Housing and health inequities during COVID-19: findings from the national Household Pulse Survey

Household material hardship and distress among parents of children with advanced cancer: A report from the PediQUEST Response trial

BACKGROUND

The prevalence and characteristics of household material hardship (HMH) in families of children with advanced cancer and its association with parent distress are unknown and herein described.

METHODS

Parents of children aged ≥2 years with advanced cancer at five cancer centers completed baseline surveys as part of the PediQUEST Response trial. HMH (housing, energy, and food) was operationalized as binary (≥1 HMH domains), ordinal (zero, one, or two or more HMH domains), and housing based (none, nonhousing [food and/or energy], only housing, or housing + other). Associations between HMH and parent distress measured by the State-Trait Anxiety Inventory-State and the 10-item Center for Epidemiologic Studies Depression Scale were estimated via linear models adjusting for confounders.

RESULTS

Among 150 parents, 41% reported ≥1 HMH (housing, 28% [only housing, 8%; housing + other, 20%]; energy, 19%; food, 27%). HMH was more prevalent among Hispanic, other non-White race, Spanish-speaking, and single parents and those with lower education (associate degree or less) or who were uninsured/Medicaid-only insured. Parents endorsing HMH reported higher anxiety (mean difference [MD], 9.2 [95% CI, 3.7-14.7]) and depression (MD, 4.1 [95% CI, 1.7-6.5]) scores compared to those without HMH. Distress increased with the number of hardships, particularly housing insecurity. Specifically, parents experiencing housing hardship, alone or combined, reported higher distress (housing only: anxiety: MD, 10.2 [95% CI, 1.8-18.5]; depression: MD, 4.9 [95% CI, 1.3-8.6]; housing + other HMH: anxiety: MD, 12.0 [95% CI, 5.2-18.9]; depression: MD, 4.8 [95% CI, 1.8-7.8]).

CONCLUSIONS

HMH is highly prevalent in pediatric advanced cancer, especially among historically marginalized families. Future research should investigate whether interventions targeting HMH, particularly housing stabilization efforts, can mitigate parent distress.

PLAIN LANGUAGE SUMMARY

In our cohort of parents of children with advanced cancer, household material hardship (HMH) was highly prevalent and significantly associated with higher parent distress. Housing hardship was the primary driver of this association. Families of children with advanced cancer may benefit from systematic HMH screening as well as targeted HMH interventions, especially stabilizing housing.

COVID-19, social determinants of transmission in the home. A population-based study

BACKGROUND

Studying transmission within the home is essential to understand the transmission dynamics of numerous infectious diseases. For Coronavirus Disease-2019 (COVID-19), transmission within the home constitutes the majority exposure context. The risk of infection in this setting can be quantified by the household/intra-family secondary attack rate (SAR). In the literature, there are discrepancies in these values and little information about its social determinants. The aim of this study was to investigate transmission in the home by analyzing the influence of occupational social class, country of origin and gender/sex.

METHODS

This was a retrospective cohort study of a population registry of cohabiting contacts with COVID-19 cases diagnosed from 15 June to 23 December 2020, in the Murcia Region. The household SAR was analyzed considering the characteristics of the primary case (sex, age, symptoms, occupational social class, country of origin and number of people in the household) and contact (age and sex) using a multilevel binary logistic regression model.

RESULTS

Among the 37 727 contacts included, the intra-family SAR was 39.1%. The contacts of confirmed primary cases in the migrant population (Africa and Latin America) had higher attack rates, even after adjusting for the other variables. Older age and female sex were independent risk factors for contracting Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) within the home.

CONCLUSION

There was greater intra-domiciliary transmission among immigrants, likely related to the conditions of the home and situation of social vulnerability. Women were more likely to be infected by transmission from a cohabiting infected individual.

Assets and depression in U.S. adults during the COVID-19 pandemic: a systematic review

PURPOSE

Mental health is shaped by social and economic contexts, which were altered during the COVID-19 pandemic. No study has systematically reviewed the literature on the relation between different assets and depression during the COVID-19 pandemic.

METHODS

We conducted a systematic review of the literature on financial (e.g. income/savings), physical (e.g., home ownership), and social (e.g., marital status, educational attainment) assets and depression in U.S. adults. For each asset type, we created binary comparisons to report on the direction of the relationship and described if each study reported insignificant, positive, negative, or mixed associations.

RESULTS

Among the 41 articles identified, we found that income was the most studied asset (n=34), followed by education (n=25), marital status (n=18), home ownership (n=5), and savings (n=4). 88%, 100%, and 100% of articles reported a significant association of higher income, home ownership, and higher savings, respectively, with less depression. The association between marital status and education with depression was more nuanced: 72% (13 of 18) studies showed that unmarried persons had greater risk of depression than married or cohabitating persons and 52% (13 of 25) of studies reported no significant difference in depression across educational groups.

CONCLUSION

This work adds to the literature a deeper understanding of how different assets relate to depression. In the context of largescale traumatic events, policies that maintain and protect access to social, physical, and financial assets may help to protect mental health.

Association of long COVID with housing insecurity in the United States, 2022-2023

Objectives

To assess the association of Long COVID with housing insecurity in the United States.

Methods

To compare the prevalence of 3 binary indicators of housing insecurity between people with Long COVID (symptoms >3 months) and COVID-19 survivors who did not report long-term symptoms, we used survey-weighted regression models on 206,969 responses from the Household Pulse Survey, a representative cross-sectional survey of US households collected September 2022-April 2023. Among people with Long COVID, we additionally assessed whether functional impairment, current COVID-19 related symptoms, and symptom impact on day-to-day life were associated with a higher prevalence of housing insecurity.

Results

During the study period, 56,353 respondents with prior COVID-19 experienced symptoms lasting 3 months or longer (27%), representing an estimated 28 million US adults. After adjusting for demographic factors, people with Long COVID were 1.5-2 times as likely to experience significant difficulty with household expenses (Prevalence ratio [PR] 1.48, 95% CI 1.42-1.55), be behind on housing payments (PR 1.48, 95% CI 1.36-1.60), and face likely eviction or foreclosure (PR 1.86, 95% CI 1.58-2.18). The risk of housing insecurity was highest among low-income adults with Long COVID. Among people with Long COVID, functional limitation and current symptoms which impact day-to-day life were associated with higher prevalence of housing insecurity.

Conclusions

Compared with COVID-19 survivors who do not experience long-term symptoms, people with Long COVID are more likely to report indicators of housing insecurity, particularly those of lower socio-economic status, and those with functional limitations or long-term COVID-19 related symptoms impacting day-to-day life. Policies are needed to support people living with chronic illnesses following SARS-CoV-2 infection.

The impact of the COVID-19 pandemic on alcohol use disorder symptoms: Testing interactions with polygenic risk

Objective: The purpose of this study was to test whether COVID impact interacts with genetic risk (polygenic risk score/PRS) to predict alcohol use disorder (AUD) symptoms. Method: Participants were n = 455 college students (79.6% female, 51% European Ancestry/EA, 24% African Ancestry/AFR, 25% Americas Ancestry/AMER) from a longitudinal study during the initial stage (March-May 2020) of the pandemic. Path models allowed for the examination of PRS and previously identified COVID-19 impact constructs. Results: There was a main effect of the AUD PRS on AUD symptoms within the EA group (β: .165, p < .01). Additionally, food/housing insecurity was predictive in the AMER group (β.295, p < .05), and greater increases in substance use were associated with AUD symptoms for EA (β:.459, p < .001) and AMER groups (β:.468, p < .001). Conclusions: Greater food/housing instability and increases in substance use, as well higher scores on PRS are associated with more AUD symptoms for some ancestral groups within this college sample.

Anxiety and Depression Symptoms After the Dobbs Abortion Decision

Importance

In 2022, the US Supreme Court abolished the federal right to abortion in the Dobbs v Jackson Women's Health Organization decision. In 13 states, abortions were immediately banned via previously passed legislation, known as trigger laws.

Objective

To estimate changes in anxiety and depression symptoms following the Dobbs decision among people residing in states with trigger laws compared with those without them.

Design, Setting, and Participants

Using the nationally representative repeated cross-sectional Household Pulse Survey (December 2021-January 2023), difference-in-differences models were estimated to examine the change in symptoms of depression and anxiety after Dobbs (either the June 24, 2022, Dobbs decision, or its May 2, 2022, leaked draft benchmarked to the baseline period, prior to May 2, 2022) by comparing the 13 trigger states with the 37 nontrigger states. Models were estimated for the full population (N = 718 753), and separately for 153 108 females and 102 581 males aged 18 through 45 years.

Exposure

Residing in states with trigger laws following the Dobbs decision or its leaked draft.

Main Outcomes and Measures

Anxiety and depression symptoms were measured via the Patient Health Questionnaire-4 ([PHQ-4]; range, 0-12; scores of more than 5 indicate elevated depression or anxiety symptoms; minimal important difference unknown).

Results

The survey response rate was 6.04% overall, and 87% of respondents completed the PHQ-4. The population-weighted mean age was 48 years (SD, 17 years), and 51% were female. In trigger states, the mean PHQ-4 scores in the baseline period and after the Dobbs decision were 3.51 (95% CI, 3.44 to 3.59) and 3.81 (95% CI, 3.75 to 3.87), respectively, and in nontrigger states were 3.31 (95% CI, 3.27 to 3.34) and 3.49 (95% CI, 3.45 to 3.53), respectively. There was a significantly greater increase in the mean PHQ-4 score by 0.11 (95% CI, 0.06 to 0.16; P < .001) in trigger states vs nontrigger states. From baseline to after the draft was leaked, the change in PHQ-4 was not significantly different for those in trigger states vs nontrigger states (difference-in-differences estimate, 0.09; 95% CI, -0.03 to 0.21; P = .15). From baseline to after the Dobbs opinion, there was a significantly greater increase in mean PHQ-4 scores for those in trigger states vs nontrigger states among females aged 18 through 45 years (difference-in-differences estimate, 0.23; 95% CI, 0.08 to 0.37; P = .002). Among males aged 18 through 45 years, the difference-in-differences estimate was not statistically significant (0.14; 95% CI, -0.08 to 0.36; P = .23). Differences in estimates for males and females aged 18 through 45 were statistically significant (P = .02).

Conclusions and Relevance

In this study of US survey data from December 2021 to January 2023, residence in states with abortion trigger laws compared with residence in states without such laws was associated with a small but significantly greater increase in anxiety and depression symptoms after the Dobbs decision.

Examining burnout in the electrical sector in Ontario, Canada: A cross-sectional study

Workers in the trades sectors often experience mental health issues and decreased work ability due to occupational stress, workplace hazards and living in danger or constant fear of injury. Understanding the impacts of psychosocial risk factors on construction workers' mental health can aid in decreasing workplace injuries, lessening disabilities and increasing worker productivity. In this study, we focus on understanding and assessing the mental health and wellness of individuals in the electrical sector that are members of the Employer Engagement Project (EEP) from the Ontario Electrical League (OEL). The subset of potential participants included electricians and plumbers in Ontario working for small to medium sized employers (SME). The recruitment took place in 2022, with a total of 82 participants who completed a survey collecting demographic information, assessing the importance and availability/satisfaction of workplace factors and stress-and burnout-related questions. The data were analyzed using IBM SPSS Statistics 29.0. Two-sample Mann-Whitney U tests were performed to test for associations between the availability of work-related factors and burnout scores among the participants. Burnout scores were determined using the Copenhagen Burnout Inventory. Our findings demonstrate that dissatisfaction of the following factors: Workload allocation, internal staff development opportunity and stable staffing/minimal turnover, were associated with high burnout levels. The findings indicate there may be a relationship between certain work-related factors and burnout levels experienced. There is a need for improvement of workload allocation in SMEs to help enhance the mental health and well-being of employees.

Association of Long COVID with housing insecurity in the United States, 2022-2023

Objectives

To assess the association of Long COVID with housing insecurity in the United States.

Methods

To compare the prevalence of 3 binary indicators of housing insecurity between people with Long COVID (symptoms > 3 months) and COVID-19 survivors who don't report long-term symptoms, we used survey-weighted regression models on 203,807 responses from the Household Pulse Survey, a representative cross-sectional survey of US households collected September 2022 - April 2023. Among people with Long COVID, we assessed whether functional impairment, current COVID-19 related symptoms, and symptom impact on day-today life were associated with a higher prevalence of housing insecurity.

Results

During the study period, 54,446 (27.2%) respondents with COVID-19 experienced symptoms lasting 3 months or longer, representing an estimated 27 million US adults. People with Long COVID were nearly twice as likely to experience significant difficulty with household expenses (Prevalence ratio [PR] 1.85, 95% CI 1.74-1.96), be behind on housing payments (PR 1.76, 95% CI 1.57-1.99), and face likely eviction or foreclosure (PR 2.12, 95% CI 1.58-2.86). Functional limitation and current symptoms which impact day-to-day life were associated with higher prevalence of housing insecurity.

Conclusions

Compared with COVID-19 survivors who don't experience long-term symptoms, people with Long COVID are more likely to report indicators housing insecurity, particularly those with functional limitations and long-term COVID-19 related symptoms impacting day-today life. Policies are needed to support people living with chronic illnesses following SARS-CoV-2 infection.

The changes in job-housing balance during the Covid-19 period in China

By using three continuous years of national-scale cellphone signaling data from Jan. 2019 to Dec. 2021, this study adds fresh evidence for job-housing balance changes at the Quxian level during the COVID-19 period in China. The findings show that according to the resident-balance index and worker-balance index, the job-housing balance jumped when the number of COVID-19 confirmed cases reached its peak in February 2020, with an average of 94.4 % which is the highest level during these three years. The study also found that the Quxian-level job-housing balance has generally improved steadily in the two years of the pandemic. In addition, the results highlighted the huge gaps between females and males in the job-housing balance, but the gender disparities in job-housing balance were reduced to a minimum during the pandemic lockdown. In addition, by comparison analysis of the changes in resident-balance index and worker-balance index during this unprecedented crisis, this study found that for Quxians with high economic vitality, worker-balance index increased greater than resident-balance index, but for Quxians with low economic vitality, the reverse happened. Our findings provide a better understanding of the job-housing relationship during public health crises that can support the urban management in the future policymaking.

Association between reasons for not working and reporting of major depression and anxiety symptoms among U.S. adult population during the COVID-19 pandemic

COVID-19 continues to take a large toll on the mental health of the not working population, particularly of those who were unable to work. This study, using the Household Pulse Survey, estimated the association between reasons for not working and major depression and anxiety symptoms (MDAS). The lowest MDAS was reported by retirees. Individuals who were unable to work because of transportation problems, layoffs, COVID-19 concerns, and sickness or disability reported the highest MDAS. Mediation analysis showed that the direct and indirect effects of reasons for not working were much higher for those individuals who were unable to work than for individuals who were working or decided not to work.

Changes in household debt due to COVID-19 and mental health concerns among adults in Ontario, Canada

BACKGROUND

Canadian households experienced unexpected changes in their economic well-being during the COVID-19 pandemic. The extent of the impact of the pandemic on household debt and its effect on health and mental health remains unknown.

AIM

The aim of the study was to examine the associations of change in household debt due to COVID-19 with serious psychological distress (SPD) and general health measures.

METHODS

Data were from the 2020 Monitor study, a repeated cross-sectional survey of adults 18 years and older in Ontario, Canada. The 2020 cycle employed a web-based panel survey of 3,033 adults. The survey included measures of change in household debt due to the COVID-19 pandemic, mental and general health. Odds ratios (OR) were estimated from logistic regression models accounting for sociodemographic factors.

RESULTS

Overall, 17.5% of respondents reported that their household debt increased due to the COVID-19 pandemic. Such an increase in household debt was significantly associated with SPD (OR = 2.92, 95% CI, 2.05-4.16), fair/poor mental health (OR = 2.02, 95% CI, 1.59-2.56), frequent mental distress days (OR = 1.80, 95% CI, 1.31-2.48), fair/poor general health (OR = 1.93, 95% CI, 1.47-2.52), and suicidal ideation (OR = 3.71, 95% CI, 2.41-5.70) after adjusting for potential confounders including education, income and employment.

CONCLUSIONS

Household debt during the COVID-19 pandemic is an important determinant of health. Individuals who reported an increase in household debt due to COVID-19 were more likely to report serious mental health concerns including suicidal ideation. This suggests that debt-related interventions may be needed to alleviate the adverse effects of indebtedness on health.

Excess Mortality in California by Education During the COVID-19 Pandemic

INTRODUCTION

Understanding educational patterns in excess mortality during the coronavirus disease 2019 (COVID-19) pandemic may help to identify strategies to reduce disparities. It is unclear whether educational inequalities in COVID-19 mortality have persisted throughout the pandemic, spanned the full range of educational attainment, or varied by other demographic indicators of COVID-19 risks, such as age or occupation.

METHODS

This study analyzed individual-level California Department of Public Health data on deaths occurring between January 2016 and February 2021 among individuals aged ≥25 years (1,502,202 deaths). Authors applied ARIMA (autoregressive integrated moving average) models to subgroups defined by the highest level of education and other demographics (age, sex, race/ethnicity, U.S. nativity, occupational sector, and urbanicity). Authors estimated excess deaths (the number of observed deaths minus the number of deaths expected to occur under the counterfactual of no pandemic) and excess deaths per 100,000 individuals.

RESULTS

Educational inequalities in excess mortality emerged early in the pandemic and persisted throughout the first year. The greatest per-capita excess occurred among people without high-school diplomas (533 excess deaths/100,000), followed by those with a high-school diploma but no college (466/100,000), some college (156/100,000), and bachelor's degrees (120/100,000), and smallest among people with graduate/professional degrees (101/100,000). Educational inequalities occurred within every subgroup examined. For example, per-capita excess mortality among Latinos with no college experience was 3.7 times higher than among Latinos with at least some college experience.

CONCLUSIONS

Pervasive educational inequalities in excess mortality during the pandemic suggest multiple potential intervention points to reduce disparities.

Well-being and social determinants of health among Australian adults: A national cross-sectional study

The social determinants of health affect an individual's capacity to cope during a crisis such as the COVID-19 pandemic which could potentially impact their well-being. The aim of this study was to examine the relationship between well-being and the social determinants of health among Australian adults during the COVID-19 pandemic. A cross-sectional study of adults residing in Australia was conducted using SurveyMonkey between 20 August and 14 October 2020. Participants were recruited via social media. Well-being was measured using the 10-item Multicultural Quality of Life Index and social determinants of health were measured using validated tools and investigator developed questions. Data were analysed using SPSS version 25. Inferential statistics, including independent t-test and one-way ANOVA, were undertaken. Multiple regression analysis was used to investigate the predictors of well-being. In total, 1211 responses were received. Females accounted for 80.7% of the responses, men 16.7% and transgender/non-binary 2.6%. The mean age of the respondents was 43 years (SD 14.2). The mean score for total well-being was 62.58 (SD 21.22). The significant predictors of higher well-being were housing security (p = 0.000), food security (p = 0.000), social support (p = 0.000) and access to healthcare (p = 0.000). This study demonstrates that those with poor social support, difficulty accessing healthcare, insecure housing and food insecurity had significantly poorer well-being during the COVID-19 pandemic. It shows that the COVID-19 pandemic has exacerbated social vulnerabilities and highlights the need for action to address the social determinants of health and inequalities.

Pandemic-related socioeconomic disruptions and adverse health outcomes: a cross-sectional study of female caregivers

Background

The COVID-19 pandemic and efforts to mitigate transmission resulted in sudden and widespread socioeconomic disruptions including school and child care closures, unemployment and underemployment, and housing precarity. Understanding the extent to which these disruptions may have contributed to adverse health outcomes is critical for establishing policy priorities that can mitigate further harm.

Methods

We explored the associations between pandemic-related child care, employment, and housing disruptions with depressive symptoms, self-rated health, and food security status among a sample of economically disadvantaged and racially diverse female caregivers of young children (n=464). Data were derived from the Assessing California Communities’ Experiences with Safety Net Supports (ACCESS) study, which conducted survey-based interviews with California caregivers with low-income from August 2020 – May 2021. We implemented a series of multivariable Poisson regressions with robust standard errors to assess the potency of each exposure, independently and within the context of one another.

Results

Most caregivers experienced disruptions to child care (70%) and employment (63%); few experienced major housing disruptions (8%). Women that experienced child care and housing disruptions had greater depressive symptoms, lower self-rated health, and greater food insecurity, although the relationships for housing and depressive symptoms were modified by the timing of participants’ interviews. Employment disruptions were not associated with any of the examined adverse health outcomes.

Conclusion

In the wake of socioeconomic stressors brought about by the COVID-19 pandemic, attending to structural deficits in the child care system and increasing housing supports may be critical for protecting the health of caregivers.

Supplementary information

The online version contains supplementary material available at 10.1186/s12889-022-14287-2.

A National Study of Zoom Fatigue and Mental Health During the COVID-19 Pandemic: Implications for Future Remote Work

Overuse of videoconferencing for work may contribute to what has been called "Zoom fatigue": feeling anxious, socially isolated, or emotionally exhausted due to lack of social connection. Given implications for employee well-being, this study investigated Zoom fatigue at work and its potential link to mental health symptoms. A national survey of mental health symptoms was conducted in the United States during the COVID-19 pandemic in August 2020. Adults (n = 902) endorsing a shift at work to videoconferencing completed an online survey; survey criteria included an age minimum of 22 years and reported annual gross income of <$75,000. Statistical raking was employed to weight the sample using U.S. census data on geographic region, age, gender, race, and ethnicity. A three-item Zoom Fatigue Scale measuring perceived stress, isolation, and depression associated with videoconferencing at work showed good internal consistency (α = 0.85). Higher scores on this scale were related to being married, nonwhite race, post-high school education, severe mental illness, greater loneliness, lower social support, lacking money for food, and more weekly videoconference calls. Depressive symptoms demonstrated a significant association with Zoom fatigue, even when adjusting for demographic, psychosocial, and clinical covariates. The study findings indicated that employers and employees should consider a complex array of individual-level and environment-level factors when assessing how videoconferencing at work may engender stress, social isolation, and emotional exhaustion. This impact could adversely impact mental health, work productivity, and quality of life, even after the COVID-19 pandemic.

Role of social determinants in anxiety and depression symptoms during COVID-19: A longitudinal study of adults in North Carolina and Massachusetts

Trajectory studies of the COVID-19 pandemic have described patterns of symptoms over time. Yet, few have examined whether social determinants of health predict the progression of depression and anxiety symptoms during COVID-19 or identified which social determinants worsen symptom trajectories. Using a racially, ethnically, and linguistically diverse sample of adults participating in a randomized clinical trial with pre-existing moderate to severe depression and/or anxiety symptoms, we compare symptom patterns before and during COVID-19; characterize symptom trajectories over a 20-week follow-up period; and evaluate whether social determinants are associated with within- and between- person differences in symptom trajectories. Data were collected before and during COVID-19 in Massachusetts and North Carolina. On average, depression and anxiety symptoms did not seem to worsen during the pandemic compared to pre-pandemic. During COVID-19, anxiety scores at follow-up were higher for participants with baseline food insecurity (vs no food insecurity). Depression scores at follow-up were higher for participants with food insecurity and for those with utilities insecurity (vs no insecurity). Participants with child or family care responsibilities at baseline had depression symptoms decreasing at a slower rate than those without these responsibilities. We discuss the important implications of these findings.

Prophylactic Architecture: Formulating the Concept of Pandemic-Resilient Homes

The lockdown instituted during the COVID-19 pandemic has drawn the world’s attention to the importance of homes as integrated structures for practicing all aspects of life. The home has been transformed from a mere place to live into a complete piece of infrastructure accommodating all activities of life, including study, work, shopping, exercise, entertainment, and even telehealth. Although quarantines were necessary to protect against viral infection, we have faced social and psychological challenges due to the failure of the current home design to accommodate the new lockdown lifestyle during the pandemic. Thus, this study aims to set a foundation for the development and design of resilient homes in a post-quarantine world by establishing a comprehensive framework for quarantine-resilient homes. The framework was established on the basis of the relevant literature and proposals from architects and experts. It brings a perspective to the future requirements of homes so as to provide architects, stakeholders, and policymakers with the appropriate knowledge to mitigate the impact of lockdowns on mental health and well-being in residential buildings by focusing on the physical and architectural environment.

COVID-19, Police Violence, and Educational Disruption: The Differential Experience of Anxiety for Racial and Ethnic Households

BACKGROUND

The threat of a deadly pandemic, racial tension, recessionary economic circumstances, and educational disruption likely contributed to the heightened anxiety felt by many Americans in 2020. This study examines the differential anxiety experienced by Black, White, and Hispanic households with and without children during 2020.

METHOD

Data from the Census Bureau's Household Pulse Survey detailing the frequency of anxiety among a nationally representative sample of adults from April 23 to December 21, 2020, was coupled with Centers for Disease Control and Prevention records of COVID-19 diagnoses and state-level police killings. Multinomial logistic regression assessed the relative contribution of COVID-19 deaths, police violence, unemployment, fear of unemployment, change in educational delivery, and geographic location to anxiety among racial/ethnic cohorts with and without children.

RESULTS

Anxiety frequency increased over the sample for all groups. However, White anxiety was highly responsive to state-level COVID-19 fatalities, while Black anxiety was highly correlated with police violence. Households with children showed higher levels of anxiety during nontraditional educational delivery, whereas both households with and without children experienced high levels of fear regarding employment uncertainty and poverty.

CONCLUSIONS

Experiences in 2020 impacted all groups differently, but each showed a high frequency of anxiety.