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Tamargo JA, Martin HR, Diaz-Martinez J, Delgado-Enciso I, Johnson A, Bastida Rodriguez JA, Trepka MJ, Brown DR, Garba NA, Roldan EO, Hernandez Suarez Y, Marty AM, Bursac Z, Campa A, Baum MK. Drug use and COVID-19 testing, vaccination, and infection among underserved, minority communities in Miami, Florida. PLoS One 2024; 19:e0297327. [PMID: 38687734 PMCID: PMC11060546 DOI: 10.1371/journal.pone.0297327] [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] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/24/2023] [Indexed: 05/02/2024] Open
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic has disproportionately impacted people who use drugs (PWUD). This study explored relationships between drug use, COVID-19 testing, vaccination, and infection. This cross-sectional study was conducted in Miami, Florida between March 2021 and October 2022 as part of the National Institutes of Health (NIH) Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) initiative and the Miami Adult Studies on HIV (MASH) cohort. Users of cannabis, cocaine/crack, heroin/fentanyl, methamphetamines, hallucinogens, and/or prescription drug misuse in the previous 12 months were considered PWUD. Sociodemographic data, COVID-19 testing history, and vaccination-related beliefs were self-reported. Vaccinations were confirmed with medical records and positivity was determined with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. Statistical analyses included chi-square tests and logistic regression. Of 1,780 participants, median age was 57 years, 50.7% were male, 50.2% Non-Hispanic Black, and 66.0% reported an annual income less than $15,000. Nearly 28.0% used drugs. PWUD were less likely than non-users to self-report ever testing positive for SARS-CoV-2 (14.7% vs. 21.0%, p = 0.006). However, 2.6% of participants tested positive for SARS-CoV-2, with no significant differences between PWUD and non-users (3.7% vs. 2.2%, p = 0.076). PWUD were more likely than non-users to experience difficulties accessing testing (10.2% vs. 7.1%, p = 0.033), vaccine hesitancy (58.9% vs. 43.4%, p = 0.002) and had lower odds of receiving any dose of a COVID-19 vaccine compared to non-users (aOR, 0.63; 95% CI, 0.49-0.81; p<0.001). PWUD presented with greater difficulties accessing COVID-19 testing, greater vaccine hesitancy, and lower odds of vaccination. Testing and immunization plans that are tailored to the needs of PWUD and consider access, trust-building campaigns, and education may be needed.
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Affiliation(s)
- Javier A. Tamargo
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, United States of America
| | - Haley R. Martin
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, United States of America
| | - Janet Diaz-Martinez
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, United States of America
| | - Ivan Delgado-Enciso
- Faculty of Medicine, University of Colima, Las Víboras, Colima, Mexico
- Cancerology State Institute, Colima State Health Services, La Esperanza, Colima, Mexico
| | - Angelique Johnson
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, United States of America
| | - Jose A. Bastida Rodriguez
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, United States of America
| | - Mary Jo Trepka
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, United States of America
| | - David R. Brown
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - Nana A. Garba
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - Eneida O. Roldan
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - Yolangel Hernandez Suarez
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - Aileen M. Marty
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - Zoran Bursac
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, United States of America
| | - Adriana Campa
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, United States of America
| | - Marianna K. Baum
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, United States of America
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Martin HR, Hu N, Liu Q, Bastida Rodriguez JA, Gieseken S, Johnson A, Enrione E, Trepka MJ, Brown DR, Marty AM, Sales Martinez S, Campa A, Roldan EO, Hernandez Suarez Y, Barbieri M, Palacios C, Bursac Z, Baum MK. Disability and COVID-19: Challenges, testing, vaccination, and postponement and avoidance of medical care among minoritized communities. Disabil Health J 2024; 17:101571. [PMID: 38071138 PMCID: PMC10999341 DOI: 10.1016/j.dhjo.2023.101571] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 04/09/2024]
Abstract
BACKGROUND People with disabilities face heightened vulnerability to COVID-19. OBJECTIVE This study investigated (1) the relationships between disability and COVID-19-related challenges, testing, vaccination, and infection and (2) predictors of loss of healthcare coverage and postponement and avoidance of medical care during the pandemic. METHODS This cross-sectional study was conducted in Miami, Florida, between March 2021 and February 2022 as part of the NIH Rapid Acceleration of Diagnostics-Underserved Populations initiative. Disability was defined using a standard measure that assesses six universal functions. Participants reported sociodemographic data, COVID-19 testing, infection history, challenges, and healthcare history. Vaccinations were confirmed with medical records and COVID-19 positivity was assessed using real-time reverse transcription-polymerase chain reaction. Statistical analyses included multivariable logistic regression. RESULTS Among 1,689 participants with a median age of 57.0, 50.6% were male, and 48.9% were non-Hispanic Black. Disability was associated with greater odds of all assessed COVID-19 challenges: healthcare (aOR:1.60; 95% CI:1.23-2.07), housing (aOR:2.15; 95% CI:1.62-2.87), insufficient food (aOR:1.97; 95% CI:1.54-2.52), water scarcity (aOR:2.33; 95% CI:1.60-3.37), medications (aOR:2.04; 95% CI:1.51-2.77), and transportation (aOR:2.56; 95% CI:1.95-3.36). Those reporting employment disability were less likely to have received COVID-19 testing (81.1% vs. 85.3%, p = 0.026) or to have history of COVID-19 positivity (aOR:0.63; 95% CI:0.44-0.92). Disability predicted avoidance (aOR:2.76; 95% CI:1.95-3.91) and postponement (aOR: 2.24; 95% CI:1.72-2.91) of medical care. CONCLUSIONS Disability is associated with higher odds of COVID-19 challenges and postponement and avoidance of medical care. Those reporting employment disability had a lower likelihood of COVID-19 testing. Public health responses to healthcare crises should prioritize the special challenges of people living with disabilities.
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Affiliation(s)
- Haley R Martin
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Dietetics and Nutrition, 11200 SW 8th Street, AHC5, Miami, FL, 33199, United States.
| | - Nan Hu
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Biostatistics, 11200 SW 8th Street, AHC5, Miami, FL, 33199, United States.
| | - Qingyun Liu
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Dietetics and Nutrition, 11200 SW 8th Street, AHC5, Miami, FL, 33199, United States.
| | - Jose A Bastida Rodriguez
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Dietetics and Nutrition, 11200 SW 8th Street, AHC5, Miami, FL, 33199, United States.
| | - Stephanie Gieseken
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Dietetics and Nutrition, 11200 SW 8th Street, AHC5, Miami, FL, 33199, United States.
| | - Angelique Johnson
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Dietetics and Nutrition, 11200 SW 8th Street, AHC5, Miami, FL, 33199, United States.
| | - Evelyn Enrione
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Dietetics and Nutrition, 11200 SW 8th Street, AHC5, Miami, FL, 33199, United States.
| | - Mary Jo Trepka
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Epidemiology, 11200 SW 8th Street, AHC5, Miami, FL, 33199, United States.
| | - David R Brown
- Florida International University, Herbert Wertheim College of Medicine, 11200 SW 8th Street, AHC2, Miami, FL, 33199, United States.
| | - Aileen M Marty
- Florida International University, Herbert Wertheim College of Medicine, 11200 SW 8th Street, AHC2, Miami, FL, 33199, United States.
| | - Sabrina Sales Martinez
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Dietetics and Nutrition, 11200 SW 8th Street, AHC5, Miami, FL, 33199, United States.
| | - Adriana Campa
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Dietetics and Nutrition, 11200 SW 8th Street, AHC5, Miami, FL, 33199, United States.
| | - Eneida O Roldan
- Florida International University, Herbert Wertheim College of Medicine, 11200 SW 8th Street, AHC2, Miami, FL, 33199, United States.
| | - Yolangel Hernandez Suarez
- Florida International University, Herbert Wertheim College of Medicine, 11200 SW 8th Street, AHC2, Miami, FL, 33199, United States.
| | - Manuel Barbieri
- Florida International University, College of Arts, Sciences & Education, Department of Biological Sciences, 11200 SW 8th Street, OE 167, Miami, FL, 33199, United States.
| | - Cristina Palacios
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Dietetics and Nutrition, 11200 SW 8th Street, AHC5, Miami, FL, 33199, United States.
| | - Zoran Bursac
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Biostatistics, 11200 SW 8th Street, AHC5, Miami, FL, 33199, United States.
| | - Marianna K Baum
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Dietetics and Nutrition, 11200 SW 8th Street, AHC5, Miami, FL, 33199, United States.
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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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Fernández CR, Silva D, Mancias P, Roldan EO, Sánchez JP. Hispanic Identity and Its Inclusion in the Race Discrimination Discourse in the United States. Acad Med 2021; 96:788-791. [PMID: 33369902 DOI: 10.1097/acm.0000000000003904] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
As protests against racism occur all over the United States and medical institutions face calls to incorporate antiracism and health equity curricula into professional training and patient care, the antiracism discourse has largely occurred through a Black/African American and White lens. Hispanics, an umbrella category created by the U.S. government to include all people of Spanish-speaking descent, are the largest minority group in the country. Hispanics are considered an ethnic rather than a racial group, although some Hispanics self-identify their race in terms of their ethnicity and/or country of origin while other Hispanics self-identify with any of the 5 racial categories used by the U.S. government (White, Black/African American, American Indian or Alaska Native, Asian, or Native Hawaiian or Other Pacific Islander). Expanding the antiracism discourse in medicine to include Hispanic perspectives and the diversity of histories and health outcomes among Hispanic groups is crucial to addressing inequities and disparities in health and medical training. A lack of inclusion of Hispanics has contributed to a growing shortage of Hispanic physicians and medical school faculty in the United States as well as discrimination against Hispanic physicians, trainees, and patients. To reverse this negative trend and advance a health care equity and antiracist agenda, the authors offer steps that medical schools, academic medical centers, and medical accreditation and licensing bodies must take to increase the representation of Hispanics and foster their engagement in this evolving antiracism discourse.
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Affiliation(s)
- Cristina R Fernández
- C.R. Fernández is assistant professor, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York; ORCID: https://orcid.org/0000-0003-1557-0041
| | - Debora Silva
- D. Silva is professor, Department of Pediatrics, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Pedro Mancias
- P. Mancias is professor, Division of Child and Adolescent Neurology, Department of Pediatrics, and assistant dean, Office of Diversity and Inclusion, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Eneida O Roldan
- E.O. Roldan is professor, Department of Pathology, associate dean for International Affairs and Master in physician assistant studies, Herbert Wertheim College of Medicine, Florida International University, and chief executive officer, Florida International University HealthCare Network, Miami, Florida
| | - John Paul Sánchez
- J.P. Sánchez is professor, Department of Emergency Medicine, vice chair for Diversity, Equity, and Inclusion, and fellowship director for Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
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Roldan EO. With 'Repeal and Replace,' the Triple Aim Needed More Than Ever. Manag Care 2017; 26:40. [PMID: 28510526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The Triple Aim hit a nerve with medical directors and health care managers of all kinds. That's because it is a concise way of summarizing the disparate issues that anyone trying to manage the delivery and cost of health care must deal with.
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Jonas MM, Roldan EO, Lyons HJ, Fojaco RM, Reddy RK. Histopathologic features of the liver in pediatric acquired immune deficiency syndrome. J Pediatr Gastroenterol Nutr 1989; 9:73-81. [PMID: 2778572] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Autopsy and liver biopsy specimens from 30 pediatric patients with acquired immune deficiency syndrome (AIDS) or AIDS-related complex (ARC) were retrospectively reviewed. Of 28 cases with histologic abnormalities, the following findings were noted singly or in combination: giant-cell transformation, cytomegalovirus inclusions, Kaposi's sarcoma, diffuse lymphoplasmocytic infiltrate, granulomatous hepatitis, mild portal inflammation, necrosis around central veins, steatosis, and cholestasis. For the most part, abnormalities in the liver were not predictive of those in other organs, but the two children with the diffuse parenchymal lymphoplasmocytic infiltrate also had lymphoid interstitial pneumonitis (LIP). Liver histopathology in pediatric patients with AIDS shares some features with that in adults, but appreciable differences are noted. In particular, these differences include the higher frequency of giant-cell transformation and the lower frequency of granulomas in children and the observation of diffuse lymphoplasmocytic infiltrate associated with LIP.
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Affiliation(s)
- M M Jonas
- Department of Pediatrics, University of Miami School of Medicine, Florida 33101
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Markowitz LE, Chandler FW, Roldan EO, Saldana MJ, Roach KC, Hutchins SS, Preblud SR, Mitchell CD, Scott GB. Fatal measles pneumonia without rash in a child with AIDS. J Infect Dis 1988; 158:480-3. [PMID: 3403997 DOI: 10.1093/infdis/158.2.480] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- L E Markowitz
- Division of Immunization, Centers for Disease Control, Atlanta, Georgia
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Roldan EO, Moskowitz L, Hensley GT. Pathology of the heart in acquired immunodeficiency syndrome. Arch Pathol Lab Med 1987; 111:943-6. [PMID: 2820341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Data on 54 persons who died of acquired immunodeficiency syndrome were reviewed for lesions of the heart. These persons met the criteria of the Centers for Disease Control (Atlanta) for acquired immunodeficiency syndrome. Pathologic changes were seen in 30 patients (55%). Changes were seen in the endocardium (17%), myocardium (83%), and epicardium (3%). The most frequent finding was lymphocytic myocarditis. Six of these were due to Toxoplasma myocarditis. Only one patient succumbed to cardiac arrest.
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Wetli CV, Roldan EO, Fojaco RM. Listeriosis as a cause of maternal death: an obstetric complication of the acquired immunodeficiency syndrome (AIDS). Am J Obstet Gynecol 1983; 147:7-9. [PMID: 6614087 DOI: 10.1016/0002-9378(83)90074-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A case of maternal death due to Listeria monocytogenes bacteremia, with survival of the prematurely delivered infant, is presented. Lymphopenia and a Haitian origin suggest that the fatal outcome was related to the acquired immunodeficiency syndrome (AIDS). To our knowledge, this is the first recorded instance of a maternal death due to listeriosis.
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