Pandemic precarity: COVID-19 is exposing and exacerbating inequalities in the American heartland

Tracking the Uneven Outcomes of COVID-19 on Racial and Ethnic Groups: Implications for Health Policy

The socioeconomic shocks of the first COVID-19 pandemic wave disproportionately affected vulnerable groups. But did that trend continue to hold during the Delta and Omicron waves? Leveraging data from the Johns Hopkins Coronavirus Resource Center, this paper examines whether demographic inequalities persisted across the waves of COVID-19 infections. The current study utilizes fixed effects regressions to isolate the marginal relationships between socioeconomic factors with case counts and death counts. Factors include levels of urbanization, age, gender, racial distribution, educational attainment, and household income, along with time- and state-specific COVID-19 restrictions and other time invariant controls captured via fixed effects controls. County-level health outcomes in large metropolitan areas show that despite higher incidence rates in suburban and exurban counties, urban counties still had disproportionately poor outcomes in the latter COVID-19 waves. Policy makers should consider health disparities when developing long-term public health regulatory policies to help shield low-income households from the adverse effects of COVID-19 and future pandemics.

Inequality in high-cost borrowing and unemployment insurance generosity in US states during the COVID-19 pandemic

US consumers may turn to the private market for credit when income and government benefits fall short. The most vulnerable consumers have access only to the highest-cost loans. Prior research on trade-offs of credit with government welfare support cannot distinguish between distinct forms of unsecured credit due to data limitations. Here we provide insight on credit-welfare state trade-offs vis-à-vis unemployment insurance generosity by leveraging a large sample of credit data that allow us to separate credit cards, personal loans and alternative financial services loans and to analyse heterogeneity in credit use by household income. We find that more generous state unemployment insurance benefits were associated with a lower probability of high-cost credit use during the first seven quarters of the coronavirus disease 2019 (COVID-19) pandemic. This inverse association was concentrated among consumers living in low-income households. Our results support theories that public benefits are inversely associated with the use of costly credit.

Rationing, Responsibility, and Vaccination during COVID-19: A Conceptual Map

Throughout the COVID-19 pandemic, shortages of scarce healthcare resources consistently presented significant moral and practical challenges. While the importance of vaccines as a key pharmaceutical intervention to stem pandemic scarcity was widely publicized, a sizable proportion of the population chose not to vaccinate. In response, some have defended the use of vaccination status as a criterion for the allocation of scarce medical resources. In this paper, we critically interpret this burgeoning literature, and describe a framework for thinking about vaccine-sensitive resource allocation using the values of responsibility, reciprocity, and justice. Although our aim here is not to defend a single view of vaccine-sensitive resource allocation, we believe that attending critically with the diversity of arguments in favor (and against) vaccine-sensitivity reveals a number of questions that a vaccine-sensitive approach to allocation should answer in future pandemics.

COVID-19, pandemic lockdowns and intimate partner violence among HIV-positive women in Ghana

This study examines the prevalence and risk factors of physical, sexual, psychological, and economic violence during lockdowns associated with COVID-19 among HIV-positive women in Ghana. Data were collected in August 2021 from a cross-section of 538 HIV-positive women aged 18 years and older in the Lower Manya Krobo District in the Eastern region of Ghana. Logit models were used to explore relationships between women's self-reported experiences of physical, sexual, psychological /emotional, and economic violence under lockdown and key socio-economic and demographic characteristics. The findings indicate moderate to high prevalence of intimate partner violence (IPV) under lockdown in our sample: physical violence (30.1%), sexual violence (28.6%), emotional/psychological violence (53.7%), and economic violence (54.2%). IPV was higher on all four measures for educated women, poorer women, employed women, cohabiting and married women, and HIV seroconcordant couples.

Food insecurity and mental health among US adults during the COVID-19 pandemic: Results from National Health Interview Survey, 2020-2021

OBJECTIVE

To examine socio-demographic disparities in food insecurity during the COVID-19 pandemic and the association between food insecurity and mental health among US adults overall and communities vulnerable to food insecurity.

METHODS

A cross-sectional study was conducted using the 2020-2021 National Health Interview Survey of 57,456 US adults. Weighted multivariable logistic regression models were used to estimate the association between food insecurity and anxiety or depression symptoms in overall US adults and subgroups including young adults (18-34 years), females, Hispanic people, non-Hispanic Black people, individuals with prior COVID-19 infection, the unemployed, low-income participants, participants with children, and Supplemental Nutrition Assistance Program (SNAP) participants.

RESULTS

Young or middle age, female sex, Hispanic/non-Hispanic Black/other race/ethnicity, lower education level, unmarried/other marital status, unemployment, being below the federal poverty level, and greater number of persons in the household were associated with food insecurity (AOR ranged from 1.35 to 2.70, all p < 0.05). Food insecurity was independently associated with anxiety (AOR = 2.67, 99 % CI: 2.33, 3.06) or depression (AOR = 3.04, 99 % CI: 2.60, 3.55) symptoms in the overall adults. Significant associations between food insecurity and anxiety or depression symptoms were also observed in all subgroups (AOR ranged from 1.95 to 3.28, all p < 0.0001). Compared with overall adults, the magnitude of the association was greater for participants with children, females (for depression only), and non-Hispanic Black people (for depression only).

LIMITATIONS

The cross-sectional design prevents inference of causality.

CONCLUSIONS

Comprehensive policies are needed to ensure accessible and affordable food resources to reduce disparities in food insecurity and improve mental health, especially for those socioeconomically disadvantaged communities.

Dignity of Work and at Work: The Relationship between Workplace Dignity and Health among Latino Immigrants during the COVID-19 Pandemic

Latino immigrants living in the United States were highly vulnerable to the health and economic consequences brought on by the COVID-19 pandemic. We use the conceptual framing of workplace dignity, worth that is acknowledged based on performance of job responsibilities, to explore Latino immigrants' experiences during the early months of the pandemic. A qualitative study was conducted with La Clínica del Pueblo (La Clínica), a community health center serving low-income Latino immigrants. From June to December 2020, we conducted in-depth video interviews with 29 Latino immigrant clients to explore pandemic-related challenges, including workplace changes, discriminatory experiences, and effects on health. We conducted thematic analysis using Dedoose software. Nearly half of participants were undocumented immigrants. Most participants were unemployed or underemployed due to the pandemic and 26-49 years of age; one-third were still working, and one-quarter were 50 years or older. About half were cisgender women and two were transgender women. Employed participants experienced a lack of dignity through being socially isolated and stigmatized at work; receiving no compensation for their extra labor or for sick leave; and experiencing discriminatory labor practices. Unemployed participants experienced a lack of dignity in being the first to lose their jobs without government support; losing self-esteem; and not being rehired. Participants associated denial of dignity with worsening health conditions and increased anxiety and depression. Our study suggests that denial of workplace dignity-through job loss, underemployment, and poor working conditions-is linked to adverse health outcomes for Latino immigrants. More research should recognize workplace dignity as an important social determinant of health.

Evaluating site-of-care-related racial disparities in kidney graft failure using a novel federated learning framework

OBJECTIVES

Racial disparities in kidney transplant access and posttransplant outcomes exist between non-Hispanic Black (NHB) and non-Hispanic White (NHW) patients in the United States, with the site of care being a key contributor. Using multi-site data to examine the effect of site of care on racial disparities, the key challenge is the dilemma in sharing patient-level data due to regulations for protecting patients' privacy.

MATERIALS AND METHODS

We developed a federated learning framework, named dGEM-disparity (decentralized algorithm for Generalized linear mixed Effect Model for disparity quantification). Consisting of 2 modules, dGEM-disparity first provides accurately estimated common effects and calibrated hospital-specific effects by requiring only aggregated data from each center and then adopts a counterfactual modeling approach to assess whether the graft failure rates differ if NHB patients had been admitted at transplant centers in the same distribution as NHW patients were admitted.

RESULTS

Utilizing United States Renal Data System data from 39 043 adult patients across 73 transplant centers over 10 years, we found that if NHB patients had followed the distribution of NHW patients in admissions, there would be 38 fewer deaths or graft failures per 10 000 NHB patients (95% CI, 35-40) within 1 year of receiving a kidney transplant on average.

DISCUSSION

The proposed framework facilitates efficient collaborations in clinical research networks. Additionally, the framework, by using counterfactual modeling to calculate the event rate, allows us to investigate contributions to racial disparities that may occur at the level of site of care.

CONCLUSIONS

Our framework is broadly applicable to other decentralized datasets and disparities research related to differential access to care. Ultimately, our proposed framework will advance equity in human health by identifying and addressing hospital-level racial disparities.

Parental Factors Associated with COVID-19 Vaccine Uptake for Children over 5 Years of Age in Texas

The COVID-19 vaccine is safe and effective for children, yet parental hesitancy towards vaccinating children against the virus persists. We conducted a telephone-administered weighted survey in Texas to examine parents' sociodemographic factors and medical conditions associated with COVID-19 vaccination intention for parents with unvaccinated children ages 5-17 years. We collected responses from 19,502 participants, of which 4879 were parents of children ages 5-17 years. We conducted multiple logistic regression with Lasso-selected variables to identify factors associated with children's vaccination status and parents' intention to vaccinate their children. From the unweighted sample, less than half of the parents (46.8%) had at least one unvaccinated child. These parents were more likely to be White, English-speaking, not concerned about illness, privately insured, and unvaccinated for COVID-19 themselves (p < 0.001). In the adjusted regression model, parents who were unvaccinated (vs. having COVID-19 booster, aOR = 28.6) and financially insecure (aOR = 1.46) had higher odds of having unvaccinated children. Parents who were Asian (aOR = 0.50), Black (aOR = 0.69), Spanish-speaking (aOR = 0.57), concerned about illness (aOR = 0.63), had heart disease (aOR = 0.41), and diabetes (aOR = 0.61) had lower odds of having unvaccinated children. Parents who were Asian, Black, Hispanic, Spanish-speaking, concerned about illness for others, and vaccine-boosted were more likely to have vaccination intention for their children (p < 0.001). Children's vaccination is essential to reduce COVID-19 transmission. It is important to raise awareness about the value of pediatric COVID-19 vaccination while considering parents' sociodemographic and medical circumstances.

Changes in Emergency Department Utilization in Vulnerable Populations After COVID-19 Shelter-in-Place Orders

OBJECTIVES

This study aims to compare emergency department (ED) utilization and admission rates for patients with a history of mental health (MH) disorders, substance use disorders (SUDs), and social determinants of health (SDOH) before and after implementing COVID-19 shelter-in-place (SIP) orders.

METHODS

This was a retrospective, multicenter study leveraging electronic medical record (EMR) data from 20 EDs across a large Midwest integrated healthcare system from 5/2/2019 to 12/31/2019 (pre-SIP) and from 5/2/2020 to 12/31/2020 (post-SIP). Diagnoses were documented in the patient's medical records. Poisson and logistic regression models were used to evaluate ED utilization and admission rate changes.

RESULTS

A total of 871,020 ED encounters from 487,028 unique patients were captured. Overall, 2,572 (0.53%) patients had a documented Z code for SDOH. Patients with previously diagnosed MH disorders or SUDs were more likely to seek ED care after the SIP orders were implemented (risk ratio (RR): 1.20, 95% confidence interval (CI): 1.18-1.22, p<0.001), as were patients with SDOH (RR: 2.37, 95% CI: 2.19-2.55, p<0.001). Patients with both previously diagnosed MH disorders or SUDs and a documented SDOH had even higher ED utilization (RR: 3.31, 95% CI: 2.83-3.88, p<0.001) than those with either condition alone. Patients with MH disorders and SUDs (OR: 0.89, 95% CI: 0.86-0.92, p<0.001) or SDOH (OR: 0.67, 95% CI: 0.54-0.83, p<0.001) were less likely to be admitted post-SIP orders, while patients with a history of diseases of physiologic systems were more likely to be admitted.

CONCLUSION

Vulnerable populations with a history of MH disorders, SUDs, and SDOH experienced increased ED utilization but a lower rate of hospital admissions after the implementation of SIP orders. The findings highlight the importance of addressing these needs to mitigate the impact of public health crises on these populations.

Unraveling socioeconomic determinants of health-related behavior, reception of information, and perceptions on disease disclosure at the time of the COVID-19 pandemic: did health insurance curb the disparities in the Philippines?

BACKGROUND

The study uncovers micro and macro socioeconomic disparities in terms of health behavior, disease perception, and reception of information. Furthermore, findings shed light on the possible role of health insurance on access to information, disease perception and the adoption of preventive behaviors in the context of a public health emergency such as the COVID-19 pandemic.

METHODS

This study employed a cross-sectional design using the Philippine Demographic and Health Survey (DHS). With a total of 29,809 respondents, it evaluated the individual or household and systemwide socioeconomic determinants of four different outcomes: receipt of information, disease perception, uptake of free preventive services, and treatment-seeking behavior. In addition to logistic regression models with the socioeconomic variables as the independent variables, models for the evaluation of the moderating effect of insurance ownership were fitted. Predicted probabilities were reported for the analysis of moderating effects.

RESULTS

Findings show that individual and householdsocioeconomic determinants affected health-behavior and access to or receipt of information pertinent to the COVID-19 pandemic. Both education and wealth affected the receipt of information such that individuals in more advantaged socioeconomic positions were at least 30% more likely to have received information on COVID-19. Wealth was also associated to treatment-seeking behavior. Regional differences were seen across all dependent variables. Moreover, the study provides evidence that ownership of insurance can close education-based gaps in the uptake of free vaccination and COVID-19 testing.

CONCLUSION

It is imperative that targeted efforts be maximized by utilizing existing strategies and mechanisms to reach the marginalized and disadvantaged segments of the population. Health insurance may give off added benefits that increase proficiency in navigating through the healthcare system. Further research may focus on examining pathways by which health insurance or social policies may be used to leverage responses to public health or environmental emergencies.

Baby Bump or Baby Slump? COVID-19, Lockdowns, and their Effects on Births in Australia

This study examines changes in birth rates in Australia during the COVID-19 pandemic and the extent to which such changes were influenced by lockdowns. We use natality data at State and small regional area levels spanning the period from 2011 to 2022. In our empirical approach, we first take advantage of a unique quasi-experimental setting that arose in Victoria, Australia's second most populous State, during the first year of the pandemic. Victoria imposed a 111-day stay-at-home lockdown while other States and Territories enforced milder restrictions on social and economic activities. We then exploit lockdowns that lasted more than three months in Victoria and New South Wales in the second year of the pandemic. Within these quasi-experimental settings, our empirical approach was to first use monthly data at the State-level and estimate birth rate deviations from secular trends for the months affected by COVID-19 policies. We also estimate separate models to examine variations in births across regional areas with different compositions of Indigenous population, unemployment, low-income, and non-English speaking residents. Our findings reveal a nationwide fertility increase in 2021, but Victoria exhibited slower growth, especially in areas with higher unemployment, lower income, and more non-English speaking residents. In 2022, we find evidence of a gradual return of birth rates to pre-pandemic trends, though this is mainly concentrated in the major cities. While the second-year lockdowns had limited impacts, language-diverse areas still mostly experienced lower rates of growth in birth rates.

Racial differences in parent response to COVID schooling policies

This paper examines whether school COVID-19 policies influenced enrollment differently by student age and race/ethnicity. Unlike much prior research, we i) analyze enrollments for virtually the entire U.S. public school population for both the 2020-2021 and 2021-2022 school years, ii) compare enrollment trends within districts in order to isolate subgroup heterogeneity from district characteristics, and iii) account for district selection into preferred learning modes. Analyzing data on over 9,000 districts that serve more than 90% of public school students in the United States, we find enrollment responses to COVID policies differed notably. We find that White enrollments declined more than Black, Hispanic, and Asian enrollments in districts that started the 2020-2021 school year virtually, but in districts that started in-person the reverse was true: Non-White enrollments declined more than White enrollments. Moreover, Black, Hispanic, and Asian families responded more than White families to higher COVID-19 death rates in the months preceding the start of the 2021 school year. In 2021-2022, enrollment differences by the previous year's learning mode persisted. Racial/ethnic differences did not vary by whether the district required masking in classrooms. These findings are consistent with the greater risk faced by communities of color during the pandemic and demonstrate an additional source of disparate impact from COVID policies.

The pandemic and social experience: For whom did discrimination and social isolation increase?

OBJECTIVE

The objective of this study was to examine whether experiences of discrimination have increased during the pandemic, particularly among negatively stigmatized racial/ethnic groups, and whether such experiences have exacerbated feelings of social isolation.

METHOD

Discrimination and social isolation were assessed before and during the pandemic in a sample of 263 Black and White young adults attending a large, predominantly White 4-year research university in the Southeastern region of the United States (52% Black, 48% White, 53% female, mean age = 19.2).

RESULTS

Increases in discrimination were evident among Black but not White participants. Black participants also reported greater increases in social isolation than White participants, and changes in discrimination partially mediated the emergent racial disparity in social isolation.

CONCLUSIONS

Findings are consistent with theoretical perspectives on discrimination during times of stress and suggest the need for broader attention to the impact of the pandemic on unfair treatment of stigmatized groups. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Transformation of social relationships in COVID-19 America: Remote communication may amplify political echo chambers

The COVID-19 pandemic, with millions of Americans compelled to stay home and work remotely, presented an opportunity to explore the dynamics of social relationships in a predominantly remote world. Using the 1972-2022 General Social Surveys, we found that the pandemic significantly disrupted the patterns of social gatherings with family, friends, and neighbors but only momentarily. Drawing from the nationwide ego-network surveys of 41,033 Americans from 2020 to 2022, we found that the size and composition of core networks remained stable, although political homophily increased among nonkin relationships compared to previous surveys between 1985 and 2016. Critically, heightened remote communication during the initial phase of the pandemic was associated with increased interaction with the same partisans, although political homophily decreased during the later phase of the pandemic when in-person contacts increased. These results underscore the crucial role of social institutions and social gatherings in promoting spontaneous encounters with diverse political backgrounds.

Multifaceted precarity: pandemic experiences of recent immigrant women in the accommodation and food services sector

The COVID-19 pandemic disproportionately affected those who face historical and ongoing marginalization. In centering pandemic experience of recent immigrant women in the accommodation and food services sector in Canada, we examine how their precarious work translated to experiences of work precarity and wellbeing. This paper illuminates how pre-existing and ongoing marginalization are reproduced during a health crisis for those at the intersection of gender, race, migration, and labour inequities. Using semi-structured interviews and systematic analysis using the Work Precarity Framework, we found that the pandemic exacerbated pre-existing socio-economic marginalization and resulted in unique experiences of work precarity. The latter was experienced as precarity of work (unpredictable work hours and job or employment insecurity), precarity from work (inadequate incomes), and precarity at work (physical, psychological, and relational unsafety). Work precarity stood out as a social determinant of health in relation to its outcome of degraded mental health and wellbeing. Recognizing the role of policies in producing, reproducing, and distributing precarity, we recommend policy directions to reduce social inequities in pandemic recovery.

Mental health during the COVID-19 pandemic in a longitudinal study of Hurricane Katrina survivors

While the COVID-19 pandemic is known to have caused widespread mental health challenges, it remains unknown how the prevalence, presentation, and predictors of mental health adversity during the pandemic compare to other mass crises. We shed light on this question using longitudinal survey data (2003-2021) from 424 low-income mothers who were affected by both the pandemic and Hurricane Katrina, which struck the U.S. Gulf Coast in 2005. The prevalence of elevated posttraumatic stress symptoms was similar 1-year into the pandemic (41.6%) as 1-year post-Katrina (41.9%), while elevated psychological distress was more prevalent 1-year into the pandemic (48.3%) than 1-year post-Katrina (37.2%). Adjusted logistic regression models showed that pandemic-related bereavement, fear or worry, lapsed medical care, and economic stressors predicted mental health adversity during the pandemic. Similar exposures were associated with mental health adversity post-Katrina. Findings underscore the continued need for pandemic-related mental health services and suggest that preventing traumatic or stressful exposures may reduce the mental health impacts of future mass crises.

Social Networks, the COVID-19 Pandemic, and Mental Health: Resiliency Through Social Bonding and Cohesion

Objectives. To assess how personal social network characteristics moderated mental health declines during the COVID-19 pandemic in emerging adults compared with other age groups. Methods. The Person to Person Health Interview Study, a representative, probability-based cohort study (n = 2485) collected data through face-to-face (baseline) and phone (follow-up) interviews before and during the pandemic. We used survey-weighted growth curve models to examine network effects on computer-adaptive testing measures of depression and anxiety severity. Results. Respondents reported significantly increased depression and anxiety in 2021, which returned almost to baseline levels for most age groups by 2022 (P < .001). Stronger ties to others and more interconnected ties were significantly associated with lower depression (B = -0.112 [P < .05]; B = -0.086 [P < .001]) and anxiety (B = -0.101 [P < .05]; B = -0.063 [P < .01]) severity across the pandemic. Interaction models revealed disproportionate protective effects of network characteristics on depression (B = -0.456 [P < .001]; B = -0.268 [P < .001]) and anxiety (B = -0.388 [P < .001]; B = -0.284 [P < .001]) for emerging adults. Conclusions. Cohesive and affectively strong personal networks promote resiliency to common mental health challenges during periods of crisis, particularly for emerging adults whose social roles and relationships were disrupted during a critical period of development. (Am J Public Health. Published online ahead of print November 10, 2023:e1-e10. https://doi.org/10.2105/AJPH.2023.307426).

Improving Outcomes of Pediatric Lupus Care Delivery With Provider Goal-Setting Activities and Multidisciplinary Care Models

OBJECTIVE

The present study was undertaken to evaluate high-quality care delivery in the context of provider goal-setting activities and a multidisciplinary care model using an electronic health record (EHR)-enabled pediatric lupus registry. We then determined associations between care quality and prednisone use among youth with systemic lupus erythematosus (SLE).

METHODS

We implemented standardized EHR documentation tools to autopopulate a SLE registry. We compared pediatric Lupus Care Index (pLCI) performance (range 0.0-1.0; 1.0 representing perfect metric adherence) and timely follow-up 1) before versus during provider goal-setting activities and population management, and 2) in a multidisciplinary lupus nephritis versus rheumatology clinic. We estimated associations between pLCI and subsequent prednisone use adjusted for time, current medication, disease activity, clinical features, and social determinants of health.

RESULTS

We analyzed 830 visits by 110 patients (median 7 visits per patient [interquartile range 4-10]) over 3.5 years. The provider-directed activity was associated with improved pLCI performance (adjusted β 0.05 [95% confidence interval (95% CI) 0.01, 0.09]; mean 0.74 versus 0.69). Patients with nephritis in multidisciplinary clinic had higher pLCI scores (adjusted β 0.06 [95% CI 0.02, 0.10]) and likelihood of timely follow-up than those in rheumatology (adjusted relative risk [RR] 1.27 [95% CI 1.02, 1.57]). A pLCI score of ≥0.50 was associated with 0.72-fold lower adjusted risk of subsequent prednisone use (95% CI 0.53, 0.93). Minoritized race, public insurance, and living in areas with greater social vulnerability were not associated with reduced care quality or follow-up, but public insurance was associated with higher risk of prednisone use.

CONCLUSION

Greater attention to quality metrics is associated with better outcomes in childhood SLE. Multidisciplinary care models with population management may additionally facilitate equitable care delivery.

Socioeconomic Determinants of Remote Patient Monitoring Implementation Among Rural and Urban Hospitals

Introduction: Remote patient monitoring (RPM) is a form of telehealth that improves quality of care for chronic disease treatment and reduces hospital readmission rates. Geographical proximity to health care is important for individuals of low socioeconomic status (SES) who face additional financial and transportation barriers. The goal of this study was to assess the association between social determinants of health and adoption of RPM. Methods: This cross-sectional study analyzed data from hospitals that responded to the American Hospital Association's Annual Survey (2018) and spatially linked census tract-level environmental and social determinants of health obtained from the Social Vulnerability Index (2018). Results: A total of 4,206 hospitals (1,681 rural and 2,525 urban hospitals) met study criteria. Rural hospitals near households in the lower middle quartile SES were associated with a 33.5% lower likelihood of having adopted RPM for chronic care management compared with rural hospitals near households in the highest quartile SES (adjusted odds ratios [aOR] = 0.665; 95% confidence interval [CI]: 0.453-0.977). Urban hospitals near households in the lowest quartile SES were associated with a 41.9% lower likelihood of having adopted RPM for chronic care management compared with urban hospitals near households in the highest quartile SES (aOR = 0.581; 95% CI: 0.435-0.775). Similar trends in accessibility were found with RPM for postdischarge services among urban hospitals. Conclusion: Our findings highlight the importance of hospital responsibility and state and federal policy approaches toward ensuring equitable access to RPM services for patients characterized by lower SES.

Financial strain and the health and well-being of college students during the COVID-19 pandemic

Objective: This study examined the associations between COVID-19-related financial strain and the stress, mental health, physical health symptoms, and health behaviors of American university students. Participants: Online data were collected from 485 participants between May 2020 and March 2021. Participants were majority female and majority white. Methods: Participants reported on stress (COVID-19 health stress and work stress), mental health (depression, anxiety, loneliness, social support, and subjective well-being), physical health symptoms, and health behaviors (sleep latency, alcohol consumption, alcohol coping, other substance use, exercise, COVID-19 health behaviors). Results: Both Pearson's correlations and Bayesian correlation indicated more stress and worse mental health, health symptoms, and health behaviors for students who experienced more financial strain. Conclusion: Pandemic-related financial strain could have enduring negative effects for students, many of whom already experience financial challenges. This work highlights a need to allocate resources to promote college student health during and after the COVID-19 pandemic.

Applying an interpretable machine learning framework to study mobility inequity in the recovery phase of COVID-19 pandemic

The COVID-19 pandemic is a public health crisis that also fuels the pervasive social inequity in the United States. Existing studies have extensively analyzed the inequity issues on mobility across different demographic groups during the lockdown phase. However, it is unclear whether the mobility inequity is perennial and will continue into the mobility recovery phase. This study utilizes ride-hailing data from Jan 1st, 2019, to Mar 31st, 2022, in Chicago to analyze the impact of various factors, such as demographic, land use, and transit connectivity, on mobility inequity in the different recovery phases. Instead of commonly used statistical methods, this study leverages advanced time-series clustering and an interpretable machine learning algorithm. The result demonstrates that inequity still exists in the mobility recovery phase of the COVID-19 pandemic, and the degree of mobility inequity in different recovery phases is varied. Furthermore, mobility inequity is more likely to exist in the census tract with more families without children, lower health insurance coverage, inflexible workstyle, more African Americans, higher poverty rate, fewer commercial land use, and higher Gini index. This study aims to further the understanding of the social inequity issue during the mobility recovery phase of the COVID-19 pandemic and help governments propose proper policies to tackle the unequal impact of the pandemic.

Racial Capitalism and Neighborhood Health Disparities: the COVID-19 in California Counties

PURPOSE

This article explores the association between racial capitalism and neighborhood-level health disparities, with a particular focus on COVID-19 in California.

METHODS

This article investigates COVID-19 incidence in 58 California counties. To account for racial capitalism, the study looks at the per capita incomes ratios (1) between whites and Blacks and (2) between whites and Hispanics. Other county-level neighborhood characteristics were controlled.

RESULTS

Findings from spatial autoregressive models indicate that increases in white-Black and white-Hispanic income disadvantages lead to an increase in COVID-19 incidence in 58 California counties. Findings also reveal that the disadvantage that results from the white-Black income ratio in COVID-19 spread decreases in counties that report high levels of income inequality between whites and Hispanics.

DISCUSSION

Findings indicate that a greater income disadvantage for racial minorities is connected to a more COVID-19 incidence. With regard to racial demographics in California, the interaction effect between measures for racial income disadvantages is discussed.

Quantifying the human impact of Melbourne's 111-day hard lockdown experiment on the adult population

Lockdown was used worldwide to mitigate the spread of severe acute respiratory syndrome coronavirus 2 and was the cornerstone non-pharmaceutical intervention of zero-COVID strategies. Many previous impact evaluations of lockdowns are unreliable because lockdowns co-occurred with severe coronavirus disease related health and financial insecurities. This was not the case in Melbourne's 111-day lockdown, which left other Australian jurisdictions unaffected. Interrogating nationally representative longitudinal survey data and quasi-experimental variation, and controlling for multiple hypothesis testing, we found that lockdown had some statistically significant, albeit small, impacts on several domains of human life. Women had lower mental health (-0.10 s.d., P = 0.043, 95% confidence interval (CI) = -0.21 to -0) and working hours (-0.13 s.d., P = 0.006, 95% CI = -0.22 to -0.04) but exercised more often (0.28 s.d., P < 0.001, 95% CI = 0.18 to 0.39) and received more government transfers (0.12 s.d., P = 0.048, 95% CI = 0.001 to 0.24). Men felt less part of their community (-0.20 s.d., P < 0.001, 95% CI = -0.30 to -0.10) and reduced working hours (-0.12 s.d., P = 0.004, 95% CI = -0.20 to -0.04). Heterogeneity analyses demonstrated that families with children were driving the negative results. Mothers had lower mental health (-0.27 s.d., P = 0.014, 95% CI = -0.48 to -0.06), despite feeling safer (0.26 s.d., P = 0.008, 95% CI = 0.07 to 0.46). Fathers increased their alcohol consumption (0.35 s.d., P = 0.002, 95% CI = 0.13 to 0.57). Some outcomes worsened with lockdown length for mothers. We discuss potential explanations for why parents were adversely affected by lockdown.

Pandemic Precarity: COVID-19's Impact on Mexican and Central American Immigrant Families

Objective

The study examines the association of gender, parenthood, and marriage with reports of perceived pandemic precarity among Mexican and Central American immigrants during the COVID-19 pandemic (Fall 2020) to understand predictors of vulnerability in periods of crisis.

Background

Latinos/as, immigrants, parents, and women have faced significant challenges during the COVID-19 pandemic. Family structure, along with social expectations for gender (i.e., self-sacrificing femininity for women and hegemonic masculinity for men), parenthood, and marriage may explain perceptions of pandemic precarity - defined as the material deprivation and economic anxiety resulting from the COVID-19 pandemic.

Method

This study used data from the Hispanic COVID-19 Rapid Response Study (n=400), a follow-up of the VidaSana Study of Mexican and Central American immigrants, to examine how family structure is associated with pandemic precarity (i.e., food, housing, and economic insecurity). Using linear regression models, average marginal effects (AMEs), and tests for group differences we investigate the independent and interactive effects of gender, parenthood, and marriage on pandemic precarity.

Results

Men and parents reported the highest pandemic precarity. Fathers reported higher pandemic precarity than mothers. For men, marriage is associated with greater precarity, and for women, marriage is associated with less precarity, yet marriage increased precarity for those without children.

Conclusion

We discuss the importance and implications of examining gender along with family structure to understand how immigrant families were faring in response to the pandemic.

Dietary trends among young adults during the COVID-19 lockdown: socioeconomic and gender disparities

BACKGROUND

Healthy eating is vital to well-being and during the COVID-19 pandemic, it was especially important for boosting immunity and protecting against viral infections. Yet, by many accounts, keeping a nutritious diet was a casualty of the pandemic rather than a means to fight it. Young adults experienced disproportionate pandemic-related disruptions during a formative stage of development while little is still known about dietary outcomes.

METHODS

We employed a cross-sectional design to examine dietary disparities targeting young adults (ages 18-28) during the COVID-19 lockdown period. Participants (N = 254) responded to a 15-20-min online survey with questions related to food composition and sources of food, perceptions of healthy eating, weight change, physical activity, and food insecurity. Comparisons were made by household income and gender. Multiple regression analyses were conducted to investigate factors that predicted perceptions of healthy eating behaviors while controlling for other sociodemographic factors.

RESULTS

A clear overall trend toward unhealthy behaviors was found while positive changes were also identified. Consumption of junk food significantly increased (+ 3%), 40% gained weight, a third were less active, and 5-8% were food insecure on a regular basis. Meanwhile, eating food from restaurants declined and, for some, home-based cooking increased. Lower income participants were overly represented in unhealthy changes and higher income participants were disproportionately represented in healthy changes. Males reported more changes in dietary composition while females reported more fluctuation in weight. Reduced activity, weight gain, and food insecurity predicted unhealthy eating behaviors. Living with friend(s)/roommate(s) predicted healthier eating, but only among lower income participants.

CONCLUSIONS

It is recommended that pandemic minded public health interventions account for negative dietary trends with particular attention to low-income young adults. Solutions should be geared toward reshaping fiscal, social and physical environments, rather than relying solely on behavioral interventions.

A Reasoned Action Approach to Social Connection and Mental Health: Racial Group Differences and Similarities in Attitudes, Norms, and Intentions

This study employed a Reasoned Action Approach to investigate two communication behaviors that were being built into a statewide behavioral health campaign: initiating a conversation about one's own mental health struggles, and starting a conversation to discuss someone else's mental health difficulties. We examined whether the extent of attitudes, perceived norms, and perceived behavioral control regarding intent to perform these behaviors varied by racial identity. Using original survey data from Texans (N = 2,033), we conducted regression analyses for the two communication behaviors and found that intention to seek help was primarily explained by instrumental attitude, injunctive norm, descriptive norm, and perceived capacity; and intention to start a conversation to help someone else was primarily explained by instrumental attitude, injunctive norm, and perceived capacity. Additionally, we identified important common and distinct determinants of the two behaviors across different racial groups. Implications for health communication campaign message development and audience segmentation are discussed.

Analysis of COVID-19 Case Demographics and Disease Outcomes in Gary, Indiana

BACKGROUND

The COVID-19 pandemic further exposed the prevalence of existing health disparities in Black communities in the U.S. The current study evaluates COVID-19 data collected in Gary, Indiana, from June 2020 to June 2021. We hypothesized that the number of COVID-19 cases, hospitalizations, and deaths were influenced by race and income.

METHODS

In collaboration with the Gary Health Department (GHD), we analyzed demographic data on COVID-19-positive cases.

RESULTS

Compared to Gary's non-Black population, age- and population-adjusted rates of hospitalizations and deaths in the Black population were 3-fold (p < 0.0001) and 2-fold (p < 0.05) higher, respectively. This is despite a higher infection rate (p < 0.0001) in the non-Black population. The median household income of a zip code was negatively correlated with COVID-19 hospitalizations (R2 = 0.6345, p = 0.03), but did not correlate with infections and deaths.

CONCLUSIONS

The current study demonstrates clear health disparities of income and race in the context of COVID-19-related infections and outcomes in the city of Gary. Indiana University School of Medicine Northwest and GHD officials can collaborate to utilize these data for the reallocation of resources and health education efforts in Gary's highly populated, low-income, and predominantly Black neighborhoods. It should also prompt further investigation into national health resource allocation.

A Call to Action on Assessing and Mitigating Bias in Artificial Intelligence Applications for Mental Health

Advances in computer science and data-analytic methods are driving a new era in mental health research and application. Artificial intelligence (AI) technologies hold the potential to enhance the assessment, diagnosis, and treatment of people experiencing mental health problems and to increase the reach and impact of mental health care. However, AI applications will not mitigate mental health disparities if they are built from historical data that reflect underlying social biases and inequities. AI models biased against sensitive classes could reinforce and even perpetuate existing inequities if these models create legacies that differentially impact who is diagnosed and treated, and how effectively. The current article reviews the health-equity implications of applying AI to mental health problems, outlines state-of-the-art methods for assessing and mitigating algorithmic bias, and presents a call to action to guide the development of fair-aware AI in psychological science.

A trauma-informed approach to suicide prevention for the COVID-19 pandemic

During the COVID-19 pandemic, researchers have questioned how the devastation of the pandemic might impact suicide rates. While initial evidence on suicide rates during the early stages of the pandemic is mixed, there are signs we should still remain vigilant. One way of conceptualizing the long-term effects of the pandemic is as a source of multiple traumatic events: the collective trauma of widespread illness and death and social upheaval, individual traumas from the virus itself (e.g., serious illness and disability, traumatic grief, vicarious trauma), traumas from the social and economic consequences (e.g., domestic violence, unemployment), and its intersections with pre-pandemic traumas and oppression. Given trauma is a well-established risk factor for suicide, this carries significant implications for suicide prevention in the wake of the pandemic. Yet access to trauma-informed care, education, and research remains limited. The pandemic presents a unique opportunity to address these gaps and implement a trauma-informed approach to suicide prevention. Building on existing frameworks, we describe how effective suicide prevention for the pandemic must incorporate trauma-informed and trauma-specific services, strategies, and policies; capacity building; collaborative research; and knowledge exchange. Attending to the traumatic effects of the pandemic may reduce the long-term impact on suicide rates.

RADx-UP Testing Core: Access to COVID-19 Diagnostics in Community-Engaged Research with Underserved Populations

Research on the COVID-19 pandemic revealed a disproportionate burden of COVID-19 infection and death among underserved populations and exposed low rates of SARS-CoV-2 testing in these communities. A landmark National Institutes of Health (NIH) funding initiative, the Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) program, was developed to address the research gap in understanding the adoption of COVID-19 testing in underserved populations. This program is the single largest investment in health disparities and community-engaged research in the history of the NIH. The RADx-UP Testing Core (TC) provides community-based investigators with essential scientific expertise and guidance on COVID-19 diagnostics. This commentary describes the first 2 years of the TC's experience, highlighting the challenges faced and insights gained to safely and effectively deploy large-scale diagnostics for community-initiated research in underserved populations during a pandemic. The success of RADx-UP shows that community-based research to increase access and uptake of testing among underserved populations can be accomplished during a pandemic with tools, resources, and multidisciplinary expertise provided by a centralized testing-specific coordinating center. We developed adaptive tools to support individual testing strategies and frameworks for these diverse studies and ensured continuous monitoring of testing strategies and use of study data. In a rapidly evolving setting of tremendous uncertainty, the TC provided essential and real-time technical expertise to support safe, effective, and adaptive testing. The lessons learned go beyond this pandemic and can serve as a framework for rapid deployment of testing in response to future crises, especially when populations are affected inequitably.

Barriers and shortcomings in access to cardiovascular management and prevention for familial hypercholesterolemia during the COVID-19 pandemic

Familial hypercholesterolemia (FH) is a hereditary condition caused by mutations in the lipid pathway. The goal in managing FH is to reduce circulating low-density lipoprotein cholesterol and, therefore, reduce the risk of developing atherosclerotic cardiovascular disease (ASCVD). Because FH patients were considered high risk groups due to an increased susceptible for contracting COVID-19 infection, we hypothesized whether the effects of the pandemic hindered access to cardiovascular care. In this review, we conducted a literature search in databases Pubmed/Medline and ScienceDirect. We included a comprehensive analysis of findings from articles in English related and summarized the effects of the pandemic on cardiovascular care through direct and indirect effects. During the COVID-19 pandemic, FH patients presented with worse outcomes and prognosis, especially those that have suffered from early ASCVD. This caused avoidance in seeking care due to fear of transmission. The pandemic severely impacted consultations with lipidologists and cardiologists, causing a decline in lipid profile evaluations. Low socioeconomic communities and ethnic minorities were hit the hardest with job displacements and lacked healthcare coverage respectively, leading to treatment nonadherence. Lock-down restrictions promoted sedentary lifestyles and intake of fatty meals, but it is unclear whether these factors attenuated cardiovascular risk in FH. To prevent early atherogenesis in FH patients, universal screening programs, telemedicine, and lifestyle interventions are important recommendations that could improve outcomes in FH patients. However, the need to research in depth on the disproportionate impact within different subgroups should be the forefront of FH research.

Frontline work and racial disparities in social and economic pandemic stressors during the first COVID-19 surge

OBJECTIVE

To assess the magnitude of racial-ethnic disparities in pandemic-related social stressors and examine frontline work's moderating relationship on these stressors.

DATA SOURCES

Employed Californians' responses to the Institute for Governmental Studies (IGS) poll from April 16-20, 2020, were analyzed. The Pandemic Stressor Scale (PSS) assessed the extent to which respondents experienced or anticipated problems resulting from the inability to pay for basic necessities, job instability, lacking paid sick leave, unavailability of childcare, and reduced wages or work hours due to COVID-19.

STUDY DESIGN

Mixed-effects generalized linear models estimated (1) racial-ethnic disparities in pandemic stressors among workers during the first COVID-19 surge, adjusting for covariates, and (2) tested the interaction between race-ethnicity and frontline worker status, which includes a subset of essential workers who must perform their job on-site, to assess differential associations of frontline work by race-ethnicity.

DATA COLLECTION

The IGS poll data from employed workers (n = 4795) were linked to the 2018 Centers for Disease Control and Prevention Social Vulnerability Index at the zip code level (N = 1068).

PRINCIPAL FINDINGS

The average PSS score was 37.34 (SD = 30.49). Whites had the lowest PSS score (29.88, SD = 26.52), and Latinxs had the highest (50.74, SD = 32.61). In adjusted analyses, Black frontline workers reported more pandemic-related stressors than White frontline workers (PSS = 47.73 vs. 36.96, p < 0.001). Latinxs reported more pandemic stressors irrespective of frontline worker status. However, the 5.09-point difference between Latinx frontline and non-frontline workers was not statistically different from the 4.6-point disparity between White frontline and non-frontline workers.

CONCLUSION

Latinx workers and Black frontline workers disproportionately reported pandemic-related stressors. To reduce stress on frontline workers during crises, worker protections like paid sick leave, universal access to childcare, and improved job security are needed, particularly for those disproportionately affected by structural inequities, such as racially minoritized populations.

Perceptions of the impact of COVID-19 in Tennessee, USA: a retrospective study

Background

Despite high incidence and mortality risks associated with COVID-19 during the pandemic, stay-at-home orders and vaccination recommendations were met with varying levels of acceptance in Tennessee. Understanding perceptions of individuals regarding the health and economic impacts of COVID-19 is necessary to address public concerns while ensuring appropriate public health response. Therefore, the objectives of this study were to (a) investigate differences in opinions among residents of Tennessee regarding the impacts of COVID-19; and (b) identify socioeconomic and demographic predictors/determinants of these opinions.

Methods

This retrospective cross-sectional study was conducted using survey data collected in nine waves during 2020. Distributions of survey-weighted sociodemographic characteristics and respondent perceptions of the impact of COVID-19 were computed. Weighted logistic models were used to investigate predictors of a number of perceptions: whether the health or economic impact was greater, concern for respondent's health, concern for family's health, and willingness to accept COVID-19 vaccine.

Results

The study included a total of 9,754 survey respondents. Approximately equal percentages considered COVID-19 to have a greater economic (48.4%) versus health impact (51.6%). Just 40.1% of the respondents reported that they would definitely accept a COVID-19 vaccine. Age group, race, educational attainment, and household composition were significant (p < 0.05) predictors of all investigated perceptions regarding COVID-19. Lack of prior infection was the strongest predictor of the perception of COVID-19 having a greater impact on health (OR = 2.40, p < 0.001), concern for respondent's health (OR = 1.86, p = 0.002), and concern for family members' health (OR = 1.90, p = 0.001). Compared to males, females had higher odds of identifying the health impact of COVID-19 as greater (OR = 1.09, p = 0.041) and reporting concern for family health (OR = 1.14, p = 0.003). However, they had lower odds (OR = 0.63, p < 0.001) of willingness to accept vaccine than males.

Conclusion

These findings improve our understanding of the drivers of health behaviors, including vaccine hesitancy, and are useful for guiding public health outreach/education programs.

Is the disability wage gap a gendered inequality? Evidence from a 13-year full population study from Norway

Recent research has confirmed the employment disadvantages of disabled people, but disability wage gaps in interaction with gender have not been sufficiently explored. This article asks how the disability wage gap can be accounted for, how the unexplained disability wage gap has evolved over time and how the intersections of disability and gender relate to wage penalties. Norwegian nation-wide annual registry data from the period 2005-2017 (N = 8.5 million) are used to estimate longitudinal pay gaps of disabled men and women in relation to nondisabled workers. The analyses arrive at a persistent residual wage gap for disabled employees. Results confirm that gender is a defining predictor for income, and that disabled women are especially disadvantaged. Implications for intersectional theory are discussed. The current study is a reminder that antidiscrimination legislation and implementation of regulations has not been successful in levelling out injustices experienced by disabled people in the labour market.

Mental Health Needs and Services Utilization among Undergraduate and Graduate Students in Texas during the COVID-19 Pandemic

COVID-19 created a global crisis, exacerbating disparities in social determinants of health (SDOH) and mental health (MH). Research on pandemic-related MH and help-seeking is scarce, especially among high-risk populations such as college/university students. We examined self-rated MH and psychological distress, the perceived need for MH services/support, and the use of MH services across the SDOH among college/university students during the start of the pandemic. Data from the COVID-19 Texas College Student Experiences Survey (n = 746) include full- and part-time undergraduate/graduate students. Regressions examined self-rated MH, psychological distress, perceived need, and service use across SDOH, controlling for pre-pandemic MH, age, gender, and race/ethnicity. Economic stability was associated with higher risk of poor MH and need for MH services/support. Aspects of the social/community context protected student MH, especially among foreign-born students. Racial discrimination was associated with both greater psychological distress and use of services. Finally, beliefs related to the sufficiency of available institutional MH resources shaped perceived need for and use of services. Although the worst of the pandemic is behind us, the inequitable distribution of the SDOH among students is unwavering. Demand for MH support is high, requiring higher education institutions to better mobilize MH services to meet the needs of students from diverse social contexts.

Food Insecurity and COVID-19 Infection: Findings From the 2020-2021 National Health Interview Survey

Introduction

The purpose of this study was to examine the sociodemographic and health-related factors associated with food insecurity and the association between food insecurity and COVID-19 infection using a nationally representative sample in the U.S.

Methods

Cross-sectional data of 61,050 adults (aged ≥18 years) from the 2020 and 2021 National Health Interview Survey were analyzed. Food insecurity was measured by the 10-item U.S. Department of Agriculture Food Security Survey Module. Weighted multivariable logistic regression models were used to estimate associations with food insecurity.

Results

A total of 6.8% of the National Health Interview Survey participants lived in food-insecure households, and 18.9% tested positive for COVID-19 infection. Young (aged 18-34 years) or middle (aged 35-64 years) age, female sex, minor race/ethnicity (Hispanic/non-Hispanic Black/non-Hispanic Asian/others), education level less than high school, unmarried status, unemployment, poverty (below the federal poverty level), having no health insurance, a larger number of adults and children in the household, poorer self-reported health status, and the presence of chronic conditions were significantly associated with food insecurity (AOR ranged from 1.20 to 3.15, all p<0.0001). Food insecurity was independently associated with positive COVID-19 infection (AOR=1.25, 95% CI=1.11, 1.40), controlling for sociodemographic and health-related factors. The greatest magnitude of the association was observed for the non-Hispanic Black participants (AOR=1.47, 95% CI=1.15, 1.88), female participants (AOR=1.44, 95% CI=1.20, 1.71), and those below the federal poverty level (AOR=1.39, 95% CI=1.12, 1.73) across all the subgroups.

Conclusions

Food insecurity disproportionately affected vulnerable subgroups such as young adults, female individuals, minority race/ethnicity groups, and those with lower socioeconomic status, and was associated with positive COVID-19 infection. Policies addressing food insecurity may help to reduce the likelihood of COVID-19 infection, especially for those vulnerable subgroups.

Environmental equity and COVID-19 experiences in the United States: Results from three survey waves of a nationally representative study conducted between 2020-2022

Certain environmental exposures, such as air pollution, are associated with COVID-19 incidence and mortality. To determine whether environmental context is associated with other COVID-19 experiences, we used data from the nationally representative Tufts Equity in Health, Wealth, and Civic Engagement Study data (n=1785; three survey waves 2020-2022). Environmental context was assessed using self-reported climate stress and county-level air pollution, greenness, toxic release inventory site, and heatwave data. Self-reported COVID-19 experiences included willingness to vaccinate against COVID-19, health impacts from COVID-19, receiving assistance for COVID-19, and provisioning assistance for COVID-19. Self-reported climate stress in 2020 or 2021 was associated with increased COVID-19 vaccination willingness by 2022 (odds ratio [OR] = 2.35; 95% confidence interval [CI] = 1.47, 3.76), even after adjusting for political affiliation (OR = 1.79; 95% CI = 1.09, 2.93). Self-reported climate stress in 2020 was also associated with increased likelihood of receiving COVID-19 assistance by 2021 (OR = 1.89; 95% CI = 1.29, 2.78). County-level exposures (i.e., less greenness, more toxic release inventory sites, more heatwaves) were associated with increased vaccination willingness. Air pollution exposure in 2020 was positively associated with likelihood of provisioning COVID-19 assistance in 2020 (OR = 1.16 per μg/m3; 95% CI = 1.02, 1.32). Associations between certain environmental exposures and certain COVID-19 outcomes were stronger among those who identify as a race/ethnicity other than non-Hispanic White and among those who reported experiencing discrimination; however, these trends were not consistent. A latent variable representing a summary construct for environmental context was associated with COVID-19 vaccination willingness. Our results add to the growing body of literature suggesting that intersectional equity issues affecting likelihood of exposure to adverse environmental conditions are also associated with health-related outcomes.

Forced social isolation and lockdown during the COVID-19 pandemic: depression, anxiety, trauma-distress and coping mechanisms of a Greek sample

Aim

The COVID-19 outbreak escalated into a global pandemic, pushing many governments around the world to impose measures affecting all aspects of life. Similar to other countries, Greece adopted social restriction, lockdowns, and quarantines to reduce transmission from person-to-person. This cross-sectional study investigated the association between social restriction measures, an mental health and coping strategies employed by a Greek adult sample.

Subject and methods

An online questionnaire was used to collect data during the second national lockdown (February to May 2021). A total of 650 participants (M age 33.13, 71.5% female) comprised the final sample.

Results

The results show 21.3% of respondents reported moderate-to-extremely severe anxiety, 33% moderate-to-extremely severe depression, 31.8% moderate-to-severe stress, and 38% clinically significant trauma-related distress. Hierarchical linear regression analyses revealed that the strongest contributors to adverse mental health outcomes were being female, of younger age, experiencing increases in verbal arguments at home, being separated from family and close friends, and being unable to afford enough or healthy food. Lastly, participants reported moving away from social support and into more individual strength and resilience-based coping strategies to cope with challenges.

Conclusion

These findings suggest that in addition to the detrimental effects on physical health, social restriction measures related to COVID-19 also imposed a heavy psychological burden on the population via forced social isolation, which, by design, increased not only physical distancing but also psychological distancing between people.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-023-01907-3.

The mediating effect of health literacy on COVID-19 vaccine confidence among a diverse sample of urban adults in Boston and Chicago

BACKGROUND

A high rate of COVID-19 vaccination is critical to reduce morbidity and mortality related to infection and to control the COVID-19 pandemic. Understanding the factors that influence vaccine confidence can inform policies and programs aimed at vaccine promotion. We examined the impact of health literacy on COVID-19 vaccine confidence among a diverse sample of adults living in two major metropolitan areas.

METHODS

Questionnaire data from adults participating in an observational study conducted in Boston and Chicago from September 2018 through March 2021 were examined using path analyses to determine whether health literacy mediates the relationship between demographic variables and vaccine confidence, as measured by an adapted Vaccine Confidence Index (aVCI).

RESULTS

Participants (N = 273) were on average 49 years old, 63 % female, 4 % non-Hispanic Asian, 25 % Hispanic, 30 % non-Hispanic white, and 40 % non-Hispanic Black. Using non-Hispanic white and other race as the reference category, Black race and Hispanic ethnicity were associated with lower aVCI (-0.76, 95 % CI -1.00 to -0.50; -0.52, 95 % CI -0.80 to -0.27, total effects from a model excluding other covariates). Lower education was also associated with lower aVCI (using college or more as the reference, -0.73 for 12th grade or less, 95 % CI -0.93 to -0.47; -0.73 for some college/associate's/technical degree, 95 % CI -1.05 to -0.39). Health literacy partially mediated these effects for Black and Hispanic participants and those with lower education (indirect effects -0.19 and -0.19 for Black race and Hispanic ethnicity; 0.27 for 12th grade or less; -0.15 for some college/associate's/technical degree).

CONCLUSIONS

Lower levels of education, Black race, and Hispanic ethnicity were associated with lower scores on health literacy, which in turn were associated with lower vaccine confidence. Our findings suggest that efforts to improve health literacy may improve vaccine confidence, which in turn may improve vaccination rates and vaccine equity.

CLINICAL TRIALS NUMBER

NCT03584490.

Rural and Urban/Suburban Victim Professionals' Perceptions of Gender-Based Violence, Victim Challenges, and Safety Advice During the COVID-19 Pandemic

This study surveyed a national sample of victim service professionals (N  =  222) and compared rural versus urban/suburban participants' perceptions of a variety of issues, such as the impact of the pandemic on gender-based violence victimization and safety advice for isolated victims. Increased interference with victim employment and the abuser monitoring of online activities were reported by participants across all communities. However, urban/suburban participants rated the magnitude of all victim challenges as greater, while more rural participants noted child abuse as a particular problem in their communities. The results highlight the importance of community context for improving coordinated responses to gender-based violence (n  =  101).

Analysis of Road Transport Response to COVID-19 Pandemic in Nigeria and its Policy Implications

The COVID-19 pandemic presents a serious global health challenge to humanity in recent times. It has caused fundamental disruptions to the global transportation system, supply chains, and trade. The impact on the transport sector resulting from lockdowns has led to huge losses in revenue. At the moment there are limited studies of the road transport sector response to the COVID-19 pandemic. This paper fills this gap using Nigeria as a case study area. A mixed method involving both qualitative and quantitative research was employed. Principal Component Analysis and Multiple Criteria Analysis were used to analyze the data. The results suggest that road transport operators strongly (90.7%) believe that 51 adopted new technologies/innovations, processes, and procedures will keep them and passengers safe from the COVID-19 pandemic in Nigeria. A breakdown shows that observing the lockdown directive is perceived by road transport operators as the most effective response to the pandemic. The breakdown continues in descending order thus: COVID-19 safety protocols, environmental sanitation, and promotion of hygiene, information technology, facemask, and social distancing. Others are public enlightenment, palliative, inclusion, and mass media. This indicates that non-pharmaceutical measures are very effective in the fight against the pandemic. This finding leverages support for the application of non-pharmaceutical guidelines in containing the COVID-19 pandemic in Nigeria.

Engaged learning during distraction: a case study of successful working moms in distance education

Adult learners are a significant proportion of distance learners and many of these students are working mothers. Several instructional design models center the learner, and this requires understanding the learner needs, strengths, and context. There is a gap in the literature describing the experience of modern working mother students in distance education. To understand this experience, the researchers interviewed and observed six academically high-achieving working mother students as they participated in their distance education courses during the pandemic. A discourse analysis approach was utilized to analyze the data. This extreme sample revealed several strategies that these students used to be successful despite their challenges. The findings suggest that understanding the experiences of distance learners as they study in the home are important for effective course design. More specifically, working mothers face significant distractions in their study environments, but the cognitive load can be reduced by making use of their prior knowledge, scaffolding instruction, and encouraging social presence. Additional strategies from the literature that address these constructs are provided for instructors and instructional designers.

The road to postpandemic recovery in the USA: a repeated cross-sectional survey of multidimensional well-being over two years

OBJECTIVES

Examine differences in multidimensional well-being from before (January 2020) to three timepoints during the COVID-19 pandemic (June 2020, January 2021, January 2022).

STUDY DESIGN

Repeated cross-sectional design.

METHODS

Nationally representative cross-sectional cohorts of US adults completed the Secure Flourish Index before (January 2020 cohort: N = 1010) and during the COVID-19 pandemic (June 2020 cohort: N = 3020; January 2021 cohort: N = 3366; January 2022 cohort: N = 2598). We estimated differences in indicators, domains, and composite well-being between the January 2020 cohort and each of the subsequent cohorts. We also explored whether changes in well-being between January 2020 and January 2022 varied based on age, gender, and race/ethnicity.

RESULTS

Initial declines in well-being observed by June 2020 were largely followed by a return to prepandemic levels in January 2022, with some exceptions. Notably, general declines in mental health have persisted through to January 2022. On the other hand, there was evidence of general improvements in character & virtue that exceeded prepandemic levels in January 2022. Young adults and racial/ethnic minorities reported lower financial & material stability in January 2022 compared to before the COVID-19 pandemic.

CONCLUSIONS

Although there are promising signs that the well-being of US adults has mostly recovered to prepandemic levels, a coordinated response is urgently needed to support population mental health and the financial security of vulnerable groups. As society continues the journey toward postpandemic recovery, continued tracking of multidimensional well-being will be important for making informed decisions about public health priorities.

Integrated Interventions to Bridge Medical and Social Care for People Living with Diabetes

Social drivers of health impact health outcomes for patients with diabetes, and are areas of interest to health systems, researchers, and policymakers. To improve population health and health outcomes, organizations are integrating medical and social care, collaborating with community partners, and seeking sustainable financing with payors. We summarize promising examples of integrated medical and social care from the Merck Foundation Bridging the Gap: Reducing Disparities in Diabetes Care initiative. The initiative funded eight organizations to implement and evaluate integrated medical and social care models, aiming to build a value case for services that are traditionally not eligible for reimbursement (e.g., community health workers, food prescriptions, patient navigation). This article summarizes promising examples and future opportunities for integrated medical and social care across three themes: (1) primary care transformation (e.g., social risk stratification) and workforce capacity (e.g., lay health worker interventions), (2) addressing individual social needs and structural changes, and (3) payment reform. Integrated medical and social care that advances health equity requires a significant paradigm shift in healthcare financing and delivery.

Gender expectations, socioeconomic inequalities and definitions of career success: A qualitative study with university students

Higher Education (HE) is seen as a tool to create job opportunities and enhance individuals' quality of life. Research demonstrates that students' expectations of career success in HE are an important predictor of their motivation and academic attainment. However, there is a lack of clarity about how career success is defined and whether individuals perceive that their experiences (e.g., gender) may be associated with these definitions. In online written interviews with 36 university students in the United Kingdom, we examine how students define career success and how they perceive their identity (gender, socioeconomic status) experiences underpinning these definitions. We analysed three main definitional themes: (a) career success as personal development, (b) career success as individual mobility, and (c) lack of clarity about what career success is. Findings suggest that gender and socioeconomic experiences had an important role in students' understanding of career success, especially for students from disadvantaged backgrounds. Indeed, in the intersection of gender and socioeconomic status, inequalities persist: female students anticipated difficulties in terms of work-life balance and gender stereotypes that constrained their career success definitions. Moreover, family experiences were important to understand students' definitions of career success, particularly for disadvantaged socioeconomic groups. The current research sheds light on an important paradox in HE organisations: while students tend to define career success in relatively individualistic ways, such as individual mobility, financial success, or personal development, it was clear that their social identities (e.g., gender, socioeconomic status) and related experiences played an important role in creating definitions of career success. This further implies that when universities encourage a perception of career success as individual mobility, for example, having better job opportunities, or by espousing the belief that higher education and/or professional sectors are truly meritocratic-this will not always align with, and may create tension for, students from disadvantaged groups.

Immunometabolic Signature during Respiratory Viral Infection: A Potential Target for Host-Directed Therapies

RNA viruses are known to induce a wide variety of respiratory tract illnesses, from simple colds to the latest coronavirus pandemic, causing effects on public health and the economy worldwide. Influenza virus (IV), parainfluenza virus (PIV), metapneumovirus (MPV), respiratory syncytial virus (RSV), rhinovirus (RhV), and coronavirus (CoV) are some of the most notable RNA viruses. Despite efforts, due to the high mutation rate, there are still no effective and scalable treatments that accompany the rapid emergence of new diseases associated with respiratory RNA viruses. Host-directed therapies have been applied to combat RNA virus infections by interfering with host cell factors that enhance the ability of immune cells to respond against those pathogens. The reprogramming of immune cell metabolism has recently emerged as a central mechanism in orchestrated immunity against respiratory viruses. Therefore, understanding the metabolic signature of immune cells during virus infection may be a promising tool for developing host-directed therapies. In this review, we revisit recent findings on the immunometabolic modulation in response to infection and discuss how these metabolic pathways may be used as targets for new therapies to combat illnesses caused by respiratory RNA viruses.

The psychological burden of COVID-19 on the desire for parenthood in minoritized sexual identities: a study on depressive symptoms and family planning in Germany

BACKGROUND

The COVID-19 pandemic continues to spread across the globe and is associated with significant clinical and humanitarian burden. The desire for parenthood has been described to be positively correlated with psychological well-being: An unfulfilled wish for parenthood is associated with impaired mental health, and the wish for parenthood is a predictor for the development of depressive symptoms. While higher rates of anxiety and depression have been reported in individuals with minoritized sexual identities (compared to heterosexual individuals) during the COVID-19 pandemic, the specific impact of the pandemic and its social restriction measures on this population is poorly understood.

METHODS

From April to July 2020, we conducted an anonymous cross-sectional survey online among N = 2463 adults living in Germany. We screened for depressive symptoms (Patient Health Questionnaire-4; PHQ-4) and assessed individuals' desire for parenthood during the pandemic, and motives for or against the desire for parenthood (Leipzig questionnaire on motives for having a child, Version 20; LKM-20), with the aim of identifying differences between individuals with minoritized sexual identities and heterosexual individuals.

RESULTS

Compared to heterosexual individuals (n = 1304), individuals with minoritized sexual identities (n = 831) indicated higher levels of depressive symptoms. In our study sample the majority of all participants (81.9%) reported no change in the desire for parenthood since the COVID-19 pandemic.

CONCLUSION

The findings underline the unmet need for social, psychological and medical support in regard to family-planning and the desire for parenthood during a pandemic. Furthermore, future research should explore COVID-19-related psychological consequences on individuals' desire for parenthood and building a family.