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D'Agostino EM, Ramirez Garcia JI, Bakken SR, Wruck L, Nilles EK, Stefano TA, Martin HR, Hungler A, Lee RE, Perreira KM, Baum MK, Brown D. Examining COVID-19 testing and vaccination behaviors by heritage and linguistic preferences among Hispanic, Latino, or Spanish RADx-UP participants. Prev Med Rep 2023; 35:102359. [PMID: 37584063 PMCID: PMC10424123 DOI: 10.1016/j.pmedr.2023.102359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/17/2023] Open
Abstract
The Hispanic, Latino, or Spanish (hereafter, "Hispanic") populations in the U.S. bear a disproportionate burden of COVID-19-related outcomes, including disease incidence and mortality. Developing culturally appropriate national public health services for Hispanic persons remains a challenge. This study examined the association of heritage and language preference with COVID-19 testing (tested vs. not tested) and vaccination (vaccinated vs. not vaccinated) outcomes among Hispanic participants from 18 Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) projects (n = 3308; mean age = 44.1 years [SD = 14.9], 60% women; 83% spoke other than English at home). Generalized estimating equation models adjusted for age, gender, education level, income, insurance coverage, geographic region, comorbidities, and prior infection. Relative to Mexican heritage, individuals identifying as Puerto Rican or Dominican were more likely to test for COVID-19, and South American heritage was associated with higher testing and vaccination rates. Speaking Spanish or another language at home was associated with increased testing compared with speaking English at home for individuals who preferred not to report their heritage, and increased vaccination for those with Mexican, Cuban, or Central American heritage. This study highlights heterogeneity in testing and vaccination behaviors among Hispanic populations based on heritage and language preference, underscoring the diversity within the U.S. Hispanic community. In contrast to other studies on linguistic acculturation and health care utilization, our study found that a language other than English spoken at home was associated with greater vaccine uptake. That is, enculturation - the retention of Spanish language and presumably of Hispanic cultural norms - was linked with being vaccinated.
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Affiliation(s)
- Emily M. D'Agostino
- Department of Orthopaedic Surgery, Occupational Therapy Doctorate Division, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Duke University School of Medicine, Durham, NC, USA
| | - Jorge I. Ramirez Garcia
- Oregon Research Institute & Prevention Science Institute, University of Oregon, Eugene, OR, USA
| | - Suzanne R. Bakken
- School of Nursing, Department of Biomedical Informatics, Data Science Institute, Columbia University, New York, NY, USA
| | - Lisa Wruck
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Ester Kim Nilles
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Troy A. Stefano
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Haley R. Martin
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Annette Hungler
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Rebecca E. Lee
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Krista M. Perreira
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Marianna K. Baum
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - David Brown
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
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Bledsoe J, Woller SC, Brooks M, Sciurba FC, Krishnan JA, Martin D, Hou P, Lin JY, Kindzelski A, Handberg E, Kirwan BA, Zaharris E, Castro L, Shapiro NL, Pepine CJ, Majercik S, Fu Z, Zhong Y, Venugopal V, Lai YH, Ridker PM, Connors JM. Clinically stable covid-19 patients presenting to acute unscheduled episodic care venues have increased risk of hospitalization: secondary analysis of a randomized control trial. BMC Infect Dis 2023; 23:325. [PMID: 37189091 PMCID: PMC10184108 DOI: 10.1186/s12879-023-08295-9] [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: 08/30/2022] [Accepted: 04/30/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Assessment for risks associated with acute stable COVID-19 is important to optimize clinical trial enrollment and target patients for scarce therapeutics. To assess whether healthcare system engagement location is an independent predictor of outcomes we performed a secondary analysis of the ACTIV-4B Outpatient Thrombosis Prevention trial. METHODS A secondary analysis of the ACTIV-4B trial that was conducted at 52 US sites between September 2020 and August 2021. Participants were enrolled through acute unscheduled episodic care (AUEC) enrollment location (emergency department, or urgent care clinic visit) compared to minimal contact (MC) enrollment (electronic contact from test center lists of positive patients).We report the primary composite outcome of cardiopulmonary hospitalizations, symptomatic venous thromboembolism, myocardial infarction, stroke, transient ischemic attack, systemic arterial thromboembolism, or death among stable outpatients stratified by enrollment setting, AUEC versus MC. A propensity score for AUEC enrollment was created, and Cox proportional hazards regression with inverse probability weighting (IPW) was used to compare the primary outcome by enrollment location. RESULTS Among the 657 ACTIV-4B patients randomized, 533 (81.1%) with known enrollment setting data were included in this analysis, 227 from AUEC settings and 306 from MC settings. In a multivariate logistic regression model, time from COVID test, age, Black race, Hispanic ethnicity, and body mass index were associated with AUEC enrollment. Irrespective of trial treatment allocation, patients enrolled at an AUEC setting were 10-times more likely to suffer from the adjudicated primary outcome, 7.9% vs. 0.7%; p < 0.001, compared with patients enrolled at a MC setting. Upon Cox regression analysis adjustment patients enrolled at an AUEC setting remained at significant risk of the primary composite outcome, HR 3.40 (95% CI 1.46, 7.94). CONCLUSIONS Patients with clinically stable COVID-19 presenting to an AUEC enrollment setting represent a population at increased risk of arterial and venous thrombosis complications, hospitalization for cardiopulmonary events, or death, when adjusted for other risk factors, compared with patients enrolled at a MC setting. Future outpatient therapeutic trials and clinical therapeutic delivery programs of clinically stable COVID-19 patients may focus on inclusion of higher-risk patient populations from AUEC engagement locations. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04498273.
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Affiliation(s)
- Joseph Bledsoe
- Intermountain Healthcare, Emergency Medicine and Trauma, Salt Lake City, UT, USA.
- Intermountain Medical Center, Department of Medicine, 5121 S. Cottonwood Drive, Murray, UT, 84157, USA.
| | - Scott C Woller
- Intermountain Medical Center, Department of Medicine, 5121 S. Cottonwood Drive, Murray, UT, 84157, USA
| | - Maria Brooks
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Frank C Sciurba
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jerry A Krishnan
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois, Chicago, IL, USA
| | - Deborah Martin
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Peter Hou
- Brigham and Women's Hospital, Boston, MA, USA
| | - Janet Y Lin
- Department of Emergency Medicine, University of Illinois, Chicago, IL, USA
| | | | - Eileen Handberg
- School of Medicine, University of Florida, Gainesville, FL, USA
| | | | | | - Lauren Castro
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois, Chicago, IL, USA
| | - Nancy L Shapiro
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois, Chicago, IL, USA
| | - Carl J Pepine
- School of Medicine, University of Florida, Gainesville, FL, USA
| | - Sarah Majercik
- Intermountain Healthcare, Emergency Medicine and Trauma, Salt Lake City, UT, USA
| | - Zhuxuan Fu
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yongqi Zhong
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vidya Venugopal
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yu-Hsuan Lai
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Adhikari EH, Lu P, Kang YJ, McDonald AR, Pruszynski JE, Bates TA, McBride SK, Trank-Greene M, Tafesse FG, Lu LL. Diverging maternal and infant cord antibody functions from SARS-CoV-2 infection and vaccination in pregnancy. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.05.01.538955. [PMID: 37205338 PMCID: PMC10187183 DOI: 10.1101/2023.05.01.538955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Immunization in pregnancy is a critical tool that can be leveraged to protect the infant with an immature immune system but how vaccine-induced antibodies transfer to the placenta and protect the maternal-fetal dyad remains unclear. Here, we compare matched maternal-infant cord blood from individuals who in pregnancy received mRNA COVID-19 vaccine, were infected by SARS-CoV-2, or had the combination of these two immune exposures. We find that some but not all antibody neutralizing activities and Fc effector functions are enriched with vaccination compared to infection. Preferential transport to the fetus of Fc functions and not neutralization is observed. Immunization compared to infection enriches IgG1-mediated antibody functions with changes in antibody post-translational sialylation and fucosylation that impact fetal more than maternal antibody functional potency. Thus, vaccine enhanced antibody functional magnitude, potency and breadth in the fetus are driven more by antibody glycosylation and Fc effector functions compared to maternal responses, highlighting prenatal opportunities to safeguard newborns as SARS-CoV-2 becomes endemic.
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Affiliation(s)
- Emily H. Adhikari
- Division of Maternal-Fetal Medicine and Department of Obstetrics and Gynecology, UTSW Medical Center, Dallas, TX
- Parkland Health, Dallas TX
| | - Pei Lu
- Division of Infectious Diseases and Geographic Medicine and Department of Internal Medicine, UTSW Medical Center, Dallas, TX
| | - Ye jin Kang
- Division of Infectious Diseases and Geographic Medicine and Department of Internal Medicine, UTSW Medical Center, Dallas, TX
| | - Ann R. McDonald
- Division of Infectious Diseases and Geographic Medicine and Department of Internal Medicine, UTSW Medical Center, Dallas, TX
| | - Jessica E. Pruszynski
- Division of Maternal-Fetal Medicine and Department of Obstetrics and Gynecology, UTSW Medical Center, Dallas, TX
| | - Timothy A. Bates
- Department of Microbiology and Immunology, Oregon Health and Science University, Portland, OR
| | - Savannah K. McBride
- Department of Microbiology and Immunology, Oregon Health and Science University, Portland, OR
| | - Mila Trank-Greene
- Department of Microbiology and Immunology, Oregon Health and Science University, Portland, OR
| | - Fikadu G. Tafesse
- Department of Microbiology and Immunology, Oregon Health and Science University, Portland, OR
| | - Lenette L. Lu
- Parkland Health, Dallas TX
- Division of Infectious Diseases and Geographic Medicine and Department of Internal Medicine, UTSW Medical Center, Dallas, TX
- Department of Immunology, UTSW Medical Center, Dallas, TX
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Jenks JD, Aneke CI, Al-Obaidi MM, Egger M, Garcia L, Gaines T, Hoenigl M, Thompson GR. Race and ethnicity: Risk factors for fungal infections? PLoS Pathog 2023; 19:e1011025. [PMID: 36602962 DOI: 10.1371/journal.ppat.1011025] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Racial and ethnic identities, largely understood as social rather than biologic constructs, may impact risk for acquiring infectious diseases, including fungal infections. Risk factors may include genetic and immunologic differences such as aberrations in host immune response, host polymorphisms, and epigenomic factors stemming from environmental exposures and underlying social determinants of health. In addition, certain racial and ethnic groups may be predisposed to diseases that increase risk for fungal infections, as well as disparities in healthcare access and health insurance. In this review, we analyzed racial and ethnic identities as risk factors for acquiring fungal infections, as well as race and ethnicity as they relate to risk for severe disease from fungal infections. Risk factors for invasive mold infections such as aspergillosis largely appear related to environmental differences and underlying social determinants of health, although immunologic aberrations and genetic polymorphisms may contribute in some circumstances. Although black and African American individuals appear to be at high risk for superficial and invasive Candida infections and cryptococcosis, the reasons for this are unclear and may be related to underling social determinants of health, disparities in access to healthcare, and other socioeconomic disparities. Risk factors for all the endemic fungi are likely largely related to underlying social determinants of health, socioeconomic, and health disparities, although immunologic mechanisms likely play a role as well, particularly in disseminated coccidioidomycosis.
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Affiliation(s)
- Jeffrey D Jenks
- Durham County Department of Public Health, Durham, North Carolina, United States of America
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Chioma Inyang Aneke
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, Maryland, United States of America
- Department of Veterinary Pathology and Microbiology, University of Nigeria, Nsukka, Nigeria
| | - Mohanad M Al-Obaidi
- Division of Infectious Diseases, Department of Medicine, University of Arizona, Tucson, Arizona, United States of America
| | - Matthias Egger
- Division of Infectious Diseases, Medical University of Graz, Graz, Austria
| | - Lorena Garcia
- Department of Public Health Sciences, UC Davis School of Medicine, Davis, California, United States of America
| | - Tommi Gaines
- Division of Infectious Diseases and Global Public Health, Department of Medicine, School of Medicine, University of California, San Diego, California, United States of America
| | - Martin Hoenigl
- Division of Infectious Diseases, Medical University of Graz, Graz, Austria
- Division of Infectious Diseases and Global Public Health, Department of Medicine, School of Medicine, University of California, San Diego, California, United States of America
| | - George R Thompson
- University of California Davis Center for Valley Fever, Sacramento, California, United States of America
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, California, United States of America
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, California, United States of America
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Spangler KR, Levy JI, Fabian MP, Haley BM, Carnes F, Patil P, Tieskens K, Klevens RM, Erdman EA, Troppy TS, Leibler JH, Lane KJ. Missing Race and Ethnicity Data among COVID-19 Cases in Massachusetts. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01387-3. [PMID: 36056195 PMCID: PMC9439275 DOI: 10.1007/s40615-022-01387-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 11/30/2022]
Abstract
Infectious disease surveillance frequently lacks complete information on race and ethnicity, making it difficult to identify health inequities. Greater awareness of this issue has occurred due to the COVID-19 pandemic, during which inequities in cases, hospitalizations, and deaths were reported but with evidence of substantial missing demographic details. Although the problem of missing race and ethnicity data in COVID-19 cases has been well documented, neither its spatiotemporal variation nor its particular drivers have been characterized. Using individual-level data on confirmed COVID-19 cases in Massachusetts from March 2020 to February 2021, we show how missing race and ethnicity data: (1) varied over time, appearing to increase sharply during two different periods of rapid case growth; (2) differed substantially between towns, indicating a nonrandom distribution; and (3) was associated significantly with several individual- and town-level characteristics in a mixed-effects regression model, suggesting a combination of personal and infrastructural drivers of missing data that persisted despite state and federal data-collection mandates. We discuss how a variety of factors may contribute to persistent missing data but could potentially be mitigated in future contexts.
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Affiliation(s)
- Keith R Spangler
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA.
| | - Jonathan I Levy
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - M Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Beth M Haley
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Fei Carnes
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Prasad Patil
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Koen Tieskens
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - R Monina Klevens
- MA Department of Public Health, Bureau of Infectious Disease and Laboratory Sciences, Boston, MA, USA
| | - Elizabeth A Erdman
- MA Department of Public Health, Office of Population Health, Boston, MA, USA
| | - T Scott Troppy
- MA Department of Public Health, Bureau of Infectious Disease and Laboratory Sciences, Boston, MA, USA
| | - Jessica H Leibler
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Kevin J Lane
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
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Aliseda-Alonso A, Lis SBD, Lee A, Pond EN, Blauer B, Rutkow L, Nuzzo JB. The Missing COVID-19 Demographic Data: A Statewide Analysis of COVID-19-Related Demographic Data From Local Government Sources and a Comparison With Federal Public Surveillance Data. Am J Public Health 2022; 112:1161-1169. [PMID: 35830674 PMCID: PMC9342811 DOI: 10.2105/ajph.2022.306892] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To collect and standardize COVID-19 demographic data published by local public-facing Web sites and analyze how this information differs from Centers for Disease Control and Prevention (CDC) public surveillance data. Methods. We aggregated and standardized COVID-19 data on cases and deaths by age, gender, race, and ethnicity from US state and territorial governmental sources between May 24 and June 4, 2021. We describe the standardization process and compare it with the CDC's process for public surveillance data. Results. As of June 2021, the CDC's public demographic data set included 80.9% of total cases and 46.7% of total deaths reported by states, with significant variation across jurisdictions. Relative to state and territorial data sources, the CDC consistently underreports cases and deaths among African American and Hispanic or Latino individuals and overreports deaths among people older than 65 years and White individuals. Conclusions. Differences exist in amounts of data included and demographic composition between the CDC's public surveillance data and state and territory reporting, with large heterogeneity across jurisdictions. A lack of standardization and reporting mechanisms limits the production of complete real-time demographic data.
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Affiliation(s)
- Angel Aliseda-Alonso
- Angel Aliseda-Alonso, Sara Bertran de Lis, Adam Lee, and Beth Blauer are with the Centers for Civic Impact, Johns Hopkins University, Baltimore, MD. Emily N. Pond is with the Center for Health Security, Johns Hopkins University Bloomberg School of Public Health. Lainie Rutkow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. Jennifer B. Nuzzo is with the Center for Health Security, the Department of Environmental Health and Engineering, and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
| | - Sara Bertran de Lis
- Angel Aliseda-Alonso, Sara Bertran de Lis, Adam Lee, and Beth Blauer are with the Centers for Civic Impact, Johns Hopkins University, Baltimore, MD. Emily N. Pond is with the Center for Health Security, Johns Hopkins University Bloomberg School of Public Health. Lainie Rutkow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. Jennifer B. Nuzzo is with the Center for Health Security, the Department of Environmental Health and Engineering, and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
| | - Adam Lee
- Angel Aliseda-Alonso, Sara Bertran de Lis, Adam Lee, and Beth Blauer are with the Centers for Civic Impact, Johns Hopkins University, Baltimore, MD. Emily N. Pond is with the Center for Health Security, Johns Hopkins University Bloomberg School of Public Health. Lainie Rutkow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. Jennifer B. Nuzzo is with the Center for Health Security, the Department of Environmental Health and Engineering, and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
| | - Emily N Pond
- Angel Aliseda-Alonso, Sara Bertran de Lis, Adam Lee, and Beth Blauer are with the Centers for Civic Impact, Johns Hopkins University, Baltimore, MD. Emily N. Pond is with the Center for Health Security, Johns Hopkins University Bloomberg School of Public Health. Lainie Rutkow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. Jennifer B. Nuzzo is with the Center for Health Security, the Department of Environmental Health and Engineering, and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
| | - Beth Blauer
- Angel Aliseda-Alonso, Sara Bertran de Lis, Adam Lee, and Beth Blauer are with the Centers for Civic Impact, Johns Hopkins University, Baltimore, MD. Emily N. Pond is with the Center for Health Security, Johns Hopkins University Bloomberg School of Public Health. Lainie Rutkow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. Jennifer B. Nuzzo is with the Center for Health Security, the Department of Environmental Health and Engineering, and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
| | - Lainie Rutkow
- Angel Aliseda-Alonso, Sara Bertran de Lis, Adam Lee, and Beth Blauer are with the Centers for Civic Impact, Johns Hopkins University, Baltimore, MD. Emily N. Pond is with the Center for Health Security, Johns Hopkins University Bloomberg School of Public Health. Lainie Rutkow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. Jennifer B. Nuzzo is with the Center for Health Security, the Department of Environmental Health and Engineering, and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
| | - Jennifer B Nuzzo
- Angel Aliseda-Alonso, Sara Bertran de Lis, Adam Lee, and Beth Blauer are with the Centers for Civic Impact, Johns Hopkins University, Baltimore, MD. Emily N. Pond is with the Center for Health Security, Johns Hopkins University Bloomberg School of Public Health. Lainie Rutkow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. Jennifer B. Nuzzo is with the Center for Health Security, the Department of Environmental Health and Engineering, and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
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