1
|
Penrose K, Abraham A, Robertson M, Berry A, Xi Jasmine Chan B, Shen Y, Srivastava A, Balasubramanian S, Yadav S, Piltch-Loeb R, Nash D, Parcesepe AM. The association between emotional and physical intimate partner violence and COVID-19 vaccine uptake in a community-based U.S. Cohort. Prev Med Rep 2024; 43:102784. [PMID: 38938628 PMCID: PMC11209635 DOI: 10.1016/j.pmedr.2024.102784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 06/29/2024] Open
Abstract
Objective To estimate risk of being unvaccinated against COVID-19 by experience of intimate partner violence (IPV). Methods Among 3,343 partnered individuals in a community-based U.S. cohort, we quantified emotional and physical IPV experienced between March and December 2020 and estimated risk of being unvaccinated against COVID-19 through June 2021 by experience of IPV. Experience of recent IPV was defined as endorsement of more frequent or severe IPV since the start of the pandemic or report of any past-month IPV in at least one of four follow-up surveys conducted by the end of December 2020. We created a three-level composite variable - no experience of IPV, experience of emotional but not physical IPV, and experience of physical IPV. Results Cisgender women, non-binary, or transgender individuals who reported experiencing emotional, but not physical, IPV and those who reported experiencing physical IPV were both at significantly higher risk of being unvaccinated for COVID-19 compared to those who reported experiencing no IPV (ARRemotional violence: 1.28 [95 % CI: 1.09 - 1.51]; ARRphysical violence: 1.70 [95 % CI: 1.41 - 2.05]). Cisgender men who reported experiencing physical IPV were also at significantly higher risk of being unvaccinated for COVID-19 (ARRphysical violence: 1.52 [95 % CI: 1.15 - 2.02]). Conclusions IPV may increase the risk of low vaccine uptake. Results highlight the need to incorporate IPV prevention and support into public health responses, with targeted resources and consideration for reducing barriers to public health interventions among those impacted.
Collapse
Affiliation(s)
- Kate Penrose
- City University of New York (CUNY), Institute for Implementation Science in Population Health (ISPH), New York, NY, USA
| | - Ansu Abraham
- University of Michigan, School of Dentistry, Ann Arbor, MI, USA
| | - McKaylee Robertson
- City University of New York (CUNY), Institute for Implementation Science in Population Health (ISPH), New York, NY, USA
| | - Amanda Berry
- City University of New York (CUNY), Institute for Implementation Science in Population Health (ISPH), New York, NY, USA
| | - Bai Xi Jasmine Chan
- City University of New York (CUNY), Institute for Implementation Science in Population Health (ISPH), New York, NY, USA
| | - Yanhan Shen
- City University of New York (CUNY), Institute for Implementation Science in Population Health (ISPH), New York, NY, USA
- City University of New York (CUNY), Graduate School of Public Health and Health Policy, Department of Epidemiology and Biostatistics, New York, NY, USA
| | - Avantika Srivastava
- City University of New York (CUNY), Institute for Implementation Science in Population Health (ISPH), New York, NY, USA
- City University of New York (CUNY), Graduate School of Public Health and Health Policy, Department of Epidemiology and Biostatistics, New York, NY, USA
| | - Subha Balasubramanian
- City University of New York (CUNY), Institute for Implementation Science in Population Health (ISPH), New York, NY, USA
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC, USA
| | - Surabhi Yadav
- City University of New York (CUNY), Institute for Implementation Science in Population Health (ISPH), New York, NY, USA
- City University of New York (CUNY), Graduate School of Public Health and Health Policy, Department of Epidemiology and Biostatistics, New York, NY, USA
| | - Rachael Piltch-Loeb
- City University of New York (CUNY), Institute for Implementation Science in Population Health (ISPH), New York, NY, USA
- City University of New York (CUNY), Graduate School of Public Health and Health Policy, Department of Environmental Occupational and Geospatial Health Sciences, New York, NY, USA
| | - Denis Nash
- City University of New York (CUNY), Institute for Implementation Science in Population Health (ISPH), New York, NY, USA
- City University of New York (CUNY), Graduate School of Public Health and Health Policy, Department of Epidemiology and Biostatistics, New York, NY, USA
| | - Angela M. Parcesepe
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Maternal and Child Health, Chapel Hill, NC, USA
- University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, USA
| |
Collapse
|
2
|
Chan JK, Marzuki AA, Vafa S, Thanaraju A, Yap J, Chan XW, Harris HA, Todi K, Schaefer A. A systematic review on the relationship between socioeconomic conditions and emotional disorder symptoms during Covid-19: unearthing the potential role of economic concerns and financial strain. BMC Psychol 2024; 12:237. [PMID: 38671542 PMCID: PMC11046828 DOI: 10.1186/s40359-024-01715-8] [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: 06/23/2023] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Covid-19 has disrupted the lives of many and resulted in high prevalence rates of mental disorders. Despite a vast amount of research into the social determinants of mental health during Covid-19, little is known about whether the results are consistent with the social gradient in mental health. Here we report a systematic review of studies that investigated how socioeconomic condition (SEC)-a multifaceted construct that measures a person's socioeconomic standing in society, using indicators such as education and income, predicts emotional health (depression and anxiety) risk during the pandemic. Furthermore, we examined which classes of SEC indicators would best predict symptoms of emotional disorders. METHODS Following PRISMA guidelines, we conducted search over six databases, including Scopus, PubMed, etc., between November 4, 2021 and November 11, 2021 for studies that investigated how SEC indicators predict emotional health risks during Covid-19, after obtaining approval from PROSPERO (ID: CRD42021288508). Using Covidence as the platform, 362 articles (324 cross-sectional/repeated cross-sectional and 38 longitudinal) were included in this review according to the eligibility criteria. We categorized SEC indicators into 'actual versus perceived' and 'static versus fluid' classes to explore their differential effects on emotional health. RESULTS Out of the 1479 SEC indicators used in these 362 studies, our results showed that 43.68% of the SEC indicators showed 'expected' results (i.e., higher SEC predicting better emotional health outcomes); 51.86% reported non-significant results and 4.46% reported the reverse. Economic concerns (67.16% expected results) and financial strains (64.16%) emerged as the best predictors while education (26.85%) and living conditions (30.14%) were the worst. CONCLUSIONS This review summarizes how different SEC indicators influenced emotional health risks across 98 countries, with a total of 5,677,007 participants, ranging from high to low-income countries. Our findings showed that not all SEC indicators were strongly predictive of emotional health risks. In fact, over half of the SEC indicators studied showed a null effect. We found that perceived and fluid SEC indicators, particularly economic concerns and financial strain could best predict depressive and anxiety symptoms. These findings have implications for policymakers to further understand how different SEC classes affect mental health during a pandemic in order to tackle associated social issues effectively.
Collapse
Affiliation(s)
- Jee Kei Chan
- Department of Psychology, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia.
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia.
- Sunway University Malaysia, Room: 4-4-11, Jalan Lagoon Selatan, Bandar Sunway, Petaling Jaya, 47500, Selangor, Malaysia.
| | - Aleya A Marzuki
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Samira Vafa
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Arjun Thanaraju
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Jie Yap
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Xiou Wen Chan
- Department of Psychology, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Hanis Atasha Harris
- Department of Psychology, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Khushi Todi
- Department of Psychology, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Alexandre Schaefer
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| |
Collapse
|
3
|
Shen Y, Robertson MM, Kulkarni SG, Puzniak L, Zamparo JM, Allen KE, Porter TM, Qasmieh SA, Grov C, Srivastava A, Zimba R, McLaughlin JM, Nash D. Oral COVID-19 Antiviral Uptake Among a Highly Vaccinated US Cohort of Adults With SARS-CoV-2 Infection Between December 2021 and October 2022. Open Forum Infect Dis 2024; 11:ofad674. [PMID: 38344131 PMCID: PMC10854389 DOI: 10.1093/ofid/ofad674] [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: 07/21/2023] [Accepted: 12/19/2023] [Indexed: 02/18/2024] Open
Abstract
Background We described the oral nirmatrelvir/ritonavir (NMV/r) and molnupiravir (MOV) uptake among a subgroup of highly vaccinated adults in a US national prospective cohort who were infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between 12/2021 and 10/2022. Methods We estimate antiviral uptake within 5 days of SARS-CoV-2 infection, as well as age- and gender-adjusted antiviral uptake prevalence ratios by antiviral eligibility (based on age and comorbidities), sociodemographic characteristics, and clinical characteristics including vaccination status and history of long coronavirus disease 2019 (COVID). Results NMV/r uptake was 13.6% (95% CI, 11.9%-15.2%) among 1594 participants, and MOV uptake was 1.4% (95% CI, 0.8%-2.1%) among 1398 participants. NMV/r uptake increased over time (1.9%; 95% CI, 1.0%-2.9%; between 12/2021 and 3/2022; 16.5%; 95% CI, 13.0%-20.0%; between 4/2022 and 7/2022; and 25.3%; 95% CI, 21.6%-29.0%; between 8/2022 and 10/2022). Participants age ≥65 and those who had comorbidities for severe COVID-19 had higher NMV/r uptake. There was lower NMV/r uptake among non-Hispanic Black participants (7.2%; 95% CI, 2.4%-12.0%; relative to other racial/ethnic groups) and among individuals in the lowest income groups (10.6%; 95% CI, 7.3%-13.8%; relative to higher income groups). Among a subset of 278 participants with SARS-CoV-2 infection after 12/2021 who also had a history of prior SARS-CoV-2 infection, those with (vs without) a history of long COVID reported greater NMV/r uptake (22.0% vs 7.9%; P = .001). Among those prescribed NMV/r (n = 216), 137 (63%; 95% CI, 57%-70%) reported that NMV/r was helpful for reducing COVID-19 symptoms. Conclusions Despite proven effectiveness against severe outcomes, COVID-19 antiviral uptake remains low among those with SARS-CoV-2 infection in the United States. Further outreach to providers and patients to improve awareness of COVID-19 oral antivirals and indications is needed.
Collapse
Affiliation(s)
- Yanhan Shen
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, New York, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, New York, USA
| | - McKaylee M Robertson
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, New York, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, New York, USA
| | - Sarah G Kulkarni
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, New York, USA
| | | | | | | | | | - Saba A Qasmieh
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, New York, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, New York, USA
| | - Christian Grov
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, New York, USA
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, New York, USA
| | - Avantika Srivastava
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, New York, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, New York, USA
| | - Rebecca Zimba
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, New York, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, New York, USA
| | | | - Denis Nash
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, New York, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, New York, USA
| |
Collapse
|
4
|
Nash D, Srivastava A, Shen Y, Penrose K, Kulkarni SG, Zimba R, You W, Berry A, Mirzayi C, Maroko A, Parcesepe AM, Grov C, Robertson MM. Seroincidence of SARS-CoV-2 infection prior to and during the rollout of vaccines in a community-based prospective cohort of U.S. adults. Sci Rep 2024; 14:644. [PMID: 38182731 PMCID: PMC10770061 DOI: 10.1038/s41598-023-51029-9] [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: 10/09/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024] Open
Abstract
This study used repeat serologic testing to estimate infection rates and risk factors in two overlapping cohorts of SARS-CoV-2 N protein seronegative U.S. adults. One mostly unvaccinated sub-cohort was tracked from April 2020 to March 2021 (pre-vaccine/wild-type era, n = 3421), and the other, mostly vaccinated cohort, from March 2021 to June 2022 (vaccine/variant era, n = 2735). Vaccine uptake was 0.53% and 91.3% in the pre-vaccine and vaccine/variant cohorts, respectively. Corresponding seroconversion rates were 9.6 and 25.7 per 100 person-years. In both cohorts, sociodemographic and epidemiologic risk factors for infection were similar, though new risk factors emerged in the vaccine/variant era, such as having a child in the household. Despite higher incidence rates in the vaccine/variant cohort, vaccine boosters, masking, and social distancing were associated with substantially reduced infection risk, even through major variant surges.
Collapse
Affiliation(s)
- Denis Nash
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA.
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, USA.
- CUNY Graduate School of Public Health and Health Policy, 55 W. 125th St., 6th Floor, New York, NY, 10027, USA.
| | - Avantika Srivastava
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, USA
| | - Yanhan Shen
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, USA
| | - Kate Penrose
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA
| | - Sarah G Kulkarni
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA
| | - Rebecca Zimba
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, USA
| | - William You
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA
| | - Amanda Berry
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA
| | - Chloe Mirzayi
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, USA
| | - Andrew Maroko
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA
- Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, USA
| | - Angela M Parcesepe
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA
- Department of Maternal and Child Health, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christian Grov
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, USA
| | - McKaylee M Robertson
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA
| |
Collapse
|
5
|
Mikolai J, Dorey P, Keenan K, Kulu H. Spatial patterns of COVID-19 and non-COVID-19 mortality across waves of infection in England, Wales, and Scotland. Soc Sci Med 2023; 338:116330. [PMID: 37907058 DOI: 10.1016/j.socscimed.2023.116330] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 09/12/2023] [Accepted: 10/10/2023] [Indexed: 11/02/2023]
Abstract
Recent studies have established the key individual-level risk factors of COVID-19 mortality such as age, gender, ethnicity, and socio-economic status. However, the spread of infectious diseases is a spatial and temporal process implying that COVID-19 mortality and its determinants may vary sub-nationally and over time. We investigate the spatial patterns of age-standardised death rates due to COVID-19 and their correlates across local authority districts in England, Wales, and Scotland across three waves of infection. Using a Spatial Durbin model, we explore within- and between-country variation and account for spatial dependency. Areas with a higher share of ethnic minorities and higher levels of deprivation had higher rates of COVID-19 mortality. However, the share of ethnic minorities and population density in an area were more important predictors of COVID-19 mortality in earlier waves of the pandemic than in later waves, whereas area-level deprivation has become a more important predictor over time. Second, during the first wave of the pandemic, population density had a significant spillover effect on COVID-19 mortality, indicating that the pandemic spread from big cities to neighbouring areas. Third, after accounting for differences in ethnic composition, deprivation, and population density, initial cross-country differences in COVID-19 mortality almost disappeared. COVID-19 mortality remained higher in Scotland than in England and Wales in the third wave when COVID-19 mortality was relatively low in all three countries. Interpreting these results in the context of higher overall (long-term) non-COVID-19 mortality in Scotland suggests that Scotland may have performed better than expected during the first two waves. Our study highlights that accounting for both spatial and temporal factors is essential for understanding social and demographic risk factors of mortality during pandemics.
Collapse
Affiliation(s)
- Júlia Mikolai
- ESRC Centre for Population Change, United Kingdom; University of St Andrews, United Kingdom.
| | | | - Katherine Keenan
- ESRC Centre for Population Change, United Kingdom; University of St Andrews, United Kingdom
| | - Hill Kulu
- ESRC Centre for Population Change, United Kingdom; University of St Andrews, United Kingdom
| |
Collapse
|
6
|
Piltch-Loeb R, Penrose K, Stanton E, Parcesepe AM, Shen Y, Fleary SA, Nash D. Safety, Efficacy, and Ill Intent: Examining COVID-19 Vaccine Perceptions among the New Undervaccinated Moveable Middle in a U.S. Cohort, October 2022. Vaccines (Basel) 2023; 11:1665. [PMID: 38005997 PMCID: PMC10675675 DOI: 10.3390/vaccines11111665] [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: 09/21/2023] [Revised: 10/16/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
Individuals who received their primary vaccine series only (with no subsequent booster) may be a new type of "moveable middle" given their receipt of the original COVID-19 vaccination. One population within the moveable middle for whom tailored interventions may be needed is individuals with common mental disorders (CMD). The purpose of this paper is to understand the vaccine perceptions among this new moveable middle-the undervaccinated-and within the undervaccinated to examine the extent to which COVID-19 vaccine perceptions and motivations differ among those with and without symptoms of CMD. Using data from the CHASING COVID Cohort, we examine the relationship between vaccination status, CMD, and vaccine perceptions in the undervaccinated. Among 510 undervaccinated participants who had completed the primary vaccine series but were not boosted, the most common reasons for undervaccination focused on efficacy (not seeing a need for an additional dose, 42.4%; there not being enough evidence that a booster dose is effective, 26.5%; already having had COVID-19, 19.6%). Other concerns were related to safety (long-term side effects, 21.0%; short-term side effects, 17.6%) and logistics (plan to get a booster but haven't had time yet, 18.8%). Overall, the greatest vaccine concerns (over 30%) for the undervaccinated focused on efficacy and safety issues. Symptoms of depression or anxiety were associated with lower levels of vaccine efficacy and greater safety concerns in adjusted models. The implications of our study are that campaigns that are hoping to maximize vaccination uptake should consider focusing on and emphasizing messaging on efficacy and safety issues.
Collapse
Affiliation(s)
- Rachael Piltch-Loeb
- Department of Environmental Occupational and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY 10027, USA
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY 10027, USA
- Emergency Preparedness Research Evaluation and Practice Program, Harvard T.H. Chan School of Public Health, Boston, MA 02120, USA
| | - Kate Penrose
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY 10027, USA
| | - Eva Stanton
- Emergency Preparedness Research Evaluation and Practice Program, Harvard T.H. Chan School of Public Health, Boston, MA 02120, USA
| | - Angela M. Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA
| | - Yanhan Shen
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY 10027, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY 10027, USA
| | - Sasha A. Fleary
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY 10027, USA
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY 10027, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY 10027, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY 10027, USA
| |
Collapse
|
7
|
Karkanitsa M, Li Y, Valenti S, Spathies J, Kelly S, Hunsberger S, Yee L, Croker JA, Wang J, Alfonso AL, Faust M, Mehalko J, Drew M, Denson JP, Putman Z, Fathi P, Ngo TB, Siripong N, Baus HA, Petersen B, Ford EW, Sundaresan V, Josyula A, Han A, Giurgea LT, Rosas LA, Bean R, Athota R, Czajkowski L, Klumpp-Thomas C, Cervantes-Medina A, Gouzoulis M, Reed S, Graubard B, Hall MD, Kalish H, Esposito D, Kimberly RP, Reis S, Sadtler K, Memoli MJ. Dynamics of SARS-CoV-2 Seroprevalence in a Large US population Over a Period of 12 Months. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.20.23297329. [PMID: 37904956 PMCID: PMC10614993 DOI: 10.1101/2023.10.20.23297329] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Due to a combination of asymptomatic or undiagnosed infections, the proportion of the United States population infected with SARS-CoV-2 was unclear from the beginning of the pandemic. We previously established a platform to screen for SARS-CoV-2 positivity across a representative proportion of the US population, from which we reported that almost 17 million Americans were estimated to have had undocumented infections in the Spring of 2020. Since then, vaccine rollout and prevalence of different SARS-CoV-2 variants have further altered seropositivity trends within the United States population. To explore the longitudinal impacts of the pandemic and vaccine responses on seropositivity, we re-enrolled participants from our baseline study in a 6- and 12- month follow-up study to develop a longitudinal antibody profile capable of representing seropositivity within the United States during a critical period just prior to and during the initiation of vaccine rollout. Initial measurements showed that, since July 2020, seropositivity elevated within this population from 4.8% at baseline to 36.2% and 89.3% at 6 and 12 months, respectively. We also evaluated nucleocapsid seropositivity and compared to spike seropositivity to identify trends in infection versus vaccination relative to baseline. These data serve as a window into a critical timeframe within the COVID-19 pandemic response and serve as a resource that could be used in subsequent respiratory illness outbreaks.
Collapse
Affiliation(s)
- Maria Karkanitsa
- Section on Immunoengineering, National Institute of Biomedical Imaging and Bioengineering (NIBIB), National Institutes of Health (NIH), Bethesda MD 20894
| | - Yan Li
- Joint Program in Survey Methodology, Department of Epidemiology and Biostatistics, University of Maryland College Park, College Park, MD 20742
| | - Shannon Valenti
- Clinical and Translational Science Institute (CTSI), University of Pittsburgh, Pittsburgh, PA 15213
| | - Jacquelyn Spathies
- Trans-NIH Shared Resource on Biomedical Engineering and Physical Science (BEPS), NIBIB, NIH, Bethesda MD 20894
| | - Sophie Kelly
- Trans-NIH Shared Resource on Biomedical Engineering and Physical Science (BEPS), NIBIB, NIH, Bethesda MD 20894
| | - Sally Hunsberger
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, MD 20894
| | - Laura Yee
- Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), NIH, MD 20894
| | - Jennifer A. Croker
- Center for Clinical and Translational Science, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jing Wang
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD 21702
| | - Andrea Lucia Alfonso
- Section on Immunoengineering, National Institute of Biomedical Imaging and Bioengineering (NIBIB), National Institutes of Health (NIH), Bethesda MD 20894
| | - Mondreakest Faust
- Section on Immunoengineering, National Institute of Biomedical Imaging and Bioengineering (NIBIB), National Institutes of Health (NIH), Bethesda MD 20894
| | - Jennifer Mehalko
- Protein Expression Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD, 21702
| | - Matthew Drew
- Protein Expression Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD, 21702
| | - John-Paul Denson
- Protein Expression Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD, 21702
| | - Zoe Putman
- Protein Expression Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD, 21702
| | - Parinaz Fathi
- Section on Immunoengineering, National Institute of Biomedical Imaging and Bioengineering (NIBIB), National Institutes of Health (NIH), Bethesda MD 20894
| | - Tran B. Ngo
- Section on Immunoengineering, National Institute of Biomedical Imaging and Bioengineering (NIBIB), National Institutes of Health (NIH), Bethesda MD 20894
| | - Nalyn Siripong
- Clinical and Translational Science Institute (CTSI), University of Pittsburgh, Pittsburgh, PA 15213
| | - Holly Ann Baus
- Laboratory of Immunoregulation, NIAID, NIH, Bethesda MD 20894
| | - Brian Petersen
- Clinical and Translational Science Institute (CTSI), University of Pittsburgh, Pittsburgh, PA 15213
| | - Eric W. Ford
- Department of Health Care Organization, and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vanathi Sundaresan
- Section on Immunoengineering, National Institute of Biomedical Imaging and Bioengineering (NIBIB), National Institutes of Health (NIH), Bethesda MD 20894
| | - Aditya Josyula
- Section on Immunoengineering, National Institute of Biomedical Imaging and Bioengineering (NIBIB), National Institutes of Health (NIH), Bethesda MD 20894
| | - Alison Han
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, MD 20894
| | - Luca T. Giurgea
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, MD 20894
| | - Luz Angela Rosas
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, MD 20894
| | - Rachel Bean
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, MD 20894
| | - Rani Athota
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, MD 20894
| | - Lindsay Czajkowski
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, MD 20894
| | - Carleen Klumpp-Thomas
- National Center for Advancing Translational Sciences (NCATS), NIH, Rockville, MD 20850
| | | | - Monica Gouzoulis
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, MD 20894
| | - Susan Reed
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, MD 20894
| | - Barry Graubard
- Division of Cancer Epidemiology & Genetics, Biostatistics Branch, NCI, NIH, Bethesda, MD 20894
| | - Matthew D. Hall
- National Center for Advancing Translational Sciences (NCATS), NIH, Rockville, MD 20850
| | - Heather Kalish
- Trans-NIH Shared Resource on Biomedical Engineering and Physical Science (BEPS), NIBIB, NIH, Bethesda MD 20894
| | - Dominic Esposito
- Protein Expression Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD, 21702
| | - Robert P. Kimberly
- Center for Clinical and Translational Science, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Steven Reis
- Clinical and Translational Science Institute (CTSI), University of Pittsburgh, Pittsburgh, PA 15213
| | - Kaitlyn Sadtler
- Section on Immunoengineering, National Institute of Biomedical Imaging and Bioengineering (NIBIB), National Institutes of Health (NIH), Bethesda MD 20894
| | - Matthew J Memoli
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, MD 20894
| |
Collapse
|
8
|
Nash D, Srivastava A, Shen J, Penrose K, Kulkarni SG, Zimba R, You W, Berry A, Mirzayi C, Maroko A, Parcesepe AM, Grov C, Robertson MM. Seroincidence of SARS-CoV-2 infection prior to and during the rollout of vaccines in a community-based prospective cohort of U.S. adults. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.29.23296142. [PMID: 37873066 PMCID: PMC10593054 DOI: 10.1101/2023.09.29.23296142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Background Infectious disease surveillance systems, which largely rely on diagnosed cases, underestimate the true incidence of SARS-CoV-2 infection, due to under-ascertainment and underreporting. We used repeat serologic testing to measure N-protein seroconversion in a well-characterized cohort of U.S. adults with no serologic evidence of SARS-CoV-2 infection to estimate the incidence of SARS-CoV-2 infection and characterize risk factors, with comparisons before and after the start of the SARS-CoV-2 vaccine and variant eras. Methods We assessed the incidence rate of infection and risk factors in two sub-groups (cohorts) that were SARS-CoV-2 N-protein seronegative at the start of each follow-up period: 1) the pre-vaccine/wild-type era cohort (n=3,421), followed from April to November 2020; and 2) the vaccine/variant era cohort (n=2,735), followed from November 2020 to June 2022. Both cohorts underwent repeat serologic testing with an assay for antibodies to the SARS-CoV-2 N protein (Bio-Rad Platelia SARS-CoV-2 total Ab). We estimated crude incidence and sociodemographic/epidemiologic risk factors in both cohorts. We used multivariate Poisson models to compare the risk of SARS-CoV-2 infection in the pre-vaccine/wild-type era cohort (referent group) to that in the vaccine/variant era cohort, within strata of vaccination status and epidemiologic risk factors (essential worker status, child in the household, case in the household, social distancing). Findings In the pre-vaccine/wild-type era cohort, only 18 of the 3,421 participants (0.53%) had ≥1 vaccine dose by the end of follow-up, compared with 2,497/2,735 (91.3%) in the vaccine/variant era cohort. We observed 323 and 815 seroconversions in the pre-vaccine/wild-type era and the vaccine/variant era and cohorts, respectively, with corresponding incidence rates of 9.6 (95% CI: 8.3-11.5) and 25.7 (95% CI: 24.2-27.3) per 100 person-years. Associations of sociodemographic and epidemiologic risk factors with SARS-CoV-2 incidence were largely similar in the pre-vaccine/wild-type and vaccine/variant era cohorts. However, some new epidemiologic risk factors emerged in the vaccine/variant era cohort, including having a child in the household, and never wearing a mask while using public transit. Adjusted incidence rate ratios (aIRR), with the entire pre-vaccine/wild-type era cohort as the referent group, showed markedly higher incidence in the vaccine/variant era cohort, but with more vaccine doses associated with lower incidence: aIRRun/undervaccinated=5.3 (95% CI: 4.2-6.7); aIRRprimary series only=5.1 (95% CI: 4.2-7.3); aIRRboosted once=2.5 (95% CI: 2.1-3.0), and aIRRboosted twice=1.65 (95% CI: 1.3-2.1). These associations were essentially unchanged in risk factor-stratified models. Interpretation In SARS-CoV-2 N protein seronegative individuals, large increases in incidence and newly emerging epidemiologic risk factors in the vaccine/variant era likely resulted from multiple co-occurring factors, including policy changes, behavior changes, surges in transmission, and changes in SARS-CoV-2 variant properties. While SARS-CoV-2 incidence increased markedly in most groups in the vaccine/variant era, being up to date on vaccines and the use of non-pharmaceutical interventions (NPIs), such as masking and social distancing, remained reliable strategies to mitigate the risk of SARS-CoV-2 infection, even through major surges due to immune evasive variants. Repeat serologic testing in cohort studies is a useful and complementary strategy to characterize SARS-CoV-2 incidence and risk factors.
Collapse
Affiliation(s)
- Denis Nash
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, New York, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York, New York, USA
| | - Avantika Srivastava
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, New York, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York, New York, USA
| | - Jenny Shen
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, New York, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York, New York, USA
| | - Kate Penrose
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, New York, USA
| | - Sarah Gorrell Kulkarni
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, New York, USA
| | - Rebecca Zimba
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, New York, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York, New York, USA
| | - William You
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, New York, USA
| | - Amanda Berry
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, New York, USA
| | - Chloe Mirzayi
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, New York, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York, New York, USA
| | - Andrew Maroko
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, New York, USA
- Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York, New York, USA
| | - Angela M. Parcesepe
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, New York, USA
- Department of Maternal and Child Health, Gillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christian Grov
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, New York, USA
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York, New York, USA
| | - McKaylee M. Robertson
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, New York, USA
| |
Collapse
|
9
|
Castel AD, Barth S, Wilbourn BC, Horberg M, Monroe AK, Greenberg AE. Trends in COVID-19 Vaccine Hesitancy and Uptake Among Persons Living With HIV in Washington, DC. J Acquir Immune Defic Syndr 2023; 94:124-134. [PMID: 37368934 PMCID: PMC10529778 DOI: 10.1097/qai.0000000000003243] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE The COVID-19 pandemic has disproportionately affected older people, people with underlying health conditions, racial and ethnic minorities, socioeconomically disadvantaged, and people living with HIV (PWH). We sought to describe vaccine hesitancy and associated factors, reasons for vaccine hesitancy, and vaccine uptake over time in PWH in Washington, DC. METHODS We conducted a cross-sectional survey between October 2020 and December 2021 among PWH enrolled in a prospective longitudinal cohort in DC. Survey data were linked to electronic health record data and descriptively analyzed. Multivariable logistic regression was performed to identify factors associated with vaccine hesitancy. The most common reasons for vaccine hesitancy and uptake were assessed. RESULTS Among 1029 participants (66% men, 74% Black, median age 54 years), 13% were vaccine hesitant and 9% refused. Women were 2.6-3.5 times, non-Hispanic Blacks were 2.2 times, Hispanics and those of other race/ethnicities were 3.5-8.8 times, and younger PWH were significantly more likely to express hesitancy or refusal than men, non-Hispanic Whites, and older PWH, respectively. The most reported reasons for vaccine hesitancy were side effect concerns (76%), plans to use other precautions/masks (73%), and speed of vaccine development (70%). Vaccine hesitancy and refusal declined over time (33% in October 2020 vs. 4% in December 2021, P < 0.0001). CONCLUSIONS This study is one of the largest analyses of vaccine hesitancy among PWH in a US urban area highly affected by HIV and COVID-19. Multilevel culturally appropriate approaches are needed to effectively address COVID-19 vaccine concerns raised among PWH.
Collapse
Affiliation(s)
- Amanda D Castel
- Department of Epidemiology, The George Washington University School of Public Health, Washington, DC; and
| | - Shannon Barth
- Department of Epidemiology, The George Washington University School of Public Health, Washington, DC; and
| | - Brittany C Wilbourn
- Department of Epidemiology, The George Washington University School of Public Health, Washington, DC; and
| | | | - Anne K Monroe
- Department of Epidemiology, The George Washington University School of Public Health, Washington, DC; and
| | - Alan E Greenberg
- Department of Epidemiology, The George Washington University School of Public Health, Washington, DC; and
| |
Collapse
|
10
|
Ng Y, Chang M, Robertson M, Grov C, Maroko A, Zimba R, Westmoreland D, Rane M, Mirzayi C, Parcesepe AM, Kulkarni S, Salgado-You W, Cohen N, Nash D. Food Insecurity During the First Year of COVID-19: Employment and Sociodemographic Factors Among Participants in the CHASING COVID Cohort Study. Public Health Rep 2023; 138:671-680. [PMID: 37209059 PMCID: PMC10200805 DOI: 10.1177/00333549231170203] [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] [Indexed: 05/22/2023] Open
Abstract
OBJECTIVE While much has been reported about the impact of the COVID-19 pandemic on food insecurity, longitudinal data and the variability experienced by people working in various industries are limited. This study aims to further characterize people experiencing food insecurity during the pandemic in terms of employment, sociodemographic characteristics, and degree of food insecurity. METHODS The study sample consisted of people enrolled in the Communities, Households and SARS-CoV-2 Epidemiology (CHASING) COVID Cohort Study from visit 1 (April-July 2020) through visit 7 (May-June 2021). We created weights to account for participants with incomplete or missing data. We used descriptive statistics and logistic regression models to determine employment and sociodemographic correlates of food insecurity. We also examined patterns of food insecurity and use of food support programs. RESULTS Of 6740 participants, 39.6% (n = 2670) were food insecure. Non-Hispanic Black and Hispanic (vs non-Hispanic White) participants, participants in households with children (vs no children), and participants with lower (vs higher) income and education levels had higher odds of food insecurity. By industry, people employed in construction, leisure and hospitality, and trade, transportation, and utilities industries had the highest prevalence of both food insecurity and income loss. Among participants reporting food insecurity, 42.0% (1122 of 2670) were persistently food insecure (≥4 consecutive visits) and 43.9% (1172 of 2670) did not use any food support programs. CONCLUSIONS The pandemic resulted in widespread food insecurity in our cohort, much of which was persistent. In addition to addressing sociodemographic disparities, future policies should focus on the needs of those working in industries vulnerable to economic disruption and ensure those experiencing food insecurity can access food support programs for which they are eligible.
Collapse
Affiliation(s)
- Yvette Ng
- Graduate School of Public Health and Health Policy, Urban Food Policy Institute, City University of New York, New York, NY, USA
| | - Mindy Chang
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - McKaylee Robertson
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Christian Grov
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Andrew Maroko
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
- Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Rebecca Zimba
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Drew Westmoreland
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Madhura Rane
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Chloe Mirzayi
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Angela M. Parcesepe
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sarah Kulkarni
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - William Salgado-You
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Nevin Cohen
- Graduate School of Public Health and Health Policy, Urban Food Policy Institute, City University of New York, New York, NY, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| |
Collapse
|
11
|
Schmitt ML, Dimond K, Maroko AR, Phillips-Howard PA, Gruer C, Berry A, Nash D, Kochhar S, Sommer M. "I stretch them out as long as possible:" U.S. women's experiences of menstrual product insecurity during the COVID-19 pandemic. BMC Womens Health 2023; 23:179. [PMID: 37060006 PMCID: PMC10104689 DOI: 10.1186/s12905-023-02333-z] [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: 06/29/2022] [Accepted: 04/05/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND A growing body of evidence highlights how the COVID-19 pandemic has exacerbated gender inequalities in the US. This resulted in women being more vulnerable to economic insecurity and decreases in their overall well-being. One relevant issue that has been less explored is that of women's menstrual health experiences, including how inconsistent access to menstrual products may negatively impact their daily lives. METHODS This qualitative study, conducted from March through May 2021, utilized in-depth interviews that were nested within a national prospective cohort study. The interviews (n = 25) were conducted with a sub-sample of cis-gender women living across the US who had reported challenges accessing products during the first year of the pandemic. The interviews sought to understand the barriers that contributed to experiencing menstrual product insecurity, and related coping mechanisms. Malterud's 'systematic text condensation', an inductive thematic analysis method, was utilized to analyze the qualitative transcripts. RESULTS Respondents came from 17 different states across the U.S. Three key themes were identified: financial and physical barriers existed to consistent menstrual product access; a range of coping strategies in response to menstrual product insecurity, including dependence on makeshift and poorer quality materials; and heightened experiences of menstrual-related anxiety and shame, especially regarding the disclosure of their menstruating status to others as a result of inadequate menstrual leak protection. CONCLUSIONS Addressing menstrual product insecurity is a critical step for ensuring that all people who menstruate can attain their most basic menstrual health needs. Key recommendations for mitigating the impact of menstrual product insecurity require national and state-level policy reform, such as the inclusion of menstrual products in existing safety net basic needs programs, and the reframing of menstrual products as essential items. Improved education and advocacy are needed to combat menstrual stigma.
Collapse
Affiliation(s)
- Margaret L Schmitt
- Mailman School of Public Health, Columbia University, 722 W 168Th St, New York, NY, 10032, USA.
| | - Katie Dimond
- Mailman School of Public Health, Columbia University, 722 W 168Th St, New York, NY, 10032, USA
| | - Andrew R Maroko
- Institute for Implementation Science in Population Health, City University of New York (CUNY), New York City, NY, USA
| | | | - Caitlin Gruer
- Mailman School of Public Health, Columbia University, 722 W 168Th St, New York, NY, 10032, USA
| | - Amanda Berry
- Institute for Implementation Science in Population Health, City University of New York (CUNY), New York City, NY, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York (CUNY), New York City, NY, USA
| | - Shivani Kochhar
- Institute for Implementation Science in Population Health, City University of New York (CUNY), New York City, NY, USA
| | - Marni Sommer
- Mailman School of Public Health, Columbia University, 722 W 168Th St, New York, NY, 10032, USA
| |
Collapse
|
12
|
Parcesepe AM, Kulkarni SG, Grov C, Zimba R, You W, Westmoreland DA, Berry A, Kochhar S, Rane MS, Mirzayi C, Maroko AR, Nash D. Psychosocial Stressors and Maternal Mental Health in the U.S. During the First Wave of the COVID-19 Pandemic: A Cross-Sectional Analysis. Matern Child Health J 2023; 27:335-345. [PMID: 36625954 PMCID: PMC9838406 DOI: 10.1007/s10995-022-03578-0] [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] [Accepted: 12/20/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The COVID pandemic has had widespread impacts on maternal mental health. This research aims to examine the relationship between psychosocial stressors and symptoms of depression and anxiety and the extent to which emotional support or resilient coping moderates the relationship between psychosocial stressors and maternal mental health during the first wave of the COVID pandemic. METHODS This analysis includes data collected in October and November 2020 from a geographically and sociodemographically diverse sample of 776 mothers in the U.S. with children ≤ 18 years of age. Log binomial models were used to estimate the association between moderate or severe symptoms of anxiety and depression and psychosocial stressors. RESULTS Symptoms of moderate or severe anxiety and depression were reported by 37.5% and 37.6% of participants, respectively. Moderate (aRR 2.76 [95% CI 1.87, 4.07]) and high (aRR 4.95 [95% CI 3.40, 7.20]) levels of perceived stress were associated with greater risk of moderate or severe anxiety symptoms. Moderate and high levels of parental burnout were also associated with greater prevalence of moderate or severe anxiety symptoms in multivariable models. Results were similar when examining the relationship among stress, parental burnout, and depressive symptoms. Neither resilient coping nor social support modified the relationship between psychosocial stressors and mental health. CONCLUSIONS FOR PRACTICE Evidence-based strategies to reduce stress and parental burnout and improve the mental health of mothers are urgently needed. Strategies focused on bolstering coping and social support may be insufficient to improve maternal mental health during acute public health emergencies.
Collapse
Affiliation(s)
- Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Sarah G Kulkarni
- Institute of Implementation Science in Population Health (ISPH), City University of New York, New York, NY, USA
| | - Christian Grov
- Institute of Implementation Science in Population Health (ISPH), City University of New York, New York, NY, USA
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Rebecca Zimba
- Institute of Implementation Science in Population Health (ISPH), City University of New York, New York, NY, USA
| | - William You
- Institute of Implementation Science in Population Health (ISPH), City University of New York, New York, NY, USA
| | - Drew A Westmoreland
- Institute of Implementation Science in Population Health (ISPH), City University of New York, New York, NY, USA
| | - Amanda Berry
- Institute of Implementation Science in Population Health (ISPH), City University of New York, New York, NY, USA
| | - Shivani Kochhar
- Institute of Implementation Science in Population Health (ISPH), City University of New York, New York, NY, USA
| | - Madhura S Rane
- Institute of Implementation Science in Population Health (ISPH), City University of New York, New York, NY, USA
| | - Chloe Mirzayi
- Institute of Implementation Science in Population Health (ISPH), City University of New York, New York, NY, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Andrew R Maroko
- Institute of Implementation Science in Population Health (ISPH), City University of New York, New York, NY, USA
- Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Denis Nash
- Institute of Implementation Science in Population Health (ISPH), City University of New York, New York, NY, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| |
Collapse
|
13
|
Qasmieh SA, Robertson MM, Rane MS, Shen Y, Zimba R, Picchio CA, Parcesepe AM, Chang M, Kulkarni SG, Grov C, Nash D. The Importance of Incorporating At-Home Testing Into SARS-CoV-2 Point Prevalence Estimates: Findings From a US National Cohort, February 2022. JMIR Public Health Surveill 2022; 8:e38196. [PMID: 36240020 PMCID: PMC9822564 DOI: 10.2196/38196] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 09/30/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Passive, case-based surveillance underestimates the true extent of active infections in the population due to undiagnosed and untested cases, the exclusion of probable cases diagnosed point-of-care rapid antigen tests, and the exclusive use of at-home rapid tests which are not reported as part of case-based surveillance. The extent in which COVID-19 surveillance may be underestimating the burden of infection is likely due to time-varying factors such as decreased test-seeking behaviors and increased access to and availability of at-home testing. OBJECTIVE The objective of this study is to estimate the prevalence of SARS-CoV-2 based on different definitions of a case to ascertain the extent to which cases of SARS-CoV-2 may be underestimated by case-based surveillance. METHODS A survey on COVID-19 exposure, infection, and testing was administered to calculate point prevalence of SARS-CoV-2 among a diverse sample of cohort adults from February 8, 2022, to February 22, 2022. Three-point prevalence estimates were calculated among the cohort, as follows: (1) proportion positives based on polymerase chain reaction (PCR) and rapid antigen tests; (2) proportion positives based on testing exclusively with rapid at-home tests; and (3) proportion of probable undiagnosed cases. Test positivity and prevalence differences across booster status were also examined. RESULTS Among a cohort of 4328, there were a total of 644 (14.9%) cases. The point prevalence estimate based on PCR or rapid antigen tests was 5.5% (95% CI 4.8%-6.2%), 3.7% (95% CI 3.1%-4.2%) based on at-home rapid tests, and 5.7% (95% CI 5.0%-6.4%) based on the case definition of a probable case. The total point prevalence across all definitions was 14.9% (95% CI 13.8%-16.0%). The percent positivity among PCR or rapid tests was 50.2%. No statistically significant differences were observed in prevalence between participants with a COVID-19 booster compared to fully vaccinated and nonboosted participants except among exclusive at-home rapid testers. CONCLUSIONS Our findings suggest a substantial number of cases were missed by case-based surveillance systems during the Omicron B.1.1.529 surge, when at-home testing was common. Point prevalence surveys may be a rapid tool to be used to understand SARS-CoV-2 prevalence and would be especially important during case surges to measure the scope and spread of active infections in the population.
Collapse
Affiliation(s)
- Saba A Qasmieh
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - McKaylee M Robertson
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States
| | - Madhura S Rane
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States
| | - Yanhan Shen
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Rebecca Zimba
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Camila A Picchio
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Angela M Parcesepe
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States
- Department of Maternal and Child Health, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, United States
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mindy Chang
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States
| | - Sarah G Kulkarni
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States
| | - Christian Grov
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| |
Collapse
|
14
|
Robertson MM, Shamsunder MG, Brazier E, Mantravadi M, Zimba R, Rane MS, Westmoreland DA, Parcesepe AM, Maroko AR, Kulkarni SG, Grov C, Nash D. Racial/Ethnic Disparities in Exposure, Disease Susceptibility, and Clinical Outcomes during COVID-19 Pandemic in National Cohort of Adults, United States. Emerg Infect Dis 2022; 28:2171-2180. [PMID: 36191624 PMCID: PMC9622253 DOI: 10.3201/eid2811.220072] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We examined racial/ethnic disparities for COVID-19 seroconversion and hospitalization within a prospective cohort (n = 6,740) in the United States enrolled in March 2020 and followed-up through October 2021. Potential SARS-CoV-2 exposure, susceptibility to COVID-19 complications, and access to healthcare varied by race/ethnicity. Hispanic and Black non-Hispanic participants had more exposure risk and difficulty with healthcare access than white participants. Participants with more exposure had greater odds of seroconversion. Participants with more susceptibility and more barriers to healthcare had greater odds of hospitalization. Race/ethnicity positively modified the association between susceptibility and hospitalization. Findings might help to explain the disproportionate burden of SARS-CoV-2 infections and complications among Hispanic/Latino/a and Black non-Hispanic persons. Primary and secondary prevention efforts should address disparities in exposure, vaccination, and treatment for COVID-19.
Collapse
|
15
|
Nash D, Qasmieh S, Robertson M, Rane M, Zimba R, Kulkarni SG, Berry A, You W, Mirzayi C, Westmoreland D, Parcesepe A, Waldron L, Kochhar S, Maroko AR, Grov C. Household factors and the risk of severe COVID-like illness early in the U.S. pandemic. PLoS One 2022; 17:e0271786. [PMID: 35862418 PMCID: PMC9302833 DOI: 10.1371/journal.pone.0271786] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/07/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To investigate the role of children in the home and household crowding as risk factors for severe COVID-19 disease. METHODS We used interview data from 6,831 U.S. adults screened for the Communities, Households and SARS/CoV-2 Epidemiology (CHASING) COVID Cohort Study in April 2020. RESULTS In logistic regression models, the adjusted odds ratio [aOR] of hospitalization due to COVID-19 for having (versus not having) children in the home was 10.5 (95% CI:5.7-19.1) among study participants living in multi-unit dwellings and 2.2 (95% CI:1.2-6.5) among those living in single unit dwellings. Among participants living in multi-unit dwellings, the aOR for COVID-19 hospitalization among participants with more than 4 persons in their household (versus 1 person) was 2.5 (95% CI:1.0-6.1), and 0.8 (95% CI:0.15-4.1) among those living in single unit dwellings. CONCLUSION Early in the US SARS-CoV-2 pandemic, certain household exposures likely increased the risk of both SARS-CoV-2 acquisition and the risk of severe COVID-19 disease.
Collapse
Affiliation(s)
- Denis Nash
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York, United States of America
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York City, New York, United States of America
| | - Saba Qasmieh
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York, United States of America
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York City, New York, United States of America
| | - McKaylee Robertson
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York, United States of America
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York City, New York, United States of America
| | - Madhura Rane
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York, United States of America
| | - Rebecca Zimba
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York, United States of America
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York City, New York, United States of America
| | - Sarah G. Kulkarni
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York, United States of America
| | - Amanda Berry
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York, United States of America
| | - William You
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York, United States of America
| | - Chloe Mirzayi
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York, United States of America
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York City, New York, United States of America
| | - Drew Westmoreland
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York, United States of America
| | - Angela Parcesepe
- Department of Maternal and Child Health, Gillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Levi Waldron
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York, United States of America
- Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York City, New York, United States of America
| | - Shivani Kochhar
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York, United States of America
| | - Andrew R. Maroko
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York, United States of America
- Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York City, New York, United States of America
| | - Christian Grov
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York, United States of America
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York City, New York, United States of America
| | | |
Collapse
|
16
|
Nash D, Rane MS, Robertson MM, Chang M, Gorrell SK, Zimba R, You W, Berry A, Mirzayi C, Kochhar S, Maroko A, Westmoreland DA, Parcesepe AM, Waldron L, Grov C. Severe Acute Respiratory Syndrome Coronavirus 2 Incidence and Risk Factors in a National, Community-Based Prospective Cohort of US Adults. Clin Infect Dis 2022; 76:e375-e384. [PMID: 35639911 PMCID: PMC9213857 DOI: 10.1093/cid/ciac423] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/01/2022] [Accepted: 05/24/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Prospective cohort studies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) incidence complement case-based surveillance and cross-sectional seroprevalence surveys. METHODS We estimated the incidence of SARS-CoV-2 infection in a national cohort of 6738 US adults, enrolled in March-August 2020. Using Poisson models, we examined the association of social distancing and a composite epidemiologic risk score with seroconversion. The risk score was created using least absolute shrinkage selection operator (LASSO) regression to identify factors predictive of seroconversion. The selected factors were household crowding, confirmed case in household, indoor dining, gathering with groups of ≥10, and no masking in gyms or salons. RESULTS Among 4510 individuals with ≥1 serologic test, 323 (7.3% [95% confidence interval (CI), 6.5%-8.1%]) seroconverted by January 2021. Among 3422 participants seronegative in May-September 2020 and retested from November 2020 to January 2021, 161 seroconverted over 1646 person-years of follow-up (9.8 per 100 person-years [95% CI, 8.3-11.5]). The seroincidence rate was lower among women compared with men (incidence rate ratio [IRR], 0.69 [95% CI, .50-.94]) and higher among Hispanic (2.09 [1.41-3.05]) than white non-Hispanic participants. In adjusted models, participants who reported social distancing with people they did not know (IRR for always vs never social distancing, 0.42 [95% CI, .20-1.0]) and with people they knew (IRR for always vs never, 0.64 [.39-1.06]; IRR for sometimes vs never, 0.60 [.38-.96]) had lower seroconversion risk. Seroconversion risk increased with epidemiologic risk score (IRR for medium vs low score, 1.68 [95% CI, 1.03-2.81]; IRR for high vs low score, 3.49 [2.26-5.58]). Only 29% of those who seroconverted reported isolating, and only 19% were asked about contacts. CONCLUSIONS Modifiable risk factors and poor reach of public health strategies drove SARS-CoV-2 transmission across the United States.
Collapse
Affiliation(s)
- Denis Nash
- CORRESPONDING AUTHOR: Denis Nash, Ph.D., MPH CUNY Graduate School of Public Health and Health Policy 55 W. 125th St., 6th Floor New York, NY USA 10027
| | - Madhura S. Rane
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - McKaylee M. Robertson
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Mindy Chang
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Sarah Kulkarni Gorrell
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Rebecca Zimba
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA,Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York City, New York USA
| | - William You
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Amanda Berry
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Chloe Mirzayi
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA,Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York City, New York USA
| | - Shivani Kochhar
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Andrew Maroko
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA,Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York City, New York USA
| | - Drew A. Westmoreland
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Angela M. Parcesepe
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA,Department of Maternal and Child Health, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, USA,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Levi Waldron
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA,Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York City, New York USA
| | - Christian Grov
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA,Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York City, New York USA
| |
Collapse
|
17
|
Mehrotra ML, Lim E, Lamba K, Kamali A, Lai KW, Meza E, Szeto I, Robinson P, Tsai CT, Gebhart D, Fonseca N, Martin AB, Ley C, Scherf S, Watt J, Seftel D, Parsonnet J, Jain S. CalScope: Monitoring SARS-CoV-2 Seroprevalence from Vaccination and Prior Infection in Adults and Children in California May 2021– July 2021. Open Forum Infect Dis 2022; 9:ofac246. [PMID: 35855959 PMCID: PMC9129171 DOI: 10.1093/ofid/ofac246] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/11/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Understanding the distribution of SARS-CoV-2 antibodies from vaccination and/or prior infection is critical to the public health response to the pandemic. CalScope is a population-based serosurvey in 7 counties in California.
Methods
We invited 200,000 randomly sampled households to enroll up to 1 adult and 1 child between April 20, 2021 and June 16, 2021. We tested all specimen for antibodies against SARS-CoV-2 nucleocapsid and spike proteins, and each participant completed an online survey. We classified participants into categories: seronegative, antibodies from infection only, antibodies from infection and vaccination, and antibodies from vaccination only.
Results
11,161 households enrolled (5.6%), with 7,483 adults and 1,375 children completing antibody testing. As of June 2021, 33% (95%CI [28%, 37%]) of adults and 57% (95%CI[48%, 66%]) of children were seronegative; 18% (95%CI[14%, 22%]) of adults and 26% (95%CI[19%, 32%]) of children had antibodies from infection alone; 9% (95%CI[6%,11%]) of adults and 5% (95%CI[1%, 8%]) of children had antibodies from infection and vaccination; and 41% (95%CI[37%, 45%]) of adults and 13% (95%CI [7%, 18%]) of children had antibodies from vaccination alone.
Conclusions
As of June 2021, a third of adults and most children in California were seronegative. Serostatus varied regionally and by demographic group.
Collapse
Affiliation(s)
| | - Esther Lim
- California Department of Public Health, Richmond, CA, United States
| | - Katherine Lamba
- California Department of Public Health, Richmond, CA, United States
| | - Amanda Kamali
- California Department of Public Health, Richmond, CA, United States
| | - Kristina W. Lai
- California Department of Public Health, Richmond, CA, United States
| | - Erika Meza
- California Department of Public Health, Richmond, CA, United States
| | - Irvin Szeto
- Stanford University, School of Medicine, Palo Alto, CA, United States
| | - Peter Robinson
- Enable Biosciences, South San Francisco, CA, United States
| | | | - David Gebhart
- Enable Biosciences, South San Francisco, CA, United States
| | - Noemi Fonseca
- Enable Biosciences, South San Francisco, CA, United States
| | - Andrew B. Martin
- Stanford University, School of Medicine, Palo Alto, CA, United States
| | - Catherine Ley
- Stanford University, School of Medicine, Palo Alto, CA, United States
| | | | - James Watt
- California Department of Public Health, Richmond, CA, United States
| | - David Seftel
- Enable Biosciences, South San Francisco, CA, United States
| | - Julie Parsonnet
- Stanford University, School of Medicine, Palo Alto, CA, United States
| | - Seema Jain
- California Department of Public Health, Richmond, CA, United States
| |
Collapse
|
18
|
Sommer M, Phillips-Howard PA, Gruer C, Schmitt ML, Nguyen AM, Berry A, Kochhar S, Gorrell Kulkarni S, Nash D, Maroko AR. Menstrual Product Insecurity Resulting From COVID-19‒Related Income Loss, United States, 2020. Am J Public Health 2022; 112:675-684. [PMID: 35319956 PMCID: PMC8961817 DOI: 10.2105/ajph.2021.306674] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To identify key effects of the pandemic and its economic consequences on menstrual product insecurity with implications for public health practice and policy. Methods. Study participants (n = 1496) were a subset of individuals enrolled in a national (US) prospective cohort study. Three survey waves were included (March‒October 2020). Menstrual product insecurity outcomes were explored with bivariate associations and logistic regression models to examine the associations between outcomes and income loss. Results. Income loss was associated with most aspects of menstrual product insecurity (adjusted odds ratios from 1.34 to 3.64). The odds of not being able to afford products for those who experienced income loss was 3.64 times (95% confidence interval [CI] = 2.14, 6.19) that of those who had no income loss and 3.95 times (95% CI = 1.78, 8.79) the odds for lower-income participants compared with higher-income participants. Conclusions. Pandemic-related income loss was a strong predictor of menstrual product insecurity, particularly for populations with lower income and educational attainment. Public Health Implications. Provision of free or subsidized menstrual products is needed by vulnerable populations and those most impacted by pandemic-related income loss.(Am J Public Health. 2022;112(4):675-684. (https://doi.org/10.2105/AJPH.2021.306674).
Collapse
Affiliation(s)
- Marni Sommer
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
| | - Penelope A Phillips-Howard
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
| | - Caitlin Gruer
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
| | - Margaret L Schmitt
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
| | - Angela-Maithy Nguyen
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
| | - Amanda Berry
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
| | - Shivani Kochhar
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
| | - Sarah Gorrell Kulkarni
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
| | - Denis Nash
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
| | - Andrew R Maroko
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
| |
Collapse
|
19
|
Rane MS, Kochhar S, Poehlein E, You W, Robertson MKM, Zimba R, Westmoreland DA, Romo ML, Kulkarni SG, Chang M, Berry A, Parcesepe AM, Maroko AR, Grov C, Nash D, CHASING COVID Cohort Study Team FT. Determinants and Trends of COVID-19 Vaccine Hesitancy and Vaccine Uptake in a National Cohort of US Adults: A Longitudinal Study. Am J Epidemiol 2022; 191:570-583. [PMID: 34999751 PMCID: PMC8755394 DOI: 10.1093/aje/kwab293] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 11/30/2021] [Accepted: 12/22/2021] [Indexed: 12/22/2022] Open
Abstract
We estimated the trends and correlates of vaccine hesitancy, and its association with subsequent vaccine uptake among 5,458 adults in the United States. Participants belonged to the CHASING COVID Cohort, a national longitudinal study. Trends and correlates of vaccine hesitancy were examined longitudinally in eight interview rounds from October 2020 to July 2021. We also estimated the association between willingness to vaccinate and subsequent vaccine uptake through July 2021. Vaccine delay and refusal decreased from 51% and 8% in October 2020 to 8% and 6% in July 2021, respectively. Compared to Non-Hispanic (NH) White participants, NH Black and Hispanic participants had higher adjusted odds ratios (aOR) for both vaccine delay (aOR: 2.0 [95% CI: 1.5, 2.7] for NH Black and 1.3 [95% CI: 1.0, 1.7] for Hispanic) and vaccine refusal (aOR: 2.5 [95% CI: 1.8, 3.6] for NH Black and 1.4 [95% CI: 1.0, 2.0] for Hispanic) in June 2021. COVID-19 vaccine hesitancy was associated with lower odds of subsequent vaccine uptake (aOR: 0.15, 95% CI: 0.13, 0.18 for vaccine-delayers and aOR: 0.02; 95% CI: 0.01, 0.03 for vaccine-refusers compared to vaccine-willing participants), adjusted for sociodemographic factors and COVID-19 history. Vaccination awareness and distribution efforts should focus on vaccine delayers.
Collapse
Affiliation(s)
- Madhura S Rane
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
- Correspondence to Dr. Madhura S. Rane, The CUNY Institute for Implementation Science In Population Health, 55 W 125th Street, New York, NY 10027 ()
| | - Shivani Kochhar
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Emily Poehlein
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - William You
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Mc Kaylee M Robertson
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Rebecca Zimba
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Drew A Westmoreland
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Matthew L Romo
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Sarah G Kulkarni
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Mindy Chang
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Amanda Berry
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrew R Maroko
- Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY) New York City, New York USA
| | - Christian Grov
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York City, New York USA
| | - Denis Nash
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York City, New York USA
| | | |
Collapse
|
20
|
Rane MS, Robertson MM, Westmoreland DA, Teasdale CA, Grov C, Nash D. Intention to Vaccinate Children Against COVID-19 Among Vaccinated and Unvaccinated US Parents. JAMA Pediatr 2022; 176:201-203. [PMID: 34870702 PMCID: PMC8649908 DOI: 10.1001/jamapediatrics.2021.5153] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study examines parental intention to vaccinate children against COVID-19 and related sociodemographic factors in a national sample of US parents.
Collapse
Affiliation(s)
- Madhura S. Rane
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, New York
| | - McKaylee M. Robertson
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, New York
| | - Drew A. Westmoreland
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, New York
| | - Chloe A. Teasdale
- Department of Epidemiology & Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, New York
| | - Christian Grov
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, New York
| | - Denis Nash
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, New York
| |
Collapse
|
21
|
Adorni F, Jesuthasan N, Perdixi E, Sojic A, Giacomelli A, Noale M, Trevisan C, Franchini M, Pieroni S, Cori L, Mastroianni CM, Bianchi F, Antonelli-Incalzi R, Maggi S, Galli M, Prinelli F. Epidemiology of SARS-CoV-2 Infection in Italy Using Real-World Data: Methodology and Cohort Description of the Second Phase of Web-Based EPICOVID19 Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1274. [PMID: 35162295 PMCID: PMC8835202 DOI: 10.3390/ijerph19031274] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/16/2022] [Accepted: 01/19/2022] [Indexed: 12/29/2022]
Abstract
Digital technologies have been extensively employed in response to the SARS-CoV-2 pandemic worldwide. This study describes the methodology of the two-phase internet-based EPICOVID19 survey, and the characteristics of the adult volunteer respondents who lived in Italy during the first (April-May 2020) and the second wave (January-February 2021) of the epidemic. Validated scales and ad hoc questionnaires were used to collect socio-demographic, medical and behavioural characteristics, as well as information on COVID-19. Among those who provided email addresses during phase I (105,355), 41,473 participated in phase II (mean age 50.7 years ± 13.5 SD, 60.6% females). After a median follow-up of ten months, 52.8% had undergone nasopharyngeal swab (NPS) testing and 13.2% had a positive result. More than 40% had undergone serological test (ST) and 11.9% were positive. Out of the 2073 participants with at least one positive ST, 72.8% had only negative results from NPS or never performed it. These results indicate that a large fraction of individuals remained undiagnosed, possibly contributing to the spread of the virus in the community. Participatory online surveys offer a unique opportunity to collect relevant data at individual level from large samples during confinement.
Collapse
Affiliation(s)
- Fulvio Adorni
- National Research Council, Institute of Biomedical Technologies, Via Fratelli Cervi 93, 20054 Segrate, Italy; (N.J.); (E.P.); (A.S.); (F.P.)
| | - Nithiya Jesuthasan
- National Research Council, Institute of Biomedical Technologies, Via Fratelli Cervi 93, 20054 Segrate, Italy; (N.J.); (E.P.); (A.S.); (F.P.)
| | - Elena Perdixi
- National Research Council, Institute of Biomedical Technologies, Via Fratelli Cervi 93, 20054 Segrate, Italy; (N.J.); (E.P.); (A.S.); (F.P.)
| | - Aleksandra Sojic
- National Research Council, Institute of Biomedical Technologies, Via Fratelli Cervi 93, 20054 Segrate, Italy; (N.J.); (E.P.); (A.S.); (F.P.)
| | - Andrea Giacomelli
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences L. Sacco, Università di Milano, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (A.G.); (M.G.)
| | - Marianna Noale
- National Research Council, Neuroscience Institute, Aging Branch, Via Vincenzo Maria Gallucci 16, 35128 Padova, Italy; (M.N.); (S.M.)
| | - Caterina Trevisan
- Geriatric Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani 2, 35128 Padova, Italy;
- Department of Medical Sciences, University of Ferrara, Via Aldo Moro 8, Cona, 44124 Ferrara, Italy
| | - Michela Franchini
- National Research Council, Institute of Clinical Physiology, Via G. Moruzzi 1, 56124 Pisa, Italy; (M.F.); (S.P.); (L.C.); (F.B.)
| | - Stefania Pieroni
- National Research Council, Institute of Clinical Physiology, Via G. Moruzzi 1, 56124 Pisa, Italy; (M.F.); (S.P.); (L.C.); (F.B.)
| | - Liliana Cori
- National Research Council, Institute of Clinical Physiology, Via G. Moruzzi 1, 56124 Pisa, Italy; (M.F.); (S.P.); (L.C.); (F.B.)
| | - Claudio Maria Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy;
| | - Fabrizio Bianchi
- National Research Council, Institute of Clinical Physiology, Via G. Moruzzi 1, 56124 Pisa, Italy; (M.F.); (S.P.); (L.C.); (F.B.)
| | | | - Stefania Maggi
- National Research Council, Neuroscience Institute, Aging Branch, Via Vincenzo Maria Gallucci 16, 35128 Padova, Italy; (M.N.); (S.M.)
| | - Massimo Galli
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences L. Sacco, Università di Milano, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (A.G.); (M.G.)
| | - Federica Prinelli
- National Research Council, Institute of Biomedical Technologies, Via Fratelli Cervi 93, 20054 Segrate, Italy; (N.J.); (E.P.); (A.S.); (F.P.)
| | | |
Collapse
|
22
|
Robertson MM, Shamsunder M, Brazier E, Mantravadi M, Rane MS, Westmoreland DA, Parcesepe AM, Zimba R, Maroko AR, Kulkarni SG, Grov C, Nash D. Racial/ethnic disparities in exposure to COVID-19, susceptibility to COVID-19 and access to health care - findings from a U.S. national cohort. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.01.11.22269101. [PMID: 35043126 PMCID: PMC8764735 DOI: 10.1101/2022.01.11.22269101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We examined the influence of racial/ethnic differences in socioeconomic position on COVID-19 seroconversion and hospitalization within a community-based prospective cohort enrolled in March 2020 and followed through October 2021 (N=6740). The ability to social distance as a measure of exposure to COVID-19, susceptibility to COVID-19 complications, and access to healthcare varied by race/ethnicity with non-white participants having more exposure risk and more difficulty with healthcare access than white participants. Participants with more (versus less) exposure had greater odds of seroconversion (aOR:1.64, 95% Confidence Interval [CI] 1.18-2.29). Participants with more susceptibility and more barriers to healthcare had greater odds of hospitalization (respective aOR:2.36; 1.90-2.96 and 2.31; 1.69-2.68). Race/ethnicity positively modified the association between susceptibility and hospitalization (aORnon-White:2.79, 2.06-3.78). Findings may explain the disproportionate burden of COVID-19 infections and complications among Hispanic and non-Hispanic Black persons. Primary and secondary prevention efforts should address disparities in exposure, COVID-19 vaccination, and treatment.
Collapse
Affiliation(s)
- McKaylee M Robertson
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
| | - Meghana Shamsunder
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
- Graduate School of Public Health and Health Policy; 55 W 125th St, New York, NY 10027, USA
| | - Ellen Brazier
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
| | - Mekhala Mantravadi
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
| | - Madhura S Rane
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
| | - Drew A Westmoreland
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
| | - Angela M Parcesepe
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
- Gillings School of Public Health, University of North Carolina, 427 Rosenau Hall, CB #7445, Chapel Hill, NC 27599-7445, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca Zimba
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
- Graduate School of Public Health and Health Policy; 55 W 125th St, New York, NY 10027, USA
| | - Andrew R Maroko
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
- Graduate School of Public Health and Health Policy; 55 W 125th St, New York, NY 10027, USA
| | - Sarah G Kulkarni
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
| | - Christian Grov
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
- Graduate School of Public Health and Health Policy; 55 W 125th St, New York, NY 10027, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
- Graduate School of Public Health and Health Policy; 55 W 125th St, New York, NY 10027, USA
| |
Collapse
|
23
|
Zimba R, Romo ML, Kulkarni SG, Berry A, You W, Mirzayi C, Westmoreland DA, Parcesepe AM, Waldron L, Rane MS, Kochhar S, Robertson MM, Maroko AR, Grov C, Nash D. Patterns of SARS-CoV-2 Testing Preferences in a National Cohort in the United States: Latent Class Analysis of a Discrete Choice Experiment. JMIR Public Health Surveill 2021; 7:e32846. [PMID: 34793320 PMCID: PMC8722498 DOI: 10.2196/32846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/21/2021] [Accepted: 11/15/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Inadequate screening and diagnostic testing in the United States throughout the first several months of the COVID-19 pandemic led to undetected cases transmitting disease in the community and an underestimation of cases. Though testing supply has increased, maintaining testing uptake remains a public health priority in the efforts to control community transmission considering the availability of vaccinations and threats from variants. OBJECTIVE This study aimed to identify patterns of preferences for SARS-CoV-2 screening and diagnostic testing prior to widespread vaccine availability and uptake. METHODS We conducted a discrete choice experiment (DCE) among participants in the national, prospective CHASING COVID (Communities, Households, and SARS-CoV-2 Epidemiology) Cohort Study from July 30 to September 8, 2020. The DCE elicited preferences for SARS-CoV-2 test type, specimen type, testing venue, and result turnaround time. We used latent class multinomial logit to identify distinct patterns of preferences related to testing as measured by attribute-level part-worth utilities and conducted a simulation based on the utility estimates to predict testing uptake if additional testing scenarios were offered. RESULTS Of the 5098 invited cohort participants, 4793 (94.0%) completed the DCE. Five distinct patterns of SARS-CoV-2 testing emerged. Noninvasive home testers (n=920, 19.2% of participants) were most influenced by specimen type and favored less invasive specimen collection methods, with saliva being most preferred; this group was the least likely to opt out of testing. Fast-track testers (n=1235, 25.8%) were most influenced by result turnaround time and favored immediate and same-day turnaround time. Among dual testers (n=889, 18.5%), test type was the most important attribute, and preference was given to both antibody and viral tests. Noninvasive dual testers (n=1578, 32.9%) were most strongly influenced by specimen type and test type, preferring saliva and cheek swab specimens and both antibody and viral tests. Among hesitant home testers (n=171, 3.6%), the venue was the most important attribute; notably, this group was the most likely to opt out of testing. In addition to variability in preferences for testing features, heterogeneity was observed in the distribution of certain demographic characteristics (age, race/ethnicity, education, and employment), history of SARS-CoV-2 testing, COVID-19 diagnosis, and concern about the pandemic. Simulation models predicted that testing uptake would increase from 81.6% (with a status quo scenario of polymerase chain reaction by nasal swab in a provider's office and a turnaround time of several days) to 98.1% by offering additional scenarios using less invasive specimens, both viral and antibody tests from a single specimen, faster turnaround time, and at-home testing. CONCLUSIONS We identified substantial differences in preferences for SARS-CoV-2 testing and found that offering additional testing options would likely increase testing uptake in line with public health goals. Additional studies may be warranted to understand if preferences for testing have changed since the availability and widespread uptake of vaccines.
Collapse
Affiliation(s)
- Rebecca Zimba
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Matthew L Romo
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Sarah G Kulkarni
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Amanda Berry
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - William You
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Chloe Mirzayi
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Drew A Westmoreland
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, United States
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Levi Waldron
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Madhura S Rane
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Shivani Kochhar
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - McKaylee M Robertson
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Andrew R Maroko
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
- Department of Environmental, Occupational, and Geospatial Health Sciences, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Christian Grov
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Denis Nash
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| |
Collapse
|
24
|
Nash D, Rane MS, Chang M, Kulkarni SG, Zimba R, You W, Berry A, Mirzayi C, Kochhar S, Maroko A, Robertson MM, Westmoreland DA, Parcesepe AM, Waldron L, Grov C. SARS-CoV-2 incidence and risk factors in a national, community-based prospective cohort of U.S. adults. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.02.12.21251659. [PMID: 33619505 PMCID: PMC7899475 DOI: 10.1101/2021.02.12.21251659] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Epidemiologic risk factors for incident SARS-CoV-2 infection as determined via prospective cohort studies greatly augment and complement information from case-based surveillance and cross-sectional seroprevalence surveys. METHODS We estimated the incidence of SARS-CoV-2 infection and risk factors in a well-characterized, national prospective cohort of 6,738 U.S. adults, enrolled March-August 2020, a subset of whom (n=4,510) underwent repeat serologic testing between May 2020 and January 2021. We examined the crude associations of sociodemographic factors, epidemiologic risk factors, and county-level community transmission with the incidence of seroconversion. In multivariable Poisson models we examined the association of social distancing and a composite score of several epidemiologic risk factors with the rate of seroconversion. FINDINGS Among the 4,510 individuals with at least one serologic test, 323 (7.3%, 95% confidence interval [CI] 6.5%-8.1%) seroconverted by January 2021. Among 3,422 participants seronegative in May-September 2020 and tested during November 2020-January 2021, we observed 161 seroconversions over 1,646 person-years of follow-up (incidence rate of 9.8 per 100 person-years [95%CI 8.3-11.5]). In adjusted models, participants who reported always or sometimes social distancing with people they knew (IRRalways vs. never 0.43, 95%CI 0.21-1.0; IRRsometimes vs. never 0.47, 95%CI 0.22-1.2) and people they did not know (IRRalways vs. never 0.64, 95%CI 0.39-1.1; IRRsometimes vs. never 0.60, 95%CI 0.38-0.97) had lower rates of seroconversion. The rate of seroconversion increased across tertiles of the composite score of epidemiologic risk (IRRmedium vs. low 1.5, 95%CI 0.92-2.4; IRRhigh vs. low 3.0, 95%CI 2.0-4.6). Among the 161 observed seroconversions, 28% reported no symptoms of COVID-like illness (i.e., were asymptomatic), and 27% reported a positive SARS-CoV-2 diagnostic test. Ultimately, only 29% reported isolating and 19% were asked about contacts. INTERPRETATION Modifiable epidemiologic risk factors and poor reach of public health strategies drove SARS-CoV-2 transmission across the U.S during May 2020-January 2021. FUNDING U.S. National Institutes of Allergy and Infectious Diseases (NIAID).
Collapse
Affiliation(s)
- Denis Nash
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York City, New York USA
| | - Madhura S. Rane
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Mindy Chang
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Sarah Gorrell Kulkarni
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Rebecca Zimba
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York City, New York USA
| | - William You
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Amanda Berry
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Chloe Mirzayi
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York City, New York USA
| | - Shivani Kochhar
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Andrew Maroko
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
- Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York City, New York USA
| | - McKaylee M. Robertson
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Drew A. Westmoreland
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Angela M. Parcesepe
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
- Department of Maternal and Child Health, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Levi Waldron
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York City, New York USA
| | - Christian Grov
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York City, New York USA
| |
Collapse
|