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Lechuga J, Galletly CL, Glasman LR, Dickson-Gomez JB, McAuliffe TL. Latinx Immigrants' Legal Concerns About SARS-CoV-2 Testing and COVID-19 Diagnosis and Treatment. J Immigr Minor Health 2022; 24:1-9. [PMID: 35013844 PMCID: PMC8747869 DOI: 10.1007/s10903-021-01314-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 12/03/2022]
Abstract
Immigration concerns can deter immigrants from utilizing healthcare services. We examined Latinx immigrants' immigration concerns related to COVID-19 testing and treatment. A multi-state sample of 336 US Latinx immigrants (documented and undocumented) completed a cross-sectional online survey in Spanish. Factor analysis informed the construction of a COVID-19 Immigration Concerns Scale. Multiple logistic regression was used to examine associations between the scale and indices of perceived immigration risk and healthcare access and utilization. Concerns clustered around two factors: (1) providers' release of information to immigration authorities and drawing government attention; and (2) eligibility for COVID-19 services and the immigration ramifications of using these. The regression equation highlighted strong associations between these and perceived instability of immigration laws and enforcement concerns after controlling for healthcare access and utilization. COVID-19-related immigration concerns were substantial and multifaceted. Perceived instability of laws was strongly related to concerns but remains understudied.
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Affiliation(s)
- Julia Lechuga
- Department of Public Health Sciences, The University of Texas at El Paso, 500 W. University, El Paso, TX, 79968, USA.
| | - Carol L Galletly
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, USA
| | - Laura R Glasman
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, USA
| | - Julia B Dickson-Gomez
- Center for AIDS Intervention Research and the Institute for Health Equity, Medical College of Wisconsin, Milwaukee, USA
| | - Timothy L McAuliffe
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, USA
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Aragona M, Tumiati MC, Ferrari F, Viale S, Nicolella G, Barbato A, Cavani A, Costanzo G, Mirisola C. Psychopathological effects of the Coronavirus (Sars-CoV-2) imposed lockdown on vulnerable patients in treatment in a mental health outpatient department for migrants and individuals in poor socioeconomic conditions. Int J Soc Psychiatry 2022; 68:203-209. [PMID: 33438510 DOI: 10.1177/0020764020988572] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The effects of Sars-Cov-2 pandemic may increase vulnerability of migrants. AIMS To investigate the effects of the governmental lockdown on the mental health of vulnerable migrants in treatment at an outpatient department. METHOD In a telephone survey post-migration living difficulties and psychopathological symptoms were investigated, particularly post-traumatic thoughts and nightmares, anxiety, depression, feelings of tension and irritability, other sleep problems, as well as COVID-19 related fears. Psychopathological changes during the lockdown were detected and rated by clinicians. Rates of treatment discontinuation and reasons why were also recorded. RESULTS Of 103 eligible patients, 81 answered the phone call and were included in the study. Mental symptoms were frequent but not as severe as expected. About 32% of patients in psychopharmacological treatment and almost 52% of patients in psychotherapy had discontinued treatment. Patients who were globally considered to have worsened if compared to their pre-coronavirus mental health conditions had in fact higher scores on several mental symptoms but mild specific fears about coronavirus issues, similar to those of patients improved or stable. Worsening was significantly associated with unemployment, lack of VISA, and treatment discontinuation. Shifting the way of providing psychotherapy into a web-based modality was significantly more frequent in stable/improved patients. CONCLUSION Findings suggest that concrete life problems and treatment discontinuation more than the coronavirus fear, have predominantly affected the mental health conditions of our patients.
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Affiliation(s)
| | | | - Federica Ferrari
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Sonia Viale
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Gianluca Nicolella
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Angelo Barbato
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Andrea Cavani
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | | | - Concetta Mirisola
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
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Brown C, Wilkins K, Craig-Neil A, Upshaw T, Pinto AD. Reducing Inequities During the COVID-19 Pandemic: A Rapid Review and Synthesis of Public Health Recommendations. Public Health Rev 2022; 42:1604031. [PMID: 35140994 PMCID: PMC8802804 DOI: 10.3389/phrs.2021.1604031] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 11/04/2021] [Indexed: 01/10/2023] Open
Abstract
Objectives: Efforts to contain the COVID-19 pandemic should take into account worsening health inequities. While many public health experts have commented on inequities, no analysis has yet synthesized recommendations into a guideline for practitioners. The objective of this rapid review was to identify the areas of greatest concern and synthesize recommendations. Methods: We conducted a rapid systematic review (PROSPERO: CRD42020178131). We searched Ovid MEDLINE, Embase, PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials databases from December 1, 2019 to April 27, 2020. We included English language peer-reviewed commentaries, editorials, and opinion pieces that addressed the social determinants of health in the context of COVID-19. Results: 338 articles met our criteria. Authors represented 81 countries. Income, housing, mental health, age and occupation were the most discussed social determinants of health. We categorized recommendations into primordial, primary, secondary and tertiary prevention that spoke to the social determinants of COVID-19 and equity. Conclusion: These recommendations can assist efforts to contain COVID-19 and reduce health inequities during the pandemic. Using these recommendations, public health practitioners could support a more equitable pandemic response. Systematic Review Registration: PROSPERO, CRD42020178131.
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Affiliation(s)
- Chloe Brown
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
- Undergraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Katie Wilkins
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
- Undergraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Amy Craig-Neil
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Tara Upshaw
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Andrew David Pinto
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada
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54
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Disney L, Koo J, Carnes S, Warner L. Essential but Excluded: Using Critical Race Theory to Examine COVID-19 Economic Relief Policies for Undocumented US Workers. JOURNAL OF HUMAN RIGHTS AND SOCIAL WORK 2022; 7:225-235. [PMID: 35039795 PMCID: PMC8754553 DOI: 10.1007/s41134-021-00202-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 06/14/2023]
Abstract
Following the onset of the COVID-19 pandemic, undocumented immigrants in the United States were vulnerable both to unemployment and to COVID-19 infection if they did remain employed, because of the sectors that employ them. Despite these heightened economic vulnerabilities, 7.8 million undocumented workers were excluded from federal economic relief policies. This article uses critical race theory (CRT) to examine the intentional and unjust exclusion of undocumented U.S. workers from COVID-19 economic relief aid within the larger context of economic marginalization and injustice. It also provides an overview of the major federal economic relief legislation and policy developments during the first year of the COVID-19 pandemic in the United States, between March 2020 and July 2021. While some states have enacted creative programs and policies related to COVID-19 economic relief, effective and comprehensive federal-level policies must be implemented to address the growing chasm of inequity in American society, particularly as experienced by often-essential undocumented immigrant workers. Specific standards related to work and quality of live are protected by the United Nations Universal Declaration of Human Rights (1948), but exclusionary federal policies render these minimum standards inaccessible for undocumented workers and deepen existing economic and social disparities. Social work aspires to provide a uniquely critical and social justice-minded perspective that considers systems of oppression, power dynamics, and human rights, and this perspective can contribute to socially just economic policy development.
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Affiliation(s)
- Lindsey Disney
- School of Social Welfare, University at Albany, Albany, NY USA
| | - Jinhee Koo
- School of Social Welfare, University at Albany, Albany, NY USA
| | | | - Lynn Warner
- School of Social Welfare, University at Albany, Albany, NY USA
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Li J, Wells J, Yang C, Wang X, Lin Y, Lyu Y, Li Y. A Novel Application of Non-Negative Matrix Factorization to the Prediction of the Health Status of Undocumented Immigrants. Health Equity 2022; 5:834-839. [PMID: 35018316 PMCID: PMC8742291 DOI: 10.1089/heq.2021.0079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: Undocumented immigrants (UIs) in the United States are less likely to be able to afford health insurance. As a result, UIs often lack family doctors and are rarely involved in annual screening programs, which makes estimating their health status remarkably challenging. This is especially true if the laboratory results from limited screening programs fail to provide sufficient clinical information. Methods: To address this issue, we have developed a machine learning model based on the non-negative matrix factorization technique. The data set we used for model training and testing was obtained from the 2004 cost-free hepatitis B screening program at the Omni Health Center located in Plano, Texas. Total 300 people were involved, with 199 identified as UIs. Results: People in the UIs group have higher cholesterol (219.6 mg/dL, p=0.038) and triglycerides (173.2 mg/dL, p=0.03) level. They also have a lower hepatitis B vaccination rate (38%, p=0.0247). No significant difference in hepatitis B(+) was found (p=0.8823). Using 16 individual clinical measurements as training features, our newly developed model has a 67.56% accuracy in predicting the ratio of cholesterol to high-density lipoprotein; in addition, this newly developed model performs 9.1% better than a comparable multiclass logistic regression model. Conclusions: Elderly UIs have poorer health status compared with permanent residents and citizens in the United States. Our newly developed machine learning model demonstrates a powerful support tool for designing health intervention programs that target UIs in the United States.
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Affiliation(s)
- Jason Li
- Austin College, Sherman, Texas, USA
| | - James Wells
- Department of Physiology, Tulane University, New Orleans, Louisiana, USA
| | - Chenli Yang
- Kunming Children's Hospital, Kunming, Yunnan, China
| | - Xiaodan Wang
- Yunnan Institute for Drug Abuse, Kunming, Yunnan, China
| | - Yihan Lin
- HKU-Pasteur Research Pole, Hong Kong, China
| | - You Lyu
- Omni Medical Center, Plano, Texas, USA
| | - Yan Li
- Omni Medical Center, Plano, Texas, USA
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56
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Al-Zoughool M, Oraby T, Vainio H, Gasana J, Longenecker J, Al Ali W, AlSeaidan M, Elsaadany S, Tyshenko MG. Using a stochastic continuous-time Markov chain model to examine alternative timing and duration of the COVID-19 lockdown in Kuwait: what can be done now? Arch Public Health 2022; 80:22. [PMID: 34998438 PMCID: PMC8742165 DOI: 10.1186/s13690-021-00778-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 12/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background Kuwait had its first COVID-19 in late February, and until October 6, 2020 it recorded 108,268 cases and 632 deaths. Despite implementing one of the strictest control measures-including a three-week complete lockdown, there was no sign of a declining epidemic curve. The objective of the current analyses is to determine, hypothetically, the optimal timing and duration of a full lockdown in Kuwait that would result in controlling new infections and lead to a substantial reduction in case hospitalizations. Methods The analysis was conducted using a stochastic Continuous-Time Markov Chain (CTMC), eight state model that depicts the disease transmission and spread of SARS-CoV 2. Transmission of infection occurs between individuals through social contacts at home, in schools, at work, and during other communal activities. Results The model shows that a lockdown 10 days before the epidemic peak for 90 days is optimal but a more realistic duration of 45 days can achieve about a 45% reduction in both new infections and case hospitalizations. Conclusions In the view of the forthcoming waves of the COVID19 pandemic anticipated in Kuwait using a correctly-timed and sufficiently long lockdown represents a workable management strategy that encompasses the most stringent form of social distancing with the ability to significantly reduce transmissions and hospitalizations. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00778-y.
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Affiliation(s)
- Mustafa Al-Zoughool
- Department of Environmental and Occupational Health Faculty of Public Health, University of Kuwait, Kuwait City, Kuwait.
| | - Tamer Oraby
- School of Mathematical and Statistical Sciences, University of Texas Rio Grande Valley, Edinburg, TX, 78539, USA
| | - Harri Vainio
- Department of Environmental and Occupational Health Faculty of Public Health, University of Kuwait, Kuwait City, Kuwait
| | - Janvier Gasana
- Department of Environmental and Occupational Health Faculty of Public Health, University of Kuwait, Kuwait City, Kuwait
| | - Joseph Longenecker
- Department of Environmental and Occupational Health Faculty of Public Health, University of Kuwait, Kuwait City, Kuwait
| | - Walid Al Ali
- Department of Epidemiology and Biostatistics, Faculty of Public Health, University of Kuwait, 13110, Safat, Kuwait
| | - Mohammad AlSeaidan
- Department of Occupational Health, Ministry of Health, Kuwait City, Kuwait
| | - Susie Elsaadany
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, K1H 8M5, Canada
| | - Michael G Tyshenko
- McLaughlin Centre for Population Health Risk Assessment, Faculty of Medicine, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
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Herzberg EM, Barrero-Castillero A, Matute JD. The healing power of language: caring for patients with limited english proficiency and COVID-19. Pediatr Res 2022; 91:526-528. [PMID: 33790416 PMCID: PMC8010487 DOI: 10.1038/s41390-021-01487-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/08/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Emily M. Herzberg
- grid.32224.350000 0004 0386 9924Division of Neonatology and Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Boston, MA USA
| | - Alejandra Barrero-Castillero
- grid.32224.350000 0004 0386 9924Division of Neonatology and Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Boston, MA USA ,grid.239395.70000 0000 9011 8547Division of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA USA
| | - Juan D. Matute
- grid.32224.350000 0004 0386 9924Division of Neonatology and Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Boston, MA USA
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58
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Shah HS, Dolwick Grieb S, Flores-Miller A, Phillips KH, Page KR, Cervantes A, Yang C. A Crowdsourcing Open Contest to Design a Latino-specific COVID-19 Campaign: A Mixed Methods Analysis (Preprint). JMIR Form Res 2021; 6:e35764. [PMID: 35357317 PMCID: PMC9106278 DOI: 10.2196/35764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/14/2022] [Accepted: 03/12/2022] [Indexed: 11/24/2022] Open
Abstract
Background Latino communities are among the most heavily impacted populations by the COVID-19 pandemic in the United States due to intersectional barriers to care. Crowdsourcing open contests can be an effective means of community engagement but have not been well studied in Latino populations nor in addressing the COVID-19 pandemic. Objective The aims of this study are to (1) implement and evaluate a crowdsourcing open contest to solicit a name for a COVID-19 social marketing campaign for Latino populations in Maryland and (2) conduct a thematic analysis of submitted entries to guide campaign messaging. Methods To assess the level of community engagement in this crowdsourcing open contest, we used descriptive statistics to analyze data on entries, votes, and demographic characteristics of participants. The submitted text was analyzed through inductive thematic analysis. Results We received 74 entries within a 2-week period. The top 10 entries were chosen by community judges and the winner was decided by popular vote. We received 383 votes within 1 week. The most common themes were collective efficacy, self-efficacy, and perceived benefits of COVID-19 testing. We used these themes to directly inform our social marketing intervention and found that advertisements based on these themes became the highest performing. Conclusions Crowdsourcing open contests are an effective means of community engagement and an agile tool for guiding interventions to address COVID-19, including in populations impacted by health care disparities, such as Latino communities. The thematic analysis of contest entries can be a valuable strategy to inform the development of social marketing campaign materials.
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Affiliation(s)
- Harita S Shah
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Suzanne Dolwick Grieb
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Alejandra Flores-Miller
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Katherine H Phillips
- The Esperanza Center, Catholic Charities of Baltimore, Baltimore, MD, United States
| | - Kathleen R Page
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Ana Cervantes
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Cui Yang
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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Weng CH, Butt WWW, Brooks MB, Clarke C, Jenkins HE, Holland SD, Chiang SS. Diagnostic value of symptoms for pediatric SARS-CoV-2 infection in a primary care setting. PLoS One 2021; 16:e0249980. [PMID: 34898635 PMCID: PMC8668089 DOI: 10.1371/journal.pone.0249980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 11/03/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To evaluate the diagnostic value of symptoms used by daycares and schools to screen children and adolescents for SARS-CoV-2 infection, we analyzed data from a primary care setting. METHODS This cohort study included all patients ≤17 years old who were evaluated at Providence Community Health Centers (PCHC; Providence, U.S.), for COVID-19 symptoms and/or exposure, and received SARS-CoV-2 polymerase chain reaction (PCR) testing between March-June 2020. Participants were identified from PCHC electronic medical records. For three age groups- 0-4, 5-11, and 12-17 years-we estimated the sensitivity, specificity, and area under the receiver operating curve (AUC) of individual symptoms and three symptom combinations: a case definition published by the Rhode Island Department of Health (RIDOH), and two novel combinations generated by different statistical approaches to maximize sensitivity, specificity, and AUC. We evaluated symptom combinations both with and without consideration of COVID-19 exposure. Myalgia, headache, sore throat, abdominal pain, nausea, anosmia, and ageusia were not assessed in 0-4 year-olds due to the lower reliability of these symptoms in this group. RESULTS Of 555 participants, 217 (39.1%) were SARS-CoV-2-infected. Fever was more common among 0-4 years-olds (p = 0.002); older children more frequently reported fatigue (p = 0.02). In children ≥5 years old, anosmia or ageusia had 94-98% specificity. In all ages, exposure history most accurately predicted infection. With respect to individual symptoms, cough most accurately predicted infection in <5 year-olds (AUC 0.69) and 12-17 year-olds (AUC 0.62), while headache was most accurate in 5-11 year-olds (AUC 0.62). In combination with exposure history, the novel symptom combinations generated statistically to maximize test characteristics had sensitivity >95% but specificity <30%. No symptom or symptom combination had AUC ≥0.70. CONCLUSIONS Anosmia or ageusia in children ≥5 years old should raise providers' index of suspicion for COVID-19. However, our overall findings underscore the limited diagnostic value of symptoms.
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Affiliation(s)
- Chien-Hsiang Weng
- Department of Family Medicine, Brown University Warren Alpert Medical School, Providence, RI, United States of America
- Providence Community Health Centers, Providence, RI, United States of America
| | - Wesley Wing Wah Butt
- Department of Family Medicine, Brown University Warren Alpert Medical School, Providence, RI, United States of America
- Providence Community Health Centers, Providence, RI, United States of America
| | - Meredith B. Brooks
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Claudia Clarke
- Providence Community Health Centers, Providence, RI, United States of America
| | - Helen E. Jenkins
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
| | - Sabina D. Holland
- Department of Pediatrics, Brown University Warren Alpert Medical School, Providence, RI, United States of America
| | - Silvia S. Chiang
- Department of Pediatrics, Brown University Warren Alpert Medical School, Providence, RI, United States of America
- Center for International Health Research, Rhode Island Hospital, Providence, RI, United States of America
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Hasan Bhuiyan MT, Mahmud Khan I, Rahman Jony SS, Robinson R, Nguyen USDT, Keellings D, Rahman MS, Haque U. The Disproportionate Impact of COVID-19 among Undocumented Immigrants and Racial Minorities in the US. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12708. [PMID: 34886437 PMCID: PMC8656825 DOI: 10.3390/ijerph182312708] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 12/22/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease 2019 (COVID-19), has had an unprecedented effect, especially among under-resourced minority communities. Surveillance of those at high risk is critical for preventing and controlling the pandemic. We must better understand the relationships between COVID-19-related cases or deaths and characteristics in our most vulnerable population that put them at risk to target COVID-19 prevention and management efforts. Population characteristics strongly related to United States (US) county-level data on COVID-19 cases and deaths during all stages of the pandemic were identified from the onset of the epidemic and included county-level socio-demographic and comorbidities data, as well as daily meteorological modeled observation data from the North American Regional Reanalysis (NARR), and the NARR high spatial resolution model to assess the environment. Advanced machine learning (ML) approaches were used to identify outbreaks (geographic clusters of COVID-19) and included spatiotemporal risk factors and COVID-19 vaccination efforts, especially among vulnerable and underserved communities. COVID-19 outcomes were found to be negatively associated with the number of people vaccinated and positively associated with age, the prevalence of cardiovascular disease, diabetes, and the minority population. There was also a strong positive correlation between unauthorized immigrants and the prevalence of COVID-19 cases and deaths. Meteorological variables were also investigated, but correlations with COVID-19 were relatively weak. Our findings suggest that COVID-19 has had a disproportionate impact across the US population among vulnerable and minority communities. Findings also emphasize the importance of vaccinations and tailored public health initiatives (e.g., mask mandates, vaccination) to reduce the spread of COVID-19 and the number of COVID-19 related deaths across all populations.
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Affiliation(s)
- Mohammad Tawhidul Hasan Bhuiyan
- Department of Computer Science & Engineering, Bangladesh University of Engineering & Technology, West Palasi, Dhaka 1205, Bangladesh; (M.T.H.B.); (S.S.R.J.); (M.S.R.)
| | - Irtesam Mahmud Khan
- Department of Computer Science and Engineering, United International University, Dhaka 1212, Bangladesh;
| | - Sheikh Saifur Rahman Jony
- Department of Computer Science & Engineering, Bangladesh University of Engineering & Technology, West Palasi, Dhaka 1205, Bangladesh; (M.T.H.B.); (S.S.R.J.); (M.S.R.)
| | - Renee Robinson
- Department of Pharmacy Practice and Administration, University of Alaska Anchorage/Idaho State University, Anchorage, AK 99508, USA;
| | - Uyen-Sa D. T. Nguyen
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX 76177, USA;
| | - David Keellings
- Department of Geography, University of Florida, Gainesville, FL 32611, USA;
| | - M. Sohel Rahman
- Department of Computer Science & Engineering, Bangladesh University of Engineering & Technology, West Palasi, Dhaka 1205, Bangladesh; (M.T.H.B.); (S.S.R.J.); (M.S.R.)
| | - Ubydul Haque
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX 76177, USA;
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61
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Tan MKI. COVID-19 in an inequitable world: the last, the lost and the least. Int Health 2021; 13:493-496. [PMID: 34528090 PMCID: PMC8499981 DOI: 10.1093/inthealth/ihab057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/13/2021] [Indexed: 01/09/2023] Open
Affiliation(s)
- Mark K I Tan
- London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT
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COVID-19 and Systemic Racism Pandemics Impact Daily Life for Immigrant/Refugees, Minneapolis, USA. Ann Glob Health 2021; 87:107. [PMID: 34824988 PMCID: PMC8588899 DOI: 10.5334/aogh.3411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The pandemics of COVID-19 and systemic racism have a deleterious impact on the daily life experiences and health for populations of color. The experiences are compounded for immigrant/refugee communities that may have other barriers such as English language literacy or trauma. Cumulative stress due to everyday racism is harmful for health. Objectives: This study describes the impact of day-to-day lived experiences of Karen, Somali, and Latinx communities during the COVID-19 pandemic and aftermath of the police murder of George Floyd in the Minneapolis/St. Paul metro area. Methods: In-depth interviews were conducted over three weeks in September and October 2020 to understand the daily life experiences of Karen, Somali and Latinx adults drawn from community contacts during the COVID-19 pandemic and the aftermath of the police murder of George Floyd. Interviewers were bilingual and from the communities they interviewed. Nine questions were asked, ranging from their knowledge of COVID-19, prevention practices, experiences during shelter-in-place, and the perceptions of the police murder of George Floyd. Qualitative analysis included transcript review, coding facilitated by Atlas.ti Cloud software, summaries, and validation by interviewers. Findings: Thirty-two adults were interviewed (Latinx = 10, Karen = 10, Somali = 12). One-third were in person per participant request and complying with COVID-19 precautions, and the remainder were remote. The average age recorded was 37 years (range 20–66 years), 43.8% males and 56.3% females. Respondents reported experiences of discrimination and systemic racism while engaging in daily life activities, including accessing foods and common goods, school, work, transportation, and healthcare, all of which were exacerbated by COVID-19 and the police murder of George Floyd. Conclusions: Immigrant/refugee communities of color in Minneapolis/St. Paul face daily experiences of racism that were compounded by the events of 2020. Discrimination and systemic racism contribute to the persistent health inequities among populations of color.
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Farina M, Lavazza A. Advocating for Greater Inclusion of Marginalized and Forgotten Populations in COVID19 Vaccine Rollouts. Int J Public Health 2021; 66:1604036. [PMID: 34707472 PMCID: PMC8542671 DOI: 10.3389/ijph.2021.1604036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 09/16/2021] [Indexed: 12/18/2022] Open
Abstract
Objectives: Many countries recently approved a number of SARS-CoV-2 vaccines. There is therefore growing optimism around the world about their future availability and effectiveness. However, supplies are likely to be limited and restricted to certain categories of individuals, at least initially. Thus, governments have suggested prioritization schemes to allocate such limited supplies. The majority of such schemes are said to be developed to safeguard the weakest sections of society; that is, healthcare personnel and the elderly. Methods: In this work, we analyse three case studies (incarcerated people; homeless people, asylum seekers and undocumented migrants). We propose a bioethical argument that frames the discussion by describing the salient facts about each of the three populations and then argue that these characteristics entail inclusion and prioritization in the queue for vaccination in their country of residence. Results: Through an analysis informed by ethical considerations revolving around the concepts of fairness and equality, we try to raise awareness of these important issues among decision makers. Conclusion: Our goal is to advocate for the development of more inclusive policies and frameworks in SARS-CoV-2 vaccine allocation and, in general, in all scenarios in which there is a shortage of optimal care and treatments.
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Affiliation(s)
- Mirko Farina
- Faculty of Humanities and Social Sciences, Innopolis University, Innopolis, Russia
| | - Andrea Lavazza
- Department of Neuroethics, Centro Universitario Internazionale, Arezzo, Italy
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Njoku A, Joseph M, Felix R. Changing the Narrative: Structural Barriers and Racial and Ethnic Inequities in COVID-19 Vaccination. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9904. [PMID: 34574827 PMCID: PMC8470519 DOI: 10.3390/ijerph18189904] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/08/2021] [Accepted: 09/13/2021] [Indexed: 12/13/2022]
Abstract
The COVID-19 pandemic has disproportionately affected racial and ethnic minority groups in the United States. Although a promising solution of the COVID-19 vaccination offers hope, disparities in access again threaten the health of these communities. Various explanations have arisen for the cause of disparate vaccination rates among racial and ethnic minorities, including discussion of vaccine hesitancy. Conversely, the role of vaccine accessibility rooted in structural racism as a driver in these disparities should be further explored. This paper discusses the impact of structural barriers on racial and ethnic disparities in COVID-19 vaccine uptake. We also recommend public health, health system, and community-engaged approaches to reduce racial disparities in COVID-19 disease and mortality.
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Affiliation(s)
- Anuli Njoku
- Department of Public Health, College of Health and Human Services, Southern Connecticut State University, 144 Farnham Avenue, New Haven, CT 06515, USA; (M.J.); (R.F.)
| | - Marcelin Joseph
- Department of Public Health, College of Health and Human Services, Southern Connecticut State University, 144 Farnham Avenue, New Haven, CT 06515, USA; (M.J.); (R.F.)
- Greater Bridgeport Area Prevention Program, 1470 Barnum Avenue, Suite 301, Bridgeport, CT 06610, USA
| | - Rochelle Felix
- Department of Public Health, College of Health and Human Services, Southern Connecticut State University, 144 Farnham Avenue, New Haven, CT 06515, USA; (M.J.); (R.F.)
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The Economic and Psychological Impacts of COVID-19 Pandemic on Indian Migrant Workers in the Kingdom of Saudi Arabia. Healthcare (Basel) 2021; 9:healthcare9091152. [PMID: 34574926 PMCID: PMC8464826 DOI: 10.3390/healthcare9091152] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022] Open
Abstract
The ongoing Coronavirus disease 2019 (COVID-19) pandemic has changed the working environment, occupation, and living style of billions of people around the world. The severest impact of the coronavirus is on migrant communities; hence, it is relevant to assess the economic impact and mental status of the Indian migrants. This study is quantitative in nature and based on a sample survey of 180 migrant workers. Descriptive statistics, chi-square test, dependent sample t-test, and Pearson’s correlation coefficient were utilized to analyze the surveyed data. The findings of the study reveal, through the working experience of the migrants, that new international migration has reduced due to lockdown and international travel restrictions. It was also reported that the majority of the migrants worked less than the normal working hours during the lockdown, causing a reduction of salary and remittances. Chi-square test confirms that the perceptions of migrants towards the COVID-19 management by the government were significantly different in opinion by different occupation/profession. Majority of the sampled migrants reported the problem of nervousness, anxiety, and depression; however, they were also hopeful about the future. The psychological problem was severe for the migrants above the age of 40, not educated, and with a higher number of family members. Subsequently, the policy implications from the findings of the research can draw attention of the policy makers towards protective measures which need to be implemented to support migrants during the ongoing pandemic. The government should take some necessary steps, such as a financial benefit scheme, to overcome the problems in the reduction of migrant earnings and remittances. The government should not focus only on vaccination and physical fitness of the migrants but also need to find out the cure of the psychological impact arising during the pandemic.
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Riley AR, Chen YH, Matthay EC, Glymour MM, Torres JM, Fernandez A, Bibbins-Domingo K. Excess mortality among Latino people in California during the COVID-19 pandemic. SSM Popul Health 2021; 15:100860. [PMID: 34307826 PMCID: PMC8283318 DOI: 10.1016/j.ssmph.2021.100860] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/31/2021] [Accepted: 06/28/2021] [Indexed: 11/30/2022] Open
Abstract
Latino people in the US are experiencing higher excess deaths during the COVID-19 pandemic than any other racial/ethnic group, but it is unclear which sociodemographic subgroups within this diverse population are most affected. Such information is necessary to target policies that prevent further excess mortality and reduce inequities. Using death certificate data for January 1, 2016 through February 29, 2020 and time-series models, we estimated the expected weekly deaths among Latino people in California from March 1 through October 3, 2020. We quantified excess mortality as observed minus expected deaths and risk ratios (RR) as the ratio of observed to expected deaths. We considered subgroups categorized by age, sex, nativity, country of birth, educational attainment, occupation, and combinations of these factors. Our results indicate that during the first seven months of the pandemic, Latino deaths in California exceeded expected deaths by 10,316, a 31% increase. Excess death rates were greatest for individuals born in Mexico (RR 1.44; 95% PI, 1.41, 1.48) or a Central American country (RR 1.49; 95% PI, 1.37, 1.64), with less than a high school degree (RR 1.41; 95% PI, 1.35, 1.46), or in food-and-agriculture (RR 1.60; 95% PI, 1.48, 1.74) or manufacturing occupations (RR 1.59; 95% PI, 1.50, 1.69). Immigrant disadvantages in excess death were magnified among working-age Latinos in essential occupations. In sum, the COVID-19 pandemic has disproportionately impacted mortality among Latino immigrants, especially those in unprotected essential jobs. Interventions to reduce these inequities should include targeted vaccination, workplace safety enforcement, and expanded access to medical care and economic support.
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Affiliation(s)
- Alicia R. Riley
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Yea-Hung Chen
- Institute for Global Health, University of California, San Francisco, CA, USA
| | - Ellicott C. Matthay
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Jacqueline M. Torres
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Alicia Fernandez
- Department of Medicine, University of California, San Francisco, CA, USA
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Carson SL, Casillas A, Castellon-Lopez Y, Mansfield LN, Morris D, Barron J, Ntekume E, Landovitz R, Vassar SD, Norris KC, Dubinett SM, Garrison NA, Brown AF. COVID-19 Vaccine Decision-making Factors in Racial and Ethnic Minority Communities in Los Angeles, California. JAMA Netw Open 2021; 4:e2127582. [PMID: 34591103 PMCID: PMC8485164 DOI: 10.1001/jamanetworkopen.2021.27582] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/23/2021] [Indexed: 11/26/2022] Open
Abstract
Importance The COVID-19 pandemic has had disproportionate effects on racial and ethnic minority communities, where preexisting clinical and social conditions amplify health and social disparities. Many of these communities report lower vaccine confidence and lower receipt of the COVID-19 vaccine. Understanding factors that influence the multifaceted decision-making process for vaccine uptake is critical for narrowing COVID-19-related disparities. Objective To examine factors that members of multiethnic communities at high risk for COVID-19 infection and morbidity report as contributing to vaccine decision-making. Design, Setting, and Participants This qualitative study used community-engaged methods to conduct virtual focus groups from November 16, 2020, to January 28, 2021, with Los Angeles County residents. Potential participants were recruited through email, video, and telephone outreach to community partner networks. Focus groups were stratified by self-identified race and ethnicity as well as age. Transcripts were analyzed using reflexive thematic analysis. Main Outcomes and Measures Themes were categorized by contextual, individual, and vaccine-specific influences using the World Health Organization's Vaccine Hesitancy Matrix categories. Results A total of 13 focus groups were conducted with 70 participants (50 [71.4%] female) who self-identified as American Indian (n = 17 [24.3%]), Black/African American (n = 17 [24.3%]), Filipino/Filipina (n = 11 [15.7%]), Latino/Latina (n = 15 [21.4%]), or Pacific Islander (n = 10 [14.3%]). A total of 39 participants (55.7%) were residents from high-poverty zip codes, and 34 (48.6%) were essential workers. The resulting themes included policy implications for equitable vaccine distribution: contextual influences (unclear and unreliable information, concern for inequitable access or differential treatment, references to mistrust from unethical research studies, accessibility and accommodation barriers, eligibility uncertainty, and fears of politicization or pharmaceutical industry influence); social and group influences (inadequate exposure to trusted messengers or information, altruistic motivations, medical mistrust, and desire for autonomy); and vaccination-specific influences (need for vaccine evidence by subpopulation, misconceptions on vaccine development, allocation ambiguity, vaccination safety preferences, the importance of perceiving vaccine equity, burden of vaccine scheduling, cost uncertainty, and desire for practitioner recommendation). Conclusions and Relevance In this qualitative study, participants reported a number of factors that affected their vaccine decision-making, including concern for inequitable vaccine access. Participants endorsed policy recommendations and strategies to promote vaccine confidence. These results suggest that support of informed deliberation and attainment of vaccine equity will require multifaceted, multilevel policy approaches that improve COVID-19 vaccine knowledge, enhance trust, and address the complex interplay of sociocultural and structural barriers to vaccination.
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Affiliation(s)
- Savanna L. Carson
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Yelba Castellon-Lopez
- Department of Family Medicine, UCLA David Geffen School of Medicine, University of California, Los Angeles
| | - Lisa N. Mansfield
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - D’Ann Morris
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Juan Barron
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Ejiro Ntekume
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Raphael Landovitz
- Division of Infectious Disease, David Geffen School of Medicine, University of California, Los Angeles
| | - Stefanie D. Vassar
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Olive View-UCLA Medical Center, Sylmar, California
| | - Keith C. Norris
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Steven M. Dubinett
- Division of Pulmonary and Critical Care, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles
| | - Nanibaa’ A. Garrison
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Institute for Society & Genetics, College of Letters and Science, University of California, Los Angeles
- Institute for Precision Health, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Arleen F. Brown
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Olive View-UCLA Medical Center, Sylmar, California
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A First Look: Disparities in COVID-19 Mortality Among US-Born and Foreign-Born Minnesota Residents. POPULATION RESEARCH AND POLICY REVIEW 2021; 41:465-478. [PMID: 34366520 PMCID: PMC8326639 DOI: 10.1007/s11113-021-09668-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/16/2021] [Indexed: 11/18/2022]
Abstract
This research brief provides one of the first examinations of the impact of COVID-19 mortality on immigrant communities in the United States. In the absence of national data, we examine COVID-19 deaths in Minnesota, historically one of the major U.S. refugee destinations, using individual-level death certificates obtained from the Minnesota Department of Health Office of Vital Records. Minnesota’s foreign-born crude COVID-19 death rates were similar to rates for the US-born, but COVID-19 death rates adjusted for age and gender were twice as high among the foreign-born. Among foreign-born Latinos, in particular, COVID-19 mortality was concentrated in relatively younger, prime working age men. Moreover, the place-based and temporal patterns of COVID-19 mortality were quite distinct, with the majority of US-born mortality concentrated in long-term care facilities and late in 2020, and foreign-born mortality occurring outside of residential institutions and earlier in the pandemic. The disparate impacts of COVID-19 for foreign-born Minnesotans demonstrate the need for targeted public health planning and intervention in immigrant communities.
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Zaidi Z, Razack S, Kumagai AK. Professionalism revisited during the pandemics of our time: COVID-19 and racism. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:238-244. [PMID: 33738767 PMCID: PMC7971352 DOI: 10.1007/s40037-021-00657-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 02/20/2021] [Accepted: 02/25/2021] [Indexed: 05/07/2023]
Abstract
In this article the authors review the current-day definition of professionalism through the lens of the two ongoing pandemics: COVID-19 and racism. The pandemics have led to contemporary practice-related questions, such as: does professionalism entail that health care providers (HCP) be compelled to treat patients without PPE or if patients refuse to wear masks? And what role do HCP play in society when confronted with glaring health disparities and police brutality? The authors propose using care ethics as a theory to view professionalism, as it takes into account broadly encompassing relationships between HCP and society, history and context. Professionalism viewed through a care ethics lens would require professionalism definitions to be expanded to allow for interventions, i.e., not just refrain from doing harm but actively interfere or take action if wrong is being witnessed. Principles related to the primacy of patient welfare need to be re-addressed to prevent systematic self-sacrifice which results in harm to HCP and burnout. Mature care should be a characteristic of professionalism ensuring that HCP care for the sick but be practically wise, highlighting the importance of balancing too little and too much care for self and others. Professionalism needs to be viewed as a bi-directional relational exchange, with society demonstrating solidarity with those providing care. Additionally, given the scale of health disparities, simply stating that HCP need to work towards social justice oversimplifies the problem. Professionalism needs to encompass incorporating critical action and critical pedagogy into health care training and the health care profession to demonstrate solidarity with those impacted by racism.
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Affiliation(s)
- Zareen Zaidi
- Department of Medicine, University of Florida College of Medicine, 32610, Gainesville, FL, USA.
| | - Saleem Razack
- Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Canada
| | - Arno K Kumagai
- Department of Medicine, University of Toronto, Toronto, Canada
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Galletly CL, Lechuga J, Dickson-Gomez JB, Glasman LR, McAuliffe TL, Espinoza-Madrigal I. Assessment of COVID-19-Related Immigration Concerns Among Latinx Immigrants in the US. JAMA Netw Open 2021; 4:e2117049. [PMID: 34279648 PMCID: PMC8290301 DOI: 10.1001/jamanetworkopen.2021.17049] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IMPORTANCE Despite the contentious immigration environment and disproportionate rates of COVID-19 infection among Latinx individuals in the US, immigrants' concerns about engaging in COVID-19-related testing, treatment, and contact tracing have been largely unexplored. OBJECTIVE To examine the proportions of Latinx immigrants who endorse statements about the potential negative immigration ramifications of seeking and using COVID-19-related testing and treatment services and engaging in contact tracing. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional survey study, 25 COVID-19-related items were incorporated into the online Spanish-language survey of an ongoing study. Data were collected between July 15 and October 9, 2020, in Chicago, Illinois; Los Angeles, California; and Phoenix, Arizona. A nonrandom sample of 379 adult, Spanish-speaking, noncitizen Latinx immigrants (with either documented or undocumented immigration status) were sent surveys. Of those, 336 individuals (88.7% participation rate) returned surveys, and 43 individuals did not. An additional 213 individuals were screened but ineligible. Descriptive statistics were computed, and mean comparisons and bivariate correlations between sociodemographic variables, indices of immigration risk, and COVID-19-related survey items were conducted. MAIN OUTCOMES AND MEASURES Items elicited agreement or disagreement with statements about immigrants' access to COVID-19-related testing and treatment services and the potential immigration ramifications of using these services. Willingness to identify an undocumented person during contact tracing was also assessed. RESULTS A total of 336 Latinx immigrants completed surveys. The mean (SD) age of participants was 39.7 (8.9) years; 210 participants (62.5%) identified as female, and 216 participants (64.3%) had undocumented immigration status. In total, 89 participants (26.5%) agreed that hospital emergency departments were the only source of COVID-19 testing or treatment for uninsured immigrants, and 106 participants (31.6%) agreed that using public testing and health care services for COVID-19 could jeopardize one's immigration prospects. A total of 96 participants (28.6%) and 114 participants (33.9%), respectively, would not identify an undocumented household member or coworker during contact tracing. Reluctance to identify an undocumented household member or coworker was associated with having had deportation experiences (r = -0.17; 95% CI, -0.06 to 0.27; P = .003) but not with the number of years lived in the US (r = 0.07; 95% CI, -0.16 to 0.17; P = .15) or immigration status (r = 0.03; 95% CI, -0.07 to 0.13; P = .56). CONCLUSIONS AND RELEVANCE In this cross-sectional survey study, a substantial number of immigrants endorsed statements about immigrants' restricted access to COVID-19-related testing and treatment services and the potential negative immigration ramifications of using these services. These results suggest that programs for COVID-19-related testing, contact tracing, and vaccine administration that are designed to allay immigration concerns are needed.
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Affiliation(s)
- Carol L. Galletly
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee
| | - Julia Lechuga
- Department of Public Health Sciences, College of Health Sciences, University of Texas–El Paso, El Paso
| | - Julia B. Dickson-Gomez
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee
- Institute for Health Equity, Medical College of Wisconsin, Milwaukee
| | - Laura R. Glasman
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee
| | - Timothy L. McAuliffe
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee
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Gehlbach D, Vázquez E, Ortiz G, Li E, Sánchez CB, Rodríguez S, Pozar M, Cheney AM. COVID-19 Testing and Vaccine Hesitancy in Latinx Farm-Working Communities in The Eastern Coachella Valley. RESEARCH SQUARE 2021:rs.3.rs-587686. [PMID: 34189524 PMCID: PMC8240686 DOI: 10.21203/rs.3.rs-587686/v1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background A novel coronavirus, SARS-CoV-2 (known as COVID-19), spread rapidly around the world, affecting all and creating an ongoing global pandemic. In the United States, Latinx, African American, and Indigenous populations across the country have been disproportionately affected by COVID-19 cases and death rates. An examination of the perceptions and beliefs about the spread of the virus, COVID-19 testing, and vaccination amongst racial/ethnic minority groups is needed in order to alleviate the widespread disparity in new cases and deaths. Methods From November to December 2020 the research team conducted focus groups with members of Latinx farm-working communities in the Eastern Coachella Valley, located in the inland southern California desert region. A total of seven focus groups, six in Spanish and one in Purepecha, with a total of 55 participants were conducted. Topics covered include knowledge of the coronavirus, COVID-19 testing and vaccination. Results Using theme identification techniques, the findings identify structural factors that underly perceptions held by immigrant, migrant, and indigenous Latinx community members about COVID-19, which, in turn, shape attitudes and behaviors related to COVID-19 testing and vaccination. Common themes that emerged across focus groups include misinformation, lack of trust in institutions, and insecurity around employment and residency. Conclusions This racial/ethnic minority population is structurally vulnerable to historical and present-day inequalities that put them at increased risk of COVID-19 exposure, morbidity, and mortality. Findings from the focus groups indicate a significant need for interventions that decrease structural vulnerabilities by addressing issues of (dis)trust in government and public health among this population.
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Affiliation(s)
| | | | | | - Erica Li
- University of California Riverside School of Medicine
| | | | - Sonia Rodríguez
- University of California Riverside Center for Health Disparities Research
| | - María Pozar
- University of California Riverside Center for Health Disparities Research
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Baggio S, Jacquerioz F, Salamun J, Spechbach H, Jackson Y. Equity in access to COVID-19 testing for undocumented migrants and homeless persons during the initial phase of the pandemic. J Migr Health 2021; 4:100051. [PMID: 34184000 PMCID: PMC8214821 DOI: 10.1016/j.jmh.2021.100051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 06/12/2021] [Accepted: 06/13/2021] [Indexed: 11/26/2022] Open
Abstract
Equity-based policies can mitigate disparities in access to care and spread of COVID-19. Disparities in COVID-19 prevalence stresses the need to ensure universal access to vaccine. Crisis provide opportunities to reinforce healthcare systems in order to better protect the whole of society.
Introduction The COVID-19 pandemic has excessively affected socially and economically deprived groups of population. There is a dearth of empirical evidence about the effect of policies regulating access to care for such groups. This study aims to document the impact of an equity-based strategy to facilitate access to COVID-19 testing during the initial phase of the pandemic. Materials and methods This cross-sectional study included all outpatients presenting at the Geneva University Hospital for COVID-19 testing in March and April 2020. We compared the testing program uptake, and the proportions of positive tests and of complicated clinical course between undocumented migrants and homeless persons and the general population. Results Underserved patients represented 215 (6.5%) of the 3299 participants. There was no significant difference in the time-lag between the first COVID-19 evocative symptoms and the testing, the number of symptoms at presentation, and the participation to the program during its first month of implementation. The proportion of positive tests was significantly higher (32.1% vs. 23.6%, p=.005) among undeserved while the proportion of complicated clinical course was comparable. Conclusions Equity-based policies can mitigate disparities in access to care during the pandemic and reduce the spread of COVID-19 in the community by early detection of infective cases. The high proportion of positive test in underserved patients highlight the need to include such groups into future COVID-19 immunization program. More globally, this study highlights the opportunity to reinforce healthcare systems to adapt to new threats and to contribute to a better protection of the whole of society.
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Affiliation(s)
- Stephanie Baggio
- Division of prison health, Geneva University Hospital and University of Geneva, Switzerland.,Office of correction, Department of justice and home affairs of the canton of Zurich, Zurich, Switzerland
| | - Frederique Jacquerioz
- Division of primary care medicine, Geneva University Hospital and University of Geneva, Switzerland.,Division of tropical and humanitarian medicine, Geneva University Hospital and University of Geneva, Switzerland
| | - Julien Salamun
- Division of primary care medicine, Geneva University Hospital and University of Geneva, Switzerland
| | - Hervé Spechbach
- Division of primary care medicine, Geneva University Hospital and University of Geneva, Switzerland
| | - Yves Jackson
- Division of primary care medicine, Geneva University Hospital and University of Geneva, Switzerland
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Mayorga NA, Garey L, Viana A, Cardoso JB, Schmidt NB, Zvolensky MJ. Psychological Distress and Physical Health Symptoms in the Latinx Population During the COVID-19 Pandemic: Exploring the Role of Anxiety Sensitivity. COGNITIVE THERAPY AND RESEARCH 2021; 46:20-30. [PMID: 34177003 PMCID: PMC8214047 DOI: 10.1007/s10608-021-10243-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2021] [Indexed: 12/24/2022]
Abstract
Objective The outbreak of the novel 2019 SARS2-Coronavirus disease (COVID-19) has led to substantial physical and mental health consequences. Rates of mortality and hospitalization are highest among those of racial and ethnic minority persons, including Latinx persons. Further, Latinx persons have been experiencing elevated mental health problems in response to the pandemic compared to non-Latinx Whites. The current study examined whether individual differences in anxiety sensitivity (AS) related to more severe emotional distress associated with social distancing, financial strain, fear of COVID-19, and physical health symptoms stemming from the COVID-19 pandemic among Latinx adults. Methods Participants included 188 Latinx persons (31.4% female, Mage = 34.1 years, SD = 8.16) recruited via an online survey panel program. Results Results indicated that AS significantly contributed to increased severity of the emotional stress response associated with social distancing (ΔR2 = 0.15, p < 0.001), financial strain (ΔR2 = 0.15, p < 0.001), physical health symptoms (ΔR2 = 0.03, p = 0.006), and fear of COVID-19 (ΔR2 = 0.15, p < 0.001). These effects were evident over and above the variance accounted for by gender, years living in the United States, education, and work and home life COVID-19-related stress. Conclusions These cross-sectional findings suggest AS may be an important individual difference factor for better understanding mental health among Latinx persons in the context of the COVID-19 pandemic.
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Affiliation(s)
- Nubia A. Mayorga
- Department of Psychology, University of Houston, Houston, TX USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX USA
| | - Andres Viana
- Department of Psychology, University of Houston, Houston, TX USA
- Texas Institute of Measurement, Evaluation, and Statistics, Houston, USA
| | - Jodi Berger Cardoso
- HEALTH Institute, University of Houston, Houston, TX USA
- Graduate College of Social Work, University of Houston, Houston, TX USA
| | | | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX USA
- HEALTH Institute, University of Houston, Houston, TX USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX USA
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX 77204 USA
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Escobar M, Mendez AD, Encinas MR, Villagomez S, Wojcicki JM. High food insecurity in Latinx families and associated COVID-19 infection in the Greater Bay Area, California. BMC Nutr 2021; 7:23. [PMID: 34112257 PMCID: PMC8192129 DOI: 10.1186/s40795-021-00419-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Food insecurity impacts nearly one-in-four Latinx households in the United States and has been exacerbated by the novel coronavirus or COVID-19 pandemic. METHODS We examined the impact of COVID-19 on household and child food security in three preexisting, longitudinal, Latinx urban cohorts in the San Francisco Bay Area (N = 375 households, 1875 individuals). Households were initially recruited during pregnancy and postpartum at Zuckerberg San Francisco General Hospital (ZSFG) and UCSF Benioff prior to the COVID-19 pandemic. For this COVID-19 sub-study, participants responded to a 15-min telephonic interview. Participants answered 18 questions from the US Food Security Food Module (US HFSSM) and questions on types of food consumption, housing and employment status, and history of COVID-19 infection as per community or hospital-based testing. Food security and insecurity levels were compared with prior year metrics. RESULTS We found low levels of household food security in Latinx families (by cohort: 29.2%; 34.2%; 60.0%) and child food security (56.9%, 54.1%, 78.0%) with differences between cohorts explained by self-reported levels of education and employment status. Food security levels were much lower than those reported previously in two cohorts where data had been recorded from prior years. Reported history of COVID-19 infection in households was 4.8% (95% Confidence Interval (CI); 1.5-14.3%); 7.2% (95%CI, 3.6-13.9%) and 3.5% (95%CI, 1.7-7.2%) by cohort and was associated with food insecurity in the two larger cohorts (p = 0.03; p = 0.01 respectively). CONCLUSIONS Latinx families in the Bay Area with children are experiencing a sharp rise in food insecurity levels during the COVID-19 epidemic. Food insecurity, similar to other indices of poverty, is associated with increased risk for COVID-19 infection. Comprehensive interventions are needed to address food insecurity in Latinx populations and further studies are needed to better assess independent associations between household food insecurity, poor nutritional health and risk of COVID-19 infection.
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Affiliation(s)
- Milagro Escobar
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of California, 550 16th Street, 5th Floor, San Francisco, CA, 94158-0136, USA
| | - Andrea DeCastro Mendez
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of California, 550 16th Street, 5th Floor, San Francisco, CA, 94158-0136, USA
| | - Maria Romero Encinas
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of California, 550 16th Street, 5th Floor, San Francisco, CA, 94158-0136, USA
| | - Sofia Villagomez
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of California, 550 16th Street, 5th Floor, San Francisco, CA, 94158-0136, USA
| | - Janet M Wojcicki
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of California, 550 16th Street, 5th Floor, San Francisco, CA, 94158-0136, USA.
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Ross HM, Desiderio S, St Mars T, Rangel P. US Immigration Policies Pose Threat to Health Security During COVID-19 Pandemic. Health Secur 2021; 19:S83-S88. [PMID: 34096788 DOI: 10.1089/hs.2021.0039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Heather M Ross
- Heather M. Ross, PhD, DNP, is a Clinical Associate Professor, School for the Future of Innovation in Society and Edson College of Nursing and Health Innovation, Arizona State University, Tempe, AZ. Stephanie Desiderio, RN, CHPN, was President, Greater Phoenix Area Chapter, Black Nurses Association; Tomi St. Mars, MSN, RN, CEN, FAEN, is Injury Prevention RN Coordinator, Trauma Services, Valleywise Health; and Paulette Rangel, RN, CCRN, is President, Phoenix Chapter, National Association of Hispanic Nurses; all in Phoenix, AZ
| | - Stephanie Desiderio
- Heather M. Ross, PhD, DNP, is a Clinical Associate Professor, School for the Future of Innovation in Society and Edson College of Nursing and Health Innovation, Arizona State University, Tempe, AZ. Stephanie Desiderio, RN, CHPN, was President, Greater Phoenix Area Chapter, Black Nurses Association; Tomi St. Mars, MSN, RN, CEN, FAEN, is Injury Prevention RN Coordinator, Trauma Services, Valleywise Health; and Paulette Rangel, RN, CCRN, is President, Phoenix Chapter, National Association of Hispanic Nurses; all in Phoenix, AZ
| | - Tomi St Mars
- Heather M. Ross, PhD, DNP, is a Clinical Associate Professor, School for the Future of Innovation in Society and Edson College of Nursing and Health Innovation, Arizona State University, Tempe, AZ. Stephanie Desiderio, RN, CHPN, was President, Greater Phoenix Area Chapter, Black Nurses Association; Tomi St. Mars, MSN, RN, CEN, FAEN, is Injury Prevention RN Coordinator, Trauma Services, Valleywise Health; and Paulette Rangel, RN, CCRN, is President, Phoenix Chapter, National Association of Hispanic Nurses; all in Phoenix, AZ
| | - Paulette Rangel
- Heather M. Ross, PhD, DNP, is a Clinical Associate Professor, School for the Future of Innovation in Society and Edson College of Nursing and Health Innovation, Arizona State University, Tempe, AZ. Stephanie Desiderio, RN, CHPN, was President, Greater Phoenix Area Chapter, Black Nurses Association; Tomi St. Mars, MSN, RN, CEN, FAEN, is Injury Prevention RN Coordinator, Trauma Services, Valleywise Health; and Paulette Rangel, RN, CCRN, is President, Phoenix Chapter, National Association of Hispanic Nurses; all in Phoenix, AZ
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Suarez-Lopez JR, Cairns MR, Sripada K, Quiros-Alcala L, Mielke HW, Eskenazi B, Etzel RA, Kordas K. COVID-19 and children's health in the United States: Consideration of physical and social environments during the pandemic. ENVIRONMENTAL RESEARCH 2021; 197:111160. [PMID: 33852915 PMCID: PMC8542993 DOI: 10.1016/j.envres.2021.111160] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/12/2021] [Accepted: 04/07/2021] [Indexed: 05/08/2023]
Abstract
Public health measures necessary to counteract the coronavirus disease 2019 (COVID-19) pandemic have resulted in dramatic changes in the physical and social environments within which children grow and develop. As our understanding of the pathways for viral exposure and associated health outcomes in children evolves, it is critical to consider how changes in the social, cultural, economic, and physical environments resulting from the pandemic could affect the development of children. This review article considers the environments and settings that create the backdrop for children's health in the United States during the COVID-19 pandemic, including current threats to child development that stem from: A) change in exposures to environmental contaminants such as heavy metals, pesticides, disinfectants, air pollution and the built environment; B) changes in food environments resulting from adverse economic repercussion of the pandemic and limited reach of existing safety nets; C) limited access to children's educational and developmental resources; D) changes in the social environments at the individual and household levels, and their interplay with family stressors and mental health; E) social injustice and racism. The environmental changes due to COVID-19 are overlaid onto existing environmental and social disparities. This results in disproportionate effects among children in low-income settings and among populations experiencing the effects of structural racism. This article draws attention to many environments that should be considered in current and future policy responses to protect children's health amid pandemics.
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Affiliation(s)
- Jose R Suarez-Lopez
- Department of Family Medicine and Public Health, and Herbert Wertheim School of Public Health and Human Longevity, University of California San Diego, La Jolla, CA, USA.
| | - Maryann R Cairns
- Department of Anthropology, Dedman College of Humanities and Sciences, Southern Methodist University, Dallas, TX, USA
| | - Kam Sripada
- Centre for Global Health Inequalities Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lesliam Quiros-Alcala
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Howard W Mielke
- Department of Pharmacology, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Brenda Eskenazi
- Center for Environmental Research and Children's Health, School of Public Health, University of California, Berkeley, CA, USA
| | - Ruth A Etzel
- Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - Katarzyna Kordas
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, 14214, USA
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77
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Kelly JD, Bravata DM, Bent S, Wray CM, Leonard SJ, Boscardin WJ, Myers LJ, Keyhani S. Association of Social and Behavioral Risk Factors With Mortality Among US Veterans With COVID-19. JAMA Netw Open 2021; 4:e2113031. [PMID: 34106264 PMCID: PMC8190626 DOI: 10.1001/jamanetworkopen.2021.13031] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE The US Department of Veterans Affairs (VA) offers programs that reduce barriers to care for veterans and those with housing instability, poverty, and substance use disorder. In this setting, however, the role that social and behavioral risk factors play in COVID-19 outcomes is unclear. OBJECTIVE To examine whether social and behavioral risk factors were associated with mortality among US veterans with COVID-19 and whether this association might be modified by race/ethnicity. DESIGN, SETTING, AND PARTICIPANTS This cohort study obtained data from the VA Corporate Data Warehouse to form a cohort of veterans who received a positive COVID-19 test result between March 2 and September 30, 2020, in a VA health care facility. All veterans who met the inclusion criteria were eligible to participate in the study, and participants were followed up for 30 days after the first SARS-CoV-2 or COVID-19 diagnosis. The final follow-up date was October 31, 2020. EXPOSURES Social risk factors included housing problems and financial hardship. Behavioral risk factors included current tobacco use, alcohol use, and substance use. MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality in the 30-day period after the SARS-CoV-2 or COVID-19 diagnosis date. Multivariable logistic regression was used to estimate odds ratios, clustering for health care facilities and adjusting for age, sex, race, ethnicity, marital status, clinical factors, and month of COVID-19 diagnosis. RESULTS Among 27 640 veterans with COVID-19 who were included in the analysis, 24 496 were men (88.6%) and the mean (SD) age was 57.2 (16.6) years. A total of 3090 veterans (11.2%) had housing problems, 4450 (16.1%) had financial hardship, 5358 (19.4%) used alcohol, and 3569 (12.9%) reported substance use. Hospitalization occurred in 7663 veterans (27.7%), and 1230 veterans (4.5%) died. Housing problems (adjusted odds ratio [AOR], 0.96; 95% CI, 0.77-1.19; P = .70), financial hardship (AOR, 1.13; 95% CI, 0.97-1.31; P = .11), alcohol use (AOR, 0.82; 95% CI, 0.68-1.01; P = .06), current tobacco use (AOR, 0.85; 95% CI, 0.68-1.06; P = .14), and substance use (AOR, 0.90; 95% CI, 0.71-1.15; P = .41) were not associated with higher mortality. Interaction analyses by race/ethnicity did not find associations between mortality and social and behavioral risk factors. CONCLUSIONS AND RELEVANCE Results of this study showed that, in an integrated health system such as the VA, social and behavioral risk factors were not associated with mortality from COVID-19. Further research is needed to substantiate the potential of an integrated health system to be a model of support services for households with COVID-19 and populations who are at risk for the disease.
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Affiliation(s)
- J. Daniel Kelly
- San Francisco VA Medical Center, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco
| | - Dawn M. Bravata
- US Department of Veterans Affairs, Health Services and Development, Center for Health Information and Communication, Indianapolis, Indiana
- Department of Medicine, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana
- Veterans Affairs Medical Center, Indianapolis, Indiana
- Department of Medicine, Indiana University School of Medicine, Indianapolis
- Regenstrief Institute, Indianapolis, Indiana
| | - Stephen Bent
- San Francisco VA Medical Center, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
- Department of Medicine, University of California, San Francisco, San Francisco
| | - Charlie M. Wray
- San Francisco VA Medical Center, San Francisco, California
- Department of Medicine, University of California, San Francisco, San Francisco
| | - Samuel J. Leonard
- Department of Medicine, University of California, San Francisco, San Francisco
| | - W. John Boscardin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
- Department of Medicine, University of California, San Francisco, San Francisco
| | - Laura J. Myers
- US Department of Veterans Affairs, Health Services and Development, Center for Health Information and Communication, Indianapolis, Indiana
| | - Salomeh Keyhani
- San Francisco VA Medical Center, San Francisco, California
- Department of Medicine, University of California, San Francisco, San Francisco
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Bigelow BF, Saxton RE, Flores-Miller A, Mostafa HH, Loss MJ, Phillips KH, Moore AM, Hale WD, Tolson TM, McCann NS, Catlett CL, Golden SH, Clark JM, Page KR. Community Testing and SARS-CoV-2 Rates for Latinxs in Baltimore. Am J Prev Med 2021; 60:e281-e286. [PMID: 33775510 DOI: 10.1016/j.amepre.2021.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/15/2020] [Accepted: 01/03/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Latinxs have been disproportionately impacted by COVID-19. Latinx immigrants, in particular, face significant barriers to SARS-CoV-2 testing, including lack of insurance, language barriers, stigma, work conflicts, and limited transportation. METHODS In response to a disproportionately high SARS-CoV-2 positivity rate among Latinxs at the Johns Hopkins Health System, investigators implemented free community-based testing by partnering with religious leaders and leveraging the skill of trusted community health workers. Data were extracted from the electronic health record and a Research Electronic Data Capture database. SARS-CoV-2 positivity was evaluated per event stratified by race/ethnicity. Total rates of SARS-CoV-2 positivity and categorical patient characteristics were compared between groups using chi-square tests. RESULTS Between June 25, 2020 and October 15, 2020, a total of 1,786 patients (57.5% Latinx, 31.2% non-Hispanic White, 5.9% non-Hispanic Black, and 5.3% non-Hispanic other) were tested for SARS-CoV-2 in 18 testing events. Among them, 355 (19.9%) tested positive. The positivity rate was 31.5% for Latinxs, 7.6% for non-Hispanic Blacks, 3.4% for non-Hispanic Whites, and 5.3% for patients of other races/ethnicities. Compared with Latinxs who tested negative, Latinxs who tested positive were more likely to report Spanish as their preferred language (91.6% vs 81.7%, p<0.001), be younger (30.4 vs 33.4 years, p<0.008), and have a larger household size (4.8 vs 4.3 members, p<0.002). CONCLUSIONS Community-based testing identified high levels of ongoing SARS-CoV-2 transmission among primarily Latinxs with limited English proficiency. During this period, the overall positivity rate at this community testing site was almost 10 times higher among Latinxs than among non-Hispanic Whites.
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Affiliation(s)
- Benjamin F Bigelow
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ronald E Saxton
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Heba H Mostafa
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Manisha J Loss
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Adrianna M Moore
- Johns Hopkins Health System, Johns Hopkins Medicine, Baltimore, Maryland
| | - W Daniel Hale
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tina M Tolson
- Johns Hopkins Health System, Johns Hopkins Medicine, Baltimore, Maryland
| | - Nicki S McCann
- Johns Hopkins Health System, Johns Hopkins Medicine, Baltimore, Maryland
| | - Christina L Catlett
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sherita H Golden
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins Medicine Office of Diversity, Inclusion and Health Equity, Baltimore, Maryland
| | - Jeanne M Clark
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kathleen Raquel Page
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Rojanaworarit C, El Bouzaidi S. Building a resilient public health system for international migrant workers: a case study and policy brief for COVID-19 and beyond. JOURNAL OF HEALTH RESEARCH 2021. [DOI: 10.1108/jhr-01-2021-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
This article analyzes deficiencies in public health services for international migrant workers (IMWs) during the COVID-19 pandemic and provides a policy brief for improvement of the public health system.
Design/methodology/approach
A COVID-19 outbreak that initially clustered in IMWs and further contributed to the resurgence of the disease across Thailand in December 2020 was analyzed to address the deficiencies in public health services based on the framework of the 10 Essential Public Health Services (EPHS). The EPHS framework was also applied to develop policy options and recommendations in the subsequent policy brief.
Findings
This outbreak unveiled unique challenges that make IMWs more vulnerable to COVID-19. The public health system, challenged by the COVID-19 outbreak among IMWs, manifested deficiencies in the planning and implementation of all essential services. Delayed detection of the outbreak along with the lack of policy accommodating undocumented IMWs and the lack of equitable access to testing and treatment for COVID-19 resulted in the transmission of the disease that harmed the public at large.
Originality/value
The comprehensive analysis of the deficiencies in public health services for IMWs enabled a clear description of problems that could be further prioritized by relevant stakeholders. The policy brief provides policymakers with evidence-based recommendations for improving public health services for IMWs during the COVID-19 pandemic and beyond.
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80
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Kim SJ, Watson K, Khare N, Shastri S, Da Goia Pinto CL, Nazir NT. Addressing Racial/Ethnic Equity in Access to COVID-19 Testing Through Drive-Thru And Walk-In Testing Sites in Chicago. ACTA ACUST UNITED AC 2021; 9. [PMID: 34109272 DOI: 10.18103/mra.v9i5.2430] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Mile Square Health Center (MSHC), a network of Federally Qualified Health Centers (FQHCs) run by the University of Illinois Hospital (UIH) in Chicago, established Drive-Thru and Walk-Up COVID-19 testing sites. The primary aim of the UIH/MSHC testing project was to increase testing capacity in the most affected, racial/ethnic minority communities. More than 7,500 tests were performed over a six-month period. Half of those who were tested were Black and Latinx residents. The majority of those tested at the Walk-Up sites were Black, while "Other" race group tended to get tested in Drive Thru testing sites. Latinx residents had the highest positivity rate, followed by Other race group. Younger age groups were more likely to have higher positivity rates. Overall, UH/MSHC testing results reflected the overall Chicago COVID-19 testing results. Our findings substantiate the need to advocate for equitable resource allocation to counter the disproportionate burden of COVID-19 infection among minority communities. FQHCs were shown to be an effective approach to reduce structural barriers to COVID-19 testing and subsequently reduce disparities. Going forward, FQHCs can be key to ensuring COVID-19 vaccine outreach and dissemination.
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Affiliation(s)
- Sage J Kim
- University of Illinois at Chicago, School of Public Health, Division of Health Policy & Administration
| | - Karriem Watson
- Associate Executive Director, Mile Square Health Center, Research Assistant Professor, University of Illinois at Chicago, School of Public Health, Division of Community Health Science
| | - Nidhi Khare
- University of Illinois at Chicago, School of Public Health
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81
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Wadhera RK, Figueroa JF, Rodriguez F, Liu M, Tian W, Kazi DS, Song Y, Yeh RW, Joynt Maddox KE. Racial and Ethnic Disparities in Heart and Cerebrovascular Disease Deaths During the COVID-19 Pandemic in the United States. Circulation 2021; 143:2346-2354. [PMID: 34000814 PMCID: PMC8191372 DOI: 10.1161/circulationaha.121.054378] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Cardiovascular deaths increased during the early phase of the COVID-19 pandemic in the United States. However, it is unclear whether diverse racial/ethnic populations have experienced a disproportionate rise in heart disease and cerebrovascular disease deaths. METHODS We used the National Center for Health Statistics to identify heart disease and cerebrovascular disease deaths for non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic individuals from March to August 2020 (pandemic period), as well as for the corresponding months in 2019 (historical control). We determined the age- and sex-standardized deaths per million by race/ethnicity for each year. We then fit a modified Poisson model with robust SEs to compare change in deaths by race/ethnicity for each condition in 2020 versus 2019. RESULTS There were a total of 339 076 heart disease and 76 767 cerebrovascular disease deaths from March through August 2020, compared with 321 218 and 72 190 deaths during the same months in 2019. Heart disease deaths increased during the pandemic in 2020, compared with the corresponding period in 2019, for non-Hispanic White (age-sex standardized deaths per million, 1234.2 versus 1208.7; risk ratio for death [RR], 1.02 [95% CI, 1.02-1.03]), non-Hispanic Black (1783.7 versus 1503.8; RR, 1.19 [95% CI, 1.17-1.20]), non-Hispanic Asian (685.7 versus 577.4; RR, 1.19 [95% CI, 1.15-1.22]), and Hispanic (968.5 versus 820.4; RR, 1.18 [95% CI, 1.16-1.20]) populations. Cerebrovascular disease deaths also increased for non-Hispanic White (268.7 versus 258.2; RR, 1.04 [95% CI, 1.03-1.05]), non-Hispanic Black (430.7 versus 379.7; RR, 1.13 [95% CI, 1.10-1.17]), non-Hispanic Asian (236.5 versus 207.4; RR, 1.15 [95% CI, 1.09-1.21]), and Hispanic (264.4 versus 235.9; RR, 1.12 [95% CI, 1.08-1.16]) populations. For both heart disease and cerebrovascular disease deaths, Black, Asian, and Hispanic populations experienced a larger relative increase in deaths than the non-Hispanic White population (interaction term, P<0.001). CONCLUSIONS During the COVID-19 pandemic in the United States, Black, Hispanic, and Asian populations experienced a disproportionate rise in deaths caused by heart disease and cerebrovascular disease, suggesting that these groups have been most impacted by the indirect effects of the pandemic. Public health and policy strategies are needed to mitigate the short- and long-term adverse effects of the pandemic on the cardiovascular health of diverse populations.
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Affiliation(s)
- Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA (R.K.W., M.L., W.T., D.S.K., Y.S., R.W.Y.)
| | - Jose F Figueroa
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (J.F.F.)
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine, Stanford University, CA (F.R.)
| | - Michael Liu
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA (R.K.W., M.L., W.T., D.S.K., Y.S., R.W.Y.).,Harvard Medical School, Boston, MA (M.L.)
| | - Wei Tian
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA (R.K.W., M.L., W.T., D.S.K., Y.S., R.W.Y.)
| | - Dhruv S Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA (R.K.W., M.L., W.T., D.S.K., Y.S., R.W.Y.)
| | - Yang Song
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA (R.K.W., M.L., W.T., D.S.K., Y.S., R.W.Y.)
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA (R.K.W., M.L., W.T., D.S.K., Y.S., R.W.Y.)
| | - Karen E Joynt Maddox
- Cardiovascular Division, Washington University School of Medicine, Saint Louis, MO (K.E.J.M.)
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Abstract
The Covid-19 pandemic has greatly impacted frontline workers' health in 2020. The objective of this commentary is to evaluate some of the challenges faced by undocumented farmworkers in the context of the current global pandemic and possible risk mitigation strategies. Undocumented farmworkers make considerable contributions to the U.S. economy and food production, but they are at an elevated risk for contracting Covid-19. Their risk is compounded by their employment and legal status, as well as their poor working and living conditions which makes it difficult for them to observe Covid-19 precautionary measures. U.S. immigration policy disincentivizes undocumented farmworkers from seeking healthcare services. Contact tracing challenges could be overcome by gaining trust with subsequent increased testing and care. Extending eligibility of safety net programs for undocumented farmworkers will help to ease the burden of Covid-19, thereby improving their overall health and productivity.
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Affiliation(s)
- Olayemi O Matthew
- Florida A&M University, Institute of Public Health, Tallahassee, FL, USA
| | - Paul F Monaghan
- University of Florida Institute of Food and Agricultural Sciences, Gainesville, FL, USA
| | - John S Luque
- Florida A&M University, Institute of Public Health, Tallahassee, FL, USA
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83
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Liu M, Neri Mini F, Torres C, Kwete GM, Boudreau AA, Hunter ML, Parra MY, Lopez W, Izen A, Price SN, Perkins ME, Taveras EM. Fostering Resilience in Pregnancy and Early Childhood During the COVID-19 Pandemic: The HUGS/Abrazos Program Design and Implementation. Front Public Health 2021; 9:633285. [PMID: 33996717 PMCID: PMC8113397 DOI: 10.3389/fpubh.2021.633285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/26/2021] [Indexed: 11/13/2022] Open
Abstract
Pregnancy and early childhood pose unique sensitivity to stressors such as economic instability, poor mental health, and social inequities all of which have been magnified by the COVID-19 pandemic. In absence of protective buffers, prolonged exposure to excessive, early adversity can lead to poor health outcomes with significant impact lasting beyond the childhood years. Helping Us Grow Stronger (HUGS/Abrazos) is a community-based program, designed and launched at the time of the COVID-19 surge in the Spring of 2020, that combines emergency relief, patient navigation, and direct behavioral health support to foster family resilience and mitigate the negative impacts of COVID-related toxic stress on pregnant women and families with children under age 6. Through a targeted referral process, community health workers provide resource navigation for social needs, and a social worker provides behavioral health support. The use of innovative tools such as a centralized resource repository, community health workers with specialized knowledge in this age range, and a direct referral system seeks to assist in streamlining communication and ensuring delivery of quality care. We aim to serve over 300 families within the 1st year. The HUGS/Abrazos program aims to fill an important void by providing the necessary tools and interventions to support pregnant women and young families impacted by adversity exacerbated by the COVID-19 pandemic.
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Affiliation(s)
- Meisui Liu
- Division of General Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Fernanda Neri Mini
- Division of General Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Carlos Torres
- Division of General Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States.,MGH Chelsea HealthCare Center, Chelsea, MA, United States
| | - Gracia M Kwete
- Division of General Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States.,MGH Revere HealthCare Center, Revere, MA, United States
| | - Alexy Arauz Boudreau
- Division of General Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States.,MGH Chelsea HealthCare Center, Chelsea, MA, United States
| | | | | | - William Lopez
- Division of General Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Amy Izen
- MGH Chelsea HealthCare Center, Chelsea, MA, United States.,Center for Community Health Improvement, Massachusetts General Hospital, Boston, MA, United States
| | - Sarah N Price
- Division of General Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Meghan E Perkins
- Division of General Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Elsie M Taveras
- Division of General Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States.,Kraft Center for Community Health, Massachusetts General Hospital, Boston, MA, United States.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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84
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Naeim A, Baxter-King R, Wenger N, Stanton AL, Sepucha K, Vavreck L. Effects of Age, Gender, Health Status, and Political Party on COVID-19-Related Concerns and Prevention Behaviors: Results of a Large, Longitudinal Cross-sectional Survey. JMIR Public Health Surveill 2021; 7:e24277. [PMID: 33908887 PMCID: PMC8080961 DOI: 10.2196/24277] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/26/2020] [Accepted: 01/15/2021] [Indexed: 12/23/2022] Open
Abstract
Background With conflicting information about COVID-19, the general public may be uncertain about how to proceed in terms of precautionary behavior and decisions about whether to return to activity. Objective The aim of this study is to determine the factors associated with COVID-19–related concerns, precautionary behaviors, and willingness to return to activity. Methods National survey data were obtained from the Democracy Fund + UCLA Nationscape Project, an ongoing cross-sectional weekly survey. The sample was provided by Lucid, a web-based market research platform. Three outcomes were evaluated: (1) COVID-19–related concerns, (2) precautionary behaviors, and (3) willingness to return to activity. Key independent variables included age, gender, race or ethnicity, education, household income, political party support, religion, news consumption, number of medication prescriptions, perceived COVID-19 status, and timing of peak COVID-19 infections by state. Results The data included 125,508 responses from web-based surveys conducted over 20 consecutive weeks during the COVID-19 pandemic (comprising approximately 6250 adults per week), between March 19 and August 5, 2020, approved by the University of California, Los Angeles (UCLA) Institutional Review Board for analysis. A substantial number of participants were not willing to return to activity even after the restrictions were lifted. Weighted multivariate logistic regressions indicated the following groups had different outcomes (all P<.001): individuals aged ≥65 years (COVID-19–related concerns: OR 2.05, 95% CI 1.93-2.18; precautionary behaviors: OR 2.38, 95% CI 2.02-2.80; return to activity: OR 0.41, 95% CI 0.37-0.46 vs 18-40 years); men (COVID-19–related concerns: OR 0.73, 95% CI 0.70-0.75; precautionary behaviors: OR 0.74, 95% CI 0.67-0.81; return to activity: OR 2.00, 95% CI 1.88-2.12 vs women); taking ≥4 medications (COVID-19–related concerns: OR 1.47, 95% CI 1.40-1.54; precautionary behaviors: OR 1.36, 95% CI 1.20-1.555; return to activity: OR 0.75, 95% CI 0.69-0.81 vs <3 medications); Republicans (COVID-19–related concerns: OR 0.40, 95% CI 0.38-0.42; precautionary behaviors: OR 0.45, 95% CI 0.40-0.50; return to activity: OR 2.22, 95% CI 2.09-2.36 vs Democrats); and adults who reported having COVID-19 (COVID-19–related concerns: OR 1.24, 95% CI 1.12-1.39; precautionary behaviors: OR 0.65, 95% CI 0.52-0.81; return to activity: OR 3.99, 95% CI 3.48-4.58 vs those who did not). Conclusions Participants’ age, party affiliation, and perceived COVID-19 status were strongly associated with their COVID-19–related concerns, precautionary behaviors, and willingness to return to activity. Future studies need to develop and test targeted messaging approaches and consider political partisanship to encourage preventative behaviors and willingness to return to activities.
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Affiliation(s)
- Arash Naeim
- Center for SMART Health, Departments of Medicine and Bioengineering, David Geffen School of Medicine at UCLA and Samueli School of Engineering and Applied Science, Los Angeles, CA, United States
| | - Ryan Baxter-King
- Department of Political Science, College of Letters and Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Neil Wenger
- Division of General Internal Medicine and Health Sciences Research, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA, United States
| | - Annette L Stanton
- Department of Psychology and Psychiatry, College of Letters and Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Karen Sepucha
- Health Decision Sciences Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Lynn Vavreck
- Departments of Political Science and Communication, College of Letters and Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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85
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Hayward SE, Deal A, Cheng C, Crawshaw A, Orcutt M, Vandrevala TF, Norredam M, Carballo M, Ciftci Y, Requena-Méndez A, Greenaway C, Carter J, Knights F, Mehrotra A, Seedat F, Bozorgmehr K, Veizis A, Campos-Matos I, Wurie F, McKee M, Kumar B, Hargreaves S. Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: A systematic review. J Migr Health 2021; 3:100041. [PMID: 33903857 PMCID: PMC8061095 DOI: 10.1016/j.jmh.2021.100041] [Citation(s) in RCA: 145] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Migrants in high-income countries may be at increased risk of COVID-19 due to their health and social circumstances, yet the extent to which they are affected and their predisposing risk factors are not clearly understood. We did a systematic review to assess clinical outcomes of COVID-19 in migrant populations, indirect health and social impacts, and to determine key risk factors. METHODS We did a systematic review following PRISMA guidelines (PROSPERO CRD42020222135). We searched multiple databases to 18/11/2020 for peer-reviewed and grey literature on migrants (foreign-born) and COVID-19 in 82 high-income countries. We used our international networks to source national datasets and grey literature. Data were extracted on primary outcomes (cases, hospitalisations, deaths) and we evaluated secondary outcomes on indirect health and social impacts and risk factors using narrative synthesis. RESULTS 3016 data sources were screened with 158 from 15 countries included in the analysis (35 data sources for primary outcomes: cases [21], hospitalisations [4]; deaths [15]; 123 for secondary outcomes). We found that migrants are at increased risk of infection and are disproportionately represented among COVID-19 cases. Available datasets suggest a similarly disproportionate representation of migrants in reported COVID-19 deaths, as well as increased all-cause mortality in migrants in some countries in 2020. Undocumented migrants, migrant health and care workers, and migrants housed in camps have been especially affected. Migrants experience risk factors including high-risk occupations, overcrowded accommodation, and barriers to healthcare including inadequate information, language barriers, and reduced entitlement. CONCLUSIONS Migrants in high-income countries are at high risk of exposure to, and infection with, COVID-19. These data are of immediate relevance to national public health and policy responses to the pandemic. Robust data on testing uptake and clinical outcomes in migrants, and barriers and facilitators to COVID-19 vaccination, are urgently needed, alongside strengthening engagement with diverse migrant groups.
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Affiliation(s)
- Sally E Hayward
- Institute for Infection and Immunity, St George's University of London, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Anna Deal
- Institute for Infection and Immunity, St George's University of London, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Cherie Cheng
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Alison Crawshaw
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Miriam Orcutt
- Institute for Global Health, University College London, London, UK
| | | | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen; Department of Infectious Diseases at Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark
| | - Manuel Carballo
- International Centre for Migration, Health, and Development, Geneva, Switzerland
| | | | - Ana Requena-Méndez
- Department of Medicine, Karolinska Insitutet, Solna, Sweden; and Barcelona Insitute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain
| | | | - Jessica Carter
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Felicity Knights
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Anushka Mehrotra
- Institute for Infection and Immunity, St George's University of London, London, UK
| | | | - Kayvan Bozorgmehr
- Department of Population Medicine and Health and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany; Section for Health Equity Studies & Migration, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Ines Campos-Matos
- Public Health England; and UCL Collaborative Centre for Inclusion Health, London, UK
| | - Fatima Wurie
- Public Health England; and UCL Research Department of Epidemiology and Public Health, London, UK
| | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Sally Hargreaves
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - on behalf of the ESCMID Study Group for Infections in Travellers and Migrants (ESGITM)
- Institute for Infection and Immunity, St George's University of London, London, UK
- Institute for Global Health, University College London, London, UK
- Faculty of Business and Social Sciences, Kingston University, London, UK
- Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen; Department of Infectious Diseases at Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark
- International Centre for Migration, Health, and Development, Geneva, Switzerland
- Doctors of the World UK, London, UK
- Department of Medicine, Karolinska Insitutet, Solna, Sweden; and Barcelona Insitute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain
- Department of Medicine, McGill University, Montreal, Canada
- Department of Population Medicine and Health and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany; Section for Health Equity Studies & Migration, Heidelberg University Hospital, Heidelberg, Germany
- Medecins Sans Frontieres Greece, Athens, Greece
- Public Health England, London, UK
- Public Health England; and UCL Collaborative Centre for Inclusion Health, London, UK
- Public Health England; and UCL Research Department of Epidemiology and Public Health, London, UK
- Norwegian Institute of Public Health, Oslo, Norway
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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86
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Menculini G, Bernardini F, Attademo L, Balducci PM, Sciarma T, Moretti P, Tortorella A. The Influence of the Urban Environment on Mental Health during the COVID-19 Pandemic: Focus on Air Pollution and Migration-A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3920. [PMID: 33917942 PMCID: PMC8068323 DOI: 10.3390/ijerph18083920] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 12/14/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused a crisis worldwide, due to both its public health impact and socio-economic consequences. Mental health was consistently affected by the pandemic, with the emergence of newly diagnosed psychiatric disorders and the exacerbation of pre-existing ones. Urban areas were particularly affected by the virus spread. In this review, we analyze how the urban environment may influence mental health during the COVID-19 pandemic, considering two factors that profoundly characterize urbanization: air pollution and migration. Air pollution serves as a possibly risk factor for higher viral spread and infection severity in the context of urban areas and it has also been demonstrated to play a role in the development of serious mental illnesses and their relapses. The urban environment also represents a complex social context where minorities such as migrants may live in poor hygienic conditions and lack access to adequate mental health care. A global rethinking of the urban environment is thus required to reduce the impact of these factors on mental health. This should include actions aimed at reducing air pollution and combating climate change, promoting at the same time a more inclusive society in a sustainable development perspective.
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Affiliation(s)
- Giulia Menculini
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy; (G.M.); (P.M.B.); (T.S.); (P.M.)
| | - Francesco Bernardini
- CSM 24 ore Area delle Dolomiti Friulane, Department of Mental Health, AsFO Friuli Occidentale, 33170 Pordenone, Italy;
- Planetary Health Lab, Old Medical School, University of Edinburgh, Edinburgh EH8 9AG, UK;
| | - Luigi Attademo
- Planetary Health Lab, Old Medical School, University of Edinburgh, Edinburgh EH8 9AG, UK;
- SPDC Potenza, Department of Mental Health, ASP Basilicata, Italian National Health Service, 85100 Potenza, Italy
| | - Pierfrancesco Maria Balducci
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy; (G.M.); (P.M.B.); (T.S.); (P.M.)
- CSM Terni, Department of Mental Health, 05100 Terni, Italy
| | - Tiziana Sciarma
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy; (G.M.); (P.M.B.); (T.S.); (P.M.)
| | - Patrizia Moretti
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy; (G.M.); (P.M.B.); (T.S.); (P.M.)
| | - Alfonso Tortorella
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy; (G.M.); (P.M.B.); (T.S.); (P.M.)
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87
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Velasco-Huerta F, Ramirez EG, Payén SS, Alvarez A, Ottosen MJ, Hernandez DC. Commentary: Social Determinants of Health and Latinx Families, Risk for COVID-19 Infection. FAMILY & COMMUNITY HEALTH 2021; 44:99-101. [PMID: 33351515 DOI: 10.1097/fch.0000000000000289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Fernanda Velasco-Huerta
- University of Texas Health Science Center at Houston, School of Public Health (Ms Velasco-Huerta); University of Texas Health Science Center at Houston, Cizik School of Nursing (Drs Ramirez, Ottosen, and Hernandez, and Mr Payén); and Ben Taub Hospital, Houston, Texas (Ms Alvarez)
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88
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Chang AY, Cullen MR, Harrington RA, Barry M. The impact of novel coronavirus COVID-19 on noncommunicable disease patients and health systems: a review. J Intern Med 2021; 289:450-462. [PMID: 33020988 PMCID: PMC7675448 DOI: 10.1111/joim.13184] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is an ongoing global pandemic affecting all levels of health systems. This includes the care of patients with noncommunicable diseases (NCDs) who bear a disproportionate burden of both COVID-19 itself and the public health measures enacted to combat it. In this review, we summarize major COVID-19-related considerations for NCD patients and their care providers, focusing on cardiovascular, pulmonary, renal, haematologic, oncologic, traumatic, obstetric/gynaecologic, operative, psychiatric, rheumatologic/immunologic, neurologic, gastrointestinal, ophthalmologic and endocrine disorders. Additionally, we offer a general framework for categorizing the pandemic's disruptions by disease-specific factors, direct health system factors and indirect health system factors. We also provide references to major NCD medical specialty professional society statements and guidelines on COVID-19. COVID-19 and its control policies have already resulted in major disruptions to the screening, treatment and surveillance of NCD patients. In addition, it differentially impacts those with pre-existing NCDs and may lead to de novo NCD sequelae. Likely, there will be long-term effects from this pandemic that will continue to affect practitioners and patients in this field for years to come.
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Affiliation(s)
- Andrew Y Chang
- From the, Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA.,Department of Medicine, Stanford University, Stanford, CA, USA.,Center for Innovation in Global Health, Stanford University, Stanford, CA, USA
| | - Mark R Cullen
- Department of Medicine, Stanford University, Stanford, CA, USA.,Division of Primary Care and Population Health, Stanford University, Stanford, CA, USA
| | | | - Michele Barry
- Department of Medicine, Stanford University, Stanford, CA, USA.,Center for Innovation in Global Health, Stanford University, Stanford, CA, USA
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89
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Lowrey K, Van Hook J. Standing on Their Own Two Feet: How the New Public Charge Rules Could Impact Non-European LPR Applicants. POPULATION RESEARCH AND POLICY REVIEW 2021; 41:559-582. [PMID: 33814656 PMCID: PMC8010279 DOI: 10.1007/s11113-021-09648-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 03/17/2021] [Indexed: 12/01/2022]
Abstract
In February 2020, the U.S. government began to implement a new Public Charge rule that greatly expands the definition of “public charge” when determining admissibility for legal permanent residency (LPR). The rule seeks to determine not only whether applicants used public benefits in the past, but also whether they are likely to use them in the future. However, predicting future use based on characteristics measured at the time of application, such as English language proficiency and income, is difficult. We evaluate the risk of being deemed inadmissible as well as the likelihood of using public assistance by regional group. Using a sample of recently arrived LPRs in the 2013–2017 American Community Survey, we find that Mexicans/Central Americans face disproportionate risk of being deemed a public charge despite their relatively low public assistance use. This increased risk would likely alter the composition of newly admitted LPRs with relatively fewer Mexican/Central American LPRs.
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Affiliation(s)
- Kendal Lowrey
- The Pennsylvania State University, University Park, PA 16802 USA
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90
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The Impact of the COVID-19 Pandemic on the Brazilian Immigrant Community in the U.S: Results from a Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073355. [PMID: 33805055 PMCID: PMC8037703 DOI: 10.3390/ijerph18073355] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 11/26/2022]
Abstract
While an increasing body of data suggests that marginalized groups have been disproportionately impacted by COVID-19, little has been published about the specific impact on Brazilian immigrants in the U.S. We conducted 15 key informant interviews, one of which included two participants (n = 16), with representatives from social service agencies, healthcare, and faith-based organizations serving Brazilian immigrants. Key informants were asked about the community’s experiences with COVID-19 testing and treatment, responses to CDC (Centers for Disease Control) guidelines, perceptions about the virus, and the pandemic’s impact on physical and mental health. Results suggest that COVID-19 has profoundly impacted Brazilian immigrants’ mental and physical health. Key informants perceived that community members faced higher risk of COVID-19 infection due to overcrowded living conditions and over-representation in public-facing and informal (e.g., housecleaning) jobs. They reported barriers to COVID-19-related healthcare services including language, immigration status, and fear of deportation. Brazilian cultural norms surrounding hygiene practices, social distancing, and information distribution have shaped the community’s pandemic response. The Brazilian community has faced extensive social, economic, and health ramifications due to the pandemic. While not unique to this community, pre-existing concerns about social disadvantage suggest a particular vulnerability of this population to the virus.
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91
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Shuaib M, Alam S, Shahnawaz Nasir M, Shabbir Alam M. Immunity credentials using self-sovereign identity for combating COVID-19 pandemic. MATERIALS TODAY. PROCEEDINGS 2021:S2214-7853(21)02115-5. [PMID: 33777707 PMCID: PMC7983450 DOI: 10.1016/j.matpr.2021.03.096] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The refugees and migrants are not recorded generally and deemed invisible by governments without providing them with identity and welfare services. The COVID-19 pandemic has badly impacted the economy, and the poor migrants and refugees have suffered most due to the closure of industries and informal sectors. Lack of legal identity made them more vulnerable and excluded them from getting benefits of even meagre government support and welfare schemes. Self-sovereign identity is a form of distributed digital identity that can provide immutable identity with full user control and interoperability features. Self-sovereign identities also ensure the privacy and security of personal information. SSI model can effectively provide migrants and refugees with an effective legal identity and include them in government welfare schemes and other schemes run by non-governmental agencies. Also, SSI can be used for uniquely identifying the people who have been already vaccinated or tested negative from COVID-19 within a stipulated time. This paper reviews the aspects of SSI application during the pandemic situation like COVID-19.
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Affiliation(s)
- Mohammed Shuaib
- Razak Faculty of Technology and Informatics, University Teknologi Malaysia, Malaysia
- Department of Computer Science, College of CS & IT, Jazan University, Jazan, Saudi Arabia
| | - Shadab Alam
- Department of Computer Science, College of CS & IT, Jazan University, Jazan, Saudi Arabia
| | | | - Mohammad Shabbir Alam
- Department of Computer Science, College of CS & IT, Jazan University, Jazan, Saudi Arabia
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92
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Beyrer C, Adimora AA, Hodder SL, Hopkins E, Millett G, Mon SHH, Sullivan PS, Walensky RP, Pozniak A, Warren M, Richman B, Copeland R, Mayer KH. Call to action: how can the US Ending the HIV Epidemic initiative succeed? Lancet 2021; 397:1151-1156. [PMID: 33617770 PMCID: PMC8522063 DOI: 10.1016/s0140-6736(21)00390-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/04/2020] [Accepted: 09/25/2020] [Indexed: 12/11/2022]
Abstract
With more than 1·2 million people living with HIV in the USA, a complex epidemic across the large and diverse country, and a fragmented health-care system marked by widening health disparities, the US HIV epidemic requires sustained scientific and public health attention. The epidemic has been stubbornly persistent; high incidence densities have been sustained over decades and the epidemic is increasingly concentrated among racial, ethnic, and sexual and gender minority communities. This fact remains true despite extraordinary scientific advances in prevention, treatment, and care-advances that have been led, to a substantial degree, by US-supported science and researchers. In this watershed year of 2021 and in the face of the COVID-19 pandemic, it is clear that the USA will not meet the stated goals of the National HIV/AIDS Strategy, particularly those goals relating to reductions in new infections, decreases in morbidity, and reductions in HIV stigma. The six papers in the Lancet Series on HIV in the USA have each examined the underlying causes of these challenges and laid out paths forward for an invigorated, sustained, and more equitable response to the US HIV epidemic than has been seen to date. The sciences of HIV surveillance, prevention, treatment, and implementation all suggest that the visionary goals of the Ending the HIV Epidemic initiative in the USA might be achievable. However, fundamental barriers and challenges need to be addressed and the research effort sustained if we are to succeed.
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Affiliation(s)
- Chris Beyrer
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Adaora A Adimora
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Sally L Hodder
- Section of Infectious Diseases, School of Medicine, West Virginia University, Morgantown, WV, USA
| | | | - Greg Millett
- Foundation for AIDS Research (amfAR), Washington, DC, USA
| | - Sandra Hsu Hnin Mon
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rochelle P Walensky
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Anton Pozniak
- Department of HIV, Chelsea and Westminster Hospital NHS Trust, London, UK
| | | | | | | | - Kenneth H Mayer
- Beth Israel Deaconess Medical Center, Harvard Medical School, Fenway Health, Boston, MA, USA
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93
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Immigration status as a health care barrier in the USA during COVID-19. J Migr Health 2021; 4:100036. [PMID: 33778797 PMCID: PMC7979269 DOI: 10.1016/j.jmh.2021.100036] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/05/2020] [Accepted: 03/14/2021] [Indexed: 11/22/2022] Open
Abstract
In the context of the United States of America (U.S.), COVID-19 has influenced migrant experiences in a variety of ways, including the government's use of public health orders to prevent migration into the country and the risk of immigrants contracting COVID-19 while in detention centers. However, this paper focuses on barriers that immigrants of diverse statuses living in the U.S.—along with their families—may face in accessing health services during the pandemic, as well as implications of these barriers for COVID-19 prevention and response efforts. We report findings from a scoping review about immigration status as a social determinant of health and discuss ways that immigration status can impede access to health care across levels of the social ecology. We then develop a conceptual outline to explore how changes to federal immigration policies and COVID-19 federal relief efforts implemented in 2020 may have created additional barriers to health care for immigrants and their families. Improving health care access for immigrant populations in the U.S. requires interventions at all levels of the social ecology and across various social determinants of health, both in response to COVID-19 and to strengthen health systems more broadly.
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94
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Wang RY, Rojo MC, Crosby SS, Rajabiun S. Examining the Impact of Restrictive Federal Immigration Policies on Healthcare Access: Perspectives from Immigrant Patients across an Urban Safety-Net Hospital. J Immigr Minor Health 2021; 24:178-187. [PMID: 33710446 PMCID: PMC7952258 DOI: 10.1007/s10903-021-01177-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2021] [Indexed: 11/24/2022]
Abstract
The Trump Administration instituted a series of restrictive policies including the expansion of the public charge ruling, which created barriers to healthcare access for immigrant communities. This study examined immigrants’ knowledge, attitudes, and health-seeking practices as a result of the public charge proposal. Thirty semi-structured interviews were conducted in English or Spanish with foreign-born adults at an urban safety-net hospital in Boston from May 2019 to August 2019. Thematic content analysis identified barriers and facilitators of healthcare access and usage. Approximately half of participants were aware of the public charge proposal. Six participants expressed concern about its implications, but only two discontinued benefits. Barriers to care included fear of deportation, interaction with law enforcement, and competing socioeconomic needs. Facilitators of care included supportive communities, immigrant-friendly environment, and personal beliefs. Hospitals can develop community-centered services for immigrant patients that offset the barriers to healthcare access resulting from adverse federal immigration policies.
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Affiliation(s)
- Rita Y Wang
- School of Medicine, Boston Medical Center, Boston University, 72 E Concord Street, Boston, MA, 02118, USA.
| | - Maria Campos Rojo
- School of Social Work, Center for Innovation in Social Work and Health, Boston University, Boston, MA, USA
| | - Sondra S Crosby
- Schools of Medicine and Public Health, Boston Medical Center, Boston University, Boston, MA, USA
| | - Serena Rajabiun
- School of Social Work, Center for Innovation in Social Work and Health, Boston University, Boston, MA, USA.,Department of Public Health, University of Massachusetts Lowell, Lowell, MA, USA
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95
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Boden M, Zimmerman L, Azevedo KJ, Ruzek JI, Gala S, Abdel Magid HS, Cohen N, Walser R, Mahtani ND, Hoggatt KJ, McLean CP. Addressing the mental health impact of COVID-19 through population health. Clin Psychol Rev 2021; 85:102006. [PMID: 33714167 PMCID: PMC7934657 DOI: 10.1016/j.cpr.2021.102006] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 12/17/2022]
Abstract
The COVID-19 pandemic has and will continue to result in negative mental health outcomes such as depression, anxiety and traumatic stress in people and populations throughout the world. A population mental health perspective informed by clinical psychology, psychiatry and dissemination and implementation science is ideally suited to address the broad, multi-faceted and long-lasting mental health impact of the pandemic. Informed by a systematic review of the burgeoning empirical research on the COVID-19 pandemic and research on prior coronavirus pandemics, we link pandemic risk factors, negative mental health outcomes and appropriate intervention strategies. We describe how social risk factors and pandemic stressors will contribute to negative mental health outcomes, especially among vulnerable populations. We evaluate the scalability of primary, secondary and tertiary interventions according to mental health target, population, modality, intensity and provider type to provide a unified strategy for meeting population mental health needs. Traditional models, in which evidence-based therapies delivered are delivered in-person, by a trained expert, at a specialty care location have proved difficult to scale. The use of non-traditional models, tailoring preventive interventions to populations based on their needs, and ongoing coordinated evaluation of intervention implementation and effectiveness will be critical to refining our efforts to increase reach.
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Affiliation(s)
- Matt Boden
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, United States of America.
| | - Lindsey Zimmerman
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Care Healthcare System, United States of America; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States of America; Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Kathryn J Azevedo
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Care Healthcare System, United States of America
| | - Josef I Ruzek
- Center for m2 Health, Palo Alto University, Palo Alto, CA, United States of America; Department of Psychology, University of Colorado, Colorado Springs, United States of America
| | - Sasha Gala
- Mission Rock Enterprise, LLC, United States of America
| | - Hoda S Abdel Magid
- Department of Epidemiology and Population Health, Stanford University, United States of America
| | - Nichole Cohen
- Department of Psychology, University of Kansas, United States of America
| | - Robyn Walser
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Care Healthcare System, United States of America; University of California, Berkeley, United States of America
| | - Naina D Mahtani
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, United States of America; School of Behavioral Health, Loma Linda University, United States of America
| | - Katherine J Hoggatt
- San Francisco VA Health Care System, United States of America; Department of Medicine, University of California, San Francisco, United States of America
| | - Carmen P McLean
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Care Healthcare System, United States of America; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States of America
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96
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Cervantes L, Martin M, Frank MG, Farfan JF, Kearns M, Rubio LA, Tong A, Matus Gonzalez A, Camacho C, Collings A, Mundo W, Powe NR, Fernandez A. Experiences of Latinx Individuals Hospitalized for COVID-19: A Qualitative Study. JAMA Netw Open 2021; 4:e210684. [PMID: 33704475 PMCID: PMC7953277 DOI: 10.1001/jamanetworkopen.2021.0684] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
IMPORTANCE Latinx individuals, particularly immigrants, are at higher risk than non-Latinx White individuals of contracting and dying from coronavirus disease 2019 (COVID-19). Little is known about Latinx experiences with COVID-19 infection and treatment. OBJECTIVE To describe the experiences of Latinx individuals who were hospitalized with and survived COVID-19. DESIGN, SETTING, AND PARTICIPANTS The qualitative study used semistructured phone interviews of 60 Latinx adults who survived a COVID-19 hospitalization in public hospitals in San Francisco, California, and Denver, Colorado, from March 2020 to July 2020. Transcripts were analyzed using qualitative thematic analysis. Data analysis was conducted from May 2020 to September 2020. MAIN OUTCOMES AND MEASURES Themes and subthemes that reflected patient experiences. RESULTS Sixty people (24 women and 36 men; mean [SD] age, 48 [12] years) participated. All lived in low-income areas, 47 participants (78%) had more than 4 people in the home, and most (44 participants [73%]) were essential workers. Four participants (9%) could work from home, 12 (20%) had paid sick leave, and 21 (35%) lost their job because of COVID-19. We identified 5 themes (and subthemes) with public health and clinical care implications: COVID-19 was a distant and secondary threat (invincibility, misinformation and disbelief, ingrained social norms); COVID-19 was a compounder of disadvantage (fear of unemployment and eviction, lack of safeguards for undocumented immigrants, inability to protect self from COVID-19, and high-density housing); reluctance to seek medical care (worry about health care costs, concerned about ability to access care if uninsured or undocumented, undocumented immigrants fear deportation); health care system interactions (social isolation and change in hospital procedures, appreciation for clinicians and language access, and discharge with insufficient resources or clinical information); and faith and community resiliency (spirituality, Latinx COVID-19 advocates). CONCLUSIONS AND RELEVANCE In interviews, Latinx patients with COVID-19 who survived hospitalization described initial disease misinformation and economic and immigration fears as having driven exposure and delays in presentation. To confront COVID-19 as a compounder of social disadvantage, public health authorities should mitigate COVID-19-related misinformation, immigration fears, and challenges to health care access, as well as create policies that provide work protection and address economic disadvantages.
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Affiliation(s)
- Lilia Cervantes
- Division of Medicine, Denver Health, Denver, Colorado
- Office of Research, Denver Health, Denver, Colorado
- Department of Medicine, University of Colorado, Aurora
| | - Marlene Martin
- Zuckerberg San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco
| | - Maria G. Frank
- Division of Medicine, Denver Health, Denver, Colorado
- Department of Medicine, University of Colorado, Aurora
| | | | - Mark Kearns
- Division of Medicine, Denver Health, Denver, Colorado
- Department of Medicine, University of Colorado, Aurora
| | - Luis A. Rubio
- Zuckerberg San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Andrea Matus Gonzalez
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | | | | | - William Mundo
- Department of Medicine, University of Colorado, Aurora
| | - Neil R. Powe
- Zuckerberg San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco
| | - Alicia Fernandez
- Zuckerberg San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco
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97
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Crookes DM, Stanhope KK, Kim YJ, Lummus E, Suglia SF. Federal, State, and Local Immigrant-Related Policies and Child Health Outcomes: a Systematic Review. J Racial Ethn Health Disparities 2021; 9:478-488. [PMID: 33559110 PMCID: PMC7870024 DOI: 10.1007/s40615-021-00978-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 11/30/2022]
Abstract
The passage of US immigrant-related policies at the federal, state, and local level is on the rise. These policies may affect child health through several mechanisms. We performed a systematic review of English-language, peer-reviewed, quantitative studies examining US immigrant-related policies and the mental and physical health of youth in immigrant families. We searched PubMed and five social science databases for studies published between 1986 and 2019. Two independent reviewers screened the studies and appraised study quality. Of the final 17 studies, ten studies examined birth outcomes and seven studies examined other outcomes in childhood and adolescence (e.g., self-rated health). Generally, exclusionary policies were associated with worse health outcomes and inclusive policies were associated with better health outcomes. Several studies did not observe an association, but only one study found an association of the opposite direction. In that study, similar trends in different policy environments and across foreign-born and US-born women suggest alternative causes for the observed association. Overall, we find that exclusionary policies are, at best, neutral, but likely harmful towards child wellbeing, while inclusive policies can be beneficial.
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Affiliation(s)
- Danielle M Crookes
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, USA.
| | - Kaitlyn K Stanhope
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, GA, USA
| | - Ye Ji Kim
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, USA
| | - Elizabeth Lummus
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Shakira F Suglia
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, USA
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98
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Quandt SA, LaMonto NJ, Mora DC, Talton JW, Laurienti PJ, Arcury TA. COVID-19 Pandemic Among Immigrant Latinx Farmworker and Non-farmworker Families: A Rural-Urban Comparison of Economic, Educational, Healthcare, and Immigration Concerns. New Solut 2021; 31:30-47. [PMID: 33557699 DOI: 10.1177/1048291121992468] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
COVID-19 has revealed social and health inequities in the United States. Structural inequalities have increased the likelihood of immigrants contracting COVID-19, by being essential workers and through poverty that forces this population to continue working. Rural and urban immigrant families may face different concerns. Using a telephone survey in May 2020 of 105 Latinx families in an existing study, quantitative and qualitative data were gathered on work and household economics, childcare and education, healthcare, and community climate. Analyses show that, although rural and urban groups experienced substantial economic effects, impacts were more acute for urban families. Rural workers reported fewer workplace protective measures for COVID-19. For both groups, fear and worry, particularly about finances and children, dominated reports of their situations with numerous reports of experiencing stress and anxiety. The experience of the pandemic is interpreted as an example of contextual vulnerability of a population already experiencing structural violence through social injustice. Policy implications are highlighted.
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Affiliation(s)
- Sara A Quandt
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Dana C Mora
- Wake Forest School of Medicine, Winston-Salem, NC, USA
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99
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Bruckner TA, Parker DM, Bartell SM, Vieira VM, Khan S, Noymer A, Drum E, Albala B, Zahn M, Boden-Albala B. Estimated seroprevalence of SARS-CoV-2 antibodies among adults in Orange County, California. Sci Rep 2021; 11:3081. [PMID: 33542329 PMCID: PMC7862219 DOI: 10.1038/s41598-021-82662-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/21/2021] [Indexed: 12/18/2022] Open
Abstract
Clinic-based estimates of SARS-CoV-2 may considerably underestimate the total number of infections. Access to testing in the US has been heterogeneous and symptoms vary widely in infected persons. Public health surveillance efforts and metrics are therefore hampered by underreporting. We set out to provide a minimally biased estimate of SARS-CoV-2 seroprevalence among adults for a large and diverse county (Orange County, CA, population 3.2 million). We implemented a surveillance study that minimizes response bias by recruiting adults to answer a survey without knowledge of later being offered SARS-CoV-2 test. Several methodologies were used to retrieve a population-representative sample. Participants (n = 2979) visited one of 11 drive-thru test sites from July 10th to August 16th, 2020 (or received an in-home visit) to provide a finger pin-prick sample. We applied a robust SARS-CoV-2 Antigen Microarray technology, which has superior measurement validity relative to FDA-approved tests. Participants include a broad age, gender, racial/ethnic, and income representation. Adjusted seroprevalence of SARS-CoV-2 infection was 11.5% (95% CI: 10.5-12.4%). Formal bias analyses produced similar results. Prevalence was elevated among Hispanics (vs. other non-Hispanic: prevalence ratio [PR] = 1.47, 95% CI 1.22-1.78) and household income < $50,000 (vs. > $100,000: PR = 1.42, 95% CI: 1.14 to 1.79). Results from a diverse population using a highly specific and sensitive microarray indicate a SARS-CoV-2 seroprevalence of ~ 12 percent. This population-based seroprevalence is seven-fold greater than that using official County statistics. In this region, SARS-CoV-2 also disproportionately affects Hispanic and low-income adults.
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Affiliation(s)
- Tim A Bruckner
- Program in Public Health, University of California, Irvine, 653 E. Peltason Dr, Irvine, CA, 92697, USA.
| | - Daniel M Parker
- Program in Public Health, University of California, Irvine, 653 E. Peltason Dr, Irvine, CA, 92697, USA
| | - Scott M Bartell
- Program in Public Health, University of California, Irvine, 653 E. Peltason Dr, Irvine, CA, 92697, USA
- Department of Statistics, University of California, Irvine, Bren Hall 2019, Irvine, CA, 92697-1250, USA
| | - Veronica M Vieira
- Program in Public Health, University of California, Irvine, 653 E. Peltason Dr, Irvine, CA, 92697, USA
| | - Saahir Khan
- School of Medicine, University of California, Irvine, 1001 Health Sciences Rd, Irvine, CA, 92697, USA
| | - Andrew Noymer
- Program in Public Health, University of California, Irvine, 653 E. Peltason Dr, Irvine, CA, 92697, USA
| | - Emily Drum
- Program in Public Health, University of California, Irvine, 653 E. Peltason Dr, Irvine, CA, 92697, USA
| | - Bruce Albala
- Center for Clinical Research, School of Medicine, University of California, Irvine, 1001 Health Sciences Rd, Irvine, CA, 92617, USA
| | - Matthew Zahn
- Orange County Health Care Agency, 405 W. 5th St., Santa Ana, CA, 92701, USA
| | - Bernadette Boden-Albala
- Program in Public Health, University of California, Irvine, 653 E. Peltason Dr, Irvine, CA, 92697, USA.
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100
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Dawson-Hahn EE, Pidaparti V, Hahn W, Stauffer W. Global mobility, travel and migration health: clinical and public health implications for children and families. Paediatr Int Child Health 2021; 41:3-11. [PMID: 33769218 DOI: 10.1080/20469047.2021.1876821] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Exponential growth of the world's population combined with increased travel has dramatically increased the spread of infectious diseases. Although there has been significant focus on migration, the major contributors to the transmission of communicable diseases are travel and tourism not migration. Given that children represent up to 10% of international travellers, it is critical to the health of all age groups to ensure that tailored guidance for children is considered in public health policy and guidelines, and pandemic responses. To further support pandemic preparedness, public health systems need to strengthen ties with communities and health systems. In addition, travel and migration issues need to be included as core competencies in medical education. Ensuring that clinicians who care for children have knowledge of travel and migration health will foster a better health outcome in an increasingly mobile population at risk of emerging infectious diseases.Abbreviations CDC: Centers for Disease Control and Prevention; DGMQ: CDC Division of Global Migration and Quarantine; EID: emerging infectious diseases; EU: European Union; VFR: visiting friends and relatives; IOM: United Nations International Organization for Migration; LPR: lawful permanent resident; US: United States of America; WHO: World Health Organization.
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Affiliation(s)
- Elizabeth E Dawson-Hahn
- Division of General Paediatrics, Department of Pediatrics, University of Washington, Seattle, WA, USA.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Vaidehi Pidaparti
- Division of General Paediatrics, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - William Hahn
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA
| | - William Stauffer
- Division of Infectious Disease, Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis, MN, USA.,Program for Human Migration and Health, Center for Social Responsibility and Global Health, University of Minnesota, Minneapolis, MN, USA
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