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Meyer D, Lowensen K, Perrin N, Moore A, Mehta SH, Himmelfarb CR, Inglesby TV, Jennings JM, Mueller AK, LaRicci JN, Gallo W, Bocek AP, Farley JE. An evaluation of the impact of social and structural determinants of health on forgone care during the COVID-19 pandemic in Baltimore, Maryland. PLoS One 2024; 19:e0302064. [PMID: 38739666 PMCID: PMC11090349 DOI: 10.1371/journal.pone.0302064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 03/27/2024] [Indexed: 05/16/2024] Open
Abstract
Evidence suggests that reductions in healthcare utilization, including forgone care, during the COVID-19 pandemic may be contributing towards excess morbidity and mortality. The objective of this study was to describe individual and community-level correlates of forgone care during the COVID-19 pandemic. We conducted a cross-sectional, secondary data analysis of participants (n = 2,003) who reported needing healthcare in two population-representative surveys conducted in Baltimore, MD in 2021 and 2021-2022. Abstracted data included the experience of forgone care, socio-demographic data, comorbidities, financial strain, and community of residence. Participant's community of residence were linked with data acquired from the Baltimore Neighborhood Indicators Alliance relevant to healthcare access and utilization, including walkability and internet access, among others. The data were analyzed using weighted random effects logistic regression. Individual-level factors found to be associated with increased odds for forgone care included individuals age 35-49 (compared to 18-34), female sex, experiencing housing insecurity during the pandemic, and the presence of functional limitations and mental illness. Black/African American individuals were found to have reduced odds of forgone care, compared to any other race. No community-level factors were significant in the multilevel analyses. Moving forward, it will be critical that health systems identify ways to address any barriers to care that populations might be experiencing, such as the use of mobile health services or telemedicine platforms. Additionally, public health emergency preparedness planning efforts must account for the unique needs of communities during future crises, to ensure that their health needs can continue to be met. Finally, additional research is needed to better understand how healthcare access and utilization practices have changed during versus before the pandemic.
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Affiliation(s)
- Diane Meyer
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing, Baltimore, MD, United States of America
- Center for Health Security, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Kelly Lowensen
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing, Baltimore, MD, United States of America
| | - Nancy Perrin
- Johns Hopkins University, School of Nursing, Baltimore, MD, United States of America
| | - Ayana Moore
- FHI 360, Durham, NC, United States of America
| | - Shruti H. Mehta
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Cheryl R. Himmelfarb
- Johns Hopkins University, School of Nursing, Baltimore, MD, United States of America
| | - Thomas V. Inglesby
- Center for Health Security, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Jacky M. Jennings
- Department of Pediatrics, Johns Hopkins University, School of Medicine, Baltimore, MD, United States of America
| | - Alexandra K. Mueller
- Department of Pediatrics, Johns Hopkins University, School of Medicine, Baltimore, MD, United States of America
| | - Jessica N. LaRicci
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing, Baltimore, MD, United States of America
| | - Woudase Gallo
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing, Baltimore, MD, United States of America
| | - Adam P. Bocek
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing, Baltimore, MD, United States of America
| | - Jason E. Farley
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing, Baltimore, MD, United States of America
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Brady PJ, Harnack L, Widome R, Berry KM, Valluri S. Food security among SNAP participants 2019 to 2021: a cross-sectional analysis of current population survey food security supplement data. J Nutr Sci 2023; 12:e45. [PMID: 37123392 PMCID: PMC10131048 DOI: 10.1017/jns.2023.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 05/02/2023] Open
Abstract
Surveillance data indicate that food security rates increased among Supplemental Nutrition Assistance Program (SNAP) participants during the COVID-19 pandemic (2020 and 2021) compared with pre-pandemic (2019), but this could have been due to increased participation from better resourced households. Our objective was to examine if demographic differences between SNAP-participating households in each year were responsible for the increased prevalence of food secure households. We calculated the observed 30-d food security prevalence among SNAP-participating households for each year. We used indirect standardisation to produce expected 2020 and 2021 prevalences with 2019 as the standard population using household size, income, age, sex, race, Hispanic ethnicity, presence of children, single parent household, metropolitan status and census region. We calculated standardised prevalence ratios (SPRs) to understand if the observed prevalence was higher than expected given any changes in the demographic profile compared to 2019. The Current Population Survey data were collected by the United States Census Bureau and Department of Agriculture. Our sample included 5,245 SNAP-participating households. The observed prevalence of food secure households increased by 3⋅6 percentage points comparing 2019 to 2020 (SPR = 1⋅06, 95 % confidence interval = 1⋅00, 1⋅11) and by 8⋅6 percentage comparing 2019 to 2021 (SPR = 1⋅13, 95 % confidence interval = 1⋅07, 1⋅18). The greater prevalence of food secure SNAP households during the pandemic did not appear to be attributable to socio-demographic differences compared to pre-pandemic. Despite hesitance among policymakers to expand or enhance social safety net programmes, permanently incorporating COVID-19-related policy interventions could lessen food insecurity in years to come.
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Affiliation(s)
- Patrick J. Brady
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Lisa Harnack
- Division of Epidemiology and Community Health, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Rachel Widome
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Kaitlyn M. Berry
- Division of Epidemiology and Community Health, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Sruthi Valluri
- Department of Epidemiology and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
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Gupta S, Mayers E, Schwierking S, Westrick M, Schier H, Sharn AR, Pannell C, Gunther C. Online Grocery Shopping and the Supplemental Nutrition Assistance Program (SNAP) Electronic Benefit Transfer Card (EBT): Perceptions of Head Start Caregivers. Ecol Food Nutr 2023; 62:75-87. [PMID: 36880800 DOI: 10.1080/03670244.2023.2187383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
The objective of this study was to explore perceptions of online grocery shopping and the online United States Department of Agriculture's (USDA) Supplemental Nutrition Assistance Program (SNAP) Electronic Benefit Transfer card (EBT) program among Head Start caregivers. Three focus groups were conducted between December 2019 and January 2020. Most participants hadn't tried online grocery shopping. Concerns included others choosing perishables, receiving wrong items, and inappropriate substitutes. Perceived benefits included saving time, preventing impulse buys, and eating healthier. Results have broad applicability in the current COVID-19 pandemic where online grocery shopping and the online SNAP EBT program have rapidly expanded across the United States.
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Affiliation(s)
- Shivani Gupta
- Nationwide Children's Hospital, Department of Gastroenterology, Hepatology, and Nutrition, Columbus, Ohio, USA
| | - Elizabeth Mayers
- College of Food, Agricultural, and Environmental Sciences, Family and Consumer Sciences, The Ohio State University, Columbus, Ohio, USA.,College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Sierra Schwierking
- College of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Miranda Westrick
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Heather Schier
- College of Education and Human Ecology, Department of Human Sciences, Human Nutrition Program, The Ohio State University, Columbus, Ohio, USA
| | - Amy R Sharn
- College of Education and Human Ecology, Department of Human Sciences, Human Nutrition Program, The Ohio State University, Columbus, Ohio, USA
| | - Cara Pannell
- College of Education and Human Ecology, Department of Human Sciences, Human Nutrition Program, The Ohio State University, Columbus, Ohio, USA
| | - Carolyn Gunther
- College of Nursing, Martha S. Pitzer Center for Women, Children, and Youth, The Ohio State University, Columbus, Ohio, USA
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Sun R, Staiger B, Chan A, Baker LC, Hernandez-Boussard T. Changes in Medicaid enrollment during the COVID-19 pandemic across 6 states. Medicine (Baltimore) 2022; 101:e32487. [PMID: 36596028 PMCID: PMC9803338 DOI: 10.1097/md.0000000000032487] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The coronavirus disease 2019 public health emergency (PHE) caused extensive job loss and loss of employer-sponsored insurance. State Medicaid programs experienced a related increase in enrollment during the PHE. However, the composition of enrollment and enrollee changes during the pandemic is unknown. This study examined changes in Medicaid enrollment and population characteristics during the PHE. A retrospective study documenting changes in Medicaid new enrollment and disenrollment, and enrollee characteristics between March and October 2020 compared to the same time in 2019 using full-state Medicaid populations from 6 states of a wide geographical region. The primary outcomes were Medicaid enrollment and disenrollment during the PHE. New enrollment included persons enrolled in Medicaid between March and October 2020 who were not enrolled in January or February, 2020. Disenrollment included persons who were enrolled in March of 2020 but not enrolled in October 2020. The study included 8.50 million Medicaid enrollees in 2020 and 8.46 million in 2019. Overall, enrollment increased by 13.0% (1.19 million) in the selected states during the PHE compared to 2019. New enrollment accounted for 24.9% of the relative increase, while the remaining 75.1% was due to disenrollment. A larger proportion of new enrollment in 2020 was among adults aged 27 to 44 (28.3% vs 23.6%), Hispanics (34.3% vs 32.5%) and in the financial needy (44.0% vs 39.0%) category compared to 2019. Disenrollment included a larger proportion of older adults (26.1% vs 8.1%) and non-Hispanics (70.3% vs 66.4%) than in 2019. Medicaid enrollment grew considerably during the PHE, and most enrollment growth was attributed to decreases in disenrollment rather than increases in new enrollment. Our results highlight the impact of coronavirus disease 2019 on state health programs and can guide federal and state budgetary planning once the PHE ends.
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Affiliation(s)
- Ran Sun
- Department of Medicine, Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA
| | - Becky Staiger
- Department of Medicine, Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA
| | - Antonia Chan
- Stanford University School of Medicine, Stanford, CA
| | - Laurence C. Baker
- The Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA
- Stanford Institute for Economic Policy Research, Stanford University, Stanford, CA
| | - Tina Hernandez-Boussard
- Department of Medicine, Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA
- Department of Surgery, Stanford University School of Medicine, Stanford, CA
- * Correspondence: Tina Hernandez-Boussard, Department of Medicine, Biomedical Data Science, and Surgery, Stanford University, Stanford, CA 94305 (e-mail: )
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Morris EJ, Quinn EL, Rose CM, Spiker M, O’Leary J, Otten JJ. Insights from Washington State's COVID-19 Response: A Mixed-Methods Evaluation of WIC Remote Services and Expanded Food Options Using the RE-AIM Framework. J Acad Nutr Diet 2022; 122:2228-2242.e7. [PMID: 35339719 PMCID: PMC8940760 DOI: 10.1016/j.jand.2022.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/07/2022] [Accepted: 03/21/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND In response to the COVID-19 pandemic, Washington State's Supplemental Nutrition Program for Women, Infants, and Children (WA WIC) adopted federal waivers to transition to remote service delivery for certification and education appointments. WA WIC also expanded the approved food list without using federal waivers, adding more than 600 new items to offset challenges participants experienced accessing foods in stores. OBJECTIVE This study aimed to assess the reach and effectiveness of the programmatic changes instituted by WA WIC during the COVID-19 pandemic; the processes, facilitators, and challenges involved in their implementation; and considerations for their continuation in the future. DESIGN A mixed-methods design, guided by the RE-AIM framework, including virtual, semi-structured focus groups and interviews with WA WIC staff and participants, and quantitative programmatic data from WIC agencies across the state. PARTICIPANTS/SETTING This study included data from 52 state and local WIC staff and 40 WIC participants across the state of Washington and from various WA WIC programmatic records (2017-2021). The research team collected data and conducted analyses between January 2021 and August 2021. ANALYSIS An inductive thematic analysis approach with Dedoose software was used to code qualitative data, generate themes, and interpret qualitative data. Descriptive statistics were calculated for quantitative programmatic data, including total participant count, percent increase and decrease in participation, percent of food benefits redeemed monthly, and appointment completion rates. RESULTS All WA WIC participants (n = 125,279 in May 2020) experienced the programmatic changes. Participation increased by 2% from March to December 2020 after WA WIC adopted programmatic changes in response to the COVID-19 pandemic. Certification and nutrition education completion rates increased by 5% and 18% in a comparison of June 2019 with June 2020. Food benefit redemption also increased immediately after the food list was expanded in April 2020. Staff and participants were highly satisfied with remote service delivery, predominantly via the phone, and participants appreciated the expanded food options. Staff and participants want a remote service option to continue and suggested various changes to improve service quality. CONCLUSIONS Participation in WIC and appointment completion rates increased after WA WIC implemented service changes in response to the COVID-19 pandemic. Staff and participants were highly satisfied with remote services, and both desire a continued hybrid model of remote and in-person WIC appointments. Some of the suggested changes to WIC, especially the continuation of remote services, would require federal policy change, and others could be implemented under existing federal regulations.
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Affiliation(s)
- Evelyn J. Morris
- Nutritional Sciences Program, School of Public Health, University of Washington, Seattle, WA
| | - Emilee L. Quinn
- Department of Health Systems and Population Health, University of Washington, Seattle, WA
| | - Chelsea M. Rose
- Center for Public Health Nutrition, University of Washington, Seattle, WA,Department of Epidemiology, University of Washington School of Public Health, Seattle, WA
| | - Marie Spiker
- Nutritional Sciences Program, School of Public Health, University of Washington, Seattle, WA,Department of Epidemiology, University of Washington School of Public Health, Seattle, WA
| | - Jean O’Leary
- Washington State Department of Health, Olympia, WA
| | - Jennifer J. Otten
- Nutritional Sciences Program, School of Public Health, University of Washington, Seattle, WA,Center for Public Health Nutrition, University of Washington, Seattle, WA,Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA,Address correspondence to: Jennifer J. Otten, PhD, MS, RD, Nutritional Sciences Program, Center for Public Health Nutrition, and Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Box 353410, Seattle, WA 98195
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Searles M, Wong R. Food Insecurity and COVID-19 Diagnosis: Findings from a National United States Sample. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2022. [DOI: 10.1080/19320248.2022.2128961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Madison Searles
- Department of Public Health and Preventive Medicine, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Roger Wong
- Department of Public Health and Preventive Medicine, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
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Brostow DP, Smith AA, Bahraini NH, Besterman-Dahan K, Forster JE, Brenner LA. Food Insecurity and Food Worries During the COVID-19 Pandemic: A Point-In-Time Study of Injured United States Veterans. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2022; 17. [DOI: 10.1080/19320248.2022.2118564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Diana P. Brostow
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alexandra A. Smith
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA
| | - Nazanin H. Bahraini
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Karen Besterman-Dahan
- Research Service, Department of Veterans Affairs, James A. Haley VA Hospital, Tampa, FL, USA
- Department of Nutrition and Dietetics, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Jeri E. Forster
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lisa A. Brenner
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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8
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Varela EG, Zeldman J, Mobley AR. Community Stakeholders' Perceptions on Barriers and Facilitators to Food Security of Families with Children under Three Years before and during COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10642. [PMID: 36078356 PMCID: PMC9518144 DOI: 10.3390/ijerph191710642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
Children living in food-insecure households have poorer overall health than children in food-secure households. While U.S. nutrition assistance programs provide resources, these cannot consistently offer age-appropriate nutritional foods for young children. This study aimed to determine community stakeholders' perceptions of the barriers and facilitators to obtaining adequate, high-quality, and age-appropriate foods for children ages 0-3 in Florida before and during COVID-19. Community stakeholders (n = 32) participated in a 60 min interview via Zoom using a semi-structured script based on the PRECEDE component of the PRECEDE-PROCEED model. Interviews were transcribed verbatim and coded by two researchers using a thematic analysis approach. Stakeholders' perceptions revealed a lack of awareness surrounding eligibility for assistance programs, a lack of knowledge regarding how to obtain resources and services, and stigma associated with receiving benefits. These remained significant barriers to obtaining healthful foods for households with young children before and during COVID-19. Nonetheless, barriers were exacerbated during the pandemic. Unemployment rates rose, intensifying these households' financial hardships and food insecurity levels. Likewise, stakeholders suggested the need for families to become more aware of federal assistance eligibility requirements and available opportunities via social media and referrals. Identifying risk factors associated with food insecurity can inform future interventions to safeguard young children's health and well-being.
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Mazzeo J, Al Abdeen Qusair Z, Gadhoke P, Freiberg T, Brenton BP, Sedlacek A, Torres A. A Tale of Two Cities During the COVID-19 Pandemic: Evaluating Food Insecurity in Chicago and New York City. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01355-x. [PMID: 35831703 PMCID: PMC9281349 DOI: 10.1007/s40615-022-01355-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022]
Abstract
Background COVID-19 revealed and broadened existing disparities in large cities. This article interprets the early impacts of COVID-19 on food insecurity (FI) in the Chicago and New York City (NYC) metropolitan areas for Black, Indigenous, and People of Color (BIPOC) and provides a study using a Social Determinants of Health (SDOH) framework. Methods A cross-sectional survey adapted from the National Food Access and COVID Research Team (NFACT) was deployed in Chicago (N = 680) and in NYC (N = 525) during summer 2020 and oversampled for race, ethnicity, and socioeconomic status. Multivariate binary logistic regression generated adjusted odds ratios (aOR) and 95% CIs for FI and select SDOH variables, which was conducted on each dataset. Results The prevalence of FI in NYC increased to 66.8% (from 57.8%) and in Chicago to 44.8% (from 41.0%). While higher income protected against FI before, protection was diminished or eliminated since COVID-19. FI declined for households with children in NYC while odds increased and became significant in Chicago. Respondents with chronic health conditions experienced increased odds of FI since COVID. In Chicago, this variable had the highest odds of FI. Respondents with depression or anxiety had increased odds of FI. In NYC, depression had the highest odds of FI. Females in NYC were protected against FI. Hispanics in NYC lost protection against FI from before to since COVID-19. Conclusions Results support the observed rise of FI for BIPOC and its association with health status. The analysis has multifaceted, structural policy implications for reducing FI in urban centers.
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Affiliation(s)
- John Mazzeo
- Master of Public Health Program, College of Liberal Arts and Social Sciences, DePaul University, 1 E. Jackson Blvd, Chicago, IL 60604 USA
| | - Zain Al Abdeen Qusair
- Master of Public Health Program, College of Liberal Arts and Social Sciences, DePaul University, 1 E. Jackson Blvd, Chicago, IL 60604 USA
| | - Preety Gadhoke
- Department of Pharmacy Administration and Public Health, St. John’s University, Queens, NY 11439 USA
| | - Tracey Freiberg
- Department of Economics and Finance, St. John’s University, 8000 Utopia Pkwy, Queens, NY 11439 USA
| | - Barrett P. Brenton
- Center for Civic Engagement, Binghamton University, 4400 Vestal Pkwy, PO Box 6000, Binghamton, NY 13902-6000 USA
| | - Anne Sedlacek
- Master of Public Health Program, College of Liberal Arts and Social Sciences, DePaul University, 1 E. Jackson Blvd, Chicago, IL 60604 USA
| | - Abigail Torres
- Master of Public Health Program, College of Liberal Arts and Social Sciences, DePaul University, 1 E. Jackson Blvd, Chicago, IL 60604 USA
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Radey M, Lowe S, Langenderfer-Magruder L, Posada K. "Showing Everybody's True Colors": Informal networks of low-income single mothers and their young children during the COVID-19 pandemic. CHILDREN AND YOUTH SERVICES REVIEW 2022; 137:106479. [PMID: 35311026 PMCID: PMC8923715 DOI: 10.1016/j.childyouth.2022.106479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 02/24/2022] [Accepted: 03/13/2022] [Indexed: 05/24/2023]
Abstract
Extensive evidence suggests low-income mothers depend upon their families and friends for emotional, practical, and economic support in times of need. This is the first study to examine the operation of low-income mothers' informal support networks and the impact of such networks on maternal well-being during the COVID-19 pandemic. We interviewed low-income, single mothers of young children (<12 years; N = 34) twice over Summer 2020 to consider mothers' decisions around network engagement and how their interactions contributed to their well-being. Consistent with the social capital framework and previous studies, most mothers turned to their networks and exchanged support. Thematic analysis uncovered 4 inter-related themes of mothers' experiences: (1) discovering emotionally-available networks, (2) navigating resource-limited networks, (3) reassessing network member relationships, and (4) establishing boundaries for in-person contact. Although emotionally valuable, networks could not meet increased economic and child care needs. The COVID-19 pandemic's economic impact and its impact on time use tested network relationships with some relationships strengthening and others dissolving. Widely-available emotional support was essential to mothers adapting to the pandemic. Safe, affordable child care options coupled with accessible, economic supplements can promote well-being among single mothers and their children.
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Affiliation(s)
- Melissa Radey
- Florida State University, College of Social Work, United States
| | - Sarah Lowe
- Yale University, School of Public Health, United States
| | | | - Kristine Posada
- Florida State University, College of Social Work, United States
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11
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Joshi K, Caspi CE, Briggs FBS, Gunzler DD, Kim-Mozeleski JE, Trapl ES. Food Banking during COVID-19 Pandemic: Food Sourcing and Food Quality across 3 Food Banks in Minnesota. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2022. [DOI: 10.1080/19320248.2022.2078683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kakul Joshi
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Caitlin E. Caspi
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, USA
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Farren B. S. Briggs
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Douglas D. Gunzler
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
- Center for Health Care Research & Policy, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Jin E. Kim-Mozeleski
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
- Prevention Research Center for Healthy Neighborhoods, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Erika S. Trapl
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
- Prevention Research Center for Healthy Neighborhoods, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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Ando M, Furuichi M. The association of COVID-19 employment shocks with suicide and safety net use: An early-stage investigation. PLoS One 2022; 17:e0264829. [PMID: 35324902 PMCID: PMC8947077 DOI: 10.1371/journal.pone.0264829] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 02/17/2022] [Indexed: 11/22/2022] Open
Abstract
This paper examines whether the COVID-19-induced employment shocks are associated with increases in suicides and safety net use in the second and third quarters of 2020. We exploit plausibly exogenous regional variation in the magnitude of the employment shocks in Japan and adopt a difference-in-differences research design to examine and control for possible confounders. Our preferred point estimates suggest that a one-percentage-point increase in the unemployment rate in the second quarter of 2020 is associated with, approximately, an additional 0.52 suicides, 28 unemployment benefit recipients, 88 recipients of a temporary loan program, and 10 recipients of public assistance per 100,000 population per month. A simple calculation based on these estimates suggests that if a region experienced a one-percentage-point increase in the unemployment rate caused by the COVID-19 crisis in the second quarter of 2020, which is roughly equivalent to the third-highest regional employment shock, this would be associated with 37.4%, 60.5%, and 26.5% increases in the total, female, and male suicide rates respectively in July 2020 compared with July 2019. These results are primarily correlational rather than causal due to the limitation of our data and research design, but our baseline findings are robust to several different model specifications.
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Affiliation(s)
- Michihito Ando
- Department of Economics, Rikkyo Univeristy, Tokyo, Japan
- * E-mail:
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Wymer JA. National Diabetes Prevention Program. Health Aff (Millwood) 2022; 41:608. [PMID: 35377747 DOI: 10.1377/hlthaff.2021.01961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Experiences of increased food insecurity, economic and psychological distress during the COVID-19 pandemic among Supplemental Nutrition Assistance Program-enrolled food pantry clients. Public Health Nutr 2022; 25:1027-1037. [PMID: 34865672 PMCID: PMC8712963 DOI: 10.1017/s1368980021004717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The COVID-19 pandemic initially doubled the rates of food insecurity across the USA and tripled rates among households with children. Despite the association among food insecurity, chronic disease and psychological distress, narratives depicting the experiences of already food insecure populations are notably underrepresented in the literature. The current study assessed the impact of COVID-19 on clients of a food pantry who were also enrolled in the Supplemental Nutrition Assistance Program (SNAP). DESIGN A qualitative study probing the effects of the pandemic on daily living, food needs, food buying and food insecurity. Interview transcripts were analysed using a combined deductive and inductive approach. SETTING Interviews were conducted via telephone between May and June of 2020. PARTICIPANTS Equal numbers of English- and Spanish-speaking clients (n 40 total). RESULTS Three main findings emerged: (1) the pandemic increased economic distress, such as from job loss or increased utility bills due to sustained home occupancy and (2) the pandemic increased food needs, food prices and food shortages. In combination with economic stressors, this led to greater food insecurity; (3) increased economic stress and food insecurity contributed to increased psychological stress, such as from fear of infection, isolation and children being confined at home. CONCLUSIONS Despite federal legislation and state and local programmes to alleviate food insecurity, COVID-19 exacerbated economic hardship, food insecurity and psychological distress among urban SNAP and food pantry clients. Additional research is needed to identify the most effective policies and programmes to ameliorate the short- and long-term health and economic inequities exacerbated by the pandemic.
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Hale L, Cameron TC, Donahue KE, Vu MB, Leeman J, Johnson A, Richman E, Rees J, Young L. Clinical Team Response to the Impact of COVID-19 on Diabetes Self-Management: Findings From a Qualitative Study. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:835845. [PMID: 36992778 PMCID: PMC10012158 DOI: 10.3389/fcdhc.2022.835845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022]
Abstract
The aims of this study were to explore providers’ perceptions of how COVID-19 affected patients’ psychological wellbeing and diabetes self-care and discover how providers responded to sustain and improve patients’ psychological health and diabetes management during the pandemic. Twenty-four semi-structured interviews were completed with primary care providers (n=14) and endocrine specialty clinicians (n=10) across sixteen clinics in North Carolina. Interview topics included: (1) current glucose monitoring approaches and diabetes management strategies for people with diabetes (2) barriers and unintended consequences encountered with respect to diabetes self-management, and (3) innovative strategies developed to overcome barriers. Interview transcripts were coded using qualitative analysis software and analyzed to identify cross-cutting themes and differences between participants. Primary care providers and endocrine specialty clinicians reported that people with diabetes experienced increased mental health symptoms, increased financial challenges and positive and negative changes in self-care routines due to COVID-19. To offer support, primary care providers and endocrine specialty providers focused discussions on lifestyle management and utilized telemedicine to connect with patients. Additionally, endocrine specialty clinicians helped patients access financial assistance programs. Findings indicate that people with diabetes experienced unique challenges to self-management during the pandemic and providers responded with targeted support strategies. Future research should explore the effectiveness of these provider interventions as the pandemic continues to evolve.
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Affiliation(s)
- Lily Hale
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- *Correspondence: Lily Hale,
| | - Thomas C. Cameron
- Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Katrina E. Donahue
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Maihan B. Vu
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jennifer Leeman
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Asia Johnson
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Erica Richman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jennifer Rees
- North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Laura Young
- Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Lee AS, Seith D, Roman JL, Taylor J, Riordan A, Seehra A, Hetling A. Examining the Early Impact of COVID-19 on Single-Parent TANF Caseloads: a Brief Analysis of New Jersey. JOURNAL OF POLICY PRACTICE AND RESEARCH 2022. [PMCID: PMC8450173 DOI: 10.1007/s42972-021-00036-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Hard economic times often force a greater number of families to turn to public benefits and programs for financial help. These larger safety net caseloads are more diverse than those of strong economic times, including families who are brand-new to the safety net as well as families who, under different economic circumstances, may have needed only short-term assistance. These families may differ from traditional recipients in terms of characteristics and circumstances. To understand how the New Jersey single-parent Temporary Assistance for Needy Families (TANF) caseload changed in response to COVID-19 between April of 2019 and April of 2020, we conducted a two-step cluster analysis that identified six different types of families. Compared to the April 2019 (pre-pandemic) caseload, we found that the number of the TANF participants increased in April 2020 (during the COVID-19 pandemic). Interestingly, we also found that the largest proportional increases in the caseload were driven by single jobless adults who are older, have at least a high school education, do not have a disability, and have fewer and older children, while the largest declines were driven by single adults with a job. Taken together, it seems that single adults with relatively better demographic circumstances are having a harder time finding jobs, and so turned to or remained on TANF in April 2020. In response to the pandemic, some, but not all, states have relaxed or temporarily suspended TANF work requirements and time limits. Our findings suggest that such changes in TANF requirements reflect empirical changes in the caseload and merit further attention, particularly in terms of federal and state budget strain.
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Affiliation(s)
- Annie S. Lee
- Department of Geography, McGill University, 805 Sherbrooke Street West, Montreal, Quebec, H3A 0B9 Canada
| | - David Seith
- Bloustein School of Planning and Public Policy, Rutgers University - New Brunswick, 33 Livingston Avenue, New Brunswick, NJ 08901 USA
| | - Jessica L. Roman
- Bloustein School of Planning and Public Policy, Rutgers University - New Brunswick, 33 Livingston Avenue, New Brunswick, NJ 08901 USA
| | - Joanne Taylor
- Department of Human Services, Division of Family Development, Trenton, NJ 08625-0716 USA
| | - Annette Riordan
- Department of Human Services, Division of Family Development, Trenton, NJ 08625-0716 USA
| | - Amman Seehra
- Department of Human Services, Division of Family Development, Trenton, NJ 08625-0716 USA
| | - Andrea Hetling
- Bloustein School of Planning and Public Policy, Rutgers University - New Brunswick, 33 Livingston Avenue, New Brunswick, NJ 08901 USA
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Dague L, Badaracco N, DeLeire T, Sydnor J, Tilhou AS, Friedsam D. Trends in Medicaid Enrollment and Disenrollment During the Early Phase of the COVID-19 Pandemic in Wisconsin. JAMA HEALTH FORUM 2022; 3:e214752. [PMID: 35977274 PMCID: PMC8903121 DOI: 10.1001/jamahealthforum.2021.4752] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/18/2021] [Indexed: 11/23/2022] Open
Abstract
Question Are increases in Medicaid enrollment during the COVID-19 pandemic associated more with maintenance of eligibility (MOE) policy or employment shocks? Findings In this cohort study of 792 777 Wisconsin Medicaid enrollees, a 13.5% increase in overall enrollment vs predicted enrollment during the pandemic was largely associated with MOE rather than novel increases in enrollment owing to employment shocks. Most increased enrollment was among beneficiaries otherwise unlikely to remain enrolled 6 months later. Meaning The findings suggest that expiration of MOE may leave many Medicaid beneficiaries without insurance coverage. Importance After the federal public health emergency was declared in March 2020, states could qualify for increased federal Medicaid funding if they agreed to maintenance of eligibility (MOE) provisions, including a continuous coverage provision. The implications of MOE provisions for total Medicaid enrollment are unknown. Objective To examine observed increases in Medicaid enrollment and identify the underlying roots of that growth during the first 7 months of the COVID-19 public health emergency in Wisconsin. Design, Setting, and Participants This population-based cohort study compared changes in Wisconsin Medicaid enrollment from March through September 2020 with predicted changes based on previous enrollment patterns (January 2015-September 2019) and early pandemic employment shocks. The participants included enrollees in full-benefit Medicaid programs for nonelderly, nondisabled beneficiaries in Wisconsin from March through September 2020. Individuals were followed up monthly as they enrolled in, continued in, and disenrolled from Medicaid. Participants were considered to be newly enrolled if they enrolled in the program after being not enrolled for at least 1 month, and they were considered disenrolled if they left and were not reenrolled within the next month. Exposures Continuous coverage provision beginning in March 2020; economic disruption from pandemic between first and second quarters of 2020. Main Outcomes and Measures Actual vs predicted Medicaid enrollment, new enrollment, disenrollment, and reenrollment. Three models were created (Medicaid enrollment with no pandemic, Medicaid enrollment with pandemic economic circumstances, and longer Medicaid enrollment with a pandemic-induced recession), and a 95% prediction interval was used to express uncertainty in enrollment predictions. Results The study estimated ongoing Medicaid enrollment in March 2020 for 792 777 enrollees (mean [SD] age, 20.6 [16.5] years; 431 054 [54.4%] women; 213 904 [27.0%] experiencing an employment shock) and compared that estimate with actual enrollment totals. Compared with a model of enrollment based on past data and incorporating the role of recent employment shocks, most ongoing excess enrollment was associated with MOE provisions rather than enrollment of newly eligible beneficiaries owing to employment shocks. After 7 months, overall enrollment had increased to 894 619, 11.1% higher than predicted (predicted enrollment 805 130; 95% prediction interval 767 991-843 086). Decomposing higher-than-predicted retention, most enrollment was among beneficiaries who, before the pandemic, likely would have disenrolled within 6 months, although a substantial fraction (30.4%) was from reduced short-term disenrollment. Conclusions and Relevance In this cohort study, observed increases in Medicaid enrollment were largely associated with MOE rather than new enrollment after employment shocks. Expiration of MOE may leave many beneficiaries without insurance coverage.
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Affiliation(s)
- Laura Dague
- Bush School of Government & Public Service, Texas A&M University, College Station
| | | | - Thomas DeLeire
- McCourt School of Public Policy, Georgetown University, Washington, DC
| | - Justin Sydnor
- Department of Risk and Insurance, University of Wisconsin–Madison, Madison
| | - Alyssa Shell Tilhou
- Department of Family Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Donna Friedsam
- Institute for Research on Poverty, University of Wisconsin–Madison, Madison
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Hoelscher DM, Brann LS, O’Brien S, Handu D, Rozga M. Prevention of Pediatric Overweight and Obesity: Position of the Academy of Nutrition and Dietetics Based on an Umbrella Review of Systematic Reviews. J Acad Nutr Diet 2022; 122:410-423.e6. [DOI: 10.1016/j.jand.2021.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/27/2021] [Accepted: 11/03/2021] [Indexed: 01/08/2023]
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Ashcroft R, Lam S, Kourgiantakis T, Begun S, Nelson MLA, Adamson K, Cadell S, Walsh B, Greenblatt A, Hussain A, Sur D, Sirotich F, Craig SL. Preparing social workers to address health inequities emerging during the COVID-19 pandemic by building capacity for health policy: a scoping review protocol. BMJ Open 2021; 11:e053959. [PMID: 34732499 PMCID: PMC8572402 DOI: 10.1136/bmjopen-2021-053959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has brought tremendous changes in healthcare delivery and exacerbated a wide range of inequities. Social workers across a broad range of healthcare settings bring an expertise in social, behavioural and mental healthcare needed to help address these health inequities. In addition, social workers integrate policy-directed interventions and solutions in clinical practice, which is a needed perspective for recovery from the COVID-19 pandemic. It remains unclear, however, what the most pressing policy issues are that have emerged during the COVID-19 pandemic. In addition, many social workers in health settings tend to underuse policy in their direct practice. The objectives of this scoping review are to: (1) systematically scope the literature on social work, COVID-19 pandemic and policy; and (2) describe the competencies required by social workers and the social work profession to address the policy issues emerging during the COVID-19 pandemic. METHODS AND ANALYSIS The scoping review follows Arksey and O'Malley's five-stage framework. Identification of literature published between 1 December 2019 and the search date, 31 March 2021, will take place in two stages: (1) title and abstract review, and (2) full-text review. In partnership with a health science librarian, the research team listed keywords related to social work and policy to search databases including Medline, Embase, PsycINFO, CINAHL, Social Services Abstract and Social Work Abstracts. Two graduate-level research assistants will conduct screening and full-text review. Data will then be extracted, charted, analysed and summarised to report on our results and implications on practice, policy and future research. ETHICS AND DISSEMINATION Results will help develop a policy practice competence framework to inform how social workers can influence policy. We will share our findings through peer-reviewed publications and conference presentations. This study does not require Research Ethics Board approval as it uses publicly available sources of data.
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Affiliation(s)
- Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Simon Lam
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Toula Kourgiantakis
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Begun
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Michelle L A Nelson
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Keith Adamson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Susan Cadell
- Renison University College, Waterloo, Ontario, Canada
| | - Benjamin Walsh
- Robarts Library, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Greenblatt
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Amina Hussain
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Deepy Sur
- Ontario Association of Social Workers, Toronto, Ontario, Canada
| | - Frank Sirotich
- Canadian Mental Health Association, Toronto, Ontario, Canada
| | - Shelley L Craig
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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20
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Rodriguez GM, Ferguson JM, Kurian A, Bondy M, Patel MI. The Impact of COVID-19 on Patients With Cancer: A National Study of Patient Experiences. Am J Clin Oncol 2021; 44:580-587. [PMID: 34519677 PMCID: PMC8541895 DOI: 10.1097/coc.0000000000000865] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic abruptly disrupted cancer care. The impact of these disruptions on patient experiences remain relatively understudied. The objective of this study was to assess patients' perspectives regarding the impact of COVID-19 on their experiences, including their cancer care, emotional and mental health, and social determinants of health, and to evaluate whether these outcomes differed by cancer stage. MATERIALS AND METHODS We conducted a survey among adults with cancer across the United States from April 1, 2020 to August 26, 2020 using virtual snowball sampling strategy in collaboration with professional organizations, cancer care providers, and patient advocacy groups. We analyzed data using descriptive statistics, χ2 and t tests. RESULTS Three hundred twelve people with cancer participated and represented 38 states. The majority were non-Hispanic White (n=183; 58.7%) and female (n=177; 56.7%) with median age of 57 years. Ninety-one percent spoke English at home, 70.1% had health insurance, and 67% had access to home internet. Breast cancer was the most common diagnosis (n=67; 21.5%). Most had Stage 4 disease (n=80; 25.6%). Forty-six percent (n=145) experienced a change in their care due to COVID-19. Sixty percent (n=187) reported feeling very or extremely concerned that the pandemic would affect their cancer and disproportionately experienced among those with advanced cancer stages compared with earlier stages (P<0.001). Fifty-two percent (n=162) reported impact of COVID-19 on 1 or more aspects of social determinants of health with disproportionate impact among those with advanced cancer stages compared with earlier stages. CONCLUSIONS COVID-19 impacted the care and well-being of patients with cancer and this impact was more pronounced among people with advanced cancer stages. Future work should consider tailored interventions to mitigate the impact of COVID-19 on patients with cancer.
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Affiliation(s)
| | - Jacqueline M. Ferguson
- Center for Population Health Sciences, Stanford University, Stanford
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Allison Kurian
- Division of Oncology, Department of Medicine
- Center for Population Health Sciences, Stanford University, Stanford
| | - Melissa Bondy
- Center for Population Health Sciences, Stanford University, Stanford
| | - Manali I. Patel
- Division of Oncology, Department of Medicine
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
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21
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Caspi CE, Davey C, Barsness CB, Wolfson J, Peterson H, Pratt RJ. Applying the Healthy Eating Index-2015 in a Sample of Choice-Based Minnesota Food Pantries to Test Associations Between Food Pantry Inventory, Client Food Selection, and Client Diet. J Acad Nutr Diet 2021; 121:2242-2250. [PMID: 34103273 PMCID: PMC8530893 DOI: 10.1016/j.jand.2021.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/15/2021] [Accepted: 05/06/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Food pantry clients are at a high risk for diet-related chronic disease and suboptimal diet. Relatively little research has examined diet quality measures in choice-based food pantries where clients can choose their own food. OBJECTIVE This study tested whether the diet quality scores for food at the pantry were associated with client food selection scores, and whether client food selection scores at the pantry were associated with client diet intake scores. DESIGN This cross-sectional regression analysis, part of a larger evaluation study (SuperShelf), used baseline data from client and food pantry surveys, food pantry inventories, assessments of client food selections ("client carts"), and single 24-hour client dietary recalls. PARTICIPANTS/SETTING The analysis includes 316 clients who completed a survey (282 of whom completed a dietary recall measure) from one of 16 choice-based Minnesota food pantries during 2018-2019. Adult English, Spanish, or Somali-speaking clients were eligible in the case that they had selected food on the day of recruitment at their food pantry visit. MAIN OUTCOME MEASURES A Healthy Eating Index-2015 (HEI-2015) Total score and 13 subcomponent scores were calculated for: pantry food inventories of food available on the shelf, client carts, and a 24-hour client dietary recall. STATISTICAL ANALYSIS Descriptive statistics were generated for client and food pantry characteristics, and for HEI-2015 Total score and subcomponent scores. Linear regression models tested the association between HEI-2015 Total score and subcomponent scores for food pantry inventory and client carts, and for client carts and dietary recalls, adjusted for covariates. RESULTS Food pantry inventory HEI-2015 Total score averaged 65.1, client cart Total score averaged 60.8, and dietary recall Total score averaged 50.9. The diet quality scores for inventory were not associated with client cart scores, except for Added Sugars (P = .005). Client cart HEI-2015 Total score was positively associated with client diet HEI-2015 Total score (P = .002) and associations for Total Fruits, Whole Fruits, Total Vegetables, Greens and Beans, Whole Grains, Seafood and Plant Proteins, and Added Sugars subcomponents were statistically significant. CONCLUSIONS In choice-based Minnesota food pantries, the diet quality of food selected by clients was positively associated with client diet quality.
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Affiliation(s)
- Caitlin E Caspi
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford; Department of Allied Health Sciences, University of Connecticut, Storrs; Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis.
| | - Cynthia Davey
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis
| | - Christina Bliss Barsness
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis
| | - Julian Wolfson
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis
| | - Hikaru Peterson
- Department of Applied Economics, University of Minnesota, St Paul
| | - Rebekah J Pratt
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis
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Haynes EN, Hilbert TJ, Westneat S, Leger KA, Keynton K, Bush H. Impact of the COVID-19 Shutdown on Mental Health in Appalachia by Working Status. JOURNAL OF APPALACHIAN HEALTH 2021; 3:18-28. [PMID: 33768206 PMCID: PMC7990317 DOI: 10.13023/jah.0301.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction To slow the spread of COVID-19 in the United States, businesses shutdown in Spring 2020. Research has indicated the impact on frontline workers, yet little is known about the impact on those who were not working outside the home or switched to working remotely. Purpose The purpose of this report is to identify the financial and healthcare issues and mental health impact of the COVID-19 shutdown on Appalachians by worker categories. Methods An online survey was administered from May 8 – June 6, 2020 to a convenience sample of previous research participants and shared through social media networks, i.e., snowball sampling. Questions investigated mental health, financial and healthcare issues, and employment status. Survey responses were summarized by percentages overall and by working categories. Results Of the 751 participants, 276 (42%) resided in Appalachia. After removing 17 who lost their job due to COVID-19, 59 (23%) indicated not working outside the home prior to COVID-19, whereas 111 (43%) and 89 (34%) switched to working remotely and continued working outside the home during the shutdown. Respondents were predominately Caucasian and female. Nearly a quarter of participants had lost or reduced income due to the shutdown. Approximately half missed or postponed healthcare appointments. Mental health impacts were similar across the groups, with half of the respondents reporting anxiety due to COVID-19. Implications Further research is needed to explore health outcomes associated with missed healthcare appointments during the shutdown. Mental health support may be needed equally by those isolated at home and frontline workers.
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Affiliation(s)
| | | | | | - Kate A Leger
- University of Kentucky College of Arts and Sciences
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