Effects of a Health Education Intervention for COVID-19 Prevention in Latinx Communities: A Cluster-Randomized Controlled Trial

Social Determinants of Health Associated With SARS-CoV-2 Testing and Vaccine Attitudes in a Cross-Sectional Study of Latinx Individuals in Oregon

Introduction

Latinx communities have reported higher barriers to SARS-CoV-2 testing and vaccination and experienced disproportionate COVID-19 burden, especially compared with non-Latinx Whites. Social determinants of health models explain health inequities; however, it is unknown how each social determinant of health is associated with SARS-CoV-2 testing and vaccination attitudes among Latinx Americans. This study determined the relative importance of social determinants of health indicators on testing and vaccine attitudes among Latinxs and whether English proficiency and parental nativity moderate associations.

Methods

Cross-sectional survey data were collected between January and December 2022. Multilevel structural equation path modeling addressed the nonindependence of respondents nested within 52 SARS-CoV-2 testing sites across Oregon, U.S. Equality constraints were used to test for differences in the magnitudes of the associations.

Results

Latinx respondents (n=1,247) predominantly spoke Spanish at home (94%) and had no U.S.-born parents (92%). Pandemic vulnerability (β=0.95, p<0.001), economic insecurity (β=0.17, p<0.001), and discrimination (β=0.16, p<0.001) were associated with testing hesitancy; education was associated with vaccine hesitancy (β=0.15, p<0.001); and education (β=0.13, p<0.001) and discrimination (β=0.08, p<0.01) were associated with vaccine safety acceptance. Social determinants of health associations were statistically equal in magnitude. English proficiency moderated the associations from discrimination (β=0.07, p<0.01) and economic insecurity (β= -0.09, p<0.05) to vaccine hesitancy. Parental nativity moderated the associations from economic insecurity to testing hesitancy (β= -0.21, p<0.001) and lack of healthcare access to vaccine hesitancy (β=0.37, p<0.01).

Conclusions

Findings from this study identified distinct social determinants of health paths to testing and vaccine attitudes among Latinxs as well as by English proficiency and parental nativity. These results inform culturally responsive disease prevention for Latinx subgroups.

Attendance of Underserved Populations at Field-Based Health Services Events: Application of Quasi-Experimental Methods that Accommodate the COVID-19 Pandemic

The COVID-19 pandemic disrupted the ability to receive health care services. Field-based health services became a logistically feasible alternative to medical center-based care. We compared two different field-based approaches to the delivery of SARS-CoV-2 testing and health education services for Latine communities using a quasi-experimental design that included propensity score matching to accommodate the challenges posed to research by the pandemic. From September 2021 through October 2022, we held 434 testing events, of which 234 used a geolocation approach and 200 used a partner-located approach to determine the location of the health services (n = 68 field sites in Oregon). We hypothesized that partner-located sites would obtain higher numbers of tests collected relative to geolocated sites, and that longer drive times to testing sites would be associated with lower testing rates. There were no differences in the number of tests collected by geolocated versus partner-located sites, controlling for population size and time-varying pandemic vulnerabilities measured as COVID-19 cases and deaths. Prior to propensity score weighting, a longer drive time to the testing site (both site types) was associated with a lower likelihood of total tests (IRR = .87, p < .01, CI [0.54, 0.92]), of Latine tests (IRR = .69, p < .001, CI [0.56, 0.84]), and of male tests collected (IRR = .67, p < .05, CI [0.47, 0.94]). The site's number of prior tests was associated with a significant 2% increase in tests collected and the prior week's number of county deaths was associated with a roughly 30% decrease in the likelihood of tests collected. However, the reduced testing rate when the death rate was higher was less likely in geolocated sites (IRR = 1.55, p < .001, CI [1.20, 2.01]). Implications for the utility of propensity score matching and time-varying covariates to accommodate pandemic challenges posed to research are discussed. Clinicaltrials.gov registration number: NCT05082935. Date of registration: 10/15/2021.

Community Partner Perceptions of Equitable Implementation Practices for a Promotores de Salud Intervention: A Qualitative Assessment

We conducted focus groups with staff from 5 community-based organizations (21 participants; 86% female, 52% Hispanic/Latino/a/x and 24% Mexican/Mexican American) between August and October 2021. Results highlighted community partner perceptions of practices congruent (e.g., communication that built trust and dismantled power dynamics, a shared mission) and incongruent (e.g., intervention-community misalignment, research driven decision-making) with equitable implementation in the development, implementation, and evaluation of a promotores de salud intervention to increase COVID-19 testing and preventive behaviors among Latinx communities in Oregon. (Am J Public Health. 2024;114(S5):S377-S383. https://doi.org/10.2105/AJPH.2024.307686).

A Translational Case Study of a Multisite COVID-19 Public Health Intervention Across Sequenced Research Trials: Embedding Implementation in a Community Engagement Phased Framework

Through a COVID-19 public health intervention implemented across sequenced research trials, we present a community engagement phased framework that embeds intervention implementation: (1) consultation and preparation, (2) collaboration and implementation, and (3) partnership and sustainment. Intervention effects included mitigation of psychological distress and a 0.28 increase in the Latinx population tested for SARS-CoV-2. We summarize community engagement activities and implementation strategies that took place across the trials to illustrate the value of the framework for public health practice and research. (Am J Public Health. 2024;114(S5):S396-S401. https://doi.org/10.2105/AJPH.2024.307669).

Exploring barriers and facilitators of implementing an at-home SARS-CoV-2 antigen self-testing intervention: The Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) initiatives

BACKGROUND

Evaluating community-based programs provides value to researchers, funding entities, and community stakeholders involved in program implementation, and can increase program impact and sustainability. To understand factors related to program implementation, we aimed to capture the perspective of community partners engaged in organizing and executing community-engaged programs to distribute COVID-19 at-home tests in underserved communities.

METHODS

We conducted semi-structured interviews and focus groups with community-based stakeholders informed by the Outcomes for Implementation Research framework.

RESULTS

Findings describe how community-engaged communication and dissemination strategies drove program adoption among grassroots stakeholders. Establishing and sustaining trusted relationships was vital to engaging partners with aligned values and capacity. Respondents characterized the programs as generally feasible and appropriate, and community partners felt capable of delivering the program successfully. However, they also described an increased burden on their workforce and desired more significant support. Respondents recognized the programs' community engagement practices as a critical facilitator of acceptability and impact.

DISCUSSION

Implementation evaluation aims to inform current and future community outreach and engagement efforts with best practices. As we continue to inform and advance community-engaged disaster response practice, a parallel reimagining of public health funding mechanisms and timelines could provide a foundation for trust, collaboration, and community resiliency that endures beyond a given crisis.

Impact of the COVID-19 pandemic on lifestyle and mental state in patients with schizophrenia: A retrospective study

The corona virus disease 2019 pandemic's movement restrictions have an effect on people's lifestyles and mental health, and the most susceptible, such as persons with schizophrenia, are more subject to external influences. To analyze the lifestyle, anxiety, depression and stress status of inpatients with schizophrenia during corona virus disease 2019. A total of 205 patients with stable schizophrenia who were hospitalized during the epidemic period were selected. The general epidemiological information was recorded, and the depression screening scale (Patient Health Questionnaire-9), the Generalized Anxiety Disorder Scale-7, and the perceived stress scale were used to determine the mental status and stress level of the included patients. Restricted physical activity and perceptual bias might result in decreased food intake, higher body mass index, and increased psychotropic medicine dosages. According to Pearson correlation analysis, stress perception was positively connected with anxiety and depression scores. The anxiety score was positively associated with the depression score, indicating that stress influenced the patient's emotional alterations. During the pandemic, the lifestyle and psychological load of people with schizophrenia may be impacted. Medical personnel should be alert to changes in anxiety, depression, and stress in patients with schizophrenia and take appropriate action.