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Ye R, Wu Y, Sun C, Wang Q, Ma Y, Chen Y, Pappas L, Feng C, Rozelle S, Zhou H. Gap in protective behaviors between Han and minority ethnicities during COVID-19 pandemic in rural western China: A decomposition analysis. Prev Med Rep 2024; 39:102617. [PMID: 38370983 PMCID: PMC10873723 DOI: 10.1016/j.pmedr.2024.102617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/03/2024] [Accepted: 01/14/2024] [Indexed: 02/20/2024] Open
Abstract
Understanding the ethnic gap in protective behavior and its explanatory factors is a promising step for reducing pandemic-induced disparities. However, no studies have endeavored to identify the factors contributing to a gap in protective behaviors between Han and minority ethnicities during COVID-19 pandemic in rural China. We aimed to analyze the gap in protective behaviors between Han and minority residents in rural China. We conducted cross-sectional studies in multi-ethnic rural China in 2020. A total of 1640 participants from Han and minority groups were invited to participate. The decomposition method was applied to analyze the gap in protective behaviors and its associated factors between the Han and minority groups. Participants in the Han group had a higher protective behavioral score (9.26 ± 1.20) than the minority group (8.97 ± 1.50), yielding a significant gap in protective behaviors between Han and minority ethnicities of 0.29. Socio-demographic characteristics, health status, the degree of knowledge held about COVID-19, and psychological responses to COVID-19 explained 79.3 % (0.23/0.29) of the behavioral gap between the Han and minority groups. The difference in household asset levels was the largest explained contributor to the behavioral gap (52.17 %) (0.12/0.23), followed by fear felt for COVID-19 (-21.74 %) (-0.05/0.23). Differences in educational attainment, degree of knowledge held about COVID-19, and self-efficacy in response to COVID-19 each explained 17.4 % (0.04/0.23) of the behavioral gap. In conclusion, Han group show greater protective behaviors than minority ethnic groups. To drive better protective behavior in the most vulnerable communities, targeted, group-specific COVID-19 preventative messages deployed in public health communication strategies is suggested to enhance individual confidence in coping with the pandemic while creating a healthy amount of fear for public health crisis.
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Affiliation(s)
- Ruixue Ye
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuju Wu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chang Sun
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qingzhi Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yue Ma
- Stanford Center on China’s Economy and Institutions, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Yunwei Chen
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lucy Pappas
- Stanford Center on China’s Economy and Institutions, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Cindy Feng
- Stanford Center on China’s Economy and Institutions, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Scott Rozelle
- Stanford Center on China’s Economy and Institutions, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Huan Zhou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
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Martin HR, Brown DR, Fluney E, Trepka MJ, Marty AM, Roldan EO, Liu Q, Barbieri MA, Baum MK. Community-Engaged Research: COVID-19 Testing, Infection, and Vaccination among Underserved Minority Communities in Miami, Florida. Vaccines (Basel) 2024; 12:117. [PMID: 38400101 PMCID: PMC10892380 DOI: 10.3390/vaccines12020117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
Community collaboration is a cornerstone of modern public health efforts. This work aimed to use community-engaged research to explore COVID-19 vaccination, testing, and infection in a minoritized community. This study was conducted in Miami, Florida, from March 2021 to February 2022 in community partner sites and the Miami Adult Studies on HIV (MASH) cohort. Sociodemographic characteristics, vaccination and testing beliefs, and COVID-19 challenges were self-reported. COVID-19 vaccinations were verified with medical records, testing history was self-reported, and severe acute respiratory syndrome coronavirus 2 positivity was determined via real-time reverse transcription-polymerase chain reaction (rt-PCR). Of 1689 participants, the median age was 57, 51% were male, 49% were non-Hispanic Black, 66% reported an income < USD 15,000/year, and 75.9% received at least one dose of a COVID-19 vaccine. Belief that COVID-19 vaccination is effective was associated with lower odds of COVID-19 positivity and was the strongest predictor of vaccination. Challenges accessing health care, housing, food, and transportation were associated with lower odds of vaccination. Employment, health insurance, higher education, and greater perceived test accuracy were associated with greater odds of COVID-19 testing. Social determinants of health and the belief that vaccines are effective and tests are accurate predicted behaviors and thus should be considered during public health crises in vulnerable communities.
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Affiliation(s)
- Haley R. Martin
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC5, Miami, FL 33199, USA; (H.R.M.); (Q.L.)
| | - David R. Brown
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, AHC2, Miami, FL 33199, USA; (D.R.B.); (A.M.M.); (E.O.R.)
| | - Eileen Fluney
- Paradise Christian School, 6184 W 21st Court, Hialeah, FL 33016, USA;
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC5, Miami, FL 33199, USA;
| | - Aileen M. Marty
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, AHC2, Miami, FL 33199, USA; (D.R.B.); (A.M.M.); (E.O.R.)
| | - Eneida O. Roldan
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, AHC2, Miami, FL 33199, USA; (D.R.B.); (A.M.M.); (E.O.R.)
| | - Qingyun Liu
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC5, Miami, FL 33199, USA; (H.R.M.); (Q.L.)
| | - Manuel A. Barbieri
- Department of Biological Sciences, College of Arts, Sciences & Education, Florida International University, 11200 SW 8th Street, OE 167, Miami, FL 33199, USA;
| | - Marianna K. Baum
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC5, Miami, FL 33199, USA; (H.R.M.); (Q.L.)
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Khalifeh Z, Saluja S, Lam CN, Kaplan C. Disparities in access to COVID-19 testing in Los Angeles County. Prev Med Rep 2024; 37:102567. [PMID: 38205170 PMCID: PMC10776643 DOI: 10.1016/j.pmedr.2023.102567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
COVID-19 has disparately impacted low-income persons and racial and ethnic minorities-primarily Black and Hispanic populations. Our objective is to quantify disparities in access to COVID-19 testing and identify barriers to testing during the winter 2020-2021 surge in COVID-19 infections in Los Angeles County. An online survey was administered between December 2020 and January 2021 through which respondents were asked about their use of COVID testing and the barriers to testing they experienced. Our sample of 1,984 was reweighted to match the demographics of Los Angeles County. Despite similar testing rates to White residents, Hispanic residents were more likely to report testing positive. Persons with an annual income of $20,000 or less were less likely to receive a test than those with an income of $100,000 or more. Barriers to testing were more prevalent among racial/ethnic minorities and low-income persons. White respondents and high-income persons were more likely to report the ability to take time off work to await test results. Rates of testing were not commensurate with the rates of infection across racial/ethnic groups, which may be explained by higher rates of reported barriers to testing among Black and Hispanic residents. These findings may inform policies that address structural barriers to testing that disproportionately impact racial/ethnic minorities and low-income populations.
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Affiliation(s)
- Zain Khalifeh
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Sonali Saluja
- Gehr Center for Health Systems Science and Innovation, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Chun Nok Lam
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Cameron Kaplan
- Gehr Center for Health Systems Science and Innovation, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
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Leonhardt M, Bramness JG, Lien L. Incidence of SARS-CoV-2 and all-cause mortality in persons with co-occurring substance use disorder and mental illness during the pandemic: a Norwegian cohort study. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02599-6. [PMID: 38015236 DOI: 10.1007/s00127-023-02599-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Most people were affected by the COVID-19 pandemic. Persons with co-occurring substance use disorder (SUD) and mental illness (MI) are already a marginalized group, with above average mortality. Thus, the study aim was to investigate SARS-CoV-2 incidence and mortality among persons with SUD/MI during the first two years of the pandemic. METHODS This historical cohort study merged data from the Norwegian Patient Register, the Norwegian Surveillance System for Communicable Diseases and census data from Statistics Norway. We calculated crude mortality rates for persons with SUD and mild/moderate vs. severe MI and compared them to persons with physical illnesses or healthy controls. The incidence rate ratios for SARS-CoV-2 infection and mortality were estimated using Poisson regression models. RESULTS Compared to healthy controls, the SARS-Cov-2-infection rate was marginally lower in persons with SUD and mild/moderate MI (IRR,1.19 [95%CI,1.09-1.30]) as in persons with physical illness (IRR,1.35 [95%CI, 1.23-1.47]), whereas persons with SUD and severe MI showed a lower rate compared to healthy controls. Crude mortality rates for persons with SUD/MI were substantially higher and increased much more during the pandemic than for persons with physical illnesses or healthy controls. The IRR for mortality in persons with SUD and mild/moderate MI was 10.61 (95%CI,7.19-15.67) and 11.44 (95%CI,7.50-17.45) for SUD and severe MI, compared to 5.03 (3.34-7.57]) for persons with physical illnesses only. CONCLUSION The analysis showed excess mortality during COVID-19-pandemic for SUD/MI, but without higher SARS-CoV-2 infection rates in this group. Consequently, excess mortality among persons with SUD/MI was not due to SARS-CoV-2 infection.
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Affiliation(s)
- Marja Leonhardt
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, PB 104, Brumunddal, 2381, Norway.
- Faculty of Health Studies, VID Specialized University, Oslo, Norway.
| | - Jørgen G Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, PB 104, Brumunddal, 2381, Norway
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
- Institute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, PB 104, Brumunddal, 2381, Norway
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
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Yan X, Schneider JA, Modali L, Korban C, Tabidze I. Racial-ethnic, gender identity, and sexual orientation disparities in COVID-19-related social and health outcomes: A decomposition analysis. SSM Popul Health 2023; 23:101474. [PMID: 37560090 PMCID: PMC10407278 DOI: 10.1016/j.ssmph.2023.101474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/21/2023] [Accepted: 07/21/2023] [Indexed: 08/11/2023] Open
Abstract
Despite the growing literature on racial-ethnic disparities during the pandemic, less is known about the explanatory mechanisms of these disparities and inequalities across other axes, such as gender and sexual identities. We studied the levels and sources of racial-ethnic, gender identity, and sexual minority disparities in social (i.e., unmet resource needs) and health (i.e., hospitalization) outcomes among individuals diagnosed with COVID-19, hypothesizing differential age structure, underlying health, and work and living arrangements as contributors to inequalities. Using large-scale administrative data from Chicago and adjusting for covariates, we found substantial racial-ethnic and gender identity disparities in both outcomes, and weak evidence of sexual minority disparities in unmet needs. Subsequent decomposition analyses revealed that living in larger households, having a higher share of non-adult cases, and facing higher burdens of chronic illness, obesity, and unemployment each statistically significantly drove racial-ethnic disparities in unmet needs, but these together explained less than 15% of the disparities. Similarly, about 20% of the Black-White gap in hospitalization resulted from disparities in underlying health and unemployment, whereas a higher proportion of non-adult cases or higher unemployment rates respectively proved the only significant pathways to partially explain transgender individuals' disadvantages in unmet needs (12%) or hospitalization (6%). These findings highlight the importance of considering multiple dimensions of social differences in studying health disparities, the vulnerabilities of transgender and non-adult communities during the pandemic, and the valid yet quite limited roles of previously suggested sociodemographic factors in accounting for COVID-19-related categorical inequalities.
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Affiliation(s)
- Xuewen Yan
- Department of Sociology, Cornell University, Chicago Department of Public Health, USA
| | - John A. Schneider
- Departments of Medicine and Public Health Sciences, University of Chicago, Chicago Department of Public Health, USA
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LeWinn KZ, Trasande L, Law A, Blackwell CK, Bekelman TA, Arizaga JA, Sullivan AA, Bastain TM, Breton CV, Karagas MR, Elliott AJ, Karr CJ, Carroll KN, Dunlop AL, Croen LA, Margolis AE, Alshawabkeh AN, Cordero JF, Singh AM, Seroogy CM, Jackson DJ, Wood RA, Hartert TV, Kim YS, Duarte CS, Schweitzer JB, Lester BM, McEvoy CT, O’Connor TG, Oken E, Bornkamp N, Brown ED, Porucznik CA, Ferrara A, Camargo CA, Zhao Q, Ganiban JM, Jacobson LP. Sociodemographic Differences in COVID-19 Pandemic Experiences Among Families in the United States. JAMA Netw Open 2023; 6:e2330495. [PMID: 37610749 PMCID: PMC10448300 DOI: 10.1001/jamanetworkopen.2023.30495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/17/2023] [Indexed: 08/24/2023] Open
Abstract
Importance Few population-based studies in the US collected individual-level data from families during the COVID-19 pandemic. Objective To examine differences in COVID-19 pandemic-related experiences in a large sociodemographically diverse sample of children and caregivers. Design, Setting, and Participants The Environmental influences on Child Health Outcomes (ECHO) multi-cohort consortium is an ongoing study that brings together 64 individual cohorts with participants (24 757 children and 31 700 caregivers in this study) in all 50 US states and Puerto Rico. Participants who completed the ECHO COVID-19 survey between April 2020 and March 2022 were included in this cross-sectional analysis. Data were analyzed from July 2021 to September 2022. Main Outcomes and Measures Exposures of interest were caregiver education level, child life stage (infant, preschool, middle childhood, and adolescent), and urban or rural (population <50 000) residence. Dependent variables included COVID-19 infection status and testing; disruptions to school, child care, and health care; financial hardships; and remote work. Outcomes were examined separately in logistic regression models mutually adjusted for exposures of interest and race, ethnicity, US Census division, sex, and survey administration date. Results Analyses included 14 646 children (mean [SD] age, 7.1 [4.4] years; 7120 [49%] female) and 13 644 caregivers (mean [SD] age, 37.6 [7.2] years; 13 381 [98%] female). Caregivers were racially (3% Asian; 16% Black; 12% multiple race; 63% White) and ethnically (19% Hispanic) diverse and comparable with the US population. Less than high school education (vs master's degree or more) was associated with more challenges accessing COVID-19 tests (adjusted odds ratio [aOR], 1.88; 95% CI, 1.06-1.58), lower odds of working remotely (aOR, 0.04; 95% CI, 0.03-0.07), and more food access concerns (aOR, 4.14; 95% CI, 3.20-5.36). Compared with other age groups, young children (age 1 to 5 years) were least likely to receive support from schools during school closures, and their caregivers were most likely to have challenges arranging childcare and concerns about work impacts. Rural caregivers were less likely to rank health concerns (aOR, 0.77; 95% CI, 0.69-0.86) and social distancing (aOR, 0.82; 95% CI, 0.73-0.91) as top stressors compared with urban caregivers. Conclusions Findings in this cohort study of US families highlighted pandemic-related burdens faced by families with lower socioeconomic status and young children. Populations more vulnerable to public health crises should be prioritized in recovery efforts and future planning.
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Affiliation(s)
- Kaja Z. LeWinn
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
| | - Leonardo Trasande
- Department of Pediatrics, New York University Grossman School of Medicine, New York
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Andrew Law
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Traci A. Bekelman
- Department of Epidemiology, Lifecourse Epidemiology of Adiposity & Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora
| | - Jessica A. Arizaga
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
| | - Alexis A. Sullivan
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
| | - Theresa M. Bastain
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
| | - Carrie V. Breton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
| | - Margaret R. Karagas
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire
| | | | | | - Kecia N. Carroll
- Jack and Lucy Clark Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anne L. Dunlop
- Department of Gynecology & Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | | | - Amy E. Margolis
- Columbia University Irving Medical Center, New York State Psychiatric Institute, New York
| | | | - Jose F. Cordero
- Department of Epidemiology & Biostatistics, College of Public Health, University of Georgia, Athens
| | - Anne Marie Singh
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Christine M. Seroogy
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Daniel J. Jackson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Robert A. Wood
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Tina V. Hartert
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Young Shin Kim
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
| | - Cristiane S. Duarte
- Columbia University Irving Medical Center, New York State Psychiatric Institute, New York
| | - Julie B. Schweitzer
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
- The MIND Institute, University of California, Davis, Sacramento
| | - Barry M. Lester
- Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women & Infants Hospital, Providence, Rhode Island
| | - Cynthia T. McEvoy
- Department of Pediatrics, Oregon Health and Science University School of Medicine, Portland
| | - Thomas G. O’Connor
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Emily Oken
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Nicole Bornkamp
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Eric D. Brown
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
| | - Christina A. Porucznik
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City
| | | | | | - Qi Zhao
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Jody M. Ganiban
- Department of Psychological & Brain Sciences, Columbian College of Arts & Sciences, George Washington University, Washington, DC
| | - Lisa P. Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Jarvie MM, Reed-Lukomski M, Southwell B, Wright D, Nguyen TNT. Monitoring of COVID-19 in wastewater across the Eastern Upper Peninsula of Michigan. Environ Adv 2023; 11:100326. [PMID: 36471702 PMCID: PMC9714184 DOI: 10.1016/j.envadv.2022.100326] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/01/2022] [Accepted: 11/29/2022] [Indexed: 05/12/2023]
Abstract
Wastewater-based epidemiology is being used as a tool to monitor the spread of COVID-19 and provide an early warning for the presence or increase of clinical cases in a community. The majority of wastewater-based epidemiology for COVID-19 tracking has been utilized in sewersheds that service populations in the tens-to-hundreds of thousands. Few studies have been conducted to assess the usefulness of wastewater in predicting COVID-19 clinical cases specifically in rural areas. This study collected samples from 16 locations across the Eastern Upper Peninsula of Michigan from June to December 2021. Sampling locations included 12 rural municipalities, a Tribal housing community and casino, a public university, three municipalities that also contained a prison, and a small island with heavy tourist traffic. Samples were analyzed for SARS-CoV-2 N1, N2, and variant gene copies using reverse transcriptase droplet digital polymerase chain reaction (RT-ddPCR). Wastewater N1 and N2 gene copies and clinical case counts were correlated to determine if wastewater results were predictive of clinical cases. Significant correlation between N1 and N2 gene copies and clinical cases was found for all sites (⍴= 0.89 to 0.48). N1 and N2 wastewater results were predictive of clinical case trends within 0-7 days. The Delta variant was detected in the Pickford and St. Ignace samples more than 12-days prior to the first reported Delta clinical cases in their respective counties. Locations with low correlation could be attributed to their high rates of tourism. This is further supported by the high correlation seen in the public university, which is a closed population. Long-term wastewater monitoring over a large, rural geographic area is useful for informing the public of potential outbreaks in the community regardless of asymptomatic cases and access to clinical testing.
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Affiliation(s)
- Michelle M Jarvie
- School of Science and Medicine, Lake Superior State University, 650 W. Easterday Ave., Sault Ste, Marie, MI 49783, USA
| | - Moriah Reed-Lukomski
- School of Science and Medicine, Lake Superior State University, 650 W. Easterday Ave., Sault Ste, Marie, MI 49783, USA
| | - Benjamin Southwell
- School of Science and Medicine, Lake Superior State University, 650 W. Easterday Ave., Sault Ste, Marie, MI 49783, USA
| | - Derek Wright
- School of Natural Resources and Environment, Lake Superior State University, 650 W. Easterday Ave., Sault Ste. Marie, MI 49783, USA
| | - Thu N T Nguyen
- School of Science and Medicine, Lake Superior State University, 650 W. Easterday Ave., Sault Ste, Marie, MI 49783, USA
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Porter A, Brown CC, Rodriguez A, Zohoori N, Wells S, Crump A, Romero J, Tilford JM. Variation in Time Between Testing Positive for COVID-19 and Hospital Admission by Race/Ethnicity and Insurance Status. J Health Care Poor Underserved 2023; 34:1290-1304. [PMID: 38661756 PMCID: PMC11101062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Understanding the extent to which demographic and socioeconomic factors play a role in the disparities associated with duration between testing positive for COVID-19 and hospital admission will help in achieving equitable health outcomes. This project linked the statewide COVID-19 registry to administrative datasets to examine the variation in times between testing positive for COVID-19 and hospital admission by race/ethnicity and insurance. In 2020, there were 11,314 patients admitted for COVID-19 in Arkansas. Approximately 42.2% tested positive for COVID-19 on the same day as hospital admission. Black patients had 38% higher odds of hospitalization on the day of testing compared with White patients (p<.001). Medicaid and uninsured patients had 51% and 50% higher odds of admission on the day of testing compared with privately insured patients (both p<.001), respectively. This study highlights the implications of reduced access to testing with respect to equitable health outcomes.
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Affiliation(s)
- Austin Porter
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR 72205
- Arkansas Department of Health, Little Rock, AR 72205
| | - Clare C. Brown
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR 72205
| | - Analiz Rodriguez
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Namvar Zohoori
- Arkansas Department of Health, Little Rock, AR 72205
- Fay W. Boozman College of Public Health, Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205
| | - Samantha Wells
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR 72205
| | - Alisha Crump
- Fay W. Boozman College of Public Health, Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205
| | - José Romero
- Arkansas Department of Health, Little Rock, AR 72205
| | - J. Mick Tilford
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR 72205
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Kirkby K, Bergen N, Vidal Fuertes C, Schlotheuber A, Hosseinpoor AR. Education-related inequalities in beliefs and behaviors pertaining to COVID-19 non-pharmaceutical interventions. Int J Equity Health 2022; 21:158. [PMID: 36357891 PMCID: PMC9648879 DOI: 10.1186/s12939-022-01751-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The coronavirus pandemic has exposed existing social inequalities in relation to disease preventive behaviors, risk of exposure, testing and healthcare access, and consequences as a result of illness and containment measures across different population groups. However, due to a lack of data, to date there has been limited evidence of the extent of such within-country inequalities globally. METHODS We examined education-related inequalities in four COVID-19 prevention and testing indicators within 90 countries, using data from the University of Maryland Social Data Science Center Global COVID-19 Trends and Impact Survey, in partnership with Facebook, over the period 1 June 2021 to 31 December 2021. The overall level of education-related inequalities, as well as how they differ across country income groups and how they have changed over time were analyzed using the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII). We also assessed whether these education-related inequalities were associated with government policies and responses. RESULTS Education-related inequalities in beliefs, mask wearing, social distancing and testing varied across the study countries. Mask wearing and beliefs in the effectiveness of social distancing and mask wearing were overall more common among people with a higher level of education. Even after controlling for other sociodemographic and health-related factors, social distancing practice was higher among the most educated in low/lower middle income countries, but was higher overall among the least educated in high income countries. Overall there were low education-related inequalities in COVID-19 testing, though there was variation across countries. CONCLUSIONS The study highlights important within-country education-related differences in COVID-19 beliefs, preventive behaviors and testing, as well as differing trends across country income groups. This has implications for considering and targeting specific population groups when designing public health interventions and messaging during the COVID-19 pandemic and future health emergencies.
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Affiliation(s)
- Katherine Kirkby
- grid.3575.40000000121633745Division of Data, Analytics and Delivery for Impact, Department of Data and Analytics, World Health Organization, 20, Avenue Appia, CH-1211, Geneva, Switzerland
| | - Nicole Bergen
- grid.3575.40000000121633745Division of Data, Analytics and Delivery for Impact, Department of Data and Analytics, World Health Organization, 20, Avenue Appia, CH-1211, Geneva, Switzerland
| | - Cecilia Vidal Fuertes
- grid.3575.40000000121633745Division of Data, Analytics and Delivery for Impact, Department of Data and Analytics, World Health Organization, 20, Avenue Appia, CH-1211, Geneva, Switzerland
| | - Anne Schlotheuber
- grid.3575.40000000121633745Division of Data, Analytics and Delivery for Impact, Department of Data and Analytics, World Health Organization, 20, Avenue Appia, CH-1211, Geneva, Switzerland
| | - Ahmad Reza Hosseinpoor
- Division of Data, Analytics and Delivery for Impact, Department of Data and Analytics, World Health Organization, 20, Avenue Appia, CH-1211, Geneva, Switzerland.
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10
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O’Neill B, Kalia S, Hum S, Gill P, Greiver M, Kirubarajan A, Eisen D, Ferguson J, Dunn S. Socioeconomic and immigration status and COVID-19 testing in Toronto, Ontario: retrospective cross-sectional study. BMC Public Health 2022; 22:1067. [PMID: 35643450 PMCID: PMC9148216 DOI: 10.1186/s12889-022-13388-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 05/03/2022] [Indexed: 12/03/2022] Open
Abstract
Background Preliminary evidence suggests that individuals living in lower income neighbourhoods are at higher risk of COVID-19 infection. The relationship between sociodemographic characteristics and COVID-19 risk warrants further study. Methods We explored the association between COVID-19 test positivity and patients’ socio-demographic variables, using neighborhood sociodemographic data collected retrospectively from two COVID-19 Assessment Centres in Toronto, ON. Results Eighty-three thousand four hundred forty three COVID-19 tests completed between April 5–September 30, 2020, were analyzed. Individuals living in neighbourhoods with the lowest income or highest concentration of immigrants were 3.4 (95% CI: 2.7 to 4.9) and 2.5 (95% CI: 1.8 to 3.7) times more likely to test positive for COVID-19 than those in highest income or lowest immigrant neighbourhoods, respectively. Testing was higher among individuals from higher income neighbourhoods, at lowest COVID-19 risk, compared with those from low-income neighbourhoods. Conclusions Targeted efforts are needed to improve testing availability in high-risk regions. These same strategies may also ensure equitable COVID-19 vaccine delivery. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13388-2.
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Moissl AP, Lorkowski S, März W. Socio-economic deprivation and COVID-19 in Germany. Scand J Public Health 2022; 50:668-670. [PMID: 35319307 PMCID: PMC9361408 DOI: 10.1177/14034948221080397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Angela P. Moissl
- Institute of Nutritional Sciences, Friedrich
Schiller University Jena, Germany
- Competence Cluster for Nutrition and
Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Germany
- Medical Faculty Mannheim, University of
Heidelberg, Germany
| | - Stefan Lorkowski
- Institute of Nutritional Sciences, Friedrich
Schiller University Jena, Germany
- Competence Cluster for Nutrition and
Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Germany
- Stefan Lorkowski, Institute of Nutritional
Sciences, Friedrich Schiller University Jena, Dornburger Straße 25, Jena, 07743, Germany.
E-mail:
| | - Winfried März
- Competence Cluster for Nutrition and
Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Germany
- Medical Faculty Mannheim, University of
Heidelberg, Germany
- Clinical Institute of Medical and Chemical
Laboratory Diagnostics, Medical University Graz, Austria
- Synlab Academy, Synlab Holding Deutschland
GmbH, Germany
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12
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Raza SA, Zhang X, Oluyomi A, Adepoju OE, King B, Amos CI, Badr H. Predictors of COVID-19 perceived susceptibility: insights from population-based self-reported survey during lockdown in the United States. J Infect Public Health 2022; 15:508-514. [PMID: 35429789 PMCID: PMC8941860 DOI: 10.1016/j.jiph.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/01/2021] [Accepted: 03/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background The COVID-19 pandemic during lockdown has highlighted the importance of identifying individuals most at risk of infection with SARS-CoV-2, underscoring the need to assess factors contributing to susceptibility to disease. With the rapidly evolving nature of the pandemic and its new variants, there is an inadequate understanding on whether there are certain factors such as a specific symptom or collection of symptoms that combined with life-style behaviors may be useful to predict susceptibility. The study aims to explore such factors from pre-vaccination data to guide public health response to potential new waves. Methods An anonymous electronic survey was distributed through social media during the lockdown period in the United States from April to June 2020. Respondents were questioned regarding COVID testing, presenting symptoms, demographic information, comorbidities, and confirmation of COVID‐19 test results. Stepwise logistic regression was used to identify predictors for COVID‐19 perceived susceptibility. Selected classifiers were assessed for prediction performance using area under receiver operating characteristic (AUROC) curve analysis. Results A total of 130 participants deemed as susceptible because they self-reported their perception of having COVID-19 (but without the evidence of positive test) were compared with 130 individuals with documented negative test results. Participants had a mean age of 45 years, and 165 (63%) were female. Final multivariable model showed significant associations with perceived susceptibility for the following variables: fever (OR:33.5; 95%CI: 3.9,85.9), body ache (OR:3.0; 95%CI:1.1,6.4), contact history (OR:2.7; 95%CI:1.1,6.4), age> 50 (OR:2.7; 95%CI:1.1, 6.6) and smoking (OR:3.3; 95%CI: 1.2,9.1) after adjusting for other symptoms and presence of comorbid conditions. The AUROC ranged from poor to fair (0.65–0.76) for cluster of symptoms but improved to a good model (AUROC = 0.803) after inclusion of sociodemographic and lifestyle behaviors e.g., age and smoking tobacco. Conclusions Fever and body aches suggest association with perceived COVID‐19 susceptibility in the presence of demographic and lifestyle behaviors. Using other constitutional and respiratory symptoms with fever and body aches, the parsimonious classifier correctly predicts 80.3% of COVID‐19 perceived susceptibility. A larger cohort of respondents will be needed to study and refine classifier performance in future lockdowns and with expected surge of new variants of COVID-19 pandemic.
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Ye R, Wu Y, Sun C, Wang Q, Mao Y, Chang W, Zhou H. What Prompted the Adoption of Self-Protective Behaviors in Response to COVID-19? Evidence From Women Living in the Rural Areas of Western China. Front Public Health 2022; 9:756933. [PMID: 35155337 PMCID: PMC8831835 DOI: 10.3389/fpubh.2021.756933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/20/2021] [Indexed: 12/01/2022] Open
Abstract
Background Self-protective behaviors, such as handwashing and mask-wearing, are effective to reduce the spread of coronavirus disease (COVID-19), but few studies have focused on women living in rural areas who bear the brunt of the impacts of the pandemic due to their economic and social vulnerabilities. This study explores what prompted the adoption of self-protective behaviors in response to COVID-19 among women living in rural areas of western China. Methods The study sample consisted of 1,524 women from 116 townships across 10 counties in rural western China. We collected data in May and August 2020 on women's socioeconomic characteristics, exposure to COVID-19-related information, psychological response to COVID-19, and adoption of self-protective behaviors. Structural equation modeling (SEM) analyses were conducted to analyze the relations among the variables. Results During the lockdown, 1,221 (80.12%) of the 1,524 women in the study sample reported wearing a mask every time when they went outside and 1,021 (66.99%) reported handwashing with soap every time after they came home. Perceived efficacy had the strongest association with self-protective behaviors (β = 0.38; p < 0.001). Receiving public health guidance (β = 0.18; p < 0.001) was indirectly associated with more self-protective behaviors via greater perceived efficacy. Higher socioeconomic status was also directly associated with increased adoption of self-protective behaviors (β = 0.24; p < 0.001). Other variables, such as receiving surveillance and risk information, communication channels, perceived risks, and fear, were indirectly associated with the adoption of self-protective behaviors with smaller effect sizes (all β were lower than 0.10). Conclusions Not all women were able to adopt self-protective behaviors, such as mask-wearing and handwashing, during the COVID-19 pandemic in western China. To further encourage behavioral changes in response to public health crises, the government should develop clear and actionable guidelines and adopt targeted health communication strategies to reach the most disadvantaged groups of society. These findings may inform tailored responses to COVID-19 in other low- and middle-income countries.
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Affiliation(s)
- Ruixue Ye
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Chengdu, China
| | - Yuju Wu
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Chengdu, China
| | - Chang Sun
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Chengdu, China
| | - Qingzhi Wang
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Chengdu, China
| | - Yuping Mao
- Department of Communication Studies, College of Liberal Arts, California State University Long Beach, Long Beach, CA, United States
| | - Wei Chang
- Harvard Chan School of Public Health, Boston, MA, United States
| | - Huan Zhou
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Chengdu, China
- *Correspondence: Huan Zhou
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Yolda-Carr D, Thammavongsa DA, Vega N, Turner SJ, Pickering PJ, Wyllie AL. Evaluation of the Liberty16 Mobile Real Time PCR Device for Use With the SalivaDirect Assay for SARS-CoV-2 Testing. Front Cell Infect Microbiol 2022; 11:808773. [PMID: 35118013 PMCID: PMC8804088 DOI: 10.3389/fcimb.2021.808773] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic has highlighted the need and benefits for all communities to be permitted timely access to on-demand screening for infectious respiratory diseases. This can be achieved with simplified testing approaches and affordable access to core resources. While RT-qPCR-based tests remain the gold standard for SARS-CoV-2 detection due to their high sensitivity, implementation of testing requires high upfront costs to obtain the necessary instrumentation. This is particularly restrictive in low-resource settings. The Ubiquitome Liberty16 system was developed as an inexpensive, portable, battery-operated single-channel RT-qPCR device with an associated iPhone app to simplify assay set-up and data reporting. When coupled with the SalivaDirect protocol for testing saliva samples for SARS-CoV-2, the Liberty16 device yielded a limit of detection (LOD) of 12 SARS-CoV-2 RNA copies/µL, comparable to the upper end of the LOD range for the standard SalivaDirect protocol when performed on larger RT-qPCR instruments. While further optimization may deliver even greater sensitivity and assay speed, findings from this study indicate that small portable devices such as the Liberty16 can deliver reliable results and provide the opportunity to further increase access to gold standard SARS-CoV-2 testing.
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Affiliation(s)
- Devyn Yolda-Carr
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
| | - Darani A. Thammavongsa
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
| | - Noel Vega
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
| | | | | | - Anne L. Wyllie
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
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15
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Yi SS, Ali SH, Chin M, Russo RG, Đoàn LN, Rummo P. Contrasting the experiences for high- and low-income Asian Americans during COVID-19. Prev Med Rep 2021; 24:101519. [PMID: 34540571 PMCID: PMC8436153 DOI: 10.1016/j.pmedr.2021.101519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/29/2021] [Accepted: 08/08/2021] [Indexed: 11/25/2022] Open
Abstract
There is a lack of quantitative research examining how the pandemic has affected individuals at different income levels. The Asian American population has the highest level of income inequality and serves as an excellent case study for examining differences in experience between income groups. A non-probability sample of 3084 Asian American adults living in the US was surveyed in June 2020, examining health-related behaviors and outcomes. Descriptive analyses and chi-squared statistics were conducted to identify differences in income groups (low, medium, high) among Asian Americans across regional subgroups (East, South, Southeast, Multiethnic) and disaggregated ethnicities (Chinese, Asian Indian, Japanese, and Filipino). In bivariable analyses, a significantly (p < 0.05) greater percentage of high-income individuals during the pandemic reported having enough money to buy the food they needed, a away to get to the store for food, and reported stores where they get food had everything they needed. High-income Chinese, Japanese, and Filipino individual also noted that, since the COVID-19 crisis, they are now working partially or fully from home. In the total sample, multivariable adjusted logistic regressions revealed medium- and low-income individuals to have low odds of working partially or fully from home (AOR:0.55, 95%CI:0.42-0.72), higher odds of not having enough money to buy the food they needed (AOR:3.54, 95%CI:1.43-11.81), and higher odds of eating less (AOR:1.58, 95%CI:1.14-2.22). These results highlight the importance of considering income distribution when characterizing disparities in health behaviors within racial/ethnic minority groups and underscore the need to bolster the infrastructure supporting low-income Asian Americans.
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Affiliation(s)
- Stella S. Yi
- Department of Population Health, Section for Health Equity, New York University Grossman School of Medicine, New York, NY, United States
| | - Shahmir H. Ali
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
| | - Matthew Chin
- Department of Population Health, Section for Health Equity, New York University Grossman School of Medicine, New York, NY, United States
| | - Rienna G. Russo
- Department of Population Health, Section for Health Equity, New York University Grossman School of Medicine, New York, NY, United States
| | - Lan N. Đoàn
- Department of Population Health, Section for Health Equity, New York University Grossman School of Medicine, New York, NY, United States
| | - Pasquale Rummo
- Department of Population Health, Section on Health Choice, Policy and Evaluation, New York University Grossman School of Medicine, New York, NY, United States
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16
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Hernández-Vásquez A, Visconti-Lopez FJ, Azañedo D. Prevalence and factors associated with non-use of health services in the Peruvian population with COVID-19 symptomatology: a secondary analysis of the 2020 National Household Survey. Epidemiol Health 2021; 43:e2021084. [PMID: 34665956 PMCID: PMC8863613 DOI: 10.4178/epih.e2021084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The objective of this study was to estimate the prevalence of non-use of health services (NUHS) and its associated factors in Peruvians with symptoms of coronavirus disease 2019 (COVID-19). METHODS A secondary analysis of the 2020 National Household Survey (ENAHO) was carried out. Participants over 18 years of age with any COVID-19 symptom (fever, cough, sensation of shortness of breath) in the last 4 weeks who did not visit health services were defined as exhibiting NUHS. Adjusted prevalence ratios (aPRs) were estimated to determine the factors associated with NUHS. RESULTS Data from 1,856 participants were analyzed; the prevalence of NUHS was 52.2% (95% confidence interval [CI], 48.0 to 56.5). Living in urban areas of the jungle (aPR, 1.61; 95% CI, 1.32 to 1.98; p<0.001) and rural areas of the jungle (aPR, 1.48; 95% CI, 1.15 to 1.90; p=0.002) was associated with a higher probability of NUHS than living in urban coastal areas. The factors associated with a lower probability of NUHS were being 50-59 years old (aPR, 0.72; 95% CI, 0.58 to 0.90) and 60 years and over (aPR, 0.74; 95% CI, 0.59 to 0.95), having a secondary educational level (aPR, 0.67; 95% CI, 0.48 to 0.93) or superior educational level (aPR, 0.67; 95% CI, 0.48 to 0.96), and having health insurance (aPR, 0.79; 95% CI, 0.68 to 0.92). CONCLUSIONS More than half of the participants with COVID-19 symptoms did not use health services, and NUHS was associated with the geographic and socio-demographic characteristics of the population. The formulation of health strategies and programs is required to increase the use of health services by people with COVID-19 symptoms.
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Affiliation(s)
- Akram Hernández-Vásquez
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
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Bevan I, Stage Baxter M, Stagg HR, Street A. Knowledge, Attitudes, and Behavior Related to COVID-19 Testing: A Rapid Scoping Review. Diagnostics (Basel) 2021; 11:1685. [PMID: 34574026 PMCID: PMC8472251 DOI: 10.3390/diagnostics11091685] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 12/23/2022] Open
Abstract
Testing programs for COVID-19 depend on the voluntary actions of members of the public for their success. Understanding people's knowledge, attitudes, and behavior related to COVID-19 testing is, therefore, key to the design of effective testing programs worldwide. This paper reports on the findings of a rapid scoping review to map the extent, characteristics, and scope of social science research on COVID-19 testing and identifies key themes from the literature. Main findings include the discoveries that people are largely accepting of testing technologies and guidelines and that a sense of social solidarity is a key motivator of testing uptake. The main barriers to accessing and undertaking testing include uncertainty about eligibility and how to access tests, difficulty interpreting symptoms, logistical issues including transport to and from test sites and the discomfort of sample extraction, and concerns about the consequences of a positive result. The review found that existing research was limited in depth and scope. More research employing longitudinal and qualitative methods based in under-resourced settings and examining intersections between testing and experiences of social, political, and economic vulnerability is needed. Last, the findings of this review suggest that testing should be understood as a social process that is inseparable from processes of contact tracing and isolation and is embedded in people's everyday routines, livelihoods and relationships.
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Affiliation(s)
- Imogen Bevan
- School of Social and Political Science, University of Edinburgh, Edinburgh EH8 9LD, UK;
| | - Mats Stage Baxter
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK; (M.S.B.); (H.R.S.)
| | - Helen R. Stagg
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK; (M.S.B.); (H.R.S.)
| | - Alice Street
- School of Social and Political Science, University of Edinburgh, Edinburgh EH8 9LD, UK;
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Parekh N, Ali SH, O'Connor J, Tozan Y, Jones AM, Capasso A, Foreman J, DiClemente RJ. Food insecurity among households with children during the COVID-19 pandemic: results from a study among social media users across the United States. Nutr J 2021; 20:73. [PMID: 34461913 PMCID: PMC8403824 DOI: 10.1186/s12937-021-00732-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background In the United States, approximately 11% of households were food insecure prior to the COVID-19 pandemic. The present study aims to describe the prevalence of food insecurity among adults and households with children living in the United States during the pandemic. Methods This study utilized social media as a recruitment platform to administer an original online survey on demographics and COVID-related food insecurity. The survey was disseminated through an advertisement campaign on Facebook and affiliated platforms. Food insecurity was assessed with a validated six-item United States Department of Agriculture (USDA) Household Food Security Survey Module, which was used to create a six-point numerical food security score, where a higher score indicates lower food security. Individual-level participant demographic information was also collected. Logistic regressions (low/very-low compared with high/marginal food security) were performed to generate adjusted odds ratios (AOR) and 95%CIs for food insecurity and select demographic characteristics. Results Advertisements reached 250,701 individuals and resulted in 5,606 complete surveys. Overall, 14.7% of participants self-identified as having low or very low food security in their households, with higher prevalence (17.5%) among households with children. Unemployment (AOR:1.76, 95%CI:1.09–2.80), high school or lower education (AOR:2.25, 95%CI:1.29–3.90), and low income (AOR[$30,000-$50,000]:5.87, 95%CI:3.35–10.37; AOR[< $30,000]:10.61, 95%CI:5.50–20.80) were associated with higher odds of food insecurity in multivariable models among households with children (and the whole sample). Conclusions These data indicate exacerbation of food insecurity during the pandemic. The study will be instrumental in guiding additional research and time-sensitive interventions targeted towards vulnerable food insecure subgroups.
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Affiliation(s)
- Niyati Parekh
- Public Health Nutrition Program, School of Global Public Health, New York University, 715 Broadway New York, Room 1220, New York, 10003, USA. .,Department of Population Health At NYU Grossman School of Medicine, New York University, New York, USA. .,Rory Meyers College of Nursing, New York University, New York, USA.
| | - Shahmir H Ali
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, USA
| | - Joyce O'Connor
- Public Health Nutrition Program, School of Global Public Health, New York University, 715 Broadway New York, Room 1220, New York, 10003, USA
| | - Yesim Tozan
- Global Health Program, School of Global Public Health, New York University, New York, USA
| | - Abbey M Jones
- Department of Epidemiology, School of Global Public Health, New York University, New York, USA
| | - Ariadna Capasso
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, USA
| | - Joshua Foreman
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, USA.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Ralph J DiClemente
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, USA
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