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Kim MK, Su GS, Chan ANY, Fu Y, Huang Y, Huang CC, Hires B, Chu MT. Mental health priorities and cultural-responsiveness of the Mental Health First Aid (MHFA) training for Asian immigrant populations in Greater Boston, Massachusetts. BMC Psychiatry 2024; 24:506. [PMID: 39014363 PMCID: PMC11251104 DOI: 10.1186/s12888-024-05894-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 06/05/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Asians and Asian Americans have the lowest rate of mental health service utilization (25%) in the US compared to other racial/ethnic groups (39 - 52%), despite high rates of depression, anxiety, and suicidal ideation. The lack of culturally-responsive mental health trainings hinders access to mental health services for these populations. We assessed the mental health priorities of Asian communities in Greater Boston and evaluated cultural responsiveness of the Mental Health First Aid (MHFA), a first-responder training teaching participants skills to recognize signs of mental health and substance use challenges, and how to appropriately respond. METHODS This is community-based participatory research with the Boston Chinatown Neighborhood Center (BCNC), Asian Women For Health (AWFH), and the Addressing Disparities in Asian Populations through Translational Research (ADAPT) Coalition. We conducted focus groups with community-based organization staff and community members to assess mental health priorities of Asian populations in Boston, MA. We then evaluated the utility and cultural-responsiveness of the English-language MHFA for Asian populations through pre- and post-training questionnaires and focus groups with community participants. Paired t-tests were used to evaluate questionnaire responses. Thematic analysis was used to analyze interviews. RESULTS In total, ten staff and eight community members participated in focus groups, and 24 community members completed the MHFA and pre- and post-training questionnaires. Common mental health challenges in the Asian communities reported by participants were loneliness, high stigma around mental illnesses, academic pressure, and acculturation stress. Compared to pre-training, MHFA participants demonstrated lower personal mental health stigma (p < 0.001) and higher mental health literacy (p = 0.04) post-training. Participants also noted the lack of data statistics and case studies relevant to Asian populations in the training, and desired the training be offered in languages spoken by Asian ethnic subgroups (e.g., Chinese, Vietnamese). CONCLUSION Cultural-responsiveness of the MHFA for Asian populations could be improved with the inclusion of data and case studies that capture common mental health challenges in the Asian communities and with translation of the MHFA to non-English languages predominant in Asian communities. Increasing the cultural relevance and language accessibility of the MHFA could facilitate wider adoption of these trainings across communities and help to reduce mental health stigma and gaps in literacy and service utilization.
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Affiliation(s)
- Min Kyung Kim
- Tufts Clinical and Translational Science Institute, Boston, MA, USA
| | - Grace S Su
- Boston Chinatown Neighborhood Center (BCNC), Boston, MA, USA
| | - Angel N Y Chan
- Boston Chinatown Neighborhood Center (BCNC), Boston, MA, USA
| | - Yuxin Fu
- Boston Chinatown Neighborhood Center (BCNC), Boston, MA, USA
| | - Yanqing Huang
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 35 Kneeland Street, Rm. 1004, Boston, MA, 02111, USA
| | | | - Ben Hires
- Boston Chinatown Neighborhood Center (BCNC), Boston, MA, USA
| | - MyDzung T Chu
- Tufts Clinical and Translational Science Institute, Boston, MA, USA.
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 35 Kneeland Street, Rm. 1004, Boston, MA, 02111, USA.
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Oliver J, Ferdinand A, Kaufman J, Allard N, Danchin M, Gibney KB. Community health workers' dissemination of COVID-19 information and services in the early pandemic response: a systematic review. BMC Health Serv Res 2024; 24:711. [PMID: 38849842 PMCID: PMC11161953 DOI: 10.1186/s12913-024-11165-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 06/03/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Community health workers (CHWs) had important roles mitigating the impact of the COVID-19 pandemic in vulnerable communities. We described how CHWs supported the dissemination of COVID-19 information and services during the early pandemic response. METHODS Online article searches were conducted across five scientific databases, with review article reference lists hand searched to identify grey/unpublished literature. Articles were included if they reported on a program that engaged CHWs and aimed to prevent/control COVID-19. RESULTS Nineteen relevant programs were identified from 18 included articles. CHWs were widely engaged in the pandemic response, especially in low- and middle-income countries and in vulnerable communities. CHWs' ability to effectively disseminate COVID-19 information/services was enabled by community trust and understanding community needs. CHWs were often underfunded and required to work in difficult conditions. Pre-existing services incorporating CHWs rapidly adapted to the new challenges brought by the pandemic. CONCLUSIONS We recommend establishing programs that employ CHWs to disseminate health information and services in communities at-risk of misinformation and poor health outcomes during non-pandemic times. CHWs are well-placed to deliver interventions should an infectious disease outbreak arise. Having pre-existing trusted relationships between CHWs and community members may help protect vulnerable groups, including when outbreaks occur.
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Affiliation(s)
- Jane Oliver
- Department of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, 792 Elizabeth St, Melbourne, VIC, 3000, Australia.
- Murdoch Children's Research Institute, Parkville, VIC, Australia.
| | - Angeline Ferdinand
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, 3000, Australia
| | - Jessica Kaufman
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, 3000, Australia
| | - Nicole Allard
- Department of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, 792 Elizabeth St, Melbourne, VIC, 3000, Australia
- cohealth, Melbourne, VIC, Australia
| | - Margie Danchin
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, 3000, Australia
- Department of General Medicine, The Royal Childrens Hospital, Melbourne, VIC, 3052, Australia
| | - Katherine B Gibney
- Department of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, 792 Elizabeth St, Melbourne, VIC, 3000, Australia
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Antonio AA, Anderson T, Ngo V, Park S, Woolner S, Farooq M, Santos R, Gorelick P. Diversity, Equity, and Inclusion Lessons From Developing Stroke Education Programs for West Michigan Asian Communities. Stroke 2024; 55:757-761. [PMID: 38299388 DOI: 10.1161/strokeaha.123.043092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 01/08/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Asians in the United States, facing health care disparities, have increased stroke risk. Multiple subgroups, with distinct cultures and languages, add complexity to caring for Asian American (AsA) communities. We developed a tailored stroke education program for underserved West Michigan AsA communities. Methodology, lessons learned, and diversity, equity, and inclusion insights are described. METHODS Neurology residents and faculty, in collaboration with trained community-specific navigators, developed culturally resonant stroke education that was tailored to meet the needs of specific self-identified West Michigan AsA communities. Educational and debriefing sessions were delivered over 6 months, following the Plan-Do-Study-Act model, to elucidate diversity, equity, and inclusion insights and improve materials and delivery methods. RESULTS Eighty-six non-English-speaking participants from 5 self-identified AsA communities (Burmese, Buddhist Vietnamese, Catholic Vietnamese, Chinese, and Nepali) attended educational stroke sessions. The average age of attendees was 57.6±13.2 years; most were females (70%). Diversity, equity, and inclusion insights included identification of Asian cultural beliefs about acute stroke treatment (eg, bloodletting), investigator insights (eg, need for kitchen-table programs), systemic barriers (eg, language), and mitigation strategies. CONCLUSIONS Institutions should consider the integration of equity-focused, trainee-influenced quality improvement projects, such as this culturally resonant stroke educational program for AsA, to enhance stroke care in these vulnerable communities.
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Affiliation(s)
- Aileen A Antonio
- Hauenstein Neurosciences, Trinity Health Grand Rapids, MI (A.A.A., T.A., V.N., S.P., S.W., M.F., R.S., P.G.)
| | - Taylor Anderson
- Hauenstein Neurosciences, Trinity Health Grand Rapids, MI (A.A.A., T.A., V.N., S.P., S.W., M.F., R.S., P.G.)
| | - Vincent Ngo
- Hauenstein Neurosciences, Trinity Health Grand Rapids, MI (A.A.A., T.A., V.N., S.P., S.W., M.F., R.S., P.G.)
| | - Sojung Park
- Hauenstein Neurosciences, Trinity Health Grand Rapids, MI (A.A.A., T.A., V.N., S.P., S.W., M.F., R.S., P.G.)
| | - Susan Woolner
- Hauenstein Neurosciences, Trinity Health Grand Rapids, MI (A.A.A., T.A., V.N., S.P., S.W., M.F., R.S., P.G.)
| | - Muhammad Farooq
- Hauenstein Neurosciences, Trinity Health Grand Rapids, MI (A.A.A., T.A., V.N., S.P., S.W., M.F., R.S., P.G.)
| | - Ronel Santos
- Hauenstein Neurosciences, Trinity Health Grand Rapids, MI (A.A.A., T.A., V.N., S.P., S.W., M.F., R.S., P.G.)
| | - Philip Gorelick
- Hauenstein Neurosciences, Trinity Health Grand Rapids, MI (A.A.A., T.A., V.N., S.P., S.W., M.F., R.S., P.G.)
- Davee Department of Neurology, Northwestern University, Chicago, IL (P.G.)
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Kader F, Cárdenas L, Lee M, Chebli P, Ðoàn LN, Kamler A, Yi SS, Scherer M. Making Oneself "Fit": Community Perspectives on Disaggregated Race and Ethnicity Data Collection and Reporting in Healthcare Settings. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01946-w. [PMID: 38411798 DOI: 10.1007/s40615-024-01946-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/28/2024]
Abstract
Patient race/ethnicity data collection in most U.S. health systems abide by federal standards, determined by the federal Office of Management and Budget. Yet, decades of research show that reliance on these categories alone limits understanding of within-group health disparities, systematically erasing key groups from health data. Because granular race/ethnicity data is complex and patients may be hesitant to disclose this personal information, it is important for health leaders to consider community perspectives when making decisions about race/ethnicity data procedures. As such, this study uses community focus groups to understand: (1) how individuals representing different racial/ethnic identities perceive the collection of race/ethnicity in healthcare settings; (2) differences in opinions between disaggregated race/ethnicity data collection instruments and those using federal standards; and (3) recommended practices for collecting race/ethnicity from patients. Participants self-selected into 13 focus groups and one key informant interview based on the race/ethnicity with which they most closely identified. Audio recordings from these groups were transcribed and evaluated using thematic content analysis. Among the 83 total participants in this study, there was a strong preference for more flexible and specific options for self-identifying race/ethnicity in healthcare settings. Participants also felt comfortable disclosing granular race/ethnicity to health providers but expressed discomfort with disclosing this information for other purposes. Recommendations for healthcare leaders include ensuring patients receive detailed communication about race/ethnicity data use and purpose, allowing multiple category selection, keeping the list of disaggregated response options short so as to not overwhelm patients, and providing a free text option to ensure inclusivity.
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Affiliation(s)
- Farah Kader
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
| | - Luisa Cárdenas
- Center for Evaluation and Applied Research, The New York Academy of Medicine, New York, NY, USA
| | - Matthew Lee
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Perla Chebli
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Lan N Ðoàn
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Alexandra Kamler
- Center for Evaluation and Applied Research, The New York Academy of Medicine, New York, NY, USA
| | - Stella S Yi
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Maya Scherer
- Center for Evaluation and Applied Research, The New York Academy of Medicine, New York, NY, USA
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Barajas-Gonzalez RG, Hoque S, Gutkin SL. Impact of the 2016 Presidential election and restrictive immigration climate on the work and wellbeing of Bangladeshi immigrant community frontline workers in New York City, U.S.A. JOURNAL OF COMMUNITY PRACTICE 2024; 32:68-85. [PMID: 38736564 PMCID: PMC11086678 DOI: 10.1080/10705422.2024.2310313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Community-based organizations (CBOs) are key players in mitigating the impact of restrictive policy changes on immigrant communities. The ability of these organizations to help diffuse the stress caused by restrictive, rapidly changing immigration policies depends, in part, on the capacity and health of their workforce. This study presents findings from a qualitative study conducted with 10 Bangladeshi community frontline workers working in various CBOs and advocacy organizations to understand their experience navigating a heightened anti-immigrant, anti-Muslim climate. Through thematic analyses, we inferred that the 2016 presidential election increased stress and mobilization among community frontline workers, with a meaningful distinction between participants working for immigration-focused institutions versus those in institutions where immigration issues were not the primary focus (e.g. health services, cultural programming). For those working in immigration-focused institutions, work burden increased due to challenges in managing misinformation, making sense of policy changes, and meeting the needs of families impacted by deportation. A toll on frontline workers' own physical health and mental health was discussed, as well as the need for culturally congruent mental health supports for the South Asian community.
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Affiliation(s)
| | - Sharmin Hoque
- Center for Early Childhood Health and Development, Department of Population Health, NYU Langone Health
| | - Stephanie L Gutkin
- Center for Early Childhood Health and Development, Department of Population Health, NYU Langone Health
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Choi SL, Hites L, Bolland AC, Lee J, Payne-Foster P, Bissell K. Telehealth uptake among middle-aged and older Americans during COVID-19: chronic conditions, social media communication, and race/ethnicity. Aging Ment Health 2024; 28:160-168. [PMID: 36450359 DOI: 10.1080/13607863.2022.2149696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVES This study investigated whether and to what extent constructs of the protection motivation theory of health (PMT)-threat appraisal (perceived vulnerability/severity) and coping appraisal (response efficacy and self-efficacy)-are related to telehealth engagement during the COVID-19 pandemic, and how these associations differ by race/ethnicity among middle-aged and older Americans. METHODS Data were from the 2020 Health and Retirement Study. Multivariable ordinary least-squares regression analyses were computed adjusting for health and sociodemographic factors. RESULTS Some PMT constructs are useful in understanding telehealth uptake. Perceived vulnerability/severity, particularly comorbidity (b = 0.13, 95% confidence interval (CI) [0.11, 0.15], p < 0.001), and response efficacy, particularly participation in communication via social media (b = 0.24, 95% CI [0.21, 0.27], p < 0.001), were significantly and positively associated with higher telehealth uptake during the COVID-19 pandemic among middle-aged and older Americans. Non-Hispanic Black adults were more likely to engage in telehealth during the pandemic than their non-Hispanic White counterparts (b = 0.20, 95% CI [0.12, 0.28], p < 0.001). Multiple moderation analyses revealed the significant association between comorbidity and telehealth uptake was similar across racial/ethnic groups, whereas the significant association between social media communication and telehealth uptake varied by race/ethnicity. Specifically, the association was significantly less pronounced for Hispanic adults (b = -0.11, 95% CI [-0.19, -0.04], p < 0.01) and non-Hispanic Asian/other races adults (b = -0.13, 95% CI [-0.26, -0.01], p < 0.05) than it was for their non-Hispanic White counterparts. CONCLUSION Results suggest the potential of using social media and telehealth to narrow health disparities, particularly serving as a bridge for members of underserved communities to telehealth uptake.
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Affiliation(s)
- Shinae L Choi
- Department of Consumer Sciences, College of Human Environmental Sciences, The University of Alabama, Tuscaloosa, AL, USA
- Center for Innovation in Social Science, College of Arts and Sciences, Boston University, Boston, MA, USA
| | - Lisle Hites
- Department of Community Medicine and Population Health, College of Community Health Sciences, The University of Alabama, Tuscaloosa, AL, USA
| | - Anneliese C Bolland
- Department of Communication Studies, College of Communication and Information Sciences, The University of Alabama, Tuscaloosa, AL, USA
| | - Jiyoung Lee
- Department of Journalism and Creative Media, College of Communication and Information Sciences, The University of Alabama, Tuscaloosa, AL, USA
| | - Pamela Payne-Foster
- Department of Community Medicine and Population Health, College of Community Health Sciences, The University of Alabama, Tuscaloosa, AL, USA
| | - Kimberly Bissell
- Department of Journalism and Creative Media, College of Communication and Information Sciences, The University of Alabama, Tuscaloosa, AL, USA
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Kim MK, Su GS, Chan ANY, Fu Y, Huang Y, Huang CC, Hires B, Chu M. Cultural-Responsiveness of the Mental Health First Aid Training for Asian Immigrant Populations in Greater Boston, Massachusetts. RESEARCH SQUARE 2023:rs.3.rs-3449868. [PMID: 38077079 PMCID: PMC10705687 DOI: 10.21203/rs.3.rs-3449868/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Background The COVID-19 pandemic and rise in anti-Asian racism have had adverse mental health impacts in Asian communities. The lack of culturally-responsive and linguistically-accessible mental health trainings hinders access to mental health services for Asian populations. In this study, we assessed the mental health needs of Asian communities in Greater Boston and evaluated cultural responsiveness of the Mental Health First Aid (MHFA), a first-responder training teaching participants skills to recognize signs of mental health and substance use challenges, and how to appropriately respond. Methods This community-based participatory research with the Boston Chinatown Neighborhood Center (BCNC), Asian Women For Health (AWFH), and the Addressing Disparities in Asian Populations through Translational Research (ADAPT) Coalition employed two phases. In phase 1, we conducted focus groups with BCNC and AWFH staff and peer educators to assess mental health priorities of Asian populations in Boston. Findings informed phase 2, which evaluated cultural responsiveness of the MHFA through pre- and post-training questionnaires and focus groups with community participants. The pre-training questionnaire asked about mental health needs and barriers, help-seeking behaviors, and literacy; and personal and Asian community stigma. The post-training questionnaire and focus group with community participants asked about cultural competence of MHFA training for Asian populations. Paired t-tests were used to evaluate questionnaire responses. Thematic analysis was used to analyze interviews. Results In total, 10 staff/educators and 8 community members participated in focus groups. They identified common mental health needs and workforce and culturally-responsive community strategies to support persons with mental health issues. Twenty-four community participants completed pre- and post-training questionnaires. They reported the MHFA training reduced mental health care stigma and increased mental health literacy. Recommendations to increase cultural-responsiveness of the MHFA were to include mental health case studies common in Asian populations and provide the training in other languages (e.g., Chinese, Vietnamese). Conclusion Cultural responsiveness of the MHFA for Asian populations could be improved with the inclusion of case studies specific to the Asian communities and accessibility of the training in other languages. Increasing the cultural relevance and language accessibility of these trainings could help reduce mental health stigma and gaps in mental health awareness and service utilization among Asian populations.
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Affiliation(s)
| | - Grace S Su
- Boston Chinatown Neighborhood Center (BCNC)
| | | | - Yuxin Fu
- Boston Chinatown Neighborhood Center (BCNC)
| | - Yanqing Huang
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center
| | | | - Ben Hires
- Boston Chinatown Neighborhood Center (BCNC)
| | - MyDzung Chu
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center
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Qi JZ, Weller SC. Factors Associated with COVID-19 Vaccine Uptake Among High School Students in a Large, Diverse Metropolitan Area. THE JOURNAL OF SCHOOL HEALTH 2023; 93:1070-1078. [PMID: 37528550 DOI: 10.1111/josh.13379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Because previous studies on adolescent COVID-19 attitudes focused on intent to get vaccinated, this study examined attitudinal factors and racial/ethnic differences associated with vaccine uptake. METHODS In a cross-sectional survey of a metropolitan high school district, students were asked about their COVID-19 attitudes, information sources, and whether they had been vaccinated. Logistic regression predicted vaccination status and adjusted odds ratios (aOR) controlled for race/ethnicity. RESULTS Being unvaccinated was associated with themes of distrust with concerns about vaccine newness (aOR: 0.10; 95% confidence intervals [CI]: 0.06-0.15), side effects (aOR: 0.22; 95% CI: 0.15-0.33), efficacy (aOR: 0.25; 95% CI: 0.17-0.38), distrust of vaccines (aOR: 0.16; 95% CI: 0.09-0.27), government oversight (aOR: 0.19; 95% CI: 0.13-0.30), and politicization (aOR: 0.60; 95% CI: 0.41-0.88). Vaccine uptake was influenced by official information sources, school closures, and vaccine availability. The majority of vaccinated and unvaccinated students trusted primary care professionals as a source for COVID-19 information, but their influence varied across race/ethnic groups. CONCLUSIONS Trust and distrust were the main themes of vaccinated and unvaccinated students, respectively. Incorporating trusted information sources (primary care professionals) in information dissemination efforts may improve vaccine uptake.
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Affiliation(s)
- Jeffrey Z Qi
- Carnegie Vanguard High School, 1501 Taft St, Houston, TX, 77019
| | - Susan C Weller
- Department of Population Science, School of Public Health, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-1153
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Nyachoti DO, Ranjit N, Ramphul R, Whigham LD, Springer AE. Association of Social Vulnerability and COVID-19 Mortality Rates in Texas between 15 March 2020, and 21 July 2022: An Ecological Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6985. [PMID: 37947543 PMCID: PMC10647229 DOI: 10.3390/ijerph20216985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/10/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Despite the key role of social vulnerability such as economic disadvantage in health outcomes, research is limited on the impact of social vulnerabilities on COVID-19-related deaths, especially at the state and county level in the USA. METHODS We conducted a cross-sectional ecologic analysis of COVID-19 mortality by the county-level Minority Health Social Vulnerability Index (MH SVI) and each of its components in Texas. Negative binomial regression (NBR) analyses were used to estimate the association between the composite MH SVI (and its components) and COVID-19 mortality. RESULTS A 0.1-unit increase in the overall MH SVI (IRR, 1.27; 95% CI, 1.04-1.55; p = 0.017) was associated with a 27% increase in the COVID-19 mortality rate. Among the MH SVI component measures, only low socioeconomic status (IRR, 1.55; 95% CI, 1.28-1.89; p = 0.001) and higher household composition (e.g., proportion of older population per county) and disability scores (IRR, 1.47; 95% CI, 1.29-1.68; p < 0.001) were positively associated with COVID-19 mortality rates. CONCLUSIONS This study provides further evidence of disparities in COVID-19 mortality by social vulnerability and can inform decisions on the allocation of social resources and services as a strategy for reducing COVID-19 mortality rates and similar pandemics in the future.
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Affiliation(s)
- Dennis Ogeto Nyachoti
- Epidemiology and Surveillance Unit, Texas Department of State Health Services, 201 W Howard Ln, Austin, TX 78753, USA
- Department of Health Promotion and Behavioral Sciences, Center for Community Health Impact, The University of Texas Health Science Center at Houston School of Public Health, 5130 Gateway Boulevard East MCA 110, El Paso, TX 79905, USA;
| | - Nalini Ranjit
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 1616 Guadalupe, Austin, TX 78701, USA;
| | - Ryan Ramphul
- Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, 1200 Pressler Street, Houston, TX 77030, USA;
| | - Leah D. Whigham
- Department of Health Promotion and Behavioral Sciences, Center for Community Health Impact, The University of Texas Health Science Center at Houston School of Public Health, 5130 Gateway Boulevard East MCA 110, El Paso, TX 79905, USA;
| | - Andrew E. Springer
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 1616 Guadalupe, Austin, TX 78701, USA;
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Han X, Yang NN, Nogueira L, Jiang C, Wagle NS, Zhao J, Shi KS, Fan Q, Schafer E, Yabroff KR, Jemal A. Changes in cancer diagnoses and stage distribution during the first year of the COVID-19 pandemic in the USA: a cross-sectional nationwide assessment. Lancet Oncol 2023; 24:855-867. [PMID: 37541271 DOI: 10.1016/s1470-2045(23)00293-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/05/2023] [Accepted: 06/14/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND The emergence of COVID-19 disrupted health care, with consequences for cancer diagnoses and outcomes, especially for early stage diagnoses, which generally have favourable prognoses. We aimed to examine nationwide changes in adult cancer diagnoses and stage distribution during the first year of the COVID-19 pandemic by cancer type and key sociodemographic factors in the USA. METHODS In this cross-sectional study, adults (aged ≥18 years) newly diagnosed with a first primary malignant cancer between Jan 1, 2018, and Dec 31, 2020, were identified from the US National Cancer Database. We included individuals across 50 US states and the District of Columbia who were treated in hospitals that were Commission on Cancer-accredited during the study period. Individuals whose cancer stage was 0 (except for bladder cancer), occult, or without an applicable American Joint Committee on Cancer staging scheme were excluded. Our primary outcomes were the change in the number and the change in the stage distribution of new cancer diagnoses between 2019 (Jan 1 to Dec 31) and 2020 (Jan 1 to Dec 31). Monthly counts and stage distributions were calculated for all cancers combined and for major cancer types. We also calculated annual change in stage distribution from 2019 to 2020 and adjusted odds ratios (aORs) using multivariable logistic regression, adjusted for age group, sex, race and ethnicity, health insurance status, comorbidity score, US state, zip code-level social deprivation index, and county-level age-adjusted COVID-19 mortality in 2020. Separate models were stratified by sociodemographic and clinical factors. FINDINGS We identified 2 404 050 adults who were newly diagnosed with cancer during the study period (830 528 in 2018, 849 290 in 2019, and 724 232 in 2020). Mean age was 63·5 years (SD 13·5) and 1 287 049 (53·5%) individuals were women, 1 117 001 (46·5%) were men, and 1 814 082 (75·5%) were non-Hispanic White. The monthly number of new cancer diagnoses (all stages) decreased substantially after the start of the COVID-19 pandemic in March, 2020, although monthly counts returned to near pre-pandemic levels by the end of 2020. The decrease in diagnoses was largest for stage I disease, leading to lower odds of being diagnosed with stage I disease in 2020 than in 2019 (aOR 0·946 [95% CI 0·939-0·952] for stage I vs stage II-IV); whereas, the odds of being diagnosed with stage IV disease were higher in 2020 than in 2019 (1·074 [1·066-1·083] for stage IV vs stage I-III). This pattern was observed in most cancer types and sociodemographic groups, although was most prominent among Hispanic individuals (0·922 [0·899-0·946] for stage I; 1·110 [1·077-1·144] for stage IV), Asian American and Pacific Islander individuals (0·924 [0·892-0·956] for stage I; 1·096 [1·052-1·142] for stage IV), uninsured individuals (0·917 [0·875-0·961] for stage I; 1·102 [1·055-1·152] for stage IV), Medicare-insured adults younger than 65 years (0·909 [0·882-0·937] for stage I; 1·105 [1·068-1·144] for stage IV), and individuals living in the most socioeconomically deprived areas (0·931 [0·917-0·946] for stage I; 1·106 [1·087-1·125] for stage IV). INTERPRETATION Substantial cancer underdiagnosis and decreases in the proportion of early stage diagnoses occurred during 2020 in the USA, particularly among medically underserved individuals. Monitoring the long-term effects of the pandemic on morbidity, survival, and mortality is warranted. FUNDING None.
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Affiliation(s)
- Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA.
| | - Nuo Nova Yang
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Leticia Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Changchuan Jiang
- Division of Hematology and Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nikita Sandeep Wagle
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Jingxuan Zhao
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Kewei Sylvia Shi
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Qinjin Fan
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Elizabeth Schafer
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
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Lin M. Khmer Girls in Action and healing justice: Expanding understandings of anti-Asian racism and public health solutions. Front Public Health 2022; 10:956308. [PMID: 36605235 PMCID: PMC9807656 DOI: 10.3389/fpubh.2022.956308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/07/2022] [Indexed: 12/24/2022] Open
Abstract
This community case study highlights how Khmer Girls in Action (KGA), a Southeast Asian young women-led organizing group in Long Beach, California, enacts healing justice. Healing justice is a framework for both transforming structures at the crux of health inequities and healing emotional, spiritual, and psychological wounds inflicted by structural violence. KGA also anchors the cross-racial and intersectional Invest in Youth (IIY-LB) coalition. IIY-LB youth leaders have successfully fought to increase the city's investments in the social determinants of health, especially young people's well-being. Meanwhile, the coalition has critiqued over-investments in criminalization and policing as devastating Black, Brown, queer, low-income, immigrant, and refugee youth and communities. This case study highlights how KGA's work expands understandings of both anti-Asian racism and public health solutions in the following ways: First, KGA cultivates youth leaders' critical analyses to define root causes of health inequities impacting Southeast Asian refugees as rooted in imperialism, disinvestment, and increased criminalization. Furthermore, youth leaders come to understand how their communities' struggles and liberation necessitate intersectional and cross-racial coalitions. Second, youth leaders forge public health solutions that involve divesting from criminalization and institutionalizing an Office of Youth Development, as co-created with young people. Third, KGA and other IIY-LB organizations cultivate youth's leadership skills and community's political power to move hearts and minds of decision-makers and community members. For example, youth leaders have passed a ballot measure funding youth, climate, and health programs in addition to the city-based Office of Youth Development. Fourth, KGA engages in a wide range of "inward" healing practices to salve wounds caused by intergenerational trauma. This case study contributes to Asian American health equity by highlighting the specific importance of organizing, while illuminating abolitionist perspectives on public health solutions- both of which are under-discussed in discourse about anti-Asian racism. KGA's work thus illustrates the importance of centering critical analyses and leadership of communities most impacted by structural violence in forging transformative public health solutions to anti-Asian racism.
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