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Azhar S, Rahman R, Wernick LJ, Tripathi S, Cohen M, Maschi T. Race, masks, residency and concern regarding COVID-19 transmission. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:1716-1735. [PMID: 36256889 PMCID: PMC9874564 DOI: 10.1002/jcop.22953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/16/2022] [Accepted: 09/28/2022] [Indexed: 05/23/2023]
Abstract
To explore sociodemographic predictors for concern regarding COVID-19 transmission and how these factors interact with the identities of others, we conducted a web-based survey where we asked 568 respondents in the United States to indicate their level of COVID-19 concern in response to a series of images with short vignettes of masked and unmasked individuals of different racial/ethnic backgrounds. Using a linear mixed effects model, we found that regardless of the race of the image being presented in the vignette, concern regarding COVID-19 transmission was associated with respondents' older age (b = 0.029, p < 0.001), residing in NYC (b = 0.556, p = 0.009), being heterosexual (b = 1.075, p < 0.001), having higher levels of education, that is, completion of a Bachelor's degree (b = 1.10, p = 0.033) or graduate degree (b = 1.78, p < 0.001), and the person in the vignette being unmasked (b = 0.822, p < 0.001). Asian respondents were more likely than White respondents to be concerned regarding COVID-19. Individuals who self-reported themselves to be at high risk for COVID-19 were more likely to be concerned about COVID-19 over those who considered themselves to be low risk. These findings highlight the importance of acknowledging interactions between race, mask status, and residency in predicting COVID-19 concern.
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Affiliation(s)
- Sameena Azhar
- Graduate School of Social ServiceFordham UniversityNew YorkNew YorkUSA
| | - Rahbel Rahman
- Graduate School of Social ServiceFordham UniversityNew YorkNew YorkUSA
| | - Laura J. Wernick
- Graduate School of Social ServiceFordham UniversityNew YorkNew YorkUSA
| | - Saumya Tripathi
- Graduate School of Social ServiceFordham UniversityNew YorkNew YorkUSA
| | - Margaret Cohen
- Graduate School of Social ServiceFordham UniversityNew YorkNew YorkUSA
| | - Tina Maschi
- Graduate School of Social ServiceFordham UniversityNew YorkNew YorkUSA
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Rahman R, Azhar S, Wernick LJ, Huang D, Maschi T, Rosenblatt C, Patel R. COVID-19 stigma and depression across race, ethnicity and residence. SOCIAL WORK IN HEALTH CARE 2023; 62:121-142. [PMID: 36934345 DOI: 10.1080/00981389.2023.2193263] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 03/02/2023] [Accepted: 03/16/2023] [Indexed: 06/18/2023]
Abstract
Our cross-sectional study seeks to understand how COVID-19 stigma, race/ethnicity [Asian, Black, Hispanic/Latinx, white] and residency [New York City (NYC) resident vs. non-NYC resident] associated with depression. Our sample includes 568 participants: 260 (45.77%) were NYC residents and 308 (54.3%) were non-NYC residents. A series of multiple linear regression were run to examine the relationship between race/ethnicity, COVID-19 stigma, and depressive symptoms. Irrespective of residency, older age and ever being diagnosed with COVID-19 were negatively associated with depressive symptoms. Stigma and thinking less of oneself significantly associates with depressive symptoms across residency. Our study expects to benefit mental health care providers and public health professionals in designing best practices to mitigate stigma in ongoing or future pandemics.
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Affiliation(s)
- Rahbel Rahman
- Graduate School of Social Service, Fordham University, New York, New York, United States
| | - Sameena Azhar
- Graduate School of Social Service, Fordham University, New York, New York, United States
| | - Laura J Wernick
- Graduate School of Social Service, Fordham University, New York, New York, United States
| | - Debbie Huang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Tina Maschi
- Graduate School of Social Service, Fordham University, New York, New York, United States
| | - Cassidy Rosenblatt
- Graduate School of Social Service, Fordham University, New York, New York, United States
| | - Rupal Patel
- Graduate School of Social Service, Fordham University, New York, New York, United States
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Swift MD, Molella RG, Vaughn AIS, Breeher LE, Newcomb RD, Abdellatif S, Murad MH. Determinants of Latent Tuberculosis Treatment Acceptance and Completion in Healthcare Personnel. Clin Infect Dis 2021; 71:284-290. [PMID: 31552416 DOI: 10.1093/cid/ciz817] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/16/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND US public health strategy for eliminating tuberculosis (TB) prioritizes treatment of latent TB infection (LTBI). Healthcare personnel (HCP) are less willing to accept treatment than other populations. Little is known about factors associated with HCP LTBI therapy acceptance and completion. METHODS We conducted a retrospective chart review to identify all employees with LTBI at time of hire at a large academic medical center during a 10-year period. Personal demographics, occupational factors, and clinic visit variables were correlated with LTBI treatment acceptance and completion rates using multivariate logistic regression. RESULTS Of 470 HCP with LTBI for whom treatment was recommended, 193 (41.1%) accepted treatment, while 137 (29.1%) completed treatment. Treatment adherence was better with 4 months of rifampin than 9 months of isoniazid (95% vs 68%, P < .005). Increased age of the healthcare worker was independently associated with lower rates of treatment acceptance (odds ratio [95% confidence interval]: 0.97 [0.94-0.99] per year), as was having an occupation of clinician (0.47 [0.26-0.85]) or researcher (0.34 [0.19-0.64]). Male gender was associated with higher treatment acceptance (1.90 [1.21-2.99]). Treatment completion was associated with being from a low- (9.49 [2.06-43.73]) or medium- (8.51 [3.93-18.44]) TB-burden country. CONCLUSIONS Geographic and occupational factors affect acceptance and completion of LTBI therapy. Short-course regimens may improve adherence. Physicians, researchers, and HCP from high-TB-burden countries have lower treatment rates than other HCP. Improving LTBI treatment in HCP will require attending to cultural and occupational differences.
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Affiliation(s)
| | | | | | | | | | | | - M Hassan Murad
- Department of Medicine, Mayo Clinic, Rochester, Minnesota
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Tuberculosis stigma as a social determinant of health: a systematic mapping review of research in low incidence countries. Int J Infect Dis 2017; 56:90-100. [DOI: 10.1016/j.ijid.2016.10.011] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 10/14/2016] [Indexed: 11/23/2022] Open
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Rodríguez-Lainz A, McDonald M, Penman-Aguilar A, Barrett DH. Getting Data Right - and Righteous to Improve Hispanic or Latino Health. JOURNAL OF HEALTHCARE, SCIENCE AND THE HUMANITIES 2016; 6:60-83. [PMID: 29416934 PMCID: PMC5798620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Hispanics or Latinos constitute the largest racial/ethnic minority in the United States. They are also a very diverse population. Latino/Hispanic's health varies significantly for subgroups defined by national origin, race, primary language, and migration-related factors (place of birth, immigration status, years of residence in the United States). Most Hispanics speak Spanish at home, and one-third have limited English proficiency (LEP). There is growing awareness on the importance for population health monitoring programs to collect those data elements (Hispanic subgroup, primary language, and migration-related factors) that better capture Hispanics' diversity, and to provide language assistance (translation of data collection forms, interpreters) to ensure meaningful inclusion of all Latinos/Hispanics in national health monitoring. There are strong ethical and scientific reasons for such expansion of data collection by public health entities. First, expand data elements can help identify otherwise hidden Hispanic subpopulations' health disparities. This may promote a more just and equitable distribution of health resources to underserved populations. Second, language access is needed to ensure fair and legal treatment of LEP individuals in federally supported data collection activities. Finally, these strategies are likely to improve the quality and representativeness of data needed to monitor and address the health of all Latino/Hispanic populations in the United States.
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Affiliation(s)
| | | | | | - Drue H. Barrett
- Public Health Ethics Unit, Office of Scientific Integrity, Office of the Associate Director for Science, CDC
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Gao J, Berry NS, Taylor D, Venners SA, Cook VJ, Mayhew M. Knowledge and Perceptions of Latent Tuberculosis Infection among Chinese Immigrants in a Canadian Urban Centre. INTERNATIONAL JOURNAL OF FAMILY MEDICINE 2015; 2015:546042. [PMID: 26690263 PMCID: PMC4672143 DOI: 10.1155/2015/546042] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 10/12/2015] [Accepted: 11/03/2015] [Indexed: 05/23/2023]
Abstract
Background. Since most tuberculosis (TB) cases in immigrants to British Columbia (BC), Canada, develop from latent TB infection (LTBI), treating immigrants for LTBI can contribute to the eradication of TB. However, adherence to LTBI treatment is a challenge that is influenced by knowledge and perceptions. This research explores Chinese immigrants' knowledge and perceptions towards LTBI in Greater Vancouver. Methods. This mixed methods study included a cross-sectional patient survey at BC's Provincial TB clinics and two focus group discussions (FGDs) with Chinese immigrants. Data from FGDs were coded and analyzed in Simplified Chinese. Codes, themes, and selected quotes were then translated into English. Results. The survey identified a mean basic knowledge score: 40.0% (95% CI: 38.3%, 41.7%). FGDs confirmed that Chinese immigrants' knowledge of LTBI was low, and they confused it with TB disease to the extent of experiencing LTBI associated stigma. Participants also expressed difficulties navigating the health system which impeded testing and treatment of LTBI. Online videos were the preferred format for receiving health information. Conclusion. We identified striking gaps in knowledge surrounding an LTBI diagnosis. Concerns of stigma may influence acceptance and adherence of LTBI treatment in Chinese immigrants. Integrating these findings into routine health care is recommended.
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Affiliation(s)
- Jie Gao
- Faculty of Health Sciences, Blusson Hall, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada V5A 1S6
- Provincial TB Services, Clinical Prevention Services, BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, Canada V5Z 4R4
| | - Nicole S. Berry
- Faculty of Health Sciences, Blusson Hall, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada V5A 1S6
| | - Darlene Taylor
- BC Women's Health Research Institute, BC Centre for Disease Control, Room H203F, 4500 Oak Street, Vancouver, BC, Canada V6H 3N1
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, Canada V6T 1Z9
| | - Scott A. Venners
- Faculty of Health Sciences, Blusson Hall, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada V5A 1S6
| | - Victoria J. Cook
- Provincial TB Services, Clinical Prevention Services, BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, Canada V5Z 4R4
| | - Maureen Mayhew
- Provincial TB Services, Clinical Prevention Services, BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, Canada V5Z 4R4
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, Canada V6T 1Z9
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Westerlund EE, Tovar MA, Lönnermark E, Montoya R, Evans CA. Tuberculosis-related knowledge is associated with patient outcomes in shantytown residents; results from a cohort study, Peru. J Infect 2015; 71:347-57. [PMID: 26033695 DOI: 10.1016/j.jinf.2015.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/19/2015] [Accepted: 05/26/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Tuberculosis is frequent among poor and marginalized people whose limited tuberculosis-related knowledge may impair healthcare access. We characterised tuberculosis-related knowledge and associations with delayed treatment and treatment outcome. METHODS Tuberculosis patients (n = 943), people being tested for suspected tuberculosis (n = 2020), and randomly selected healthy controls (n = 476) in 16 periurban shantytowns were interviewed characterizing: socio-demographic factors; tuberculosis risk-factors; and patients' treatment delay. Principle component analysis was used to generate a tuberculosis-related knowledge score. Patients were followed-up for median 7.7 years. Factors associated with tuberculosis treatment delay, treatment outcome and tuberculosis recurrence were assessed using linear, logistic and Cox regression. RESULTS Tuberculosis-related knowledge was poor, especially in older people who had not completed schooling and had never been diagnosed with tuberculosis. Tuberculosis treatment delay was median 60 days and was more delayed for patients who were poorer, older, had more severe tuberculosis and in only unadjusted analysis with incomplete schooling and low tuberculosis-related knowledge (all p ≤ 0.03). Lower than median tuberculosis-related knowledge was associated with tuberculosis recurrence (unadjusted hazard ratio = 2.1, p = 0.008), and this association was independent of co-morbidities, disease severity and demographic factors (multiple regression adjusted hazard ratio = 2.6, p = 0.008). CONCLUSIONS Low tuberculosis-related knowledge independently predicted tuberculosis recurrence. Thus health education may improve tuberculosis prognosis.
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Affiliation(s)
- Emma E Westerlund
- IFHAD: Innovation For Health And Development, Laboratory of Research and Development #218, Universidad Peruana Cayetano Heredia, San Martin de Porres, Lima, Peru; Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Marco A Tovar
- IFHAD: Innovation For Health And Development, Laboratory of Research and Development #218, Universidad Peruana Cayetano Heredia, San Martin de Porres, Lima, Peru; Innovacion Por la Salud Y el Desarollo (IPSYD), Asociación Benefica Prisma, Lima, Peru
| | - Elisabet Lönnermark
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Rosario Montoya
- Innovacion Por la Salud Y el Desarollo (IPSYD), Asociación Benefica Prisma, Lima, Peru
| | - Carlton A Evans
- IFHAD: Innovation For Health And Development, Laboratory of Research and Development #218, Universidad Peruana Cayetano Heredia, San Martin de Porres, Lima, Peru; Infectious Diseases & Immunity, Imperial College London, and Wellcome Trust Imperial College Centre for Global Health Research, London, UK.
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Knowledge and Attitudes About Tuberculosis Among U.S.-Born Blacks and Whites with Tuberculosis. J Immigr Minor Health 2014; 17:1487-95. [PMID: 25432148 DOI: 10.1007/s10903-014-0105-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Non-Hispanic blacks represent 13% of the U.S.-born population but account for 37% of tuberculosis (TB) cases reported in U.S.-born persons. Few studies have explored whether this disparity is associated with differences in TB-related knowledge and attitudes. Interviews were conducted with U.S.-born, non-Hispanic blacks and whites diagnosed with TB from August 2009 to December 2010 in cities and states that accounted for 27% of all TB cases diagnosed in these racial groups in the U.S. during that time period. Of 477 participants, 368 (77%) were non-Hispanic black and 109 (23%) were non-Hispanic white. Blacks had significantly less knowledge and more misconceptions about TB transmission and latent TB infection than whites. Most TB patients in both groups recalled being given TB information; having received such information was strongly correlated with TB knowledge. Providing information to U.S.-born TB patients significantly increased their knowledge and understanding of TB. More focused efforts are needed to provide TB information to U.S.-born black TB patients.
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