns. Challenging health decisions included attempting to avoid an airborne infectious illness when employers were mainly only concerned with droplet precautions and trying to decide protocols for testing and isolation without clear guidance, free tests, or paid sick leave. Key mental health concerns were anxiety, depression, and substance use. Longer-term challenges included Long COVID, lack of mental healthcare access, and financial instability. Food service workers suggest the need for more research aimed at reducing in-home COVID-19 transmission and supporting long-term mental health, physical health, and financial concerns. This research provides an illustrative example of how to cultivate community-based partnerships to respond to immediate and critical issues affecting populations most burdened by public health crises.
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Affiliation(s)
- Michael Hoerger
- New Orleans Louisiana (NOLA) Pandemic Food Collaborative, Tulane University, New Orleans, LA, USA.
- Department of Psychology, Tulane University, New Orleans, LA, USA.
- Departments of Psychiatry and Medicine, Tulane University, New Orleans, LA, USA.
- Freeman School of Business, Tulane University, New Orleans, LA, USA.
- Department of Palliative Medicine and Supportive Care, University Medical Center of New Orleans, New Orleans, LA, USA.
- Louisiana Cancer Research Center, New Orleans, LA, USA.
| | - Seowoo Kim
- New Orleans Louisiana (NOLA) Pandemic Food Collaborative, Tulane University, New Orleans, LA, USA
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Brenna Mossman
- New Orleans Louisiana (NOLA) Pandemic Food Collaborative, Tulane University, New Orleans, LA, USA
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Sarah Alonzi
- New Orleans Louisiana (NOLA) Pandemic Food Collaborative, Tulane University, New Orleans, LA, USA
- Department of Psychology, Tulane University, New Orleans, LA, USA
- Department of Psychology, University of California, Los Angeles, USA
| | - Kenneth Xu
- New Orleans Louisiana (NOLA) Pandemic Food Collaborative, Tulane University, New Orleans, LA, USA
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - John C Coward
- New Orleans Louisiana (NOLA) Pandemic Food Collaborative, Tulane University, New Orleans, LA, USA
| | - Kathleen Whalen
- New Orleans Louisiana (NOLA) Pandemic Food Collaborative, Tulane University, New Orleans, LA, USA
| | - Elizabeth Nauman
- New Orleans Louisiana (NOLA) Pandemic Food Collaborative, Tulane University, New Orleans, LA, USA
- Louisiana Public Health Institute, New Orleans, USA
| | - Jonice Miller
- New Orleans Louisiana (NOLA) Pandemic Food Collaborative, Tulane University, New Orleans, LA, USA
| | - Tracey De La Cerda
- New Orleans Louisiana (NOLA) Pandemic Food Collaborative, Tulane University, New Orleans, LA, USA
| | - Tristen Peyser
- New Orleans Louisiana (NOLA) Pandemic Food Collaborative, Tulane University, New Orleans, LA, USA
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Addison Dunn
- New Orleans Louisiana (NOLA) Pandemic Food Collaborative, Tulane University, New Orleans, LA, USA
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Dana Zapolin
- New Orleans Louisiana (NOLA) Pandemic Food Collaborative, Tulane University, New Orleans, LA, USA
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Dulcé Rivera
- New Orleans Louisiana (NOLA) Pandemic Food Collaborative, Tulane University, New Orleans, LA, USA
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Navya Murugesan
- New Orleans Louisiana (NOLA) Pandemic Food Collaborative, Tulane University, New Orleans, LA, USA
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Courtney N Baker
- New Orleans Louisiana (NOLA) Pandemic Food Collaborative, Tulane University, New Orleans, LA, USA
- Department of Psychology, Tulane University, New Orleans, LA, USA
- Freeman School of Business, Tulane University, New Orleans, LA, USA
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11
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Brown JL. Addressing Racial Capitalism's Impact on Black Essential Workers During the COVID-19 Pandemic: Policy Recommendations. J Racial Ethn Health Disparities 2023; 10:1597-1604. [PMID: 35689156 PMCID: PMC9187152 DOI: 10.1007/s40615-022-01346-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/26/2022] [Accepted: 05/31/2022] [Indexed: 11/09/2022]
Abstract
Black Americans are more likely to be essential workers due to racial capitalism. Because of the COVID-19 pandemic, essential workers are less able to adhere to social distancing and stay-at-home guidelines due to the nature of their work, because they are more likely to occupy crowded households, and are more likely to possess pre-existing health conditions. To assist Black essential workers in preventing infection or reducing the intensity of symptoms if contracted, vaccination against the virus is essential. Unfortunately, Black essential workers face considerable barriers to accessing vaccinations and are hesitant to receive the vaccine due to widespread misinformation and justified historical mistrust of the American medical system. The purpose of this work is to (1) describe the disproportionate impact of COVID-19 on Black essential workers due to racial capitalism, (2) outline the socioeconomic and racial barriers related to vaccination within this population, and (3) to suggest policy-related approaches to facilitate vaccination such as access to on-site vaccination opportunities, the funding of community outreach efforts, and the mandating of increased employee benefits.
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Affiliation(s)
- Jocelyn L Brown
- School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA.
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12
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Welton-Mitchell C, Dally M, Dickinson KL, Morris-Neuberger L, Roberts JD, Blanch-Hartigan D. Influence of mental health on information seeking, risk perception and mask wearing self-efficacy during the early months of the COVID-19 pandemic: a longitudinal panel study across 6 U.S. States. BMC Psychol 2023; 11:203. [PMID: 37430351 DOI: 10.1186/s40359-023-01241-z] [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: 03/13/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Understanding factors that influence information seeking, assessment of risk and mitigation behaviors is critical during a public health crises. This longitudinal study examined the influence of self-reported mental health during the early months of the COVID-19 pandemic on information seeking, risk perception and perceived mask wearing ability. Mental health screener items included fear, anger, and hopelessness in addition to avoidance, diminished functional ability and global distress. Theoretical models inform hypotheses linking mental health items and outcomes. METHODS The research employed a longitudinal 6-state 3-wave online panel survey, with an initial sample of 3,059 participants (2,232 included in longitudinal analyses). Participants roughly represented the states' age, race, ethnicity, and income demographics. RESULTS Women, those who identified as Hispanic/Latinx, Black Americans and lower income participants reported higher overall rates of distress than others. Information seeking was more common among older persons, Democrats, retirees, those with higher education, and those who knew people who had died of COVID-19. Controlling for such demographic variables, in multivariable longitudinal models that included baseline mental health measures, distress and fear were associated with increased information seeking. Distress and fear were also associated with increased risk perception, and feelings of hopelessness were associated with lower reported mask-wearing ability. CONCLUSIONS Results advance understanding of the role mental health can play in information seeking, risk perception and mask wearing with implications for clinicians, public health practitioners and policy makers.
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Affiliation(s)
- Courtney Welton-Mitchell
- Colorado School of Public Health, University of Colorado, Mail Stop, 13001 E 17th Pl B119, Aurora, CO, 80045, USA.
| | - Miranda Dally
- Colorado School of Public Health, University of Colorado, Mail Stop, 13001 E 17th Pl B119, Aurora, CO, 80045, USA
| | - Katherine L Dickinson
- Colorado School of Public Health, University of Colorado, Mail Stop, 13001 E 17th Pl B119, Aurora, CO, 80045, USA
| | - Lindsay Morris-Neuberger
- Communication Studies, West Virginia University, Armstrong Hall, 94 Beechurst Ave STE 108, Morgantown, WV, 26505, USA
| | - Jennifer D Roberts
- School of Public Health, University of Maryland, 4200 Valley Dr, College Park, MD, 20742, USA
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Woods EH, Zhang Y, Roemer EC, Kent KB, Davis MF, Goetzel RZ. Addressing Psychosocial, Organizational, and Environmental Stressors Emerging From the COVID-19 Pandemic and Their Effect on Essential Workers' Mental Health and Well-being: A Literature Review. J Occup Environ Med 2023; 65:419-427. [PMID: 36701793 PMCID: PMC10171099 DOI: 10.1097/jom.0000000000002802] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This study aimed to identify stressors faced by essential workers amid the coronavirus disease pandemic and effective interventions mitigating these stressors. METHODS We reviewed literature on psychosocial, organizational, and environmental stressors faced by essential workers during the pandemic, the consequences of those stressors, and interventions to improve worker health and well-being. FINDINGS Stressors included elevated risk of coronavirus disease 2019 exposure, fear of spreading the virus, lack of social and organizational supports, and financial insecurity. Negative outcomes included burnout, depression, and high turnover. Promising interventions included robust safety protocols, increased wages, childcare benefits, enhanced access to mental health services, and frequent leadership communications. CONCLUSION Stress has taken a heavy toll on essential workers' physical and emotional health, productivity, and job satisfaction. To effectively protect Total Worker Health, employers should adopt evidence-based interventions promoting psychosocial, organizational, and environmental health and safety.
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14
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Scott JL, Lee-Johnson NM, Danos D. Place, Race, and Case: Examining Racialized Economic Segregation and COVID-19 in Louisiana. J Racial Ethn Health Disparities 2023; 10:775-787. [PMID: 35239176 PMCID: PMC8893059 DOI: 10.1007/s40615-022-01265-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 12/19/2022]
Abstract
Early COVID-19 pandemic data suggested racial/ethnic minority and low-income earning people bore the greatest burden of infection. Structural racism, the reinforcement of racial and ethnic discrimination via policy, provides a framework for understanding disparities in health outcomes like COVID-19 infection. Residential racial and economic segregation is one indicator of structural racism. Little attention has been paid to the relationship of infection to relative overall concentrations of risk (i.e., segregation of the most privileged from the most disadvantaged). We used ordinary least squares and geographically weighted regression models to evaluate the relationship between racial and economic segregation, measured by the Index of Concentration at the Extremes, and COVID-19 cases in Louisiana. We found a significant global association between racial segregation and cumulative COVID-19 case rate in Louisiana and variation across the state during the study period. The northwest and central regions exhibited a strong negative relationship indicating greater risk in areas with high concentrations of Black residents. On the other hand, the southeastern part of the state exhibited more neutral or positive relationships indicating greater risk in areas with high concentrations of White residents. Our findings that the relationship between racial segregation and COVID-19 cases varied within a state further support evidence that social and political determinants, not biological, drive racial disparities. Small area measures and measures of polarization provide localized information better suited to tailoring public health policy according to the dynamics of communities at the census tract level, which may lead to better health outcomes.
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Affiliation(s)
- Jennifer L Scott
- School of Social Work, Louisiana State University, 2167 Pleasant Hall, Baton Rouge, LA, 70803, USA.
| | - Natasha M Lee-Johnson
- School of Social Work, Louisiana State University, 2167 Pleasant Hall, Baton Rouge, LA, 70803, USA
| | - Denise Danos
- School of Public Health, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, USA
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15
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Kim KE. Ten Takeaways from the COVID-19 Pandemic for Transportation Planners. TRANSPORTATION RESEARCH RECORD 2023; 2677:517-530. [PMID: 37153166 PMCID: PMC10149348 DOI: 10.1177/03611981221090515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The COVID-19 pandemic has created significant challenges but also unprecedented opportunities for transportation researchers and practitioners. In this article, the major lessons and gaps in knowledge for those working in the transportation sector are identified, including the following: (1) integration between public health and transportation; (2) technology to support contact tracing and tracking of travelers; (3) focus on vulnerable, at-risk operators, patrons, and underserved members of society; (4) re-engineering of travel demand models to support social distancing, quarantine, and public health interventions; (5) challenges with Big Data and information technologies; (6) trust relationships between the general public, government, private sector, and others in disaster management; (7) conflict management during disasters; (8) complexities of transdisciplinary knowledge and engagement; (9) demands for training and education; and (10) transformative change to support community resilience. With a focus on transportation planning and community resilience, the lessons from the pandemic need to be shared and customized for different systems, services, modalities, and users. While many of the interventions during the pandemic have been based on public health, the management, response, recovery, adaptation, and transformation of transportation systems resulting from the crisis require multi-disciplinary, multi-jurisdictional communications and coordination, and resource sharing. Further research to support knowledge to action is needed.
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Affiliation(s)
- Karl E. Kim
- Department of Urban and Regional Planning, University of Hawaii, Honolulu, HI
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16
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Rudolphi JM, Cuthbertson C, Kaur A, Sarol JN. Agricultural Producers' and Stakeholders' Perceived Effectiveness and Participation in COVID-19 Protective Behaviors. J Agromedicine 2023; 28:105-115. [PMID: 36310383 DOI: 10.1080/1059924x.2022.2142347] [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: 11/08/2022]
Abstract
This study was designed to identify the perceived effectiveness of COVID-19 protective behaviors and participation in COVID-19 protective behaviors among agricultural producers and stakeholders in the Midwest, United States. A questionnaire was disseminated online to agricultural producers and stakeholders in April-July 2020. Respondents (N = 1,876) shared their perceptions of the effectiveness of COVID-19 protective behaviors and participation in those behaviors. Respondents were primarily agricultural producers (85.5%), aged 64 or younger (66.4%), male (81.2%), white (98.3%), and rural residents (88.7%). About three-quarters of respondents thought washing hands with soap and water and covering a cough or sneeze is very effective at preventing the spread of COVID-19, however, only 30% thought wearing a face mask when in contact with others or in public is very effective. Similarly, over 80% reported washing hands with soap regularly every day and covering their cough or sneeze every day in the past two weeks. In contrast, less than 40% reported staying home as much as possible and wearing a face mask when in public every day in the past two weeks. Rural residents were less likely than urban or suburban residents to report wearing a face mask when in public or with people outside their household. Agricultural producers and stakeholders were found to be at risk of getting COVID-19 due to the perceptions and practices, especially those related to protective social measures. Understanding engagement in protective behaviors and perceptions of their effectiveness is critical to developing effective public health interventions for agricultural communities.
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Affiliation(s)
- Josie M Rudolphi
- Department of Agricultural and Biological Engineering, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Courtney Cuthbertson
- Department of Human Development and Family Studies, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Amandeep Kaur
- Biostatistics, Epidemiology, and Research Design Core, Interdisciplinary Health Sciences Institute, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Jesus Natividad Sarol
- Biostatistics, Epidemiology, and Research Design Core, Interdisciplinary Health Sciences Institute, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
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Bollyky TJ, Castro E, Aravkin AY, Bhangdia K, Dalos J, Hulland EN, Kiernan S, Lastuka A, McHugh TA, Ostroff SM, Zheng P, Chaudhry HT, Ruggiero E, Turilli I, Adolph C, Amlag JO, Bang-Jensen B, Barber RM, Carter A, Chang C, Cogen RM, Collins JK, Dai X, Dangel WJ, Dapper C, Deen A, Eastus A, Erickson M, Fedosseeva T, Flaxman AD, Fullman N, Giles JR, Guo G, Hay SI, He J, Helak M, Huntley BM, Iannucci VC, Kinzel KE, LeGrand KE, Magistro B, Mokdad AH, Nassereldine H, Ozten Y, Pasovic M, Pigott DM, Reiner RC, Reinke G, Schumacher AE, Serieux E, Spurlock EE, Troeger CE, Vo AT, Vos T, Walcott R, Yazdani S, Murray CJL, Dieleman JL. Assessing COVID-19 pandemic policies and behaviours and their economic and educational trade-offs across US states from Jan 1, 2020, to July 31, 2022: an observational analysis. Lancet 2023; 401:1341-1360. [PMID: 36966780 PMCID: PMC10036128 DOI: 10.1016/s0140-6736(23)00461-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/14/2023] [Accepted: 02/21/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND The USA struggled in responding to the COVID-19 pandemic, but not all states struggled equally. Identifying the factors associated with cross-state variation in infection and mortality rates could help to improve responses to this and future pandemics. We sought to answer five key policy-relevant questions regarding the following: 1) what roles social, economic, and racial inequities had in interstate variation in COVID-19 outcomes; 2) whether states with greater health-care and public health capacity had better outcomes; 3) how politics influenced the results; 4) whether states that imposed more policy mandates and sustained them longer had better outcomes; and 5) whether there were trade-offs between a state having fewer cumulative SARS-CoV-2 infections and total COVID-19 deaths and its economic and educational outcomes. METHODS Data disaggregated by US state were extracted from public databases, including COVID-19 infection and mortality estimates from the Institute for Health Metrics and Evaluation's (IHME) COVID-19 database; Bureau of Economic Analysis data on state gross domestic product (GDP); Federal Reserve economic data on employment rates; National Center for Education Statistics data on student standardised test scores; and US Census Bureau data on race and ethnicity by state. We standardised infection rates for population density and death rates for age and the prevalence of major comorbidities to facilitate comparison of states' successes in mitigating the effects of COVID-19. We regressed these health outcomes on prepandemic state characteristics (such as educational attainment and health spending per capita), policies adopted by states during the pandemic (such as mask mandates and business closures), and population-level behavioural responses (such as vaccine coverage and mobility). We explored potential mechanisms connecting state-level factors to individual-level behaviours using linear regression. We quantified reductions in state GDP, employment, and student test scores during the pandemic to identify policy and behavioural responses associated with these outcomes and to assess trade-offs between these outcomes and COVID-19 outcomes. Significance was defined as p<0·05. FINDINGS Standardised cumulative COVID-19 death rates for the period from Jan 1, 2020, to July 31, 2022 varied across the USA (national rate 372 deaths per 100 000 population [95% uncertainty interval [UI] 364-379]), with the lowest standardised rates in Hawaii (147 deaths per 100 000 [127-196]) and New Hampshire (215 per 100 000 [183-271]) and the highest in Arizona (581 per 100 000 [509-672]) and Washington, DC (526 per 100 000 [425-631]). A lower poverty rate, higher mean number of years of education, and a greater proportion of people expressing interpersonal trust were statistically associated with lower infection and death rates, and states where larger percentages of the population identify as Black (non-Hispanic) or Hispanic were associated with higher cumulative death rates. Access to quality health care (measured by the IHME's Healthcare Access and Quality Index) was associated with fewer total COVID-19 deaths and SARS-CoV-2 infections, but higher public health spending and more public health personnel per capita were not, at the state level. The political affiliation of the state governor was not associated with lower SARS-CoV-2 infection or COVID-19 death rates, but worse COVID-19 outcomes were associated with the proportion of a state's voters who voted for the 2020 Republican presidential candidate. State governments' uses of protective mandates were associated with lower infection rates, as were mask use, lower mobility, and higher vaccination rate, while vaccination rates were associated with lower death rates. State GDP and student reading test scores were not associated with state COVD-19 policy responses, infection rates, or death rates. Employment, however, had a statistically significant relationship with restaurant closures and greater infections and deaths: on average, 1574 (95% UI 884-7107) additional infections per 10 000 population were associated in states with a one percentage point increase in employment rate. Several policy mandates and protective behaviours were associated with lower fourth-grade mathematics test scores, but our study results did not find a link to state-level estimates of school closures. INTERPRETATION COVID-19 magnified the polarisation and persistent social, economic, and racial inequities that already existed across US society, but the next pandemic threat need not do the same. US states that mitigated those structural inequalities, deployed science-based interventions such as vaccination and targeted vaccine mandates, and promoted their adoption across society were able to match the best-performing nations in minimising COVID-19 death rates. These findings could contribute to the design and targeting of clinical and policy interventions to facilitate better health outcomes in future crises. FUNDING Bill & Melinda Gates Foundation, J Stanton, T Gillespie, J and E Nordstrom, and Bloomberg Philanthropies.
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Affiliation(s)
| | - Emma Castro
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Aleksandr Y Aravkin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Applied Mathematics, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Kayleigh Bhangdia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jeremy Dalos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Erin N Hulland
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Amy Lastuka
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Theresa A McHugh
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Samuel M Ostroff
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Henry M Jackson School of International Studies, University of Washington, Seattle, WA, USA
| | - Peng Zheng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Hamza Tariq Chaudhry
- Council on Foreign Relations, Washington, DC, USA; Department of Public Policy, Harvard University, Cambridge, MA, USA
| | | | | | - Christopher Adolph
- Department of Political Science, University of Washington, Seattle, WA, USA; Center for Statistics and the Social Sciences, University of Washington, Seattle, WA, USA
| | - Joanne O Amlag
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Ryan M Barber
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Austin Carter
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Cassidy Chang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Rebecca M Cogen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - James K Collins
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Xiaochen Dai
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - William James Dangel
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Carolyn Dapper
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Amanda Deen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Alexandra Eastus
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Health Management and Policy, Drexel University, Philadelphia, PA, USA
| | - Megan Erickson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Tatiana Fedosseeva
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Abraham D Flaxman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Nancy Fullman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - John R Giles
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Gaorui Guo
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Jiawei He
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Bethany M Huntley
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Vincent C Iannucci
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kasey E Kinzel
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kate E LeGrand
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Beatrice Magistro
- Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, ON, Canada
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Hasan Nassereldine
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Yaz Ozten
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Maja Pasovic
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - David M Pigott
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Robert C Reiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Grace Reinke
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Austin E Schumacher
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Elizabeth Serieux
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Emma E Spurlock
- Department of Social and Behavioral Sciences, Yale University, New Haven, CT, USA; Yale School of Public Health-Social and Behavioral Sciences, Yale University, New Haven, CT, USA
| | - Christopher E Troeger
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Anh Truc Vo
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Rebecca Walcott
- Evans School of Public Policy & Governance, University of Washington, Seattle, WA, USA
| | - Shafagh Yazdani
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Joseph L Dieleman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
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18
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Nikolaidou A, Kopsacheilis A, Georgiadis G, Noutsias T, Politis I, Fyrogenis I. Factors affecting public transport performance due to the COVID-19 outbreak: A worldwide analysis. CITIES (LONDON, ENGLAND) 2023; 134:104206. [PMID: 36683673 PMCID: PMC9841081 DOI: 10.1016/j.cities.2023.104206] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/31/2022] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
In this paper we investigate the public transport trip frequency variations, as well as the reasons that led to the shift away from public transport means, due to the COVID-19 pandemic. We studied relevant data from the Moovit platform, and we compared operational and trip frequency characteristics of public transport systems before and after the outbreak of the pandemic in 87 cities worldwide. On average, waiting times at public transport stops/stations increased while trip distances decreased, apparently due to the mobility restriction and social distancing measures implemented in 2020. Most of the Moovit users who said that they abandoned public transport in 2020 were found in Italy and Greece. We developed linear regression analysis models to investigate (among the 35 variables examined in the study) the relationship between public transport abandonment rates and socioeconomic factors, quality of service characteristics, and indicators of pandemic's spread. Empirical findings show that public transport dropout rates are positively correlated with the COVID-19 death toll figures, the cleanliness of public transport vehicles and facilities, as well as with the income inequality (GINI) index of the population, and thus reconfirm previous research findings. In addition, the waiting time at stops/stations and the number of transfers required for commute trips appeared to be the most critical public transport trip segments, which significantly determine the discontinuation of public transport use under pandemic circumstances. Our research findings indicate specific aspects of public transport services, which require tailored adjustments in order to recover ridership in the post-pandemic period.
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Affiliation(s)
- Anastasia Nikolaidou
- Transport Engineering Laboratory, Department of Civil Engineering, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Aristomenis Kopsacheilis
- Transport Engineering Laboratory, Department of Civil Engineering, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Georgios Georgiadis
- Transport Engineering Laboratory, Department of Civil Engineering, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Theodoros Noutsias
- Transport Engineering Laboratory, Department of Civil Engineering, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Ioannis Politis
- Transport Engineering Laboratory, Department of Civil Engineering, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Ioannis Fyrogenis
- Transport Engineering Laboratory, Department of Civil Engineering, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
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19
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Henke RM. Knowing Well, Being Well: well-being born of understanding: The COVID-19 Pandemic and Children: Implications for Future Health. Am J Health Promot 2023; 37:263-288. [PMID: 36646664 DOI: 10.1177/08901171221140641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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20
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Kerker BD, Rojas NM, Dawson-McClure S, Gonzalez C. Re-imagining Early Childhood Education and School Readiness for Children and Families of Color in the Time of COVID-19 and Beyond. Am J Health Promot 2023; 37:270-273. [PMID: 36646660 DOI: 10.1177/08901171221140641c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
High quality and culturally responsive early childhood education and care (ECEC) for young children before kindergarten is seen as a way to ensure that all children enter school ready to learn. ECEC is even more crucial in the context of recovery from the COVID-19 pandemic and the disproportionate burden of trauma and stress borne by families of color in disinvested neighborhoods. Remote learning and repeated disruptions to in-person instruction as protocols shifted during waves of the pandemic placed an extra strain on families, and may have increased educational disparities in the U.S. Taken together, these challenges have implications for children's school readiness due to their impact on opportunities for learning at home and in the classroom. This paper explores how ECEC programs can be strengthened to better meet children's needs, and ways in which future research can shed light on these important issues.
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Affiliation(s)
- Bonnie D Kerker
- Department of Population Health, NYU Grossman School of Medicine, USA.,Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, USA
| | - Natalia M Rojas
- Department of Population Health, NYU Grossman School of Medicine, USA
| | | | - Cristina Gonzalez
- New York City Department of Education, PS 94, The Henry Longfellow School, Brooklyn, NY, USA
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21
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Kerker BD, Willheim E, Weis JR. The COVID-19 Pandemic: Implications for Maternal Mental Health and Early Childhood Development. Am J Health Promot 2023; 37:265-269. [PMID: 36646659 DOI: 10.1177/08901171221140641b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Women are particularly susceptible to mental health challenges during the perinatal period. With the onset of the COVID-19 pandemic in 2020, much concern was raised about the impact that the associated isolation, uncertainty, grief, loss and economic upheaval would have on mental health. Women experienced a disproportionate amount of environmental strain during this time, including economic stress and challenges associated with being essential workers; stressors were perhaps most prevalent in communities of color and immigrant groups. For women who were pregnant during the height of the pandemic, it is clear that stress, anxiety, and depression were increased due to changes in medical care and decreases in social support. Increased mental health challenges in the perinatal period have been shown to impact social-emotional, cognitive and behavioral health in infants and children, so the potential consequences of the COVID-19 era are great. This paper discusses these potential impacts and describes important pathways for future research.
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Affiliation(s)
- Bonnie D Kerker
- Department of Population Health, NYU Grossman School of Medicine, USA.,Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, USA
| | - Erica Willheim
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, USA
| | - J Rebecca Weis
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, USA.,Bellevue Hospital, USA
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22
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Patel JR, Brown CC, Prewitt TE, Alfanek Z, Stewart MK. Social determinants of health and COVID-19: An evaluation of racial and ethnic disparities in attitudes, practices, and mental health. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000558. [PMID: 36962947 PMCID: PMC10021267 DOI: 10.1371/journal.pgph.0000558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 12/15/2022] [Indexed: 01/24/2023]
Abstract
Previous evaluations have reported racial minorities feel they are at greater risk of contracting COVID-19, but that on average, they have better preventative practices, such as wearing face masks and avoiding large gatherings. In this study, we explored associations between social determinants of health (SDOH), race and ethnicity, COVID-19 practices and attitudes, and mental health outcomes during the pandemic. We examined associations between SDOHs and practices, attitudes, and mental health symptoms by race and ethnicity using multivariable linear and logistic regressions in 8582 Arkansan pulse poll respondents (September-December, 2020). Compared to White respondents, mean attitude and practice scores were greater (indicating safer) among Black (4.90 vs. 3.45 for attitudes; 2.63 vs. 2.41 for practices) and Hispanic respondents (4.26 vs. 3.45 for attitudes; 2.50 vs. 2.41 for practices). Respondents' SDOH scores by race/ethnicity were: White (3.65), Black (3.33), and Hispanic (3.22). Overall, attitude and practice scores decreased by 0.35 and 0.09, respectively, for every one-point increase in SDOH. Overall, a one-point increase in SDOH was associated with 76% and 85% increased odds of screening negative for anxiety and depression, respectively. To conclude, underlying social inequities are likely driving safer attitudes, practices, and worse anxiety and depression symptoms in Black and Hispanic Arkansans. In terms of policy implications, our study supports the urgency of addressing SDOHs for rural states similar to Arkansas.
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Affiliation(s)
- Jenil R. Patel
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas, United States of America
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Clare C. Brown
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - T. Elaine Prewitt
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Zain Alfanek
- Department of Internal Medicine, UAMS College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - M. Kathryn Stewart
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
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23
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Zitek T, Bui J, Eily A, Farcy DA. Discrepancies in Outcomes by Race and Ethnicity in COVID-19 Patients Receiving Casirivimab and Imdevimab. South Med J 2023; 116:15-19. [PMID: 36578112 PMCID: PMC9812297 DOI: 10.14423/smj.0000000000001498] [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] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The Centers for Disease Control and Prevention has reported increased rates of coronavirus disease 2019 (COVID-19)-related hospitalizations and deaths in Black and Hispanic individuals. One contributing factor to this may be a difference in access to treatment. We thus sought to compare the outcomes of Black, non-Hispanic patients and Hispanic patients with White, non-Hispanic individuals using a group of patients with COVID-19 who received casirivimab/imdevimab. METHODS This was a secondary analysis of data from a previously published retrospective chart review of patients who received casirivimab/imdevimab for COVID-19 between December 9, 2020 and August 20, 2021, when they were treated at one of three facilities within a single hospital system. We compared the baseline characteristics (including age, sex, body mass index, duration of symptoms, and vaccination status) and outcomes of Black, non-Hispanic patients and Hispanic patients with those of White, non-Hispanic patients. Our primary outcome was the odds of a return visit to the emergency department (ED) within 28 days of treatment as assessed by multivariate logistic regression. We also assessed the rates of return visits to the ED for symptoms caused by COVID-19, hospitalizations, and hospitalizations from hypoxia. RESULTS In total, 1318 patients received casirivimab/imdevimab for COVID-19 at the three study facilities. Of these, 410 (31.1%) identified themselves as White and non-Hispanic, 88 (6.7%) as Black and non-Hispanic, and 736 (55.8%) as Hispanic. Vaccination rates at the time of treatment were as follows: Black, non-Hispanic 10.2%, Hispanic 13.6%, and White, non-Hispanic 21.5%. On multivariate analysis, the odds of return visits to the ED within 28 days were higher for Black, non-Hispanic patients and Hispanic patients as compared with White, non-Hispanic patients, with odds ratios of 2.8 (95% confidence interval [CI] 1.4-5.5, P = 0.003) and of 2.3 (95% CI 1.5-3.6, P = 0.0002), respectively. For hospitalizations caused by hypoxia within 28 days of treatment, the adjusted odds ratio for Black, non-Hispanic patients was 3.4 (95% CI 1.1-10.5, P = 0.03) as compared with White, non-Hispanic patients. There were no other statistically significant differences among groups in regard to subsequent hospitalizations within 28 days. CONCLUSIONS Black, non-Hispanic patients and Hispanic patients are more likely to make a return visit to the ED within 28 days after casirivimab/imdevimab treatment for COVID-19 as compared with White, non-Hispanic patients. This holds true even when adjusting for higher vaccination rates among White, non-Hispanic individuals.
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Affiliation(s)
- Tony Zitek
- From the Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, Florida
| | - Joseph Bui
- Herbert Wertheim College of Medicine, Florida International University, Miami
| | - Alyssa Eily
- From the Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, Florida
| | - David A. Farcy
- From the Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, Florida
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24
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Overstreet DS, Pester BD, Wilson JM, Flowers KM, Kline NK, Meints SM. The Experience of BIPOC Living with Chronic Pain in the USA: Biopsychosocial Factors that Underlie Racial Disparities in Pain Outcomes, Comorbidities, Inequities, and Barriers to Treatment. Curr Pain Headache Rep 2023; 27:1-10. [PMID: 36527589 PMCID: PMC10683048 DOI: 10.1007/s11916-022-01098-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW This review synthesizes recent findings related to the biopsychosocial processes that underlie racial disparities in chronic pain, while highlighting opportunities for interventions to reduce disparities in pain treatment among BIPOC. RECENT FINDINGS Chronic pain is a prevalent and costly public health concern that disproportionately burdens Black, Indigenous, and people of color (BIPOC). This unequal burden arises from an interplay among biological, psychological, and social factors. Social determinants of health (e.g., income, education level, and lack of access or inability to utilize healthcare services) are known to affect overall health, including chronic pain, and disproportionately affect BIPOC communities. This burden is exacerbated by exposure to psychosocial stressors (i.e., perceived injustice, discrimination, and race-based traumatic stress) and can affect biological systems that modulate pain (i.e., inflammation and pain epigenetics). Further, there are racial/ethnic disparities in pain treatment, perpetuating the cycle of undermanaged chronic pain among BIPOC.
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Affiliation(s)
- Demario S Overstreet
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman's Hospital, 75 Francis Street, Boston, MA, 02411, USA
- Harvard Medical School, Boston, MA, USA
| | - Bethany D Pester
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman's Hospital, 75 Francis Street, Boston, MA, 02411, USA
- Harvard Medical School, Boston, MA, USA
| | - Jenna M Wilson
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman's Hospital, 75 Francis Street, Boston, MA, 02411, USA
- Harvard Medical School, Boston, MA, USA
| | - K Mikayla Flowers
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman's Hospital, 75 Francis Street, Boston, MA, 02411, USA
- Harvard Medical School, Boston, MA, USA
| | - Nora K Kline
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman's Hospital, 75 Francis Street, Boston, MA, 02411, USA
- Department of Psychology, Clark University, Worcester, MA, USA
| | - Samantha M Meints
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman's Hospital, 75 Francis Street, Boston, MA, 02411, USA.
- Harvard Medical School, Boston, MA, USA.
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25
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Haldane V, Morales-Vazquez M, Jamieson M, Veillard J, Marchildon GP, Allin S. Learning from the first wave of the COVID-19 pandemic: Comparing policy responses in Uruguay with 10 other Latin American and Caribbean countries. HEALTH POLICY OPEN 2022; 3:100081. [PMID: 36405237 PMCID: PMC9661545 DOI: 10.1016/j.hpopen.2022.100081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/12/2022] [Accepted: 10/30/2022] [Indexed: 11/16/2022] Open
Abstract
A range of public health and social measures have been employed in response to the disproportionate impact of COVID-19 in Latin America and the Caribbean (LAC). Yet, pandemic responses have varied across the region, particularly during the first 6 months of the pandemic, with Uruguay effectively limiting transmission during this crucial phase. This review describes features of pandemic responses which may have contributed to Uruguay's early success relative to 10 other LAC countries - Argentina, Chile, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Panama, Paraguay, and Trinidad and Tobago. Uruguay differentiated its early response efforts from reviewed countries by foregoing strict border closures and restrictions on movement, and rapidly implementing a suite of economic and social measures. Our findings describe the importance of supporting adherence to public health interventions by ensuring that effective social and economic safety net measures are in place to permit compliance with public health measures.
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Affiliation(s)
- Victoria Haldane
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St., Toronto, ON M5T 3M6, Canada
| | - Mariana Morales-Vazquez
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St., Toronto, ON M5T 3M6, Canada
| | - Margaret Jamieson
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St., Toronto, ON M5T 3M6, Canada
| | - Jeremy Veillard
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St., Toronto, ON M5T 3M6, Canada,World Bank, Health, Nutrition and Population, Washington, DC, USA
| | - Gregory P. Marchildon
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St., Toronto, ON M5T 3M6, Canada
| | - Sara Allin
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St., Toronto, ON M5T 3M6, Canada,Corresponding author at: Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St., Toronto, ON M5T 3M6, Canada
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26
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Sjörs Dahlman A, Anund A. Seroprevalence of SARS-CoV-2 antibodies among public transport workers in Sweden. JOURNAL OF TRANSPORT & HEALTH 2022; 27:101508. [PMID: 36188635 PMCID: PMC9515328 DOI: 10.1016/j.jth.2022.101508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Public transportation is an essential societal function in crisis situations like the coronavirus disease 2019 (COVID-19) pandemic. Bus drivers and other public transport workers are essential workers that need to keep working despite the risk of contagion. The SARS-CoV-2 virus may pose an occupational health risk to public transport workers and especially to bus drivers as they interact with passengers in a confined area. By analyzing antibodies towards SARS-CoV-2 proteins in blood samples it is possible to measure if an individual has been infected by COVID-19. Here, we report the prevalence of antibodies among bus drivers and other public transport employees in Stockholm, Sweden and relate it to socio-demographic factors. METHODS Seroprevalence of IgG antibodies towards SARS-CoV-2 proteins was investigated in a sample of 262 non-vaccinated public transport workers (182 men and 40 women) recruited between April 26 and May 7, 2021. Most of the participants were bus drivers (n = 222). The relationship between socio-demographic factors and seroprevalence was investigated with logistic regression. RESULTS The seroprevalence was 50% in the total sample of public transport workers. Among bus drivers, 51% were seropositive compared to 44% seropositive among the other public transport workers. The difference was not significant. The seroprevalence was higher than the national seroprevalence in Sweden during the same period (18.3% in non-vaccinated people aged 20-64 years). The logistic regression model using Wald forward selection showed that men had a higher risk of being seropositive (OR 2.7, 95% CI 1.3 - 5.8) and there was a higher risk with increasing number of people in the household (OR 1.3, 95% CI 1.1 - 1.6). CONCLUSIONS These findings could imply an occupational risk for COVID-19 infection among public transport workers. Infection control measures are warranted during virus epidemics to assure bus drives' safety and reduce transmission in public transport.
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Affiliation(s)
- Anna Sjörs Dahlman
- The Swedish National Road and Transport Research Institute (VTI), Linköping, Sweden
- Department of Electrical Engineering and SAFER Vehicle and Traffic Safety Centre at Chalmers University of Technology, Gothenburg, Sweden
| | - Anna Anund
- The Swedish National Road and Transport Research Institute (VTI), Linköping, Sweden
- Rehabilitation Medicine, Linköping University, Linköping, Sweden and Stockholm University, Stockholm Stress Centre, Stockholm, Sweden
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27
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Podstawski R, Finn KJ, Borysławski K, Omelan AA, Podstawska AM, Skrzypczak AR, Pomianowski A. The Influence of COVID-19 on University Students' Well-Being, Physical Activity, Body Composition, and Strength Endurance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15680. [PMID: 36497754 PMCID: PMC9740601 DOI: 10.3390/ijerph192315680] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Very few scientific studies have simultaneously evaluated changes in well-being (WB), physical activity (PA), and strength endurance (SE) based on results from before and during the COVID-19 pandemic. AIM The aim of the study was to assess WB, PA, and SE levels, as well as body composition parameters in university students before and during the pandemic. METHODS The study included 30 males and 30 females (mean age: 21.7 ± 2.51 and 21.6 ± 2.34 years, respectively). Well-being using the Self-Perception Questionnaire (POMS), PA from the Polish regular version of the International Physical Activity Questionnaire (IPAQ), body composition parameters using the InBody 270 analyzer, and SE based on the results of a 12 min test involving a Concept 2PM-5 rowing ergometer were assessed before and during the pandemic. RESULTS An assessment of university students' WB revealed a significant increase in variables such as tension, depression, anger, confusion, and a significant decline in vigor (p < 0.05). In both sexes, PA and SE decreased significantly-from 2115.4 to 1822.8 METs-min/week and from 2184.5 to 2035 m, respectively, in males, and from 1793.5 to 1699.8 METs-min/week and from 2021.5 to 1943.8 m, respectively, in females. At the same time, body mass and BMI values increased significantly (p < 0.001) in both females and males. CONCLUSIONS The COVID-19 pandemic caused a significant decrease in WB, PA and SE levels in young females and males, and led to a significant increase in their body mass and BMI.
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Affiliation(s)
- Robert Podstawski
- Department of Tourism, Recreation and Ecology, University of Warmia and Mazury in Olsztyn, 10-957 Olsztyn, Poland
| | - Kevin John Finn
- Department of Nutrition, Kinesiology, and Health, University of Central Missouri, Warrensburg, MO 64093, USA
| | - Krzysztof Borysławski
- Institute of Health, The Angelus Silesius University of Applied Sciences, 58-300 Wałbrzych, Poland
| | - Aneta Anna Omelan
- Department of Tourism, Recreation and Ecology, University of Warmia and Mazury in Olsztyn, 10-957 Olsztyn, Poland
| | | | - Andrzej Robert Skrzypczak
- Department of Tourism, Recreation and Ecology, University of Warmia and Mazury in Olsztyn, 10-957 Olsztyn, Poland
| | - Andrzej Pomianowski
- Department of Internal Diseases with Clinic, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland
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28
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MacEachen E, de Rijk A, Dyreborg J, Fassier JB, Fletcher M, Hopwood P, Koivusalo M, Majowicz S, Meyer S, Ståhl C, Welti F. Laws, Policies, and Collective Agreements Protecting Low-wage and Digital Platform Workers During the COVID-19 Pandemic. New Solut 2022; 32:201-212. [PMID: 36262099 PMCID: PMC9582739 DOI: 10.1177/10482911221133796] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
In the context of the COVID-19 pandemic, this commentary describes and compares
shifting employment and occupational health social protections of low-wage
workers, including self-employed digital platform workers. Through a focus on
eight advanced economy countries, this paper identifies how employment
misclassification and definitions of employees were handled in law and policy.
Debates about minimum wage and occupational health and safety standards as they
relate to worker well-being are considered. Finally, we discuss promising
changes introduced during the COVID-19 pandemic that protect the health of
low-wage and self-employed workers. Overall, we describe an ongoing “haves” and
a “have not” divide, with on the one extreme, traditional job arrangements with
good work-and-health social protections and, on the other extreme, low-wage and
self-employed digital platform workers who are mostly left out of schemes.
However, during the pandemic small and often temporary gains occurred and are
discussed.
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Affiliation(s)
| | | | - Johnny Dyreborg
- 2686National Research Centre for the Working Environment, København, Denmark
| | - Jean-Baptiste Fassier
- Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France.,University of Sherbrooke, Sherbrooke, Quebec, Canada
| | | | | | | | | | | | | | - Felix Welti
- 9178University of Kassel, Kassel, Hessen, Germany
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Vazquez R, Navarrete A, Thien Nguyen A, Montiel GI. “A Voice to Uplift Other People”: A Case Study of Integrating Organizing Methods in an FQHC-Based COVID-19 Vaccine Initiative in Latinx Communities. JOURNAL OF HUMANISTIC PSYCHOLOGY 2022. [DOI: 10.1177/00221678221125330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The COVID-19 pandemic added another layer of trauma for working-class communities who have experienced trauma from systemic inequity and racism. Early pandemic response efforts failed to reach the most vulnerable Latinx communities in the United States due to historic disinvestment in these communities. Federally Qualified Health Centers (FQHCs) were uniquely positioned to respond to the pandemic through testing and vaccine implementation because of their footprint in these communities. However, to advance equitable COVID-19 recovery and long-term, trauma-informed community resilience, FQHCs need to expand their role beyond immediate response through testing and vaccine deployment. Applying Freirean principles of liberation to an integrated model for crisis recovery and community resilience-building, this article presents a case study of the implementation of a COVID-19 vaccine outreach and education initiative at AltaMed Health Services, one of the largest FQHCs in the United States. Findings suggest that leveraging organizing and empowerment strategies to implement COVID-19 vaccine distribution in working-class communities contributes to pathways for community health and well-being, infrastructure for crisis response and recovery, equitable service and information delivery ecosystems, and engaged and empowered communities. Lessons from this study can provide a blueprint for integrating strategies for long-term community resilience, capacity-building, and empowerment in crisis response and community harm mitigation initiatives. Findings from this study also present a model for enhancing the role of FQHCs to facilitate community organizing and engagement for health equity.
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Martin MA, Lennon RP, Smith RA, Myrick JG, Small ML, Van Scoy LJ. Essential and non-essential US workers' health behaviors during the COVID-19 pandemic. Prev Med Rep 2022; 29:101889. [PMID: 35847125 PMCID: PMC9270843 DOI: 10.1016/j.pmedr.2022.101889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/09/2022] [Accepted: 07/01/2022] [Indexed: 11/26/2022] Open
Abstract
We seek to quantify the relationship between health behaviors and work-related experiences during the COVID-19 pandemic by predicting health behaviors as a function of essential worker status, job loss, change in work hours, and COVID-19 experiences. We use multivariate models and survey data from 913 employed adults in a semi-rural mid-Atlantic US county, and test whether essential worker results vary by gender, parenthood, and/or university employment. Multivariate models indicate that essential workers used tobacco on more days (4.5; p <.01) and were less likely to sleep 8 h (odds ratio [OR] 0.6; p <.01) than non-essential workers. The risk of sleeping less than 8 h is concentrated among essential workers in the service industry (OR 0.5; p <.05) and non-parents (OR 0.5; p <.05). Feminine essential workers exercised on fewer days (-0.8; p <.05) than feminine non-essential workers. Workers with reduced work hours consumed more alcoholic drinks (0.3; p <.05), while workers with increased work hours consumed alcohol (0.3; p <.05) and exercised (0.6; p <.05) on more days. Essential worker status and changes in work hours are correlated with unhealthy behaviors during the COVID-19 pandemic.
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Affiliation(s)
- Molly A. Martin
- Department of Sociology and Criminology, Pennsylvania State University, University Park, PA, USA
| | - Robert P. Lennon
- Department of Family and Community Medicine, Pennsylvania State College of Medicine, Hershey, PA, USA
| | - Rachel A. Smith
- Department of Communication Arts and Sciences, Pennsylvania State University, University Park, PA, USA
| | - Jessica G. Myrick
- Donald P. Bellisario College of Communications, Pennsylvania State University, University Park, PA, USA
| | - Meg L. Small
- College of Health and Human Development, Pennsylvania State University, University Park, PA, USA
| | - Lauren J. Van Scoy
- Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey, PA, USA
| | - Data4Action Research Group
- Department of Sociology and Criminology, Pennsylvania State University, University Park, PA, USA
- Department of Family and Community Medicine, Pennsylvania State College of Medicine, Hershey, PA, USA
- Department of Communication Arts and Sciences, Pennsylvania State University, University Park, PA, USA
- Donald P. Bellisario College of Communications, Pennsylvania State University, University Park, PA, USA
- College of Health and Human Development, Pennsylvania State University, University Park, PA, USA
- Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey, PA, USA
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Yuan B, Lan J, Li J. Disparity in Occupational Health Risk During the Pandemic: Potential Misestimation and Its Implications for Health Policies. J Occup Environ Med 2022; 64:809-814. [PMID: 35673258 PMCID: PMC9524524 DOI: 10.1097/jom.0000000000002563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study clarifies potential misestimation of occupational risk caused by the dichotomy of frontline essential and nonessential occupations in prior studies. METHODS The linear regression is used to investigate the occupational risk in terms of incidence rate, hospitalization, and mortality on community level during the pandemic. RESULTS Overall, frontline essential occupations were positively associated with incidence rate, hospitalization, and mortality (156.06, 18.47, and 3.49; P < 0.01). Among essential occupations, however, education, training, and library occupations were negatively associated with them, whereas transportation, protective service, food preparation, and serving occupations were insignificantly associated with them. Moreover, among nonessential occupations, building and grounds cleaning, construction, and extraction occupations were positively associated with them. CONCLUSION The dichotomy of frontline essential and nonessential occupations can bring overestimation and underestimation of occupational risk during the COVID-19 pandemic.
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Zhang Y, Woods EH, Roemer EC, Kent KB, Goetzel RZ. Addressing Workplace Stressors Emerging from the Pandemic. Am J Health Promot 2022; 36:1215-1223. [PMID: 36003011 PMCID: PMC9412133 DOI: 10.1177/08901171221112488b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ying Zhang
- Johns Hopkins Bloomberg School of Public Health
| | | | - Enid Chung Roemer
- Institute for Health and Productivity Studies, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karen B. Kent
- Institute for Health and Productivity Studies, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ron Z. Goetzel
- Institute for Health and Productivity Studies, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Henke RM. Knowing Well, Being Well: well-being born of understanding: Supporting Workforce Mental Health During the Pandemic. Am J Health Promot 2022; 36:1213-1244. [PMID: 36003017 PMCID: PMC9523433 DOI: 10.1177/08901171221112488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Nelson KN, Siegler AJ, Sullivan PS, Bradley H, Hall E, Luisi N, Hipp-Ramsey P, Sanchez T, Shioda K, Lopman BA. Nationally representative social contact patterns among U.S. adults, August 2020-April 2021. Epidemics 2022; 40:100605. [PMID: 35810698 PMCID: PMC9242729 DOI: 10.1016/j.epidem.2022.100605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 06/14/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022] Open
Abstract
The response to the COVID-19 pandemic in the U.S prompted abrupt and dramatic changes to social contact patterns. Monitoring changing social behavior is essential to provide reliable input data for mechanistic models of infectious disease, which have been increasingly used to support public health policy to mitigate the impacts of the pandemic. While some studies have reported on changing contact patterns throughout the pandemic, few have reported differences in contact patterns among key demographic groups and none have reported nationally representative estimates. We conducted a national probability survey of US households and collected information on social contact patterns during two time periods: August-December 2020 (before widespread vaccine availability) and March-April 2021 (during national vaccine rollout). Overall, contact rates in Spring 2021 were similar to those in Fall 2020, with most contacts reported at work. Persons identifying as non-White, non-Black, non-Asian, and non-Hispanic reported high numbers of contacts relative to other racial and ethnic groups. Contact rates were highest in those reporting occupations in retail, hospitality and food service, and transportation. Those testing positive for SARS-CoV-2 antibodies reported a higher number of daily contacts than those who were seronegative. Our findings provide evidence for differences in social behavior among demographic groups, highlighting the profound disparities that have become the hallmark of the COVID-19 pandemic.
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Affiliation(s)
- Kristin N Nelson
- Department of Epidemiology, Rollins School of Public Health, Emory University, USA.
| | - Aaron J Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, USA
| | - Heather Bradley
- Department of Population Health Sciences, Georgia State University School of Public Health, USA
| | - Eric Hall
- School of Public Health, Oregon Health & Science University, USA
| | - Nicole Luisi
- Department of Epidemiology, Rollins School of Public Health, Emory University, USA
| | - Palmer Hipp-Ramsey
- Department of Epidemiology, Rollins School of Public Health, Emory University, USA
| | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, USA
| | - Kayoko Shioda
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, USA
| | - Benjamin A Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, USA
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Meza E, Giglio L, Franco AO, Rodriguez E, Stock L, Balmes J, Torres JM, Fernandez A. Worker Perspectives on COVID-19 Risks: A Qualitative Study of Latino Construction Workers in Oakland, California. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19169822. [PMID: 36011454 PMCID: PMC9408167 DOI: 10.3390/ijerph19169822] [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: 06/23/2022] [Revised: 07/30/2022] [Accepted: 08/05/2022] [Indexed: 05/10/2023]
Abstract
Latino construction workers in the U.S. have faced a disproportionate risk for COVID-19 infection in the workplace. Prior studies have focused on quantifying workplace risk for COVID-19 infection; few have captured workers' experiences and perspectives. This study describes COVID-19-related workplace risks from the perspectives of Latino construction workers. We conducted a qualitative study using semi-structured phone interviews with Latino construction workers from the Fruitvale District of Oakland, California. Twenty individuals were interviewed from December 2020 to March 2021. Nearly all participants (19/20) were Spanish-speaking men; mean age 42.6 years. The majority were low-income and over one-third did not have health insurance. Participants worked in varied construction-related jobs ranging from demolition to office work; additionally, four were day laborers, and three belonged to a labor union. We identified four major themes with public health policy and workplace safety implications: (1) Major concern about the risk of SARS-CoV-2 infection for family health and economic wellbeing; (2) Clarity about mask use and social distancing but not disclosure; (3) Variability in access to additional resources provided by employers; and (4) Uncertainty around structural support for SARS-CoV-2 quarantine/isolation. Our findings provide further evidence from workers' own perspectives of the major gaps experienced during the pandemic in workplace protections and resources.
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Affiliation(s)
- Erika Meza
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158, USA
- Correspondence:
| | - Leslie Giglio
- Department of Medicine, Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA 94110, USA
| | - Ana O. Franco
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158, USA
| | - Elizabeth Rodriguez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158, USA
- Department of Biology, San Francisco State University, San Francisco, CA 94132, USA
| | - Laura Stock
- Labor Occupational Health Program, School of Public Health, University of California, Berkeley, CA 94720, USA
| | - John Balmes
- Division of Occupational and Environmental Medicine, School of Medicine, University of California, San Francisco, CA 94143, USA
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94704, USA
| | - Jacqueline M. Torres
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158, USA
| | - Alicia Fernandez
- Department of Medicine, Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA 94110, USA
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Sivin DD. Racial Justice Demands a Permanent OSHA Standard to Protect All Workers From COVID-19. New Solut 2022; 32:84-85. [PMID: 35822780 PMCID: PMC9280118 DOI: 10.1177/10482911221112195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Darius D Sivin
- NEW SOLUTIONS: A Journal of Occupational and Environmental Health Policy, Washington, DC USA
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Billock RM, Haring Sweeney M, Steege AL, Michaels R, Luckhaupt SE. Identifying essential critical infrastructure workers during the COVID-19 pandemic using standardized industry codes. Am J Ind Med 2022; 65:548-555. [PMID: 35532007 PMCID: PMC9347652 DOI: 10.1002/ajim.23361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/29/2022] [Accepted: 04/25/2022] [Indexed: 11/09/2022]
Abstract
Background The Cybersecurity and Infrastructure Security Agency (CISA) produced an advisory list identifying essential critical infrastructure workers (ECIW) during the coronavirus disease 2019 (COVID‐19) response. The CISA advisory list is the most common national definition of ECIW but has not been mapped to United States (U.S.) Census industry codes (CICs) to readily identify these worker populations in public health data sources. Methods We identified essential critical infrastructure industry designations corresponding to v4.0 of the CISA advisory list for all six‐digit North American Industry Classification System (NAICS) codes and cross‐walked NAICS codes to CICs. CICs were grouped as essential, non‐essential, or mixed essential/non‐essential according to component NAICS industries. We also obtained national estimated population sizes for NAICS and Census industries and cross‐tabulated Census industry and occupation codes to identify industry‐occupation pairs. Results We produced and made publicly available spreadsheets containing essential industry designations corresponding to v4.0 of the CISA advisory list for NAICS and Census industry titles and codes and population estimates by six‐digit NAICS industry, Census industry, and Census industry‐occupation pair. The CISA advisory list is highly inclusive and contains most industries and U.S. workers; 71.0% of Census industries comprising 80.6% of workers and 80.7% of NAICS industries comprising 87.1% of workers were designated as essential. Conclusions We identified workers in essential critical infrastructure industries as defined by CISA using standardized industry codes. These classifications may support public health interventions and analyses related to the COVID‐19 pandemic and future public health crises.
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Affiliation(s)
- Rachael M. Billock
- Division of Field Studies and Engineering National Institute for Occupational Safety and Health, CDC Cincinnati Ohio USA
| | - Marie Haring Sweeney
- Division of Field Studies and Engineering National Institute for Occupational Safety and Health, CDC Cincinnati Ohio USA
| | - Andrea L. Steege
- Division of Field Studies and Engineering National Institute for Occupational Safety and Health, CDC Cincinnati Ohio USA
| | - Ryan Michaels
- Federal Reserve Bank of Philadelphia Philadelphia Pennsylvania USA
| | - Sara E. Luckhaupt
- Division of Field Studies and Engineering National Institute for Occupational Safety and Health, CDC Cincinnati Ohio USA
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Seidenfeld J, Tupetz A, Fiorino C, Limkakeng A, Silva L, Staton C, Vissoci JRN, Purakal J. Experiences of COVID-19 infection in North Carolina: A qualitative analysis. PLoS One 2022; 17:e0269338. [PMID: 35653407 PMCID: PMC9162358 DOI: 10.1371/journal.pone.0269338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/18/2022] [Indexed: 11/02/2022] Open
Abstract
Background and aim
It has been demonstrated that marginalized populations across the U.S. have suffered a disproportionate burden of the coronavirus disease 2019 (COVID-19) pandemic, illustrating the role that social determinants of health play in health outcomes. To better understand how these vulnerable and high-risk populations have experienced the pandemic, we conducted a qualitative study to better understand their experiences from diagnosis through recovery.
Methods
We conducted a qualitative study of patients in a North Carolina healthcare system’s registry who tested positive for COVID-19 from March 2020 through February 2021, identified from population-dense outbreaks of COVID-19 (hotspots). We conducted semi-structured phone interviews in English or Spanish, based on patient preference, with trained bilingual study personnel. Each interview was evaluated using a combination of deductive and inductive content analysis to determine prevalent themes related to COVID-19 knowledge, diagnosis, disease experience, and long-term impacts.
Findings
The 10 patients interviewed from our COVID-19 hotspot clusters were of equal distribution by sex, predominantly Black (70%), aged 22–70 years (IQR 45–62 years), and more frequently publicly insured (50% Medicaid/Medicare, vs 30% uninsured, vs 20% private insurance). Major themes identified included prior knowledge of COVID-19 and patient perceptions of their personal risk, the testing process in numerous settings, the process of quarantining at home after a positive diagnosis, the experience of receiving medical care during their illness, and difficulties with long-term recovery.
Discussion
Our findings suggest areas for targeted interventions to reduce COVID-19 transmission in these high-risk communities, as well as improve the patient experience throughout the COVID-19 illness course.
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Affiliation(s)
- Justine Seidenfeld
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, United States of America
- * E-mail:
| | - Anna Tupetz
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
| | - Cassandra Fiorino
- Duke University School of Medicine, Durham, NC, United States of America
| | - Alexander Limkakeng
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
| | - Lincoln Silva
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Catherine Staton
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Joao R. N. Vissoci
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - John Purakal
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States of America
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Service innovation in the restaurant sector during COVID-19: digital technologies to reduce customers' risk perception. TQM JOURNAL 2022. [DOI: 10.1108/tqm-01-2022-0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis paper investigates the extent to which the COVID-19 pandemic has accelerated service innovation in the restaurant sector. It explores the use of digital technologies (DT) as a safety-empowerment and resilient strategy in the food-service industry during the pandemic. It also investigates the impact of DT on customers' risk perception (CRP) and customers' intention to go to restaurants (CIR) in Italy.Design/methodology/approachBased on the theory of planned behaviour and perceived risk theory, this study investigates a sample of customers residing in Italy. Multiple regression and mediation analyses are conducted to test the research hypotheses, adapting the logic model developed. Using the bootstrapping technique, this study also explores whether the pandemic has moderated the relationship among several variables adapted from the literature. Robustness tests are also performed to corroborate the analysis.FindingsThe pandemic has accelerated the food-service industry's digital transformation, forcing restauranteurs to implement DT to survive. Findings show that DT support restauranteurs in implementing innovative services that reduce interactions and empower cleanliness among workers and customers, reducing CRP and preserving CIR. Thus, managing risk perception is helping the restaurant sector to recover.Practical implicationsPractical implications are presented for policymakers to catalyse the digital transformation in small- and medium-sized restaurants. The results may also be beneficial for entrepreneurs who can implement innovative service practices in order to reduce interaction and empower cleanliness levels. Moreover, academics can use these results to conduct similar research in other geographical contexts.Originality/valueThe present research represents the first study investigating the relationship between the use of digital technologies and the intentions of customers to go out for dinner during the ongoing pandemic in Italy.
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Pizarro AB, Persad E, Durao S, Nussbaumer-Streit B, Engela-Volker JS, McElvenny D, Rhodes S, Stocking K, Fletcher T, Martin C, Noertjojo K, Sampson O, Verbeek JH, Jørgensen KJ, Bruschettini M. Workplace interventions to reduce the risk of SARS-CoV-2 infection outside of healthcare settings. Cochrane Database Syst Rev 2022; 5:CD015112. [PMID: 35514111 PMCID: PMC9073086 DOI: 10.1002/14651858.cd015112.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although many people infected with SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) experience no or mild symptoms, some individuals can develop severe illness and may die, particularly older people and those with underlying medical problems. Providing evidence-based interventions to prevent SARS-CoV-2 infection has become more urgent with the spread of more infectious SARS-CoV-2 variants of concern (VoC), and the potential psychological toll imposed by the coronavirus disease 2019 (COVID-19) pandemic. Controlling exposures to occupational hazards is the fundamental method of protecting workers. When it comes to the transmission of viruses, such as SARS-CoV-2, workplaces should first consider control measures that can potentially have the most significant impact. According to the hierarchy of controls, one should first consider elimination (and substitution), then engineering controls, administrative controls, and lastly, personal protective equipment (PPE). OBJECTIVES To assess the benefits and harms of interventions in non-healthcare-related workplaces to reduce the risk of SARS-CoV-2 infection relative to other interventions, or no intervention. SEARCH METHODS We searched MEDLINE, Embase, Web of Science, Cochrane COVID-19 Study Register, the Canadian Centre for Occupational Health and Safety (CCOHS), Clinicaltrials.gov, and the International Clinical Trials Registry Platform to 14 September 2021. We will conduct an update of this review in six months. SELECTION CRITERIA We included randomised control trials (RCT) and planned to include non-randomised studies of interventions. We included adult workers, both those who come into close contact with clients or customers (e.g. public-facing employees, such as cashiers or taxi drivers), and those who do not, but who could be infected by co-workers. We excluded studies involving healthcare workers. We included any intervention to prevent or reduce workers' exposure to SARS-CoV-2 in the workplace, defining categories of intervention according to the hierarchy of hazard controls, i.e. elimination; engineering controls; administrative controls; personal protective equipment. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were incidence rate of SARS-CoV-2 infection (or other respiratory viruses), SARS-CoV-2-related mortality, adverse events, and absenteeism from work. Our secondary outcomes were all-cause mortality, quality of life, hospitalisation, and uptake, acceptability, or adherence to strategies. We used the Cochrane RoB 2 tool to assess the risk of bias, and GRADE methods to assess the certainty of evidence for each outcome. MAIN RESULTS Elimination of exposure interventions We included one study examining an intervention that focused on elimination of hazards. This study is an open-label, cluster-randomised, non-inferiority trial, conducted in England in 2021. The study compared standard 10-day self-isolation after contact with an infected person to a new strategy of daily rapid antigen testing and staying at work if the test is negative (test-based attendance). The trialists hypothesised that this would lead to a similar rate of infections, but lower COVID-related absence. Staff (N = 11,798) working at 76 schools were assigned to standard isolation, and staff (N = 12,229) at 86 schools to the test-based attendance strategy. The results between test-based attendance and standard 10-day self-isolation were inconclusive for the rate of symptomatic PCR-positive SARS-COV-2 infection rate ratio ((RR) 1.28, 95% confidence interval (CI) 0.74 to 2.21; 1 study, very low-certainty evidence)). The results between test-based attendance and standard 10-day self-isolation were inconclusive for the rate of any PCR-positive SARS-COV-2 infection (RR 1.35, 95% CI 0.82 to 2.21; 1 study, very low-certainty evidence). COVID-related absenteeism rates were 3704 absence days in 566,502 days-at-risk (6.5 per 1000 days at risk) in the control group and 2932 per 539,805 days-at-risk (5.4 per 1000 days at risk) in the intervention group (RR 0.83; 95% CI 0.55 to 1.25). The certainty of the evidence was downgraded to low, due to imprecision. Uptake of the intervention was 71 % in the intervention group, but not reported for the control intervention. The trial did not measure other outcomes, SARS-CoV-2-related mortality, adverse events, all-cause mortality, quality of life, and hospitalisation. We found one ongoing RCT about screening in schools, using elimination of hazard strategies. Personal protective equipment We found one ongoing non-randomised study on the effects of closed face shields to prevent COVID-19 transmission. Other intervention categories We did not find studies in the other intervention categories. AUTHORS' CONCLUSIONS We are uncertain whether a test-based attendance policy affects rates of PCR-postive SARS-CoV-2 infection (any infection; symptomatic infection) compared to standard 10-day self-isolation amongst school and college staff. Test-based attendance policy may result in little to no difference in absence rates compared to standard 10-day self-isolation. As a large part of the population is exposed in the case of a pandemic, an apparently small relative effect that would not be worthwhile from the individual perspective may still affect many people, and thus, become an important absolute effect from the enterprise or societal perspective. The included study did not report on any other primary outcomes of our review, i.e. SARS-CoV-2-related mortality and adverse events. No completed studies were identified on any other interventions specified in this review, but two eligible studies are ongoing. More controlled studies are needed on testing and isolation strategies, and working from home, as these have important implications for work organisations.
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Affiliation(s)
| | - Emma Persad
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | - Solange Durao
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Barbara Nussbaumer-Streit
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | - Jean S Engela-Volker
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Damien McElvenny
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
| | - Sarah Rhodes
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Katie Stocking
- Centre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Tony Fletcher
- Epidemiology Department, Public Health England Centre for Radiation Chemical and Environmental Hazards (CRCE), London, UK
| | | | | | | | | | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Matteo Bruschettini
- Cochrane Sweden, Lund University, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Skåne University Hospital, Lund, Sweden
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Gerdes ME, Aistis LA, Sachs NA, Williams M, Roberts JD, Rosenberg Goldstein RE. Reducing Anxiety with Nature and Gardening (RANG): Evaluating the Impacts of Gardening and Outdoor Activities on Anxiety among U.S. Adults during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5121. [PMID: 35564513 PMCID: PMC9100102 DOI: 10.3390/ijerph19095121] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 02/05/2023]
Abstract
The COVID-19 pandemic impacted mental health. Growing research has identified the mental health benefits of nature contact, including gardening. We used a cross-sectional survey to investigate the association between gardening and other outdoor activities with anxiety among U.S. adults. The RANG (Reducing Anxiety with Nature and Gardening) survey was distributed online from June−September 2020 through social media (Twitter and Facebook) and a national Master Gardeners listserv. Survey questions captured demographics, COVID-19 experiences, gardening, outdoor activities, and anxiety using the Generalized Anxiety Disorder 7-item scale. Data were analyzed using chi-square, Fisher’s exact, and Kruskal−Wallis tests, as well as logistic regression. Among participants, 46% reported anxiety symptoms. Participants who had gardened ≥ 15 years and those gardening > 8 h over two weeks had lower anxiety scores. Spending more time outdoors on weekdays also decreased anxiety scores. After adjusting for covariates, lower odds of anxiety were identified for 50−69 and 70−89-year-olds vs. 18−29-year-olds; males vs. females; and Texas vs. Maryland residents. These findings confirm increased anxiety during the COVID-19 pandemic and suggest that sustained gardening and other outdoor activities could help reduce anxiety.
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Affiliation(s)
- Megan E. Gerdes
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD 20742, USA;
| | - Lucy A. Aistis
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD 20742, USA;
| | - Naomi A. Sachs
- Department of Plant Science and Landscape Architecture, University of Maryland, College Park, MD 20742, USA;
| | - Marcus Williams
- Baltimore City Extension, University of Maryland Extension, Baltimore, MD 21215, USA;
| | - Jennifer D. Roberts
- Department of Kinesiology, School of Public Health, University of Maryland, College Park, MD 20742, USA;
| | - Rachel E. Rosenberg Goldstein
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD 20742, USA;
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Nelson KN, Siegler AJ, Sullivan PS, Bradley H, Hall E, Luisi N, Hipp-Ramsey P, Sanchez T, Shioda K, Lopman BA. Nationally Representative Social Contact Patterns among U.S. adults, August 2020-April 2021. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2021.09.22.21263904. [PMID: 35378746 PMCID: PMC8978954 DOI: 10.1101/2021.09.22.21263904] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The response to the COVID-19 pandemic in the U.S prompted abrupt and dramatic changes to social contact patterns. Monitoring changing social behavior is essential to provide reliable input data for mechanistic models of infectious disease, which have been increasingly used to support public health policy to mitigate the impacts of the pandemic. While some studies have reported on changing contact patterns throughout the pandemic., few have reported on differences in contact patterns among key demographic groups and none have reported nationally representative estimates. We conducted a national probability survey of US households and collected information on social contact patterns during two time periods: August-December 2020 (before widespread vaccine availability) and March-April 2021 (during national vaccine rollout). Overall, contact rates in Spring 2021 were similar to those in Fall 2020, with most contacts reported at work. Persons identifying as non-White, non-Black, non-Asian, and non-Hispanic reported high numbers of contacts relative to other racial and ethnic groups. Contact rates were highest in those reporting occupations in retail, hospitality and food service, and transportation. Those testing positive for SARS-CoV-2 antibodies reported a higher number of daily contacts than those who were seronegative. Our findings provide evidence for differences in social behavior among demographic groups, highlighting the profound disparities that have become the hallmark of the COVID-19 pandemic.
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Affiliation(s)
- Kristin N Nelson
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Aaron J Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Heather Bradley
- Department of Population Health Sciences, Georgia State University School of Public Health
| | - Eric Hall
- School of Public Health, Oregon Health & Science University
| | - Nicole Luisi
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | | | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Kayoko Shioda
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University
| | - Benjamin A Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University
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Hannon PA, Hammerback K, Kava CM, Bravo-Acevedo P, Strait M, Harris JR. By the Seat of Our Pants: the Experience of Small Businesses in the COVID-19 Pandemic, Washington State, March-October 2020. Prev Chronic Dis 2022; 19:E14. [PMID: 35324423 PMCID: PMC8992682 DOI: 10.5888/pcd19.210366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Most US businesses are small, yet they employ almost half of the nation's workforce. Literature is limited about how small employers (those with 20-250 employees) have made decisions about operating their businesses during the COVID-19 pandemic. We sought to learn how employers made these decisions, what information sources they used, what information they wanted, and to what extent they worked with or used information from their local health department. METHODS We conducted qualitative, semistructured interviews with 26 employers in Washington State, from August through October 2020. Employers were recruited from 7 counties (4 urban and 3 rural) that were experiencing either higher or lower COVID-19 case rates than Washington State overall. RESULTS Employers relied heavily on national government resources to make decisions about how to operate their businesses during the COVID-19 pandemic. Few employers had relationships with or turned to their local health departments for information or support. Employers wanted information about COVID-19 safety that was specific to their business operations and industry. Employers also described the emotional toll of COVID-19 and the challenge of trying to make high-stakes decisions with rapidly evolving information. CONCLUSION Small employers showed little awareness of their local health departments and the information and assistance they could provide. Local health departments could increase their visibility and build relationships with small employers by partnering with them on value-added services such as workplace health promotion. Establishing these relationships could support more rapid collaboration between local health departments and small employers during future public health crises.
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Affiliation(s)
- Peggy A Hannon
- Department of Health Systems and Population Health, University of Washington, 3980 15th Ave NE, 4th Floor, UW Mailbox 351621, Seattle, WA 98105.
| | - Kristen Hammerback
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington
| | - Christine M Kava
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington
| | - Perla Bravo-Acevedo
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington
| | - Michelle Strait
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington
| | - Jeffrey R Harris
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington
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Roberts JD, Dickinson KL, Hendricks MD, Jennings V. "I Can't Breathe": Examining the Legacy of American Racism on Determinants of Health and the Ongoing Pursuit of Environmental Justice. Curr Environ Health Rep 2022; 9:211-227. [PMID: 35244891 PMCID: PMC8894549 DOI: 10.1007/s40572-022-00343-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 12/03/2022]
Abstract
Purpose of Review “I can’t breathe” were the last words spoken by Eric Garner (July 17, 2014), Javier Ambler (March 28, 2019), Elijah McClain (August 30, 2019), Manuel Ellis (March 3, 2020), and George Floyd (May 25, 2020). These were all African American men who died at the hands of police in the United States. Recently, police brutality has gained critical and overdue attention as one clear manifestation of systemic racism. However, historical and current policies related to a wide range of environmental hazards have exposed Black, Indigenous, and People of Color (BIPOC) to disproportionately high levels of physical, mental, social, emotional, and cultural toxicities, thus creating unbreathable and unlivable communities. Recent Findings This paper traces the roots of systemic anti-Black racism in America from its origins in the 1400s, through systems of scientific racism that pathologized Blackness in order to justify slavery, and through evolving policies and structures that have shifted over time but consistently exposed many African American communities to unsafe and unhealthy environments. Summary We conclude with calls for bold solutions to move through and past this oppressive history and toward true environmental justice the enables all communities to thrive together.
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Affiliation(s)
- Jennifer D Roberts
- Department of Kinesiology, School of Public Health, University of Maryland, College Park, MD, 20742, USA.
| | - Katherine L Dickinson
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz, Aurora, CO, 80045, USA
| | - Marccus D Hendricks
- Department of Urban Studies and Planning, School of Architecture, Planning and Preservation, University of Maryland, College Park, MD, 20742, USA
| | - Viniece Jennings
- Department of Public Health, Agnes Scott College, Decatur, GA, 30030, USA
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Early Care and Education Workers' Experience and Stress during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052670. [PMID: 35270362 PMCID: PMC8910108 DOI: 10.3390/ijerph19052670] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/18/2022] [Accepted: 02/24/2022] [Indexed: 01/29/2023]
Abstract
Early care and education (ECE) workers experience many job-related stressors. During the COVID-19 pandemic, ECE programs either closed or remained open while workers faced additional demands. We deployed a survey of the center-based ECE workforce in Washington State (United States) one year into the COVID-19 pandemic to assess impacts and workers' perceived stress levels. We describe the prevalence of reported impacts, including workplace closures; job changes; COVID-19 transmission; risk factors for severe COVID-19; the use of social distancing practices; satisfaction with workplace responses; perceptions of worker roles, respect, and influence; and food and financial insecurity. Themes from open-ended responses illustrate how workers' jobs changed and the stressors that workers experienced as a result. Fifty-seven percent of ECE workers reported moderate or high levels of stress. In a regression model assessing unique contributions to stress, work changes that negatively impacted home life contributed most to stress. Feeling respected for one's work and feeling positive about one's role as an "essential worker" contributed to lower levels of stress. Experiencing financial insecurity, caring for school-aged children or children of multiple ages, being younger, and being born in the United States also contributed to higher stress. Findings can inform policies designed to support the workforce.
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Robinson JM, Redvers N, Camargo A, Bosch CA, Breed MF, Brenner LA, Carney MA, Chauhan A, Dasari M, Dietz LG, Friedman M, Grieneisen L, Hoisington AJ, Horve PF, Hunter A, Jech S, Jorgensen A, Lowry CA, Man I, Mhuireach G, Navarro-Pérez E, Ritchie EG, Stewart JD, Watkins H, Weinstein P, Ishaq SL. Twenty Important Research Questions in Microbial Exposure and Social Equity. mSystems 2022; 7:e0124021. [PMID: 35089060 PMCID: PMC8725600 DOI: 10.1128/msystems.01240-21] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Social and political policy, human activities, and environmental change affect the ways in which microbial communities assemble and interact with people. These factors determine how different social groups are exposed to beneficial and/or harmful microorganisms, meaning microbial exposure has an important socioecological justice context. Therefore, greater consideration of microbial exposure and social equity in research, planning, and policy is imperative. Here, we identify 20 research questions considered fundamentally important to promoting equitable exposure to beneficial microorganisms, along with safeguarding resilient societies and ecosystems. The 20 research questions we identified span seven broad themes, including the following: (i) sociocultural interactions; (ii) Indigenous community health and well-being; (iii) humans, urban ecosystems, and environmental processes; (iv) human psychology and mental health; (v) microbiomes and infectious diseases; (vi) human health and food security; and (vii) microbiome-related planning, policy, and outreach. Our goal was to summarize this growing field and to stimulate impactful research avenues while providing focus for funders and policymakers.
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Affiliation(s)
- Jake M. Robinson
- University of Sheffield, Department of Landscape Architecture, Sheffield, United Kingdom
| | - Nicole Redvers
- Department of Family & Community Medicine, University of North Dakota School of Medicine & Health Sciences, Grand Forks, North Dakota, USA
| | | | - Christina A. Bosch
- Department of Literacy, Early, Bilingual and Special Education, Kremen School of Education and Human Development, California State University, Fresno, California, USA
| | - Martin F. Breed
- College of Science and Engineering, Flinders University, Bedford Park, SA, Australia
| | - Lisa A. Brenner
- University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Megan A. Carney
- School of the Environment, Florida Agricultural and Mechanical University, Tallahassee, Florida, USA
| | - Ashvini Chauhan
- University of Arizona, School of Anthropology and Center for Regional Food Studies, Tucson, Arizona, USA
| | - Mauna Dasari
- Department of Biological Sciences, University of Notre Dame, Notre Dame, Indiana, USA
| | - Leslie G. Dietz
- University of Oregon, Biology and the Built Environment Center, Eugene, Oregon, USA
| | - Michael Friedman
- American International College of Arts and Sciences of Antigua, Antigua and Barbuda, West Indies
| | - Laura Grieneisen
- Department of Genetics, Cell, and Development, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Patrick F. Horve
- University of Oregon, Institute of Molecular Biology, Eugene, Oregon, USA
| | - Ally Hunter
- Department of Student Development, University of Massachusetts, Amherst, Massachusetts, USA
| | - Sierra Jech
- University of Colorado Boulder, Department of Ecology and Evolutionary Biology, Boulder, Colorado, USA
| | - Anna Jorgensen
- Department of Landscape Architecture, University of Sheffield, Sheffield, United Kingdom
| | - Christopher A. Lowry
- Department of Integrative Physiology, Center for Neuroscience, and Center for Microbial Exploration, University of Colorado Boulder, Boulder, Colorado, USA
| | - Ioana Man
- Architectural Association School of Architecture, London, United Kingdom
| | - Gwynne Mhuireach
- Department of Architecture, University of Oregon, Eugene, Oregon, USA
| | - Edauri Navarro-Pérez
- Program of Environmental Life Sciences, School of Life Sciences, Arizona State University, Tempe, Arizona, USA
| | - Euan G. Ritchie
- School of Life and Environmental Sciences and Centre for Integrative Ecology, Deakin University, Burwood, VIC, Australia
| | - Justin D. Stewart
- Department of Ecological Science, Faculty of Earth and Life Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Harry Watkins
- St. Andrews Botanic Garden, Canongate, St. Andrews, Fife, United Kingdom
- Bio-integrated Design Lab, Bartlett School of Architecture, London, United Kingdom
| | - Philip Weinstein
- School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Suzanne L. Ishaq
- University of Maine, School of Food and Agriculture, Orono, Maine, USA
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Grills C, Carlos Chavez FL, Saw A, Walters KL, Burlew K, Randolph Cunningham SM, Rosario CC, Samoa R, Jackson‐Lowman H. Applying culturalist methodologies to discern COVID-19's impact on communities of color. JOURNAL OF COMMUNITY PSYCHOLOGY 2022:10.1002/jcop.22802. [PMID: 35102549 PMCID: PMC9015500 DOI: 10.1002/jcop.22802] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/06/2021] [Accepted: 01/07/2022] [Indexed: 05/23/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has disproportionately impacted communities of color (CoC) amid increasing incidents of racial injustices and racism. In this article, we describe our culturalist methodologies for designing and implementing a multi-ethnic, interdisciplinary national needs assessment developed in partnership with CoC. Instead of a typical western-centric social science approach that typically ignores and perpetuates structural racism and settler colonialism, the research team implemented culturalist and community-partnered approaches that were further contextualized to the context of structural racism and settler colonialism. The culturalist approach yielded two sets of themes both related to the impact of the pandemic on CoC. The first set involved syndemic factors that contribute to the adverse impact of COVID-19. These include historical trauma; racism, racial stress, and discrimination; and cultural mistrust. The second set consisted of factors that potentially mitigate the impact of the COVID-19. These include cultural protective factors; community engagement; communal ethos, and data disaggregation. Our methodologies and the resulting findings encourage research praxis that uplifts the shared effects of the social determinants of health while honoring unique cultural and contextual experiences-a lesson that social science researchers largely have yet to learn.
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Affiliation(s)
- Cheryl Grills
- Department of Psychological ScienceLoyola Marymount UniversityLos AngelesCaliforniaUSA
| | - Fiorella L. Carlos Chavez
- Edson College of Nursing and Health InnovationArizona State University – Downtown Phoenix CampusPhoenixArizonaUSA
| | - Anne Saw
- Department of PsychologyDe Paul UniversityChicagoIllinoisUSA
| | | | - Kathleen Burlew
- Department of PsychologyUniversity of CincinnatiCincinnatiOhioUSA
| | | | - Cristalis Capielo Rosario
- Department of Counseling and Counseling and PsychologyArizona State University – TempeTempeArizonaUSA
| | - Raynald Samoa
- City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
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Nagata JM, Cortez CA, Dooley EE, Iyer P, Ganson KT, Pettee Gabriel K. Moderate-to-vigorous intensity physical activity among adolescents in the USA during the COVID-19 pandemic. Prev Med Rep 2022; 25:101685. [PMID: 35004134 PMCID: PMC8719022 DOI: 10.1016/j.pmedr.2021.101685] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/04/2021] [Accepted: 12/26/2021] [Indexed: 12/27/2022] Open
Abstract
The study examined adolescents’ physical activity during the COVID-19 pandemic. Median moderate-to-vigorous physical activity was 2 h per week. 8.9% met physical activity guidelines during the pandemic compared to 16.1% before. Poor mental health, worry, and stress were associated with lower physical activity. Higher coping and social support were associated with higher physical activity.
This study aimed to evaluate adolescents’ moderate-to-vigorous intensity physical activity (MVPA) during the COVID-19 pandemic with regards to sociodemographic characteristics and determine mental health and resiliency factors associated with MVPA among a diverse national sample of adolescents ages 10–14 years. Data were collected during the pandemic in May 2020 from the Adolescent Brain Cognitive Development Study (ABCD, N = 5,153), a national prospective cohort study in the U.S. MVPA was quantified as the product of reported duration and frequency (hours per week), which was further summarized as the proportion meeting age-appropriate 2018 Physical Activity Guidelines for Americans. A similar estimate was generated using MVPA data collected prior to the pandemic. Mental health and resiliency measures were collected during the pandemic. Regression models examined associations between mental health or resiliency measures and MVPA during the pandemic. Median MVPA was 2 h per week (IQR 0, 6). Overall, the percentage of the cohort meeting MVPA guidelines decreased from 16.1% (pre-pandemic) to 8.9% (during the pandemic). Racial/ethnic minority adolescents and adolescents from lower socioeconomic backgrounds were significantly less likely to meet MVPA guidelines during the pandemic. Poorer mental health, COVID-related worry, and stress were associated with lower MVPA, while more social support and coping behaviors were associated with higher MVPA during the pandemic. In this large, national sample of adolescents, the proportion of those meeting MVPA Guidelines was lower during the COVID-19 pandemic, with significant disparities by race/ethnicity and socioeconomic status. Interventions to promote social support and coping behaviors may improve MVPA levels among adolescents during the pandemic.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0110, San Francisco, CA 94143, USA
| | - Catherine A Cortez
- Fielding School of Public Health, University of California, Los Angeles, 650 Charles E Young Dr, Los Angeles, CA 90095, USA
| | - Erin E Dooley
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL 35233, USA
| | - Puja Iyer
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0110, San Francisco, CA 94143, USA
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St W, Toronto, ON M5S 1V4, Canada
| | - Kelley Pettee Gabriel
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL 35233, USA
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Damian AJ, Stinchfield K, Kearney RT. Telehealth and Beyond: Promoting the Mental Well-Being of Children and Adolescents During COVID. Front Pediatr 2022; 10:793167. [PMID: 35237538 PMCID: PMC8882817 DOI: 10.3389/fped.2022.793167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- April Joy Damian
- Weitzman Institute, Community Health Center, Inc., Middletown, CT, United States.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - R Timothy Kearney
- Weitzman Institute, Community Health Center, Inc., Middletown, CT, United States
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50
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Chiumento G, Yousey-Hindes K, Edmundson A, Hadler JL. Persistence of racial/ethnic and socioeconomic status disparities among non-institutionalized patients hospitalized with COVID-19 in Connecticut, July to December 2020. Influenza Other Respir Viruses 2021; 16:532-541. [PMID: 34874099 PMCID: PMC8983889 DOI: 10.1111/irv.12945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 01/08/2023] Open
Abstract
Background COVID‐19 hospitalizations of non‐institutionalized persons during the first COVID‐19 wave in Connecticut disproportionately affected the elderly, communities of color, and individuals of low socioeconomic status (SES). Whether the magnitude of these disparities changed after the initial lockdown and before vaccine rollout is not well documented. Methods All first‐time hospitalizations with laboratory‐confirmed COVID‐19 during July to December 2020, including patients' geocoded residential addresses, were obtained from the Connecticut Department of Public Health. Those living in congregate settings, including nursing homes, were excluded. Community‐dwelling patients were assigned census tract‐level poverty and crowding measures from the 2014–2018 American Community Survey by linking their geocoded addresses to census tracts. Age‐adjusted incidence and relative rates were calculated across demographic and SES measures and compared with those from a similar analysis of hospitalized cases during the initial wave. Results During July to December 2020, there were 5652 COVID‐19 hospitalizations in community residents in Connecticut. Incidence was highest among those >85 years, non‐Hispanic Blacks and Hispanic/Latinx compared with non‐Hispanic Whites {relative rate (RR) 3.1 (95% confidence interval [CI] 2.83–3.32) and 5.9 (95% CI 5.58–6.28)}, and persons living in high poverty and high crowding census tracts. Although racial/ethnic and SES disparities during the study period were substantial, they were significantly decreased compared with the first wave of COVID‐19. Conclusions The finding of persistent, if reduced, large racial/ethnic disparities in COVID‐19 hospitalizations 2–7 months after the initial lockdown was relaxed and before vaccination was widely available is of concern. These disparities cause a challenge to achieving health equity and are relevant for future pandemic planning.
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Affiliation(s)
- Geena Chiumento
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut, USA.,Division of Epidemiology, Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, USA
| | - Kimberly Yousey-Hindes
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut, USA
| | | | - James L Hadler
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut, USA
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