"Be honest and gain trust": a population health study to understand the factors associated with building trust in local government related to COVID-19 and vaccination in three historically disinvested neighborhoods in New York City

Background

Distrust in government among people of color is a response to generations of systemic racism that have produced preventable health inequities. Higher levels of trust in government are associated with better adherence to government guidelines and policies during emergencies, but factors associated with trust and potential actions to increase trust in local government are not well understood.

Methods

The COVID-19 Community Recovery study sampled participants from the New York City (NYC) Department of Health and Mental Hygiene's NYC Health Panel, a probability-based survey panel who complete health surveys periodically. Participants who lived in one of three historically disinvested communities in NYC where the NYC Department of Health and Mental Hygiene has dedicated resources to reduce health inequities were included. The cross-sectional survey was fielded from September 30 to November 4, 2021 and could be self-administered online or conducted via CATI (Computer Assisted Telephone Interviewing) in English, Spanish, and Simplified Chinese (Mandarin and Cantonese by phone). Demographic data were summarized by descriptive statistics. Crude and adjusted logistic regression analyses were used to assess factors predictive of trust in local government as a source of information about COVID-19 vaccines. Open-ended responses about strengthening residents' trust in local government were coded using an iteratively generated codebook.

Results

In total, 46% of respondents indicated NYC local government was a trusted source of information about COVID-19 vaccines, relatively high compared to other sources. In bivariate analyses, race/ethnicity, age group, educational attainment, length of time living in NYC, and household income were significantly associated with identifying NYC government as a trusted source of information about COVID-19 vaccines. In multivariable logistic regression, no variables remained significant predictors of selecting local government as a trusted source of information. Key recommendations for local government agencies to build residents' trust include communicating clearly and honestly, addressing socioeconomic challenges, and enhancing public COVID-19 protection measures.

Conclusion

Study findings demonstrate that nearly half of residents in three historically divested NYC communities consider local government to be a trusted source of information about COVID-19 vaccines. Strategies to increase trust in local government can help reduce community transmission of COVID-19 and protect public health.

Intersectional inequities in the birthweight gap between twin and singleton births: A random effects MAIHDA analysis of 2012-2018 New York City birth data

Birthweight is a widely-used biomarker of infant health, with inequities patterned intersectionally by maternal age, race/ethnicity, nativity/immigration status, and socioeconomic status in the United States. However, studies of birthweight inequities almost exclusively focus on singleton births, neglecting high-risk twin births. We address this gap using a large sample (N = 753,180) of birth records, obtained from the 2012-2018 New York City (NYC) Department of Health and Mental Hygiene, Bureau of Vital Statistics, representing 99% of all births registered in NYC, and a novel random coefficients intersectional MAIHDA (Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy) model. Our results show evidence of intersectional inequities in birthweight outcomes for both twin and singleton births by maternal age, race/ethnicity, education, and nativity status. Twins have considerably lower predicted birthweights than singletons overall (-930 g on average), and this is especially true for babies born to mothers who are younger (11-19 years), older (40+), racial/ethnic minoritized, foreign-born, and have lower education. However, the magnitude of this birthweight 'gap' between twins and singletons varies considerably across social identity strata, ranging between 830.8 g (observed among 40+ year old Black foreign-born mothers with high school degrees) and 1013.7 g (observed among 30-39 year old Hispanic/Latina foreign-born mothers with less than high school degrees). This study underscored the needs of a high-risk population and the need for aggressive social policies to address health inequities and dismantle intersectional systems of marginalization, oppression, and socioeconomic inequality. In addition to our substantive contributions, we add to the growing methods literature on intersectional quantitative analysis by demonstrating how to apply intersectional MAIHDA with random coefficients and random slopes. We conclude with a discussion of the significant potential for this methodological extension in future research on inequities.

The application of intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to examine birthweight inequities in New York City

Exploring the intersection of dimensions of social identity is critical for understanding drivers of health inequities. We used multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to examine the intersection of age, race/ethnicity, education, and nativity status on infant birthweight among singleton births in New York City from 2012 to 2018 (N = 725,875). We found evidence of intersectional effects of various systems of oppression on birthweight inequities and identified U.S.-born Black women as having infants of lower-than-expected birthweights. The MAIHDA approach should be used to identify intersectional causes of health inequities and individuals affected most to develop policies and interventions redressing inequities.

Adverse birth outcomes in New York City women: Revisiting the Hispanic Paradox

In the United States, African American or non-Hispanic Black infants experienced worst birth outcomes whereas Hispanic and Asian infants have intermediate or similar outcomes compared with non-Hispanic white infants. The findings of better birth outcomes for Hispanic women have been coined the "Hispanic Paradox" given their low education, income, and access to care. New York City (NYC) has a great racial/ethnic diversity with implications for neighborhood racial/ethnic composition on birth outcomes by protecting women from psychosocial stress via social support that may buffer against racial/ethnic discrimination and/or racism. Data from 2012 to 2018 were used to examine the association of NYC women's race/ethnicity and neighborhood racial/ethnic minority composition with adverse birth outcomes (low birthweight [LBW], small for gestational age [SGA], preterm birth and infant mortality); and whether the association between mother's race/ethnicity and each birth outcome differed by neighborhood racial/ethnic composition. Multilevel logistic regression was used to control for the clustering of outcomes within neighborhoods. Black, Asian, and American Indian women have poorer birth outcomes than white women. Infants of Mexican American, Central American, and South American women were less likely to be of LBW whereas the opposite was true for infants of Cuban and other Hispanic women compared with infants of white women. When compared with white women, Mexican American, and South American women were less likely to have an SGA infant whereas Puerto Rican and other Hispanic women were more likely to have an SGA infant. All Hispanic women were more likely to have a preterm birth than white women whereas for infant mortality, greater odds of dying were observed for infants of Puerto Rican, Dominican, and other Hispanic women. Higher neighborhood racial/ethnic minority composition was associated with greater odds of having an adverse outcome. Finally, we observed heterogeneity of the associations between mother's race/ethnicity and birth outcomes by neighborhood racial/ethnic minority composition.

Health in Action: Evaluation of a Participatory Grant-Making Project in East Harlem

Decision-making processes that include resident input have been shown to be effective in addressing community needs. However, few examples discuss the role of a local health department in leading a participatory decision-making process. In 2016, the New York City Department of Health and Mental Hygiene implemented a participatory grant-making process to allocate grant funds to community organizations in East Harlem. Findings from the evaluation suggest that a participatory grant-making process can be an effective way to include community member as decision makers. It can also build capacity among organizations and foster meaningful community engagement with a local health department.

The influence of partnership on contraceptive use among HIV-infected women accessing antiretroviral therapy in rural Uganda

OBJECTIVE

The objective was to determine individual and dyadic factors associated with effective contraceptive use among human immunodeficiency virus (HIV)-infected women accessing antiretroviral therapy (ART) in rural Uganda.

STUDY DESIGN

HIV-infected women enrolled in the Uganda AIDS Rural Treatment Outcomes cohort completed questionnaires (detailing sociobehavioral characteristics, sexual and reproductive history, contraceptive use, fertility desires) and phlebotomy (October 2011-March 2013). We describe prevalence of effective contraceptive use (i.e., consistent condom use and/or oral contraceptives, injectable hormonal contraception, intrauterine device, female sterilization) in the previous 6 months among sexually active, nonpregnant women (18-40 years). We assessed covariates of contraceptive use using multivariable logistic regression.

RESULTS

A total of 362 women (median values: age 30 years, CD4 count 397 cells/mm(3), 4.0 years since ART initiation) were included. Among 284 sexually active women, 50% did not desire a(nother) child, and 51% had a seroconcordant partner. Forty-five percent (n=127) reported effective contraceptive use, of whom 57% (n=72) used condoms, 42% (n=53) injectables, 12% (n=15) oral contraceptives and 11% (n=14) other effective methods. Dual contraception was reported by 6% (n=8). Only "partnership fertility desire" was independently associated with contraceptive use; women who reported that neither partner desired a child had significantly increased odds of contraceptive use (adjusted odds ratio: 2.40, 95% confidence interval: 1.07-5.35) compared with women in partnerships where at least one partner desired a child.

CONCLUSIONS

Less than half of sexually active HIV-infected women accessing ART used effective contraception, of which 44% (n=56) relied exclusively on male condoms, highlighting a continued need to expand access to a wider range of longer-acting female-controlled contraceptive methods. Association with partnership fertility desire underscores the need to include men in reproductive health programming.

IMPLICATIONS STATEMENT

Less than half of sexually active HIV-infected women accessing ART in rural Uganda reported using effective contraception, of whom 44% relied exclusively on the male condom. These findings highlight the need to expand access to a wider range of longer-acting, female-controlled contraceptive methods for women seeking to limit or space pregnancies. Use of contraception was more likely when both the male and female partner expressed concordant desires to limit future fertility, emphasizing the importance of engaging men in reproductive health programming.