The impact of the COVID-19 pandemic on marginalized populations in the United States: A research agenda

COVID-19 and the decline in Asian American employment

The unemployment rate has sharply increased as a result of the lockdown associated with the spread of COVID-19. The negative effect of the lockdown is more conspicuous among the less-educated workers than the highly-educated workers. Because Asian Americans are more likely to have a bachelor or higher degree than any other racial group, they are expected to be relatively immune to the drop in employment unless the detrimental impact of the lockdown is severer for Asian Americans. Exploiting the panel aspect of the Current Population Survey - Merged Outgoing Rotation Group, we examine the changes in At-work status before and after the lockdown and between the lockdown and months of the reopening. The empirical results uncover that Asian Americans are more negatively affected by the lockdown than any other racial group, net of education, immigration status, and other covariates. Surprisingly, the negative impact of the lockdown is entirely concentrated on less-educated Asian Americans. Regardless of gender, less-educated Asian Americans are substantially more likely to lose employment than equally educated Whites and are not more likely to regain employment during the reopening months. Other less-educated racial minorities do not experience more reduction in At-work status than Whites, net of covariates. Highly-educated Asian Americans' employment is equally affected by the lockdown with equally educated Whites.

A tool to measure work adjustment in the post-pandemic economy: The Illinois work adjustment scale

OBJECTIVE: This article introduces the Illinois Work Adjustment Scale (IWAS) and sets out to confirm the internal validity of the IWAS as well as determine if there are meaningful dimensions among the items of the IWAS that can be further defined as instrument subscales. METHODS: In order to meet these objectives, a survey of 738 individuals, all of whom self-reported as having disabilities, was conducted online. RESULTS: As a result of this survey and exploratory and confirmatory factor analyses, the IWAS was reduced from a 26-question scale to an 18-question scale consisting of two meaningful subscales, Work Context and Work Capacity. Significant and meaningful correlations between the two subscales indicate that Work Context and Work Capacity are related to the broader concept of work adjustment and assess unique aspects of work. CONCLUSION: The IWAS has the potential to be applied to facilitate positive career development and vocational rehabilitation outcomes for people with disabilities and chronic health conditions. This is of greater importance now as the COVID-19 crisis has significantly impacted the economy and workforce, leaving those with the greatest barriers to employment such as individuals with disabilities and chronic health conditions further marginalized and disconnected from work.

Building Health Services in a Rapidly Changing Landscape: Lessons in Adaptive Leadership and Pivots in a COVID-19 Remote Monitoring Program

Adaptive leadership has become an essential skill for leaders in health systems to respond to the COVID-19 pandemic as new knowledge emerges and case counts rise, fall, and rise again. This leadership approach has been described as an iterative process of taking a wide view of the situation, interpreting the meaning of incoming data from multiple directions, and taking real-time action. This process is also common in start-ups, which attempt to create new products or services of uncertain value for consumer markets that may not yet exist. Start-ups manage uncertainty through "pivots," which can include changes in the target group, need, features, or intended benefit of a product or service. Pivots are large changes that account for the high likelihood of getting something wrong during development, and they are distinct from the "tweaks" or small tests of change that define quality improvement methodology. This case study describes three pivots in the launch of a remote monitoring program for COVID-19. Adaptive leadership helped inform strategic decisions, with pivots providing a framework for internal and external stakeholders to articulate options for changes to address shifting needs. There is considerable uncertainty in the appropriate design and implementation of health services, and although this case example focuses on the use of adaptive leadership and pivots during a pandemic, these strategies are relevant for health care leaders at any time.

The influence of demographics and personality on COVID-19 coping in young adults

The global COVID-19 pandemic has had an unprecedented effect on human behavior and well-being. Demographic factors and personality traits have been shown to independently influence whether individuals adopt adaptive or maladaptive coping responses. However, to date, researchers have not considered how demographics and personality could interact to influence COVID-19 coping responses. In a sample of 516 North American young adults, we found direct links from two demographic factors (i.e., income and having children) and from multiple personality traits (as captured by the HEXACO model) to adaptive and maladaptive COVID-19 coping responses. We also found that personality indirectly linked a broader range of demographic factors (income, age, gender, having children) with COVID-19 coping responses. We encourage future research on COVID-19 coping responses to consider not just the individual contributions of demographics and personality, but their interdependent influence on whether individuals adopt more or less adaptive COVID-19 pandemic coping responses.

Confronting COVID-19 in under-resourced, African American neighborhoods: a qualitative study examining community member and stakeholders' perceptions

OBJECTIVE

The purpose of this study was to examine perceptions of COVID-19 related to prevention, coping, and testing of African American residents in under-resourced communities in Alabama.

DESIGN

Guided by the PRECEDE-PROCEED model, virtual focus groups were conducted in five urban and rural Alabama communities using secure Zoom meetings. Community residents and stakeholders (N = 36 total) participated; meetings were audio- and video-recorded, transcribed, and analyzed according to Thematic Analysis. Themes were organized by the PRECEDE portion of the model in Predisposing, Reinforcing, and Enabling barriers and facilitators in three focus areas: prevention, coping, and testing.

RESULTS

Prevention barriers included apathy, difficulty with social distancing, lack of information, mixed messages from authority figures, and lack of personal protective equipment (PPE). Prevention facilitators included concerns about contracting COVID-19, clear and consistent messages from trusted sources, contact tracing, and the provision of PPE. Coping barriers included food insecurity, mental health issues, isolation, economic hardships, lack of health care access, and issues with virtual schooling and church services, which were exacerbated by the inability to connect to the internet. Facilitators to coping included religious faith, increased physical activity, and a sense of hope. Testing barriers included misunderstanding, fear, mistrust, testing restrictions, and location of testing sites. Facilitators to testing included incentives, clear information from trusted sources, convenient testing locations, and free tests.

CONCLUSION

Gaining community members' perspectives can identify barriers and facilitators to prevention, coping, and testing and potentially improve outcomes. While addressing the social determinants of health (e.g. income, education, medical trust) would be an effective path by which to diminish health disparities related to COVID-19, there is an urgent need to mitigate the spread and severity of COVID-19 in vulnerable populations. Interventions should focus on downstream determinants, such as those emerging from our study.

Looking for "us": power reimagined in mathematics learning for Black communities in the pandemic

In this reflective essay, a BlackCrit lens is used to explore new and evolving possibilities for Black teachers, families, leaders, and students in ways that highlight and honor parents' agency, expand notions of digital equity in mathematics, and preview new and re-prioritized approaches which aid liberatory mathematics, teaching, and learning spaces that resurfaced in the pandemic. Several actions reimagine the work of mathematics as building blocks for engaging the flourishing for Black communities: (1) expanding and amplifying direct networks for Black parents to share, communicate, and advocate for their own needs and spaces around mathematics; (2) making visible and amplifying our advocacy for racial justice in the content creation and representation found in current digital platforms for meeting the needs of Black communities; and the need to (3) invest in, prioritize usage of, and illuminate mathematics commercial and academic entities focused solely on creating content and centering Black (and other people's) knowledge and experiences in mathematics for Black families.

An introduction to the special section on the Capability Approach to career guidance

This editorial introduces readers to the Capability Approach to career guidance. It outlines the origins of the approach in the work of economist Amartya Sen, and explains some of its key concepts. The Capability Approach offers a way to think about freedom, justice and well-being that has great relevance to the concerns of career guidance. A brief summary is provided of scholarship adapting the Capability Approach for application to career research, policy and practice. Finally, the four papers in the special section (Egdell & Robertson; Joncas & Pilote; Skovhus; Fuertes et al.) are introduced.

An introduction to the special section on the Capability Approach to career guidance

This editorial introduces readers to the Capability Approach to career guidance. It outlines the origins of the approach in the work of economist Amartya Sen, and explains some of its key concepts. The Capability Approach offers a way to think about freedom, justice and well-being that has great relevance to the concerns of career guidance. A brief summary is provided of scholarship adapting the Capability Approach for application to career research, policy and practice. Finally, the four papers in the special section (Egdell & Robertson; Joncas & Pilote; Skovhus; Fuertes et al.) are introduced.

Staying Home, Distancing, and Face Masks: COVID-19 Prevention among U.S. Women in The COPE Study

The novel coronavirus (COVID-19) pandemic has significantly impacted United States residents. Prevention behaviors are critical to minimizing transmission of SARS-CoV-2 in the U.S., to ultimately reduce the health, social, and economic burdens of COVID-19. Yet, health behavior decision-making is complex, and uptake of preventative behaviors has been variable. Women may provide pro-prevention behavior modeling to their networks, facilitating uptake diffusion. The COPE Study enrolled 491 women residing in the United States from May to June of 2020; women completed an online survey of COVID-19 experiences and prevention behaviors. We employed binary logistic modeling to identify factors predicting women's practice of (1) staying home except for essential activities, (2) physical distancing in public, and (3) wearing a face mask in public. Findings demonstrate that women's prevention behaviors are influenced by multilevel factors. Women living in urban environments, having minimal formal education, or having a household annual income of USD 30,000-50,000 are less likely to practice prevention behaviors. Cultural context may be an important factor in the decision-making process. Results aid in the identification what interventional "levers" may warrant consideration to promote uptake of such behaviors, and whom to engage. Because women are modelers of behavior, it is critical to engage them in prevention behavior interventions.

Risk and Resilience Factors During the COVID-19 Pandemic: A Snapshot of the Experiences of Canadian Workers Early on in the Crisis

Research highlights several risk and resilience factors at multiple ecological levels that influence individuals’ mental health and wellbeing in their everyday lives and, more specifically, in disaster or outbreak situations. However, there is limited research on the role of these factors in the early days of the COVID-19 crisis. The present study examined if and how potential risk factors (i.e., reduction in income, job insecurity, feelings of vulnerability to contracting the virus, lack of confidence in avoiding COVID-19, compliance with preventative policies) and resilience factors (i.e., trait resilience, family functioning, social support, social participation, and trust in healthcare institutions) are associated with mental health and well-being outcomes, and whether these resilience factors buffer (i.e., moderate) the associations between risk factors and said outcomes. One to two weeks after the government recommended preventative measures, 1,122 Canadian workers completed an online questionnaire, including multiple wellbeing outcome scales in addition to measures of potential risk and resilience factors. Structural equation models were tested, highlighting that overall, the considered risk factors were associated with poorer wellbeing outcomes, except social distancing which was associated with lower levels of stress. Each of the potential resilience factors was found to have a main effect on one or more of the wellbeing outcomes. Moderation analysis indicated that in general these resilience factors did not, however, buffer the risk factors. The findings confirm that the COVID-19 crisis encompasses several stressors related to the virus as well as to its impact on one’s social, occupational, and financial situation, which put people at risk for lower wellbeing as early as one to two weeks after the crisis began. While several resilience factors emerged as positively related to wellbeing, such factors may not be enough, or sufficiently activated at that time, to buffer the effects of the numerous life changes required by COVID-19. From an ecological perspective, while mental health professionals and public health decision-makers should offer/design services directly focused on mental health and wellbeing, it is important they go beyond celebrating individuals’ inner potential for resilience, and also support individuals in activating their environmental resources during a pandemic.

Mental Health Outcomes of the COVID-19 Pandemic and a Collapsing Economy: Perspectives from a Developing Country

The COVID-19 pandemic has affected physical and mental health worldwide, particularly vulnerable populations with lower social and economic status. This study explored the independent and combined effects of the COVID-19 and economy-related variables on stress and anxiety among Lebanese adults in a developing country facing a severe socio-economic crisis and political turmoil. A cross-sectional study was conducted online between May 10 and 20, 2020, using the snowball sampling technique. All individuals over 18 were eligible. The final sample included 502 respondents. Higher stress and anxiety were associated with younger age, female gender, previous higher socio-economic status, having a family member with a chronic disease, fear of not getting access to treatment, fear of COVID-19, and physical violence at home. However, financial wellness and higher family satisfaction were significantly associated with lower stress. The multivariate analysis showed a significant interaction between fear of COVID-19 and financial wellness on estimated marginal means of stress and anxiety. The combined presence of fear of the pandemic and financial hardship is associated with higher stress and anxiety, particularly among women and younger Lebanese adults with difficult home circumstances. Thus, healthcare professionals need to screen for mental health problems among subgroups presenting multiple risk factors.

Impact of COVID-19 pandemic on socioeconomic and mental health aspects in Nepal

BACKGROUND

Public health concern is increasing with recent rise in the number of COVID-19 cases in Nepal. To curb this pandemic, Nepal is facing some forms of lockdown, encouraging people to implement social distancing so as to reduce interactions between people which could eventually reduce the possibilities of new infection; however, it has affected the overall physical, mental, social and spiritual health of the people.

METHODS

Published articles related to psychosocial effects due to COVID-19 and other outbreaks were searched and reviewed.

CONCLUSION

While many countries are supporting their citizens with sophisticated health safety-nets and various relief funds, some developing countries have unique challenges with vulnerable populations and limited resources to respond to the pandemic. This review presents the consequences of pandemic and lockdown on socioeconomic, mental health and other aspects in Nepalese society.

Identifying Predictors of Psychological Distress During COVID-19: A Machine Learning Approach

Scientific understanding about the psychological impact of the COVID-19 global pandemic is in its nascent stage. Prior research suggests that demographic factors, such as gender and age, are associated with greater distress during a global health crisis. Less is known about how emotion regulation impacts levels of distress during a pandemic. The present study aimed to identify predictors of psychological distress during the COVID-19 pandemic. Participants (N = 2,787) provided demographics, history of adverse childhood experiences, current coping strategies (use of implicit and explicit emotion regulation), and current psychological distress. The overall prevalence of clinical levels of anxiety, depression, and post-traumatic stress was higher than the prevalence outside a pandemic and was higher than rates reported among healthcare workers and survivors of severe acute respiratory syndrome. Younger participants (<45 years), women, and non-binary individuals reported higher prevalence of symptoms across all measures of distress. A random forest machine learning algorithm was used to identify the strongest predictors of distress. Regression trees were developed to identify individuals at greater risk for anxiety, depression, and post-traumatic stress. Somatization and less reliance on adaptive defense mechanisms were associated with greater distress. These findings highlight the importance of assessing individuals' physical experiences of psychological distress and emotion regulation strategies to help mental health providers tailor assessments and treatment during a global health crisis.

The Disproportionate Burden of the COVID-19 Pandemic Among Pregnant Black Women

The COVID-19 pandemic has disproportionately impacted the well-being of vulnerable populations in the US, including Black people. The impact on pregnant women is of special concern for the intrauterine and post-natal development of their offspring. We evaluated in an online survey a sample of 913 pregnant women, 216 Black, 571 White, 126 Other, during a 2-week stay-at-home mandate in the Philadelphia region. We applied logistic regression models and analysis of covariance to examine general and pregnancy-specific worries and negative consequences arising from the COVID-19 pandemic, symptoms of anxiety and depression, and resilience. Black pregnant women reported greater likelihood of having their employment negatively impacted, more concerns about a lasting economic burden, and more worries about their prenatal care, birth experience, and post-natal needs. In the full sample, 11.1% of women met screening criteria for anxiety and 9.9% met criteria for depression. Black women were more likely to meet criteria for depression than White women, but this difference was not significant accounting for covariates. Resilience factors including self-reliance and emotion regulation were higher in Black women. Racial disparities related to COVID-19 in pregnant women can advance the understanding of pregnancy related stressors and improve early identification of mental health needs.

Mental distress during the COVID-19 pandemic among US adults without a pre-existing mental health condition: Findings from American trend panel survey

Most individuals in the United States have no history of a mental health condition yet are at risk for psychological distress due to the COVID-19 pandemic. The objective of this study was to assess the frequency and risk and protective factors of psychological distress, during the beginning of the COVID-19 pandemic, in this group. Data comes from the Pew Research Center's American Trends Panel (ATP), a probability-based online survey panel representative of the US adult population. The analytic sample consisted of 9687 individuals with no prior history of a mental health condition who completed the survey between March 19-24, 2020. Explanatory variables included sociodemographic factors and items related to behavior, perceptions, and experiences surrounding the pandemic. The outcome was psychological distress, measured by five items on symptoms of anxiety, depression, loneliness, sleep difficulties, and hyperarousal. A multivariable linear regression model was used to identify risk and protective factors for psychological distress. Fifteen percent of the sample experienced 2 psychological distress symptoms for at least 3 days over the past week; 13% had three or more symptoms. Risk factors for higher distress included searching online or using social media to post about coronavirus, reporting that the outbreak caused major changes to personal life, and perception that the virus was a threat to the US economy, the individual's personal health or finances. This has important implications for mental health service delivery.

We Need to Talk About Racism-In All of Its Forms-To Understand COVID-19 Disparities

Purpose: Racism is an essential factor to understand racial health disparities in infection and mortality due to COVID-19 and must be thoroughly integrated into any successful public health response. But highlighting the effect of racism generally does not go far enough toward understanding racial/ethnic health disparities or advocating for change; we must interrogate the various forms of racism in the United States, including behaviors and practices that are not recognized by many as racism.

Methods: In this article, we explore the prevalence and demographic distribution of various forms of racism in the United States and how these diverse racial ideologies are potentially associated with racialized responses to the COVID-19 crisis.

Results: We find that among white Americans, more than a quarter express traditional racist attitudes, whereas more than half endorse more contemporary and implicit forms of racist ideology. Each of these types of racism helps us explain profound disparities related to COVID-19.

Conclusions: Despite a robust literature documenting persistent patterns of racial disparities in the United States, a focus on the role that various forms of racism play in perpetuating these disparities is absent. These distinctions are essential to realizing health equity and countering disparities in COVID-19 and other health outcomes among people of color in the United States.

Transform or Perish: Preparing the Business for a Postpandemic Future

The Coronavirus outbreak presents a significant threat to public health and is profoundly distresses the global economy. There are no sectors left affected by the outbreak on a local, national, and global scale. Some sectors have come to a complete standstill, whereas others have received high demands. All known business models came under question. The crisis served as a check-up, allowing executives to question existing systems, the company, and its management capacities. Nonetheless, crises have enabled businesses to adopt innovative approaches such as new ways of working and the use of modern technology quickly. It will be challenging for businesses to adapt to these innovations that are coming very fast in the postcrisis uncertainty. This article aims to inform managers, decision-makers, and team leaders about the changes they will face in the post-Covid-19 world, based on the example of the agriculture and food sector, and to provide them with a road map.

Discrimination and Well-Being Among Asians/Asian Americans During COVID-19: The Role of Social Media

Since the outbreak of COVID-19, Asians and Asian Americans have been experiencing an uptick of discrimination. With most people experiencing months of lockdowns, social media may become a particularly important tool in Asian people's coping with discrimination. Grounded in the multiactivity framework of social media use, this study explored whether experience with discrimination was associated with more social media use among Asian people and how adaptive social media use was for their well-being during COVID-19. A sample of 242 Asians/Asian Americans residing in the United States (M_age = 32.88, SD = 11.13; 48 percent female) completed an online survey. Results showed that more experience of discrimination during COVID-19 was associated with more engagement in social media private messaging, posting/commenting, and browsing, but the activities yielded different implications for subjective well-being. Both social media private messaging and posting/commenting were associated with more perceived social support, which contributed to better subjective well-being. Social media posting/commenting was also related to better subjective well-being through lower worry about discrimination. In contrast, social media browsing was associated with poorer subjective well-being through more worry about discrimination.

More than Just Soup: Use of a Student-Led COVID-19 Social Pediatrics Initiative to Propose the Integration of Social Medicine Electives in Undergraduate Medical Education

INTRODUCTION

The need to educate medical students on the social forces shaping disease and health patterns is paramount in preparing incoming physicians with the aptitudes to address health inequities. Despite its well-documented merit as a model of practice, social medicine remains underrepresented at the undergraduate medical education level. We hypothesize that the success of this student-led COVID-19 initiative proposes a tangible and innovative solution to address the lack of social medicine exposure in undergraduate medical education.

METHODOLOGY

We sought to evaluate the impact of sustaining clinical learning during the pandemic using the social pediatrics model as a didactic vector for clerkship students. We extracted learning objectives relevant to the teaching of social medicine from the Royal College of Physicians and Surgeons of Canada's CanMEDS framework and developed a survey aimed at evaluating the attainability of each of those objectives. The survey was distributed to students enrolled in the social pediatrics COVID-19 initiative after 6 weeks (April-May), as well as a control group.

RESULTS

Completing the survey were 19 students from the University of Ottawa Faculty of Medicine, 7 in the intervention group and 12 in the control group. Students that participated in the social pediatrics initiative yielded significantly higher values for the achievement of 6 out of 9 social medicine learning objectives when compared to the control group. Although the values followed a similar trend for the remaining 3 objectives, favoring the intervention group, they were not statistically significant.

CONCLUSION

The positive results from this study and the COVID-19 student-led initiative template can serve as a catalyst for curricular change so as to ensure graduates are adequately trained to contend with the realities of the social landscape in which they will practice. Future plans include the incorporation of interactive social medicine experiences throughout all 4 years of medical school.