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SteelFisher GK, Caporello HL, Stein RI, Lubell KM, Lane L, Moharam Ali S, Briseño L, Dicent Taillepierre J, Rodriguez-Lainz A, Boyea A, Espino L, Aveling EL. Developing Infectious Disease Outbreak Emergency Communications for Populations With Limited English Proficiency: Insights to Sustain Collaborations Between Local Health Departments and Community-Based Organizations. Am J Health Promot 2024:8901171241273349. [PMID: 39159601 DOI: 10.1177/08901171241273349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024]
Abstract
PURPOSE State and local public health departments (LHDs) are encouraged to collaborate with community-based organizations (CBOs) to enhance communication and promote protective practices with communities made vulnerable during emergencies, but there is little evidence-based understanding of practical approaches to fostering collaboration in this context. This research focuses on how collaboration enhances LHD capacity for effective communication for people with limited English proficiency (LEP) during infectious disease outbreaks specifically and strategies to facilitate productive LHD-CBO collaboration. DESIGN Qualitative, telephone interviews, conducted March-October 2021. SETTING Rural and urban jurisdictions with Chinese-speaking or Spanish-speaking populations across the United States. PARTICIPANTS 36 LHD and 31 CBO staff working on outreach to Chinese and Spanish speakers during COVID-19. METHOD Interviews were audio-recorded, transcribed verbatim, and analyzed using a team-based, codebook approach to thematic analysis. RESULTS During COVID-19, CBOs extended LHD capacity to develop and disseminate effective communication, meaning communication that is rapidly in-language, culturally resonant, locally relevant, and trusted. Practical strategies to enable and sustain effective collaboration were needed to address operational dimensions (eg, material and administrative) and relational dimensions (eg, promoting trust and respect). CONCLUSION Policies and financing to support LHD-CBO collaborations are critical to improving communication with people with LEP and addressing long-standing inequities in outcomes during outbreaks.
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Affiliation(s)
- Gillian K SteelFisher
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Hannah L Caporello
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Rebekah I Stein
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Keri M Lubell
- Office of Communications, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Lindsay Lane
- Office of Communications, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Shakila Moharam Ali
- Office of Communications, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Lisa Briseño
- Office of Communications, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - Alfonso Rodriguez-Lainz
- National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Alyssa Boyea
- Association of State and Territorial Health Officials, Arlington, VA, USA
| | - Laura Espino
- National Public Health Information Coalition, Canton, GA, USA
| | - Emma-Louise Aveling
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Ashraf H, Ashfaq H, Ahmed S, Ashraf A. Two decades of influenza and pneumonia mortality trends: Demographics, regional shifts and disparities in the United States: 1999 to 2020. Am J Infect Control 2024:S0196-6553(24)00495-4. [PMID: 38776982 DOI: 10.1016/j.ajic.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND In the 20th century, influenza and pneumonia constituted the largest proportion of infectious disease deaths in the United States. Despite progress in management, US mortality trends for these diseases have not been thoroughly investigated. OBJECTIVES We aim to examine the patterns of influenza and pneumonia-related deaths among US residents. METHODS Crude death rates and age-adjusted mortality rates (AAMRs) per 100,000 individuals were calculated using influenza and pneumonia mortality data (International Classification of Diseases, 10th revision codes: J09-J18) from the CDC WONDER database. Annual percentage changes with a 95% confidence interval were determined using joinpoint regression analysis. Average annual percentage changes were computed as the weighted average of annual percentage changes. RESULTS From 1999 to 2020, US influenza and pneumonia deaths totaled 1,257,088 (AAMR: 17.09), with a significantly decreasing AAMR (-2.94). Males had a higher AAMR (20.13) than females (15.02). Non-Hispanic American Indians had the highest AAMR (20.44), while Hispanics had the lowest AAMR (13.91). The Northeast had the highest AAMR (18.02). All other regions had similar AAMRs. Rural regions had a consistently higher AAMR (19.80) than urban regions (AAMR: 16.51). CONCLUSION Tailoring interventions toward high-risk groups can enhance the effectiveness of preventive measures, vaccination, and health care access.
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Affiliation(s)
- Hamza Ashraf
- Department of Medicine, Allama Iqbal Medical College, Lahore, Punjab, Pakistan.
| | - Haider Ashfaq
- Department of Medicine, Allama Iqbal Medical College, Lahore, Punjab, Pakistan
| | - Sophia Ahmed
- Department of Medicine, Allama Iqbal Medical College, Lahore, Punjab, Pakistan
| | - Ali Ashraf
- Department of Medicine, Punjab Medical College, Faisalabad, Punjab, Pakistan
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Dopelt K, Krispel E, Davidovitch N. Role of Grassroots Public Health Leadership in Bedouin Society in Israel in Reducing Health Disparities. J Healthc Leadersh 2024; 16:177-192. [PMID: 38595328 PMCID: PMC11003427 DOI: 10.2147/jhl.s447950] [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: 11/02/2023] [Accepted: 03/22/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction Negev Bedouin settlements suffer from poor infrastructure, and the population's health status is low across all indicators. While it is difficult for Bedouin citizens of Israel to integrate into the Israeli employment market, integrating this population into the health system is far-reaching. The aim of this study is to analyze the barriers and motivational factors experienced by Bedouin doctors to promote public health in the Bedouin community in southern Israel and to examine the perceptions these doctors have around the concept of leadership in a public health setting. Methods We conducted semi-structured interviews with Bedouin doctors from the Negev Bedouin community and analyzed them using thematic analysis. Results Most interviewees saw themselves as leaders whose role was to improve public health in their community. They stressed the need for health leadership in Negev Bedouin society, and their desire to lead change in the community from within. All interviewees had grown used to a different way of life and a higher standard of living, and as a result, had difficulty returning home. Interviewees presented that trust in the health system is a critical factor for the success of health promotion programs. However, they noted the evolving trends of general mistrust in the government and its institutions that form the infrastructure for mistrust in the health system. Lack of time and workload were barriers to exercising leadership. Interviewees reported their perception of how socioeconomic status, the standard of living, and lack of infrastructure, education, and training affect health outcomes and collaboration potential. Discussion This study presents a unique perspective on the views of doctors from the Negev Bedouin population on their involvement with grassroots leadership as a strategy to reduce health disparities in this community.
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Affiliation(s)
- Keren Dopelt
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
| | - Einat Krispel
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Nadav Davidovitch
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
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Morrow AJ, Sykes R, Saleh M, Zahra B, MacIntosh A, Kamdar A, Bagot C, Bayes HK, Blyth KG, Bulluck H, Carrick D, Church C, Corcoran D, Findlay I, Gibson VB, Gillespie L, Grieve D, Barrientos PH, Ho A, Lang NN, Lowe DJ, Lennie V, Macfarlane PW, Mayne KJ, Mark PB, McConnachie A, McGeoch R, Nordin S, Payne A, Rankin AJ, Robertson K, Ryan N, Roditi G, Sattar N, Stobo D, Allwood-Spiers S, Touyz RM, Veldtman G, Weeden S, Weir R, Watkins S, Welsh P, Mangion K, Berry C. Socioeconomic deprivation and illness trajectory in the Scottish population after COVID-19 hospitalization. COMMUNICATIONS MEDICINE 2024; 4:32. [PMID: 38418616 PMCID: PMC10901805 DOI: 10.1038/s43856-024-00455-5] [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: 01/27/2023] [Accepted: 02/07/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The associations between deprivation and illness trajectory after hospitalisation for coronavirus disease-19 (COVID-19) are uncertain. METHODS A prospective, multicentre cohort study was conducted on post-COVID-19 patients, enrolled either in-hospital or shortly post-discharge. Two evaluations were carried out: an initial assessment and a follow-up at 28-60 days post-discharge. The study encompassed research blood tests, patient-reported outcome measures, and multisystem imaging (including chest computed tomography (CT) with pulmonary and coronary angiography, cardiovascular and renal magnetic resonance imaging). Primary and secondary outcomes were analysed in relation to socioeconomic status, using the Scottish Index of Multiple Deprivation (SIMD). The EQ-5D-5L, Brief Illness Perception Questionnaire (BIPQ), Patient Health Questionnaire-4 (PHQ-4) for Anxiety and Depression, and the Duke Activity Status Index (DASI) were used to assess health status. RESULTS Of the 252 enrolled patients (mean age 55.0 ± 12.0 years; 40% female; 23% with diabetes), deprivation status was linked with increased BMI and diabetes prevalence. 186 (74%) returned for the follow-up. Within this group, findings indicated associations between deprivation and lung abnormalities (p = 0.0085), coronary artery disease (p = 0.0128), and renal inflammation (p = 0.0421). Furthermore, patients with higher deprivation exhibited worse scores in health-related quality of life (EQ-5D-5L, p = 0.0084), illness perception (BIPQ, p = 0.0004), anxiety and depression levels (PHQ-4, p = 0.0038), and diminished physical activity (DASI, p = 0.002). At the 3-month mark, those with greater deprivation showed a higher frequency of referrals to secondary care due to ongoing COVID-19 symptoms (p = 0.0438). However, clinical outcomes were not influenced by deprivation. CONCLUSIONS In a post-hospital COVID-19 population, socioeconomic deprivation was associated with impaired health status and secondary care episodes. Deprivation influences illness trajectory after COVID-19.
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Affiliation(s)
- Andrew J Morrow
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Robert Sykes
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Merna Saleh
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Baryab Zahra
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | | | - Anna Kamdar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Catherine Bagot
- Department of Haemostasis and Thrombosis, Glasgow Royal Infirmary, Glasgow, UK
| | - Hannah K Bayes
- Department of Respiratory Medicine, Glasgow Royal Infirmary, Glasgow, UK
| | - Kevin G Blyth
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | - David Carrick
- Department of Cardiology, University Hospital Hairmyres, East Kilbride, UK
| | - Colin Church
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
- Regional Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK
| | - David Corcoran
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Iain Findlay
- Department of Cardiology, Royal Alexandra Hospital, Paisley, UK
| | - Vivienne B Gibson
- Department of Haemostasis and Thrombosis, Glasgow Royal Infirmary, Glasgow, UK
| | - Lynsey Gillespie
- Project Management Unit, Glasgow Clinical Research Facility, Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Douglas Grieve
- Department of Respiratory Medicine, Royal Alexandra Hospital, Glasgow, UK
| | | | - Antonia Ho
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Ninian N Lang
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - David J Lowe
- Department of Emergency Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Vera Lennie
- Department of Cardiology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Peter W Macfarlane
- Electrocardiology Core Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kaitlin J Mayne
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Patrick B Mark
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Ross McGeoch
- Regional Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK
| | - Sabrina Nordin
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Alexander Payne
- Department of Cardiology, University Hospital Crosshouse, Kilmarnock, UK
| | - Alastair J Rankin
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Keith Robertson
- Department of Cardiology, Royal Alexandra Hospital, Paisley, UK
| | - Nicola Ryan
- Department of Cardiology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Giles Roditi
- Department of Radiology, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - David Stobo
- Department of Radiology, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | | | - Rhian M Touyz
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Gruschen Veldtman
- Scottish Adult Congenital Cardiac Service, NHS Golden Jubilee, Clydebank, UK
| | - Sarah Weeden
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Robin Weir
- Regional Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK
| | - Stuart Watkins
- Department of Cardiology, Royal Alexandra Hospital, Paisley, UK
| | - Paul Welsh
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Kenneth Mangion
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Colin Berry
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK.
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Kim PC, Cochran C, Bai B, Bhandari N, Khan B, Keyoung ES, Shen JJ. Increasing Emotional Distress and Use of Health Services among Hospitality Industry Workers During and After the COVID-19 Lockdown. Ethn Dis 2024; 34:75-83. [PMID: 38973805 PMCID: PMC11223034 DOI: 10.18865/ed.34.2.75] [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] [Indexed: 07/09/2024] Open
Abstract
Objective To examine the emotional distress situation among hospitality industry workers and their access to and use of health care including telehealth services during the COVID-19 pandemic. Methods A survey was administered on the Qualtrics platform both in English and Spanish from November 18, 2020, to November 30, 2020, through the Culinary Workers Union in Nevada. A total of 1182 union members participated in the survey, of whom 892 completed the survey. Descriptive and multivariable regression analyses were conducted. Results Among 892 respondents, 78% were people of color; 71% were laid off or furloughed during the COVID-related shutdown, but most had access to health care. Further, 78.8% experienced at least 2 or more signs of emotional distress during the pandemic. Females and unemployment status were positively associated with experiencing emotional distress. About 43.5% received care through telehealth, although most did not prefer telehealth (74.2%). Only 18.3% of non-telehealth users were interested in telehealth and 15.0% had never heard about telehealth. Conclusions Health insurance coverage is essential for access to health services regardless of employment status. Strengthening mental health services, including psychological counselling for hospitality workers, is needed in such public health emergency situations as the ongoing COVID-19 pandemic.
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Affiliation(s)
- Pearl C. Kim
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV
| | - Christopher Cochran
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV
| | - Billy Bai
- William F. Harrah College of Hospitality, University of Nevada Las Vegas, Las Vegas, NV
| | - Neeraj Bhandari
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV
| | | | | | - Jay J. Shen
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV
- Center for Health Disparities and Research, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV
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6
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Silverman RA, Short D, Wenzel S, Friesen MA, Cook NE. COVID-19 related messaging, beliefs, information sources, and mitigation behaviors in Virginia: a cross-sectional survey in the summer of 2020. PeerJ 2024; 12:e16714. [PMID: 38213767 PMCID: PMC10782956 DOI: 10.7717/peerj.16714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 12/04/2023] [Indexed: 01/13/2024] Open
Abstract
Background Conflicting messages and misleading information related to the coronavirus (COVID-19) pandemic (SARS-CoV-2) have hindered mitigation efforts. It is important that trust in evidence-based public health information be maintained to effectively continue pandemic mitigation strategies. Officials, researchers, and the public can benefit from exploring how people receive information they believe and trust, and how their beliefs influence their behaviors. Methods To gain insight and inform effective evidence-based public health messaging, we distributed an anonymous online cross-sectional survey from May to July, 2020 to Virginia residents, 18 years of age or older. Participants were surveyed about their perceptions of COVID-19, risk mitigation behaviors, messages and events they felt influenced their beliefs and behaviors, and where they obtained information that they trust. The survey also collected socio-demographic information, including gender, age, race, ethnicity, level of education, income, employment status, occupation, changes in employment due to the pandemic, political affiliation, sexual orientation, and zip code. Analyses included specific focus on the most effective behavioral measures: wearing a face mask and distancing in public. Results Among 3,488 respondents, systematic differences were observed in information sources that people trust, events that impacted beliefs and behaviors, and how behaviors changed by socio-demographics, political identity, and geography within Virginia. Characteristics significantly associated (p < 0.025) with not wearing a mask in public included identifying as non-Hispanic white, male, Republican political identity, younger age, lower income, not trusting national science and health organizations, believing one or more non-evidence-based messages, and residing in Southwest Virginia in logistic regression. Similar, lesser in magnitude correlations, were observed for distancing in public. Conclusions This study describes how information sources considered trustworthy vary across different populations and identities, and how these differentially correspond to beliefs and behaviors. This study can assist decision makers and the public to improve and effectively target public health messaging related to the ongoing COVID-19 pandemic and future public health challenges in Virginia and similar jurisdictions.
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Affiliation(s)
- Rachel A. Silverman
- Statistics, Virginia Polytechnic Institute and State University (Virginia Tech), Blacksburg, VA, United States of America
| | - Danielle Short
- Population Health Sciences, Virginia Polytechnic Institute and State University (Virginia Tech), Blacksburg, VA, United States of America
| | - Sophie Wenzel
- Population Health Sciences, Virginia Polytechnic Institute and State University (Virginia Tech), Blacksburg, VA, United States of America
| | | | - Natalie E. Cook
- Population Health Sciences, Virginia Polytechnic Institute and State University (Virginia Tech), Blacksburg, VA, United States of America
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Findling MG, Caporello HL, Stein RI, Wade CG, Lubell KM, Briseño L, SteelFisher GK. Communications for US Populations With Limited English Proficiency During Infectious Disease Outbreaks: A Scoping Review. Health Secur 2023; 21:489-499. [PMID: 37889614 PMCID: PMC11301523 DOI: 10.1089/hs.2023.0050] [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: 10/29/2023] Open
Abstract
The COVID-19 pandemic has highlighted the need for research about communicating with populations who have limited English proficiency in the United States during infectious disease outbreaks. These populations have experienced significantly worse health outcomes during emergencies, including the COVID-19 pandemic, and evidence-based risk communications are critical to protecting their health. To support improved development of emergency communications for these communities, we conducted a scoping review that examined the extent of research available, with an intent to identify which communications topics are covered in the literature and where research gaps exist. Following the JBI framework, with reporting guided by the PRISMA extension for scoping reviews, 6 electronic databases were systematically searched in October 2022. The inclusion criteria for articles selected were: data collected between 2009 and 2022, published in English, and focused on communications pertaining to emergency infectious disease outbreaks (eg, H1N1 influenza, Zika virus, COVID-19) for populations with limited English proficiency. Of 2,049 articles identified through the search, 31 met the inclusion criteria and were selected for review. We identified major limitations in the evidence base: a majority of studies were conducted only among Spanish speakers or during the COVID-19 pandemic, and most used qualitative or nonrandom samples. Most studies documented basic language barriers in communications, but there was little exploration of more nuanced barriers, such as cultural relevance or social context. Ahead of future outbreaks, more research is urgently needed to examine the information landscapes of populations with limited English proficiency, to inform the development of more effective communications strategies from public health institutions and others.
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Affiliation(s)
- Mary G Findling
- Mary G. Findling, PhD, ScM, is Assistant Director, in the Harvard Opinion Research Program, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Hannah L Caporello
- Hannah L. Caporello is Senior Research Projects Manager, in the Harvard Opinion Research Program, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Rebekah I Stein
- Rebekah I. Stein is a Research Assistant, in the Harvard Opinion Research Program, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Carrie G Wade
- Carrie G. Wade, MLIS, is a Research and Instruction Librarian, Countway Library of Medicine, Harvard Medical School, Boston, MA
| | - Keri M Lubell
- Keri M. Lubell, PhD, is a Behavioral Scientist, at the US Centers for Disease Control and Prevention, Atlanta, GA
| | - Lisa Briseño
- Lisa Briseño, MS, is a Senior Health Communication Specialist, at the US Centers for Disease Control and Prevention, Atlanta, GA
| | - Gillian K SteelFisher
- Gillian K. SteelFisher, PhD, MSc, is Principal Research Scientist and Director of Global Polling, in the Harvard Opinion Research Program, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
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Larson N, Tavernier RE, Berge JM, Barr-Anderson DJ, Neumark-Sztainer D. Implications of the COVID-19 Pandemic for the Well-Being of Emerging Adult Populations: A Synthesis of Findings From the COVID-19 Eating and Activity Over Time (C-EAT) Study. EMERGING ADULTHOOD (PRINT) 2023; 11:779-796. [PMID: 37832141 PMCID: PMC10064195 DOI: 10.1177/21676968231166034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
Research addressing the impact of the COVID-19 pandemic on psychosocial well-being and health behavior is accumulating; however, implications for emerging adult populations are underexplored. This manuscript synthesizes findings from a mixed-methods study of well-being, eating and activity behaviors, and food insecurity among a diverse, longitudinal cohort of emerging adults. The review includes findings from 11 original studies that involved collecting online surveys from 720 emerging adults and in-depth, virtual interviews with 33 respondents who were food insecure. Findings indicated the pandemic had widespread impacts on well-being. Population groups at greatest risk for poor outcomes included women; those who identified as Black, Indigenous, or a Person of Color; persons in households of low socioeconomic status; parents of young children; and persons who previously experienced mental health challenges or weight stigma. Further research will be needed to evaluate efforts to improve the well-being of emerging adults in the aftermath of the pandemic.
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Affiliation(s)
- Nicole Larson
- Division of Epidemiology and Community
Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Rebecca Emery Tavernier
- Department of Family Medicine and
Biobehavioral Health, University of Minnesota Medical
School, Duluth, MN, USA
| | - Jerica M. Berge
- Department of Family Medicine and Community
Health, University of Minnesota Medical School,
University of Minnesota, Minneapolis, MN, USA
| | | | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community
Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Wang Z, Jamal A, Wang R, Dan S, Kappagoda S, Kim G, Palaniappan L, Long J, Singh J, Srinivasan M. Disparities and Trends in Routine Adult Vaccination Rates Among Disaggregated Asian American Subgroups, National Health Interview Survey 2006-2018. AJPM FOCUS 2023; 2:100044. [PMID: 37789943 PMCID: PMC10546520 DOI: 10.1016/j.focus.2022.100044] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Vaccination rates may be improved through culturally tailored messages, but little is known about them among disaggregated Asian American subgroups. We assessed the vaccination rates for key vaccines among these subgroups. Methods Using the National Health Interview Survey, we analyzed recent vaccination rates (2015-2018, n=188,250) and trends (2006-2018) among Asians (Chinese [n=3,165], Asian Indian [n=3,525], Filipino [n=3,656], other Asian [n=5,819]) and non-Hispanic White adults (n=172,085) for 6 vaccines (the human papillomavirus, hepatitis B, pneumococcal, influenza, tetanus-diphtheria [tetanus], and shingles vaccines). We controlled demographic, socioeconomic, and health-related variables in multivariable logistic regression and predicted marginal modeling analyses. We also computed vaccination rates among Asian American subgroups on the 2015-2018 National Health Interview Survey data stratified by foreign-born and U.S.-born status. We used Joinpoint regression to analyze trends in vaccination rates. All analyses were conducted in 2021 and 2022. Results Among Asians, shingles (29.2%; 95% CI=26.6, 32.0), tetanus (53.7%; 95% CI=51.8, 55.6), and pneumococcal (53.8%; 95% CI=50.1, 57.4) vaccination rates were lower than among non-Hispanic Whites. Influenza (47.9%; 95% CI=46.2, 49.6) and hepatitis B (40.5%; 95% CI=39.0, 42.7) vaccination rates were similar or higher than among non-Hispanic Whites (48.4%; 95% CI=47.9, 48.9 and 30.7%; 95% CI=30.1, 31.3, respectively). Among Asians, we found substantial variations in vaccination rates and trends. For example, Asian Indian women had lower human papillomavirus vaccination rates (12.9%; 95% CI=9.1, 18.0) than all other Asian subgroups (Chinese: 37.9%; 95% CI=31.1, 45.2; Filipinos: 38.7%; 95% CI=29.9, 48.3; other Asians: 30.4%; 95% CI=24.8, 36.7) and non-Hispanic Whites (36.1%; 95% CI=34.8, 37.5). Being male, having lower educational attainment and income, having no health insurance or covered by public health insurance only, and lower frequency of doctor visits were generally associated with lower vaccine uptakes. Foreign-born Asian aggregate had lower vaccination rates than U.S.-born Asian aggregate for all vaccines except for influenza. We also found subgroup-level differences in vaccination rates between foreign-born and U.S.-born Asians. We found that (1) foreign-born Chinese, Asian Indians, and other Asians had lower human papillomavirus and hepatitis B vaccination rates; (2) foreign-born Chinese and Filipinos had lower pneumococcal vaccination rates; (3) foreign-born Chinese and Asian Indians had lower influenza vaccination rates; and (4) all foreign-born Asian subgroups had lower tetanus vaccination rates. Conclusions Vaccination rates and trends differed among Asian American subgroups. Culturally tailored messaging and interventions may improve vaccine uptakes.
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Affiliation(s)
- Ziqing Wang
- The Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California
- Department of Statistics and Data Science, Cornell University, Ithaca, New York
| | - Armaan Jamal
- The Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ryan Wang
- The Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California
- Department of BioSciences, Rice University, Houston, Texas
- Department of Computer Science, Rice University, Houston, Texas
| | - Shozen Dan
- The Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California
- Department of Mathematics, Imperial College London, London, United Kingdom
- Department of Statistics, Imperial College London, London, United Kingdom
| | - Shanthi Kappagoda
- The Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California
- Division of Infectious Diseases & Geographic Medicine, Stanford University School of Medicine, Stanford, California
| | - Gloria Kim
- The Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Latha Palaniappan
- The Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Jin Long
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jaiveer Singh
- The Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California
- Department of Molecular Biochemistry and Biophysics, Yale University, New Heaven, Connecticut
| | - Malathi Srinivasan
- The Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
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10
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Cook EJ, Elliott E, Donald L, Gaitan A, Randhawa G, Cartwright S, Waqar M, Egbutah C, Nduka I, Guppy A, Ali N. Knowledge, perceived risk, and attitudes towards COVID-19 protective measures amongst ethnic minorities in the UK: A cross-sectional study. Front Public Health 2023; 10:1060694. [PMID: 36711414 PMCID: PMC9880421 DOI: 10.3389/fpubh.2022.1060694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/19/2022] [Indexed: 01/15/2023] Open
Abstract
Background Minority ethnic groups are at increased risk of COVID-19 related mortality or morbidity yet continue to have a disproportionally lower uptake of the vaccine. The importance of adherence to prevention and control measures to keep vulnerable populations and their families safe therefore remains crucial. This research sought to examine the knowledge, perceived risk, and attitudes toward COVID-19 among an ethnically diverse community. Methods A cross-sectional self-administered questionnaire was implemented to survey ethnic minority participants purposefully recruited from Luton, an ethnically diverse town in the southeast of England. The questionnaire was structured to assess participants knowledge, perceived risk, attitudes toward protective measures as well as the sources of information about COVID-19. The questionnaire was administered online via Qualtrics with the link shared through social media platforms such as Facebook, Twitter, and WhatsApp. Questionnaires were also printed into brochures and disseminated via community researchers and community links to individuals alongside religious, community and outreach organisations. Data were analysed using appropriate statistical techniques, with the significance threshold for all analyses assumed at p = 0.05. Findings 1,058 participants (634; 60% females) with a median age of 38 (IQR, 22) completed the survey. National TV and social networks were the most frequently accessed sources of COVID-19 related information; however, healthcare professionals, whilst not widely accessed, were viewed as the most trusted. Knowledge of transmission routes and perceived susceptibility were significant predictors of attitudes toward health-protective practises. Conclusion/recommendation Improving the local information provision, including using tailored communication strategies that draw on trusted sources, including healthcare professionals, could facilitate understanding of risk and promote adherence to health-protective actions.
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Affiliation(s)
- Erica Jane Cook
- School of Psychology, University of Bedfordshire, Luton, United Kingdom,*Correspondence: Erica Jane Cook ✉
| | | | - Louisa Donald
- School of Psychology, University of Bedfordshire, Luton, United Kingdom
| | - Alfredo Gaitan
- School of Psychology, University of Bedfordshire, Luton, United Kingdom
| | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, Luton, United Kingdom
| | - Sally Cartwright
- Public Health Luton, Luton Borough Council, Luton, United Kingdom
| | - Muhammad Waqar
- Institute for Health Research, University of Bedfordshire, Luton, United Kingdom
| | - Chimeme Egbutah
- Public Health Luton, Luton Borough Council, Luton, United Kingdom
| | - Ifunanya Nduka
- Institute for Health Research, University of Bedfordshire, Luton, United Kingdom
| | - Andy Guppy
- School of Psychology, University of Bedfordshire, Luton, United Kingdom
| | - Nasreen Ali
- Institute for Health Research, University of Bedfordshire, Luton, United Kingdom
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11
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Sethy G, Chisema MN, Sharma L, Singhal S, Joshi K, Nicks PO, Laher B, Mamba KC, Deokar K, Damte T, Phuka J. 'Vaccinate my village' strategy in Malawi: an effort to boost COVID-19 vaccination. Expert Rev Vaccines 2023; 22:180-185. [PMID: 36688599 DOI: 10.1080/14760584.2023.2171398] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To boost COVID-19 vaccine uptake, an innovative 'vaccinate my village' (VMV) strategy using door-to-door vaccination by Health Surveillance Assistants (HSA) was adopted. In this study, we assessed the impact of the 'vaccinate my village' strategy on COVID-19 vaccine uptake. METHODS This was a cross-sectional review of the data on COVID-19 vaccination obtained from the Ministry of Health, Malawi, from 11 March 2021 to September 2022. RESULTS From March 2021-4 September 2022,091,551 COVID-19 vaccine doses were administered, out of which 2,253,546 were administered over just six months as a part of VMV as compared to 1,838,005 doses were administered over 13 months as a part of other strategies. The proportion of Malawi's population receiving at least one dose of the COVID-19 vaccine increased substantially from 4.66 to 15.4 with the implementation of the VMV strategy (p = 0.0001). District-wise coverage of the COVID-19 vaccine also increased significantly after its implementation (p = 0.0001). CONCLUSIONS Door-to-door vaccination involving HSAs benefitted the COVID-19 vaccination program in Malawi by ensuring accessibility, availability, and acceptability.
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Affiliation(s)
| | - Mike Nenani Chisema
- Preventive Health Services & Program Manager-Expanded Program on Immunization (EPI), Lilongwe, Malawi
| | | | - Sanjay Singhal
- Department of Pulmonary Medicine, All India Institute of Medical Science -Rajkot, Gujarat, India
| | - Krupal Joshi
- Department of Community and Family Medicine, All India Institute of Medical Science -Rajkot, Gujarat, India
| | | | - Beverly Laher
- School of Global & Public Health, Kamuzu University of Health Sciences (Kuhes), Lilongwe, Malawi
| | | | - Kunal Deokar
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rajkot, India
| | - Tedla Damte
- Chief Health and Nutrition, Programme Health Section, UNICEF Khartoum, Sudan & PhD Scholar, LIKA UFPE Brazil
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12
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Pranzo AMR, Dai Prà E, Besana A. Epidemiological geography at work: An exploratory review about the overall findings of spatial analysis applied to the study of CoViD-19 propagation along the first pandemic year. GEOJOURNAL 2023; 88:1103-1125. [PMID: 35370348 PMCID: PMC8961483 DOI: 10.1007/s10708-022-10601-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 05/09/2023]
Abstract
The present work aims to give an overview on the international scientific papers related to the territorial spreading of SARS-CoV-2, with a specific focus upon applied quantitative geography and territorial analysis, to define a general structure for epidemiological geography research. The target publications were based on GIS spatial analysis, both in the sense of topological analysis and descriptive statistics or lato sensu geographical approaches. The first basic purpose was to organize and enhance the vast knowledge developments generated hitherto by the first pandemic that was studied "on-the-fly" all over the world. The consequent target was to investigate to what extent researchers in geography were able to draw scientifically consistent conclusions about the pandemic evolution, as well as whether wider generalizations could be reasonably claimed. This implied an analysis and a comparison of their findings. Finally, we tested what geographic approaches can say about the pandemic and whether a reliable spatial analysis routine for mapping infectious diseases could be extrapolated. We selected papers proposed for publication during 2020 and 209 articles complied with our parameters of query. The articles were divided in seven categories to enhance existing commonalities. In some cases, converging conclusions were extracted, and generalizations were derived. In other cases, contrasting or inconsistent findings were found, and possible explanations were provided. From the results of our survey, we extrapolated a routine for the production of epidemiological geography analyses, we highlighted the different steps of investigation that were attained, and we underlined the most critical nodes of the methodology. Our findings may help to point out what are the most critical conceptual challenges of epidemiological mapping, and where it might improve to engender informed conclusions and aware outcomes.
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Affiliation(s)
- Andrea Marco Raffaele Pranzo
- Geo-Cartographic Centre for Studies and Documentation, University of Trento, Trento, Italy
- Interuniversity Department of Regional and Urban Studies and Planning, Polytechnic of Turin, Torino, Italy
| | - Elena Dai Prà
- Geo-Cartographic Centre for Studies and Documentation, University of Trento, Trento, Italy
| | - Angelo Besana
- Geo-Cartographic Centre for Studies and Documentation, University of Trento, Trento, Italy
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13
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Mohagheghi S, Gharipour M, DeClercq C, Bui A, Tyne IA. Identifying Optimal Locations for Potential Temporary Community Clinics During Public Health Emergencies. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2023; 16:113-130. [PMID: 36071681 DOI: 10.1177/19375867221124234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES This article argues that community healthcare clinics managed by dedicated medical professionals who are familiar with the special needs of the local community may serve as effective alternatives to centralized hospitals and medical facilities, which may be disconnected from these local communities. BACKGROUND The literature indicates that socioeconomic factors that affect an individual's ability to seek medical help when needed can cause vulnerability to public health emergencies. These factors include belonging to lower income populations, being African American, being dependent due to age (below 18 or above 65) or disability, being an immigrant, English-language ability, access to transportation means, and the strength of an individual's social network. METHOD This study aims at developing a multifaceted methodology to identify optimal locations for deployment of temporary healthcare clinics to address health disparity issues among socially vulnerable populations, especially during pandemics and public health crises. This case study looks at the Health Enterprise Zone (HEZ) in Baltimore and ranks Census tracts based on their vulnerability, using two novel health vulnerability indices and considering their locations. RESULTS Using the proposed methodology, the optimal tracts within the HEZ are identified as potential locations for deploying temporary healthcare clinics. CONCLUSION The analysis of vulnerabilities to public health emergencies based on socioeconomic factors can assist in identifying potential locations for setting up temporary healthcare clinics with the goal of assisting socially vulnerable populations during outbreaks and pandemics.
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Affiliation(s)
- Salman Mohagheghi
- Electrical Engineering Department, Colorado School of Mines, Golden, CO, USA
| | | | | | - Andrew Bui
- Morgan State University, Baltimore, MD, USA
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14
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Bhatta TR, Lekhak N, Goler TD, Kahana E, Rathi S. The intersection of race and financial strain: The pain of social disconnection among women in the United States. J Women Aging 2023; 35:38-48. [PMID: 35226586 DOI: 10.1080/08952841.2022.2041154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives: Considerable attention has been directed at increased social isolation and loneliness during the COVID-19 pandemic and their impact on later-life psychological well-being. There is a dearth of research on the effect of financial strain and associated psychosocial mechanisms on loneliness among women across racial groups. It is unclear how racial status and financial strain intersect to impact later-life loneliness amid immense uncertainty, social isolation, and anxiety induced by the pandemic.Methods: Based on our nationwide Web-based survey (n = 1,301), we used ordinary least square regression to examine the effects of financial strain on loneliness among Black and White women and assessed the role of emotional support in contributing to such effects.Results: We found that Black women face significantly more financial strain than White women but also receive more emotional support and experience less loneliness. Findings show that women experiencing financial strain report increased loneliness, but the negative effects of financial strain are significantly greater for Black women than for White women. Our mediation analysis revealed that emotional support made a significant contribution to the effects of financial strain on loneliness in White women but not in Black women.Discussion: Despite shared vulnerability and social isolation across the general population, our findings suggest that negative effects of financial strain on loneliness among women continue to differ across race, even amid the pandemic. Our findings demonstrate how emotional support explains the relationship between financial strain and later-life loneliness in a racially distinct manner.
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Affiliation(s)
- Tirth R Bhatta
- Department of Sociology, University of Nevada, Las Vegas, Nevada, USA
| | - Nirmala Lekhak
- School of Nursing, University of Nevada, Las Vegas, Nevada, USA
| | - Timothy D Goler
- Department of Sociology, Norfolk State University, Norfolk, Virginia, USA
| | - Eva Kahana
- Department of Sociology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sfurti Rathi
- School of Public Health, University of Nevada, Las Vegas, Nevada, USA
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15
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ENİÇ D. Effects of the COVID-19 Pandemic on Intergroups Inequalities: The Case of Women. PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2022. [DOI: 10.18863/pgy.1056432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The ongoing COVID-19 pandemic has crucial implications for intergroup inequalities. The main aims of the current study are to examine how the COVID-19 affects inequalities between women and men, understand the causes of increasing gender-based inequalities during pandemic, and offer practical solutions on how these inequalities can be reduced. The results of studies from different countries demonstrated that gender-based inequalities that existed before the pandemic deepened with the COVID-19. After the COVID-19, there has been a serious rise in the level of physical, psychological and economic violence that women are exposed to, the labor they spend on housework and caring has increased dramatically, and the problems they face in business life ascended. Understanding why gender-based inequalities have increased during the COVID-19 is one of the influential steps to achieve gender equality. When the reasons are examined, it has been determined that many factors, including the policies implemented in the struggle against the pandemic and gender roles, play critical roles in this rise. Finally, in order to diminish gender-based inequalities, short and long-term solutions are presented such as carrying out gender-based awareness education, adequate representations of women in decision-making processes, developing gender-sensitive policies, strengthening the mechanisms that support women.
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Affiliation(s)
- Deniz ENİÇ
- Adana Alparslan Türkeş Bilim ve Teknoloji Üniversitesi
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16
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Rahimi Z, Mohammadi MJ, Araban M, Shirali GA, Cheraghian B. Socioeconomic correlates of face mask use among pedestrians during the COVID-19 pandemic: An ecological study. Front Public Health 2022; 10:921494. [PMID: 36466470 PMCID: PMC9709397 DOI: 10.3389/fpubh.2022.921494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
Abstract
Background Many countries have recommended using face masks for the general population in public places to reduce the risk of COVID-19 transmission. This study aimed to assess the effects of socioeconomic status on face mask use among pedestrians during the COVID-19 pandemic. Methods This cross-sectional study was conducted in Ahvaz, southwest Iran in August 2020. A total of 10,440 pedestrians have been studied from 92 neighborhoods of the city. Three socioeconomic indicators including Land price, Literacy rate, and the Employment rate for each neighborhood were used in this study. Analysis of Covariance and partial correlation coefficients were applied to assess the relationship between prevalence rates of mask usage and SES indicators. Results The mean ± SD age of the pedestrians was 32.2 ± 15.1 years. Of 10,440 observed participants, 67.9% were male. The overall prevalence of face mask usage was 45.6%. The prevalence of mask usage in older people and women was significantly higher than the others. The three assessed socioeconomic indicators were directly correlated to the prevalence of mask usage at individual and neighborhood levels. Conclusion We found that literacy had the strongest correlation with the prevalence of mask usage compared to the land price and employment rate among the three assessed SES indicators. Hence, it can be concluded that the social component of socioeconomic status has a greater effect on mask usage by people than the economic component of socioeconomic status.
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Affiliation(s)
- Zahra Rahimi
- Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Javad Mohammadi
- Department of Environmental Health Engineering, Air Pollution, and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Marzieh Araban
- Department of Health Education and Promotion, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Gholam Abbas Shirali
- Department of Occupational Safety and Health Engineering, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Bahman Cheraghian
- Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran,*Correspondence: Bahman Cheraghian
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17
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Gaffney AW. Disparities in Disease Burden and Treatment of Patients Asthma and Chronic Obstructive Pulmonary Disease. Med Clin North Am 2022; 106:1027-1039. [PMID: 36280330 DOI: 10.1016/j.mcna.2022.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lung health reflects the inequities of our society. Asthma and chronic obstructive pulmonary disease are 2 lung conditions commonly treated in general clinical practice; each imposes a disproportionate burden on disadvantaged patients. Numerous factors mediate disparities in lung health, including air pollution, allergen exposures, tobacco, and respiratory infections. Members of racial/ethnic minorities and those of low socioeconomic status also have inferior access to high-quality medical care, compounding disparities in disease burden. Physicians can work against disparities in their practice, but wide-ranging policy reforms to achieve better air quality, housing, workplace safety, and healthcare for all are needed to achieve equity in lung health.
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Affiliation(s)
- Adam W Gaffney
- Harvard Medical School, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02138, USA.
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18
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Eiermann M, Wrigley-Field E, Feigenbaum JJ, Helgertz J, Hernandez E, Boen CE. Racial Disparities in Mortality During the 1918 Influenza Pandemic in United States Cities. Demography 2022; 59:1953-1979. [PMID: 36124998 PMCID: PMC9714293 DOI: 10.1215/00703370-10235825] [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: 11/19/2022]
Abstract
Against a backdrop of extreme racial health inequality, the 1918 influenza pandemic resulted in a striking reduction of non-White to White influenza and pneumonia mortality disparities in United States cities. We provide the most complete account to date of these reduced racial disparities, showing that they were unexpectedly uniform across cities. Linking data from multiple sources, we then examine potential explanations for this finding, including city-level sociodemographic factors such as segregation, implementation of nonpharmaceutical interventions, racial differences in exposure to the milder spring 1918 "herald wave," and racial differences in early-life influenza exposures, resulting in differential immunological vulnerability to the 1918 flu. While we find little evidence for the first three explanations, we offer suggestive evidence that racial variation in childhood exposure to the 1889-1892 influenza pandemic may have shrunk racial disparities in 1918. We also highlight the possibility that differential behavioral responses to the herald wave may have protected non-White urban populations. By providing a comprehensive description and examination of racial inequality in mortality during the 1918 pandemic, we offer a framework for understanding disparities in infectious disease mortality that considers interactions between the natural histories of particular microbial agents and the social histories of those they infect.
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Affiliation(s)
| | - Elizabeth Wrigley-Field
- Department of Sociology and Minnesota Population Center, University of Minnesota, Twin Cities, Minneapolis, MN, USA
| | - James J Feigenbaum
- Department of Economics, Boston University, Boston, MA, USA
- National Bureau of Economic Research, Cambridge, MA, USA
| | - Jonas Helgertz
- Institute for Social Research and Data Innovation, Minnesota Population Center, University of Minnesota, Twin Cities, Minneapolis, MN, USA
- Centre for Economic Demography and Department of Economic History, Lund University, Lund, Sweden
| | - Elaine Hernandez
- Department of Sociology, Indiana University, Bloomington, IN, USA
| | - Courtney E Boen
- Department of Sociology, Population Studies and Population Aging Research Centers, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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19
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Wilkins K. Intersectional Immunity? Examining How Race/Ethnicity and Sexual Orientation Combine to Shape Influenza Vaccination Among US Adults. POPULATION RESEARCH AND POLICY REVIEW 2022; 41:2585-2612. [PMID: 36160377 PMCID: PMC9483472 DOI: 10.1007/s11113-022-09739-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 08/18/2022] [Indexed: 11/25/2022]
Abstract
Influenza vaccination is a critical preventive healthcare behavior designed to prevent spread of seasonal flu. This paper contributes to existing scholarship by applying an intersectional perspective to examine how influenza vaccination differs across specific intersections of racial/ethnic and sexual identity. Drawing on aggregated state-level data from Behavioral Risk Factor Surveillance System (BRFSS) from 2011 to 2020, I examine how flu vaccination differs across 18 racial/ethnic-by-sexual orientation groups (N = 1,986,432). Findings from descriptive analyses and logistic regression modeling demonstrate three key findings. First, it corroborates previous studies of vaccination, finding lower rates of flu vaccination among black adults relative to whites; gays/lesbians vaccinate at higher rates than heterosexuals and bisexuals, with bisexuals reporting lower vaccination relative to both heterosexuals and gays/lesbians. Second, it demonstrates how sexual orientation complicates established patterns between race/ethnicity and vaccination (e.g., influenza vaccination is more racially stratified among heterosexuals, with patterns more variable among gays/lesbians) and how race/ethnicity complicates previous patterns of vaccination by sexual orientation (e.g., Asian bisexuals vaccinate more than both heterosexuals). Third, findings pinpoint identities (e.g., black heterosexuals relative to their white peers and white bisexuals relative to their gay/lesbian peers) most in need of influenza vaccination outreach efforts. Implications for findings suggest that heterosexuals, especially black, may be less likely to vaccinate against influenza thus may need more encouragement from clinicians to vaccinate. Additionally, influenza vaccination should be free for all persons to lessen the barrier of access for this preventative healthcare.
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Affiliation(s)
- Kiana Wilkins
- Department of Sociology, Rice University, 6100 Main Street, Houston, TX MS-2877005 USA
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20
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Patel JR, Amick BC, Vyas KS, Bircan E, Boothe D, Nembhard WN. Racial disparities in symptomatology and outcomes of COVID-19 among adults of Arkansas. Prev Med Rep 2022; 28:101840. [PMID: 35634216 PMCID: PMC9128301 DOI: 10.1016/j.pmedr.2022.101840] [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: 10/27/2021] [Revised: 04/14/2022] [Accepted: 05/20/2022] [Indexed: 11/22/2022] Open
Abstract
Few reports have suggested that non-Hispanic (NH) blacks may present with different symptoms for COVID-19 than NH-whites. The objective of this study was to investigate patterns in symptomatology and COVID-19 outcomes by race/ethnicity among adults in Arkansas. Data on COVID-19 symptoms were collected on day of testing, 7th and 14th day among participants at UAMS mobile testing units throughout the state of Arkansas. Diagnosis for SARS-CoV-2 infection was confirmed via nasopharyngeal swab and RT-PCR methods. Data analysis was conducted using Chi-square test and Poisson regression to assess the differences in characteristics by race/ethnicity. A total of 60,648 individuals were RT-PCR tested from March 29, 2020 through October 7, 2020. Among adults testing positive, except shortness of breath, Hispanics were more likely to report all symptoms than NH-whites or NH-blacks. NH-whites were more likely to report fever (19.6% vs. 16.6%), cough (27.5% vs. 26.1%), shortness of breath (13.6% vs. 9.6%), sore throat (16.7% vs. 10.7%), chills (12.5% vs. 11.8%), muscle pain (15.6% vs. 12.4%), and headache (20.3% vs. 17.8%). NH-blacks were more likely to report loss of taste/smell (10.9% vs. 10.6%). To conclude, we found differences in COVID-19 symptoms by race/ethnicity, with NH-blacks and Hispanics more often affected with specific or all symptoms, compared to NH-whites. Due to the cross-sectional study design, these findings do not necessarily reflect biological differences by race/ethnicity; however, they suggest that certain race/ethnicities may have underlying differences in health status that impact COVID-19 outcomes.
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Affiliation(s)
- Jenil R. Patel
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Benjamin C. Amick
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Keyur S. Vyas
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Emine Bircan
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Danielle Boothe
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Wendy N. Nembhard
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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21
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Martínez-Donate AP, Correa-Salazar C, Bakely L, González-Fagoaga JE, Asadi-Gonzalez A, Lazo M, Parrado E, Zhang X, Rangel Gomez MG. COVID-19 testing, infection, and vaccination among deported Mexican migrants: Results from a survey on the Mexico-U.S. border. Front Public Health 2022; 10:928385. [PMID: 35968453 PMCID: PMC9372570 DOI: 10.3389/fpubh.2022.928385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/06/2022] [Indexed: 11/30/2022] Open
Abstract
Background Migrants detained and held in immigration and other detention settings in the U.S. have faced increased risk of COVID-19 infection, but data on this population is scarce. This study sought to estimate rates of COVID-19 testing, infection, care seeking, and vaccination among Mexican migrants detained by U.S. immigration authorities and forcibly returned to Mexico. Methods We conducted a cross-sectional probability survey of Mexican migrants deported from the U.S. to three Mexican border cities: Tijuana, Ciudad Juárez, and Matamoros (N = 306). Deported migrants were recruited at Mexican migration facilities after being processed and cleared for departure. A two-stage sampling strategy was used. Within each city, a selection of days and shifts were selected during the operating hours of these deportation facilities. The probability of selection was proportional to the volume of migrants deported on each day of the month and during each time period. During the selected survey shifts, migrants were consecutively approached, screened for eligibility, and invited to participate in the survey. Survey measures included self-reported history of COVID-19 testing, infection, care seeking, vaccination, intentions to vaccinate, and other prevention and risk factors. Weighted data were used to estimate population-level prevalence rates. Bivariate tests and adjusted logistic regression models were estimated to identify associations between these COVID-19 outcomes and demographic, migration, and contextual factors. Results About 84.1% of migrants were tested for COVID-19, close to a third were estimated to have been infected, and, among them, 63% had sought care for COVID-19. An estimated 70.1% had been vaccinated against COVID-19 and, among those not yet vaccinated, 32.5% intended to get vaccinated. Close to half (44.3%) of respondents had experienced crowdedness while in detention in the U.S. Socio-demographic (e.g. age, education, English fluency) and migration-related (e.g. type of detention facility and time in detention) variables were significantly associated with COVID-19 testing, infection, care seeking, and vaccination history. Age, English fluency, and length of detention were positively associated with testing and vaccination history, whereas detention in an immigration center and length of time living in the U.S. were negatively related to testing, infection, and vaccination history. Survey city and survey quarter also showed adjusted associations with testing, infection, and vaccination history, reflecting potential variations in access to services across geographic regions and over time as the pandemic unfolded. Conclusion These findings are evidence of increased risk of COVID-19 infection, insufficient access to testing and treatment, and missed opportunities for vaccination among Mexican migrants detained in and deported from the U.S. Deportee receiving stations can be leveraged to reduce disparities in testing and vaccination for deported migrants. In addition, decarceration of migrants and other measures informed by public health principles must be implemented to reduce COVID-19 risk and increase access to prevention, diagnostic, and treatment services among this underserved population.
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Affiliation(s)
- Ana P. Martínez-Donate
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
- *Correspondence: Ana P. Martínez-Donate
| | - Catalina Correa-Salazar
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Leah Bakely
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | | | - Ahmed Asadi-Gonzalez
- School of Medicine and Psychology, Autonomous University of Baja California, Tijuana, Mexico
| | - Mariana Lazo
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Emilio Parrado
- Department of Sociology, University of Pennsylvania, Philadelphia, PA, United States
| | - Xiao Zhang
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
| | - Maria Gudelia Rangel Gomez
- Mexico Section of the U.S.-Mexico Border Health Commission, Tijuana, Mexico
- El Colegio de la Frontera Norte, Tijuana, Mexico
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22
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Jahan FA, Zviedrite N, Gao H, Ahmed F, Uzicanin A. Causes, characteristics, and patterns of prolonged unplanned school closures prior to the COVID-19 pandemic—United States, 2011–2019. PLoS One 2022; 17:e0272088. [PMID: 35905084 PMCID: PMC9337642 DOI: 10.1371/journal.pone.0272088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 07/12/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
Outside of pandemics, there is little information about occurrence of prolonged unplanned K-12 school closures (PUSC). We describe here the reasons, characteristics, and patterns of PUSC in the United States during 8 consecutive inter-pandemic academic years, 2011–2019.
Methods
From August 1, 2011 through June 30, 2019, daily systematic online searches were conducted to collect data on publicly announced unplanned school closures lasting ≥1 school days in the United States. Closures were categorized as prolonged when schools were closed for ≥5 unplanned days (approximating one full workweek), excluding weekends and scheduled days off per school calendars.
Results
During the eight academic years, a total of 22,112 PUSCs were identified, affecting over 800,000 teachers and 13 million students that resulted in 91.5 million student-days lost. A median of 62.9% of students in PUSC-affected schools were eligible for subsidized school meals. Most affected schools were in cities (35%) and suburban areas (33%). Natural disasters (47%), adverse weather conditions (35%), and budget/teacher strikes (15%) were the most frequently cited reasons for PUSC; illness accounted for 1%, and building/facility issues, environmental issues and violence together accounted for the remaining 2%. The highest number of PUSCs occurred in Health and Human Services Regions 2, 3, 4, and 6 encompassing areas that are frequently in the path of hurricanes and tropical storms. The majority of PUSCs in these regions were attributed to a handful of hurricanes during the fall season, including hurricanes Sandy, Irma, Harvey, Florence, and Matthew.
Conclusions
PUSCs occur annually in the United States due to a variety of causes and are associated with a substantive loss of student-days for in-school learning. Both these prior experiences with PUSCs and those during the current COVID-19 pandemic illustrate a need for creating sustainable solutions for high-quality distance learning and innovative supplemental feeding programs nationwide, especially in disaster-prone areas.
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Affiliation(s)
- Ferdous A. Jahan
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Cherokee Nation Operational Solutions, LLC, Tulsa, Oklahoma, United States of America
| | - Nicole Zviedrite
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Hongjiang Gao
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Faruque Ahmed
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Amra Uzicanin
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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23
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SteelFisher GK, Caporello HL, Lubell KM, Ben-Porath EN, Green AR, Luo F, Briseno L, Lane L, Sheff SE, Taillepierre JD, Espino L, Boyea A. Getting Critical Information During the COVID-19 Pandemic: Experiences of Spanish and Chinese Speakers With Limited English Proficiency. Health Secur 2022; 20:273-285. [PMID: 35771967 DOI: 10.1089/hs.2021.0218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
People with limited English proficiency in the United States have suffered disproportionate negative health outcomes during the COVID-19 pandemic. Effective communications are critical tools in addressing inequities insofar as they can motivate adoption of protective behaviors and reduce incidence of disease; however, little is known about experiences of communities with limited English proficiency receiving relevant information during COVID-19 or other outbreaks. To address this gap and provide inputs for communication strategies, we completed a study based on 2 novel and nationally representative surveys conducted between June and August 2020 among Spanish and Chinese speakers with limited English proficiency (n = 764 and n = 355, respectively). Results first showed that Spanish and Chinese speakers did not consistently receive information about protective behaviors from key public health and government institutions early in the pandemic. Second, for such information, Spanish and Chinese speakers used a diverse set of information resources that included family and friends, social media, and traditional media from both inside and outside the United States. Third, Spanish and Chinese speakers faced challenges getting COVID-19 information, including receiving media messages that felt discriminatory toward Latinx or Chinese people. Together, these findings suggest gaps in effectively reaching Spanish and Chinese speakers. Data highlight the important role of bilingual materials to support sharing of information between Spanish or Chinese speakers and English speakers within their social networks, and the need for digital news content for traditional and social media. Finally, efforts are needed to address discriminatory messaging in media and to actively counter it in public health communications.
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Affiliation(s)
- Gillian K SteelFisher
- Gillian K. SteelFisher, PhD, MSc, is a Senior Research Scientist and Deputy Director, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Hannah L Caporello
- Hannah L. Caporello is Senior Research Projects Manager, Harvard Opinion Research Program, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Keri M Lubell
- Keri M. Lubell, PhD, is a Behavioral Scientist, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Eran N Ben-Porath
- Eran N. Ben-Porath, PhD, is Executive Vice President, SSRS, Glen Mills, PA
| | - Alexander R Green
- Alexander R. Green, MD, MPH, was an Associate Professor of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Feijun Luo
- Feijun Luo, PhD, is a Senior Economist, National Center for Chronic Disease Prevention and Health Promotion, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Lisa Briseno
- Lisa Briseno, MS, is a Senior Health Communication Specialist, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Lindsay Lane
- Lindsay Lane, MPH, is a Health Communication Specialists, Center for Preparedness and Response, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Sarah E Sheff
- Sarah E. Sheff, PhD, is a Health Communication Specialists, Center for Preparedness and Response, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Julio Dicent Taillepierre
- Julio Dicent Taillepierre, MS, is Team Lead, Initiatives and Partnerships Team, Office of Minority Health and Health Equity, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Laura Espino
- Laura Espino is Membership Director, National Public Health Information Coalition, Canton, GA
| | - Alyssa Boyea
- Alyssa Boyea, MPH, CPH, is Director, Infectious Disease Preparedness, Association of State and Territorial Health Officials, Arlington, VA
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Zhang Y, Ding Y, Xie X, Guo Y, van Lange PAM. Lower class people suffered more (but perceived fewer risk disadvantages) during the COVID-19 pandemic. ASIAN JOURNAL OF SOCIAL PSYCHOLOGY 2022; 26:AJSP12543. [PMID: 35942133 PMCID: PMC9348012 DOI: 10.1111/ajsp.12543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 01/06/2023]
Abstract
Does COVID-19 affect people of all classes equally? In the current research, we focus on the social issue of risk inequality during the early stages of the COVID-19 pandemic. Using a nationwide survey conducted in China (N = 1,137), we predicted and found that compared to higher-class individuals, lower-class participants reported a stronger decline in self-rated health as well as economic well-being due to the COVID-19 outbreak. At the same time, we examined participants' beliefs regarding the distribution of risks. The results demonstrated that although lower-class individuals were facing higher risks, they expressed lesser belief in such a risk inequality than their higher-class counterparts. This tendency was partly mediated by their stronger endorsement of system-justifying beliefs. The findings provide novel evidence of the misperception of risk inequality among the disadvantaged in the context of COVID-19. Implications for science and policy are discussed.
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Affiliation(s)
- Yue Zhang
- School of PsychologyNanjing Normal UniversityNanjingJiangsu ProvinceChina
| | - Yi Ding
- School of PsychologyNanjing Normal UniversityNanjingJiangsu ProvinceChina
| | - Xiaona Xie
- School of PsychologyNanjing Normal UniversityNanjingJiangsu ProvinceChina
| | - Yongyu Guo
- School of PsychologyNanjing Normal UniversityNanjingJiangsu ProvinceChina
| | - Paul A. M. van Lange
- Department of Experimental and Applied Psychology, VU AmsterdamInstitute for Brain and Behavior Amsterdam (IBBA)AmsterdamThe Netherlands
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25
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History Repeating-How Pandemics Collide with Health Disparities in the United States. J Racial Ethn Health Disparities 2022; 10:1455-1465. [PMID: 35595916 PMCID: PMC9122254 DOI: 10.1007/s40615-022-01331-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/25/2022] [Accepted: 05/13/2022] [Indexed: 11/24/2022]
Abstract
Across the United States, public health responses to the COVID-19 pandemic have fallen short. COVID-19 has exacerbated longstanding public health shortfalls in disadvantaged communities. Was this predestined? Understanding where we are today requires reflection on our longer journey. Disparities cataloged during COVID-19 reflect the same unequal host exposure and susceptibility risks that shaped previous pandemics. In this review, we provide historical context to better understand current events and to showcase forgotten lessons which may motivate future action to protect our most vulnerable citizens.
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26
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Douglas JA, Bostean G, Miles Nash A, John EB, Brown LM, Subica AM. Citizenship Matters: Non-Citizen COVID-19 Mortality Disparities in New York and Los Angeles. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095066. [PMID: 35564460 PMCID: PMC9102427 DOI: 10.3390/ijerph19095066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/14/2022] [Accepted: 04/17/2022] [Indexed: 12/04/2022]
Abstract
U.S. non-citizen residents are burdened by inequitable access to socioeconomic resources, potentially placing them at heightened risk of COVID-19-related disparities. However, COVID-19 impacts on non-citizens are not well understood. Accordingly, the current study investigated COVID-19 mortality disparities within New York (NYC) and Los Angeles (LAC) to test our hypothesis that areas with large proportions of non-citizens will have disproportionately high COVID-19 mortality rates. We examined ecological associations between March 2020–January 2021 COVID-19 mortality rates (per 100,000 residents) and percent non-citizens (using ZIP Code Tabulation Areas (ZCTA) for NYC and City/Community units of analysis for LAC) while controlling for sociodemographic factors. Multiple linear regression analyses revealed significant positive associations between the percentage of non-citizen residents and COVID-19 mortality rates in NYC (95% CI 0.309, 5.181) and LAC (95% CI 0.498, 8.720). Despite NYC and LAC policies intended to provide sanctuary and improve healthcare access for non-citizen residents, communities with larger proportions of non-citizens appear to endure higher COVID-19 mortality rates. The challenges that non-citizens endure—e.g., inequitable access to public benefits—may discourage help-seeking behaviors. Thus, improved health surveillance, public health messaging, and sanctuary policies will be essential for reducing COVID-19 mortality disparities in communities with large shares of non-citizens.
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Affiliation(s)
- Jason A. Douglas
- Department of Health Sciences, Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA
- Correspondence: ; Tel.: +1-714-516-5612
| | - Georgiana Bostean
- Sociology and Environmental Science & Policy Programs, Schmid & Wilkinson Colleges, Chapman University, Orange, CA 92866, USA;
| | - Angel Miles Nash
- Donna Ford Attallah College of Educational Studies, Chapman University, Orange, CA 92866, USA;
| | - Emmanuel B. John
- Department of Physical Therapy, Crean College of Health and Behavioral Sciences, Chapman University, Irvine, CA 92618, USA;
| | | | - Andrew M. Subica
- Department of Social Medicine, Population & Public Health, Riverside School of Medicine, University of California, Riverside, CA 92521, USA;
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27
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Arora S, Bø B, Tjoflåt I, Eslen-Ziya H. Immigrants in Norway: Resilience, challenges and vulnerabilities in times of COVID-19. J Migr Health 2022; 5:100089. [PMID: 35280118 PMCID: PMC8897975 DOI: 10.1016/j.jmh.2022.100089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 02/25/2022] [Accepted: 03/04/2022] [Indexed: 02/03/2023] Open
Abstract
Immigrants have been found to be disproportionately impacted during the COVID-19 pandemic across the world. Our study, exploring the experiences of immigrants in Norway during the pandemic, is based on interviews and focus group discussions with 10 and 21 immigrants, respectively. Our analysis showed that participants perceived the circumstances induced by the pandemic to be difficult and voiced the challenges experienced. Their experiences encompassed social, economic, and the public sphere, where immigrants felt themselves to be in more vulnerable positions than before the pandemic. Our analysis identified four main themes: 1) Feeling stagnated, 2) Perceptions towards government and health authorities, 3) Boundaries of us vs them, and 4) Coping. We conclude our paper by stating that government and health authorities should consider both short-term and long-term consequence of the pandemic to mitigate impact on communities at risk.
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Affiliation(s)
- Sanjana Arora
- Department of Safety, Economics and Planning, The Faculty of Science and Technology, University of Stavanger, P.O. Box 8600, 4036 Stavanger, Norway
| | - Bodil Bø
- Department of Quality and Health Technology, The Faculty of Health Sciences, University of Stavanger, P.O. Box 8600, 4036 Stavanger, Norway
| | - Ingrid Tjoflåt
- Department of Quality and Health Technology, The Faculty of Health Sciences, University of Stavanger, P.O. Box 8600, 4036 Stavanger, Norway
| | - Hande Eslen-Ziya
- Department of Media and Social Sciences, Faculty of Social Sciences, University of Stavanger, P.O. Box 8600, 4036 Stavanger, Norway
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28
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Uddin S, Khan A, Lu H, Zhou F, Karim S. Suburban Road Networks to Explore COVID-19 Vulnerability and Severity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2039. [PMID: 35206227 PMCID: PMC8872200 DOI: 10.3390/ijerph19042039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 02/01/2023]
Abstract
The Delta variant of COVID-19 has been found to be extremely difficult to contain worldwide. The complex dynamics of human mobility and the variable intensity of local outbreaks make measuring the factors of COVID-19 transmission a challenge. The inter-suburb road connection details provide a reliable proxy of the moving options for people between suburbs for a given region. By using such data from Greater Sydney, Australia, this study explored the impact of suburban road networks on two COVID-19-related outcomes measures. The first measure is COVID-19 vulnerability, which gives a low score to a more vulnerable suburb. A suburb is more vulnerable if it has the first COVID-19 case earlier and vice versa. The second measure is COVID-19 severity, which is proportionate to the number of COVID-19-positive cases for a suburb. To analyze the suburban road network, we considered four centrality measures (degree, closeness, betweenness and eigenvector) and core-periphery structure. We found that the degree centrality measure of the suburban road network was a strong and statistically significant predictor for both COVID-19 vulnerability and severity. Closeness centrality and eigenvector centrality were also statistically significant predictors for COVID-19 vulnerability and severity, respectively. The findings of this study could provide practical insights to stakeholders and policymakers to develop timely strategies and policies to prevent and contain any highly infectious pandemics, including the Delta variant of COVID-19.
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Affiliation(s)
- Shahadat Uddin
- School of Project Management, Faculty of Engineering, The University of Sydney, Forest Lodge, NSW 2037, Australia; (A.K.); (H.L.); (F.Z.); (S.K.)
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29
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Williams BE, Kondo KK, Ayers CK, Kansagara D, Young S, Saha S. Preventing Unequal Health Outcomes in COVID-19: A Systematic Review of Past Interventions. Health Equity 2022; 5:856-871. [PMID: 35018320 PMCID: PMC8742307 DOI: 10.1089/heq.2021.0016] [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] [Accepted: 11/10/2021] [Indexed: 11/12/2022] Open
Abstract
Background: We sought to identify interventions that reduced disparities in health outcomes in infectious disease outbreaks or natural disasters in the United States to understand whether these interventions could reduce health disparities in the current COVID-19 pandemic. Methods: We searched MEDLINE and other databases to May 2020 to find studies that examined interventions to mitigate health inequalities in previous infectious disease pandemics or disasters. We assessed study quality using the Newcastle-Ottawa Scale and the Critical Appraisal Skills Program (CASP) Checklist for Qualitative Studies. Results: We included 14 articles (12 studies) and 5 Centers for Disease Control (CDC) stakeholder meeting articles on pandemic influenza preparedness in marginalized populations. Studies called for intervention and engagement before pandemic or disaster onset. Several studies included interventions that could be adapted to COVID-19, including harnessing technology to reach disadvantaged populations, partnering with trusted community liaisons to deliver important messaging around disease mitigation, and using culturally specific communication methods and messages to best reach marginalized groups. Discussion: To our knowledge this is the first systematic review to examine interventions to mitigate health inequities during an infectious disease pandemic. However, given that we identified very few disparities-focused infectious disease intervention studies, we also included studies from the disaster response literature, which may not be as generalizable to the current context of COVID-19. Overall, community outreach and tailored communication are essential in disease mitigation. More research is needed to evaluate systemic interventions that target the distal determinants of poor health outcomes among marginalized populations during pandemics and natural disasters.
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Affiliation(s)
- Beth E Williams
- Primary Care, VA Portland Health Care System, Portland, Oregon, USA
| | - Karli K Kondo
- Evidence Synthesis Program, VA Portland Health Care System, Portland, Oregon, USA.,Research Integrity Office, Oregon Health and Science University, Portland, Oregon, USA
| | - Chelsea K Ayers
- Evidence Synthesis Program, VA Portland Health Care System, Portland, Oregon, USA
| | - Devan Kansagara
- Evidence Synthesis Program, VA Portland Health Care System, Portland, Oregon, USA.,Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Sarah Young
- Evidence Synthesis Program, VA Portland Health Care System, Portland, Oregon, USA
| | - Somnath Saha
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA.,Division of General Internal Medicine, Oregon Health and Science University, Portland, Oregon, USA
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30
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Lowe AE, Dineen KK, Mohapatra S. Structural Discrimination in Pandemic Policy: Essential Protections for Essential Workers. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2022; 50:67-75. [PMID: 35243996 DOI: 10.1017/jme.2022.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
An inordinate number of low wage workers in essential industries are Black, Hispanic, or Latino, immigrants or refugees - groups beset by centuries of discrimination and burdened with disproportionate but preventable harms during the COVID-19 pandemic.
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31
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Acquati C, Chen TA, Martinez Leal I, Connors SK, Haq AA, Rogova A, Ramirez S, Reitzel LR, McNeill LH. The Impact of the COVID-19 Pandemic on Cancer Care and Health-Related Quality of Life of Non-Hispanic Black/African American, Hispanic/Latina and Non-Hispanic White Women Diagnosed with Breast Cancer in the U.S.: A Mixed-Methods Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413084. [PMID: 34948695 PMCID: PMC8702073 DOI: 10.3390/ijerph182413084] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 02/07/2023]
Abstract
The COVID-19 pandemic has had critical consequences for cancer care delivery, including altered treatment protocols and delayed services that may affect patients’ quality of life and long-term survival. Breast cancer patients from minoritized racial and ethnic groups already experience worse outcomes, which may have been exacerbated by treatment delays and social determinants of health (SDoH). This protocol details a mixed-methods study aimed at comparing cancer care disruption among a diverse sample of women (non-Hispanic White, non-Hispanic Black/African American, and Hispanic/Latina) and assessing how proximal, intermediate, and distal SDoH differentially contribute to care continuity and health-related quality of life. An embedded mixed-methods design will be implemented. Eligible participants will complete an online survey, followed by a semi-structured interview (with a subset of participants) to further understand factors that influence continuity of care, treatment decision-making, and self-reported engagement. The study will identify potentially modifiable factors to inform future models of care delivery and improve care transitions. These data will provide the necessary evidence to inform whether a subsequent, multilevel intervention is warranted to improve quality of care delivery in the COVID-19 aftermath. Additionally, results can be used to identify ways to leverage existing social resources to help manage and support patients’ outcomes.
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Affiliation(s)
- Chiara Acquati
- Graduate College of Social Work, University of Houston, 3511 Cullen Blvd, Houston, TX 77204, USA
- Department of Health Disparities Research, The UT MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA;
- Correspondence: ; Tel.: +1-713-743-4343
| | - Tzuan A. Chen
- HEALTH Research Institute, University of Houston, 4849 Calhoun Road, Houston, TX 77204, USA; (T.A.C.); (I.M.L.); (L.R.R.)
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
| | - Isabel Martinez Leal
- HEALTH Research Institute, University of Houston, 4849 Calhoun Road, Houston, TX 77204, USA; (T.A.C.); (I.M.L.); (L.R.R.)
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
| | - Shahnjayla K. Connors
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
- Department of Social Sciences, University of Houston-Downtown, Houston, TX 77002, USA
| | - Arooba A. Haq
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
| | - Anastasia Rogova
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
| | - Stephanie Ramirez
- College of Natural Sciences and Mathematics, University of Houston, 3507 Cullen Blvd, Houston, TX 77204, USA;
| | - Lorraine R. Reitzel
- HEALTH Research Institute, University of Houston, 4849 Calhoun Road, Houston, TX 77204, USA; (T.A.C.); (I.M.L.); (L.R.R.)
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
| | - Lorna H. McNeill
- Department of Health Disparities Research, The UT MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA;
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Nguyen AT, Arnold BF, Kennedy CJ, Mishra K, Pokpongkiat NN, Seth A, Djajadi S, Holbrook K, Pan E, Kirley PD, Libby T, Hubbard AE, Reingold A, Colford JM, Benjamin-Chung J. Evaluation of a city-wide school-located influenza vaccination program in Oakland, California with respect to race and ethnicity: A matched cohort study. Vaccine 2021; 40:266-274. [PMID: 34872797 PMCID: PMC8881996 DOI: 10.1016/j.vaccine.2021.11.073] [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: 08/02/2021] [Revised: 10/12/2021] [Accepted: 11/23/2021] [Indexed: 11/23/2022]
Abstract
Background: Increasing influenza vaccination coverage in school-aged children may substantially reduce community transmission. School-located influenza vaccinations (SLIV) aim to promote vaccinations by increasing accessibility, which may be especially beneficial to race/ethnicity groups that face high barriers to preventative care. Here, we evaluate the effectiveness of a city-wide SLIV program by race/ethnicity from 2014 to 2018. Methods: We used multivariate matching to pair schools in the intervention district in Oakland, CA with schools in a comparison district in West Contra Costa County, CA. We distributed cross-sectional surveys to measure caregiver-reported student vaccination status and estimated differences in vaccination coverage levels and reasons for non-vaccination between districts stratifying by race/ethnicity. We estimated difference-in-differences (DID) of laboratory confirmed influenza hospitalization incidence between districts stratified by race/ethnicity using surveillance data. Results: Differences in influenza vaccination coverage in the intervention vs. comparison district were larger among White (2017–18: 21.0% difference [95% CI: 9.7%, 32.3%]) and Hispanic/Latino (13.4% [8.8%, 18.0%]) students than Asian/Pacific Islander (API) (8.9% [1.3%, 16.5%]), Black (5.9% [−2.2%, 14.0%]), and multiracial (6.3% [−1.8%, 14.3%)) students. Concerns about vaccine effectiveness or safety were more common among Black and multiracial caregivers. Logistical barriers were less common in the intervention vs. comparison district, with the largest difference among White students. In both districts, hospitalizations in 2017–18 were higher in Blacks (Intervention: 111.5 hospitalizations per 100,00; Comparison: 134.1 per 100,000) vs. other races/ethnicities. All-age influenza hospitalization incidence was lower in the intervention site vs. comparison site among White/API individuals in 2016–17 (DID −25.14 per 100,000 [95% CI: −40.14, −10.14]) and 2017–18 (−36.6 per 100,000 [−52.7, −20.5]) and Black older adults in 2017–18 (−282.2 per 100,000 (−508.4, −56.1]), but not in other groups. Conclusions: SLIV was associated with higher vaccination coverage and lower influenza hospitalization, but associations varied by race/ethnicity. SLIV alone may be insufficient to ensure equitable influenza outcomes.
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Affiliation(s)
- Anna T Nguyen
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, United States; Department of Epidemiology and Population Health, Stanford University, Stanford, CA, United States.
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, United States
| | - Chris J Kennedy
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, United States
| | - Kunal Mishra
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, United States
| | - Nolan N Pokpongkiat
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, United States
| | - Anmol Seth
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, United States
| | - Stephanie Djajadi
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, United States
| | - Kate Holbrook
- Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, Oakland, CA, United States; Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, CA, United States
| | - Erica Pan
- Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, Oakland, CA, United States; California Department of Public Health, Richmond, CA, United States; Department of Pediatrics, Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, United States
| | - Pam D Kirley
- California Emerging Infections Program, Oakland, CA, United States
| | - Tanya Libby
- California Emerging Infections Program, Oakland, CA, United States
| | - Alan E Hubbard
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, United States
| | - Arthur Reingold
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, United States
| | - John M Colford
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, United States
| | - Jade Benjamin-Chung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, United States; Department of Epidemiology and Population Health, Stanford University, Stanford, CA, United States
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Casillas E, Wu G, Iantorno S, Ning WV, Choi J, Chan P, Lee MM. COVID-19: Highlighting Health Disparities in the Los Angeles Latinx Community. Clin Med Res 2021; 19:161-168. [PMID: 34933948 PMCID: PMC8691427 DOI: 10.3121/cmr.2021.1654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/25/2021] [Accepted: 05/20/2021] [Indexed: 12/24/2022]
Abstract
Objective: Characterization of COVID-19 in the Latinx community is necessary for guiding public health initiatives, health system policy, clinical management practices, and improving outcomes. Our aim was to describe the socioeconomic background and clinical profile of patients with COVID-19 at a large public hospital in Los Angeles to improve health disparities leading to poor outcomes during the pandemic.Design, Setting and Participants: A single center retrospective cross-sectional study of all patients with a positive polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who presented to Los Angeles County (LAC)+University of Southern California (USC) Medical Center between March 15, 2020 and April 30, 2020.Methods: We describe patient characteristics, socioeconomic factors, laboratory findings, and outcomes of the first 278 patients to present to LAC+USC Medical Center with COVID-19.Results: Patients self-identified as Hispanic (82.4%) or non-Hispanic (17.6%). Hispanic patients presented later from symptom onset (6 days vs 3 days, P = 0.027) and had higher post-intubation mortality (40.9% vs. 33.3%, P = 1), intensive care unit (ICU) mortality (31.1% vs. 22.2%, P = 0.87), and overall mortality (11.1% vs 10.2%, P = 1). However, the difference in admission rates, mechanical ventilation rates, and overall mortality rates were not statistically significant. A majority of patients, 275/278 (98.9%), reported residency ZIP codes in areas of higher population density, higher percentage of Latinx, born outside the United States, lower median income, and lower high school graduation rate when compared to the rest of Los Angeles County. Regression analysis within the Hispanic cohort found that age, history of hypertension, history of diabetes, lactate dehydrogenase (LDH), and C-reactive protein (CRP) were predictors of mechanical ventilation and mortality.Conclusion: We show the Latinx community has been disproportionally affected by the pandemic in Los Angeles and we identified multiple socioeconomic and clinical characteristics that predispose this population to COVID-19 infection. This study highlights the need for change in local and national strategies to protect vulnerable communities during public health outbreaks.
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Affiliation(s)
- Ernesto Casillas
- Department of Internal Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Gloria Wu
- Department of Internal Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Stefano Iantorno
- Department of Internal Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Weihuang Vivian Ning
- Department of Internal Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Joon Choi
- Department of Internal Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Patrick Chan
- Department of Internal Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - May M Lee
- Department of Pulmonary and Critical Care Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA
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Seethaler M, Just S, Stötzner P, Bermpohl F, Brandl EJ. Psychosocial Impact of COVID-19 Pandemic in Elderly Psychiatric Patients: a Longitudinal Study. Psychiatr Q 2021; 92:1439-1457. [PMID: 33904123 PMCID: PMC8075010 DOI: 10.1007/s11126-021-09917-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2021] [Indexed: 01/28/2023]
Abstract
The study was designed to investigate the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on mental health and perceived psychosocial support for elderly psychiatric patients in a longitudinal design. n = 32 patients with affective or anxiety disorders aged ≥60 years were included. Telephone interviews were conducted in April/May 2020 (T1) and August 2020 (T2). The psychosocial impact (PSI) of the pandemic and psychopathology were measured. Changes between T1 and T2 were examined. Patients' psychosocial support system six months before the pandemic and at T1/T2 was assessed. We found a significant positive correlation between general PSI and depression as well as severity of illness. General PSI differed significantly depending on social contact. Neither general PSI nor psychopathology changed significantly between T1 and T2. At T1, patients' psychosocial support systems were reduced as compared to six months before. Patients reported an increase in psychosocial support between T1 and T2 and high demand for additional support (sports, arts/occupational therapy, physiotherapy, psychotherapy). Elderly psychiatric patients show a negative PSI of the pandemic. They are likely to suffer from an impaired psychosocial situation, emphasizing the importance of developing concepts for sufficient psychosocial support during a pandemic.
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Affiliation(s)
- Magdalena Seethaler
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric University Clinic at St. Hedwig Hospital), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Sandra Just
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric University Clinic at St. Hedwig Hospital), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Philip Stötzner
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric University Clinic at St. Hedwig Hospital), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric University Clinic at St. Hedwig Hospital), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eva Janina Brandl
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric University Clinic at St. Hedwig Hospital), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Nimgaonkar V, Thompson JC, Pantalone L, Cook T, Kontos D, McCarthy AM, Carpenter EL. Racial Disparities in 30-Day Outcomes Following Index Admission for COVID-19. Front Med (Lausanne) 2021; 8:750650. [PMID: 34796186 PMCID: PMC8592899 DOI: 10.3389/fmed.2021.750650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/07/2021] [Indexed: 11/29/2022] Open
Abstract
We investigated racial disparities in a 30-day composite outcome of readmission and death among patients admitted across a 5-hospital health system following an index COVID-19 admission. A dataset of 1,174 patients admitted between March 1, 2020 and August 21, 2020 for COVID-19 was retrospectively analyzed for odds of readmission among Black patients compared to all other patients, with sequential adjustment for demographics, index admission characteristics, type of post-acute care, and comorbidities. Tabulated results demonstrated a significantly greater odds of 30-day readmission or death among Black patients (18.0% of Black patients vs. 11.3% of all other patients; Univariate Odds Ratio: 1.71, p = 0.002). Sequential adjustment via logistic regression revealed that the odds of 30-day readmission or death were significantly greater among Black patients after adjustment for demographics, index admission characteristics, and type of post-acute care, but not comorbidities. Stratification by type of post-acute care received on discharge revealed that the same disparity in odds of 30-day readmission or death existed among patients discharged home without home services, but not those discharged to home with home services or to a skilled nursing facility or acute rehab facility. Collectively, the findings suggest that weighing comorbidity burdens in post-acute care decisions may be relevant in addressing racial disparities in 30-day outcomes following discharge from an index COVID-19 admission.
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Affiliation(s)
- Vivek Nimgaonkar
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jeffrey C Thompson
- Division of Pulmonary, Allergy, and Critical Care Medicine, Thoracic Oncology Group, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Lauren Pantalone
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Tessa Cook
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Despina Kontos
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Anne Marie McCarthy
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Erica L Carpenter
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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Golden SH, Galiatsatos P, Wilson C, Page KR, Jones V, Tolson T, Lugo A, McCann N, Wilson A, Hill-Briggs F. Approaching the COVID-19 Pandemic Response With a Health Equity Lens: A Framework for Academic Health Systems. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1546-1552. [PMID: 34705750 PMCID: PMC8541896 DOI: 10.1097/acm.0000000000003999] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Racially and ethnically diverse and socioeconomically disadvantaged communities have historically been disproportionately affected by disasters and public health emergencies in the United States. The U.S. Department of Health and Human Services' Office of Minority Health established the National Consensus Panel on Emergency Preparedness and Cultural Diversity to provide guidance to agencies and organizations on developing effective strategies to advance emergency preparedness and eliminate disparities among racially and ethnically diverse communities during these crises. Adopting the National Consensus Panel recommendations, the Johns Hopkins Medicine Office of Diversity, Inclusion, and Health Equity; Language Services; and academic-community partnerships used existing health equity resources and expertise to develop an operational framework to support the organization's COVID-19 response and to provide a framework of health equity initiatives for other academic medical centers. This operational framework addressed policies to support health equity patient care and clinical operations, accessible COVID-19 communication, and staff and community support and engagement, which also supported the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care. Johns Hopkins Medicine identified expanded recommendations for addressing institutional policy making and capacity building, including unconscious bias training for resource allocation teams and staff training in accurate race, ethnicity, and language data collection, that should be considered in future updates to the National Consensus Panel's recommendations.
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Affiliation(s)
- Sherita H. Golden
- S.H. Golden is professor of medicine, Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, professor of epidemiology, Johns Hopkins University Bloomberg School of Public Health, and vice president and chief diversity officer, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, Maryland
| | - Panagis Galiatsatos
- P. Galiatsatos is assistant professor of medicine, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, and health equity colead, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, Maryland
| | - Cheri Wilson
- C. Wilson is diversity and inclusion education and training program manager, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, Maryland
| | - Kathleen R. Page
- K.R. Page is associate professor of medicine, Division of Infectious Disease Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vanya Jones
- V. Jones is associate professor, Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Tina Tolson
- T. Tolson is senior director, Office of Language Services, Johns Hopkins Medicine, Baltimore, Maryland
| | - April Lugo
- A. Lugo is diversity, inclusion, and health equity program coordinator, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, Maryland
| | - Nicki McCann
- N. McCann is vice president for payer/provider transformation, Presidents Office Administration, Johns Hopkins Health System, Baltimore, Maryland
| | - Alicia Wilson
- A. Wilson is vice president for economic development, Presidents Office Administration for Johns Hopkins University and Johns Hopkins Health System, Baltimore, Maryland
| | - Felicia Hill-Briggs
- F. Hill-Briggs is professor, Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, and health equity senior lead, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, Maryland
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Kunutsor SK, Jae SY, Mäkikallio TH, Kurl S, Laukkanen JA. High fitness levels offset the increased risk of chronic obstructive pulmonary disease due to low socioeconomic status: A cohort study. Respir Med 2021; 189:106647. [PMID: 34655960 DOI: 10.1016/j.rmed.2021.106647] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/03/2021] [Accepted: 10/07/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Evidence suggests that higher cardiorespiratory fitness (CRF) levels can offset the increased risk of adverse outcomes due to other risk factors. The impact of high CRF levels on the increased risk of chronic obstructive pulmonary disease (COPD) due to low socioeconomic status (SES) is unknown. We aimed to assess the combined effects of SES and CRF on the future risk of COPD. METHODS We employed a prospective cohort of 2312 Finnish men aged 42-61 years at study entry. Socioeconomic status was self-reported and CRF was objectively assessed using respiratory gas exchange analyzers. Both exposures were categorized as low and high based on median cutoffs. Multivariable-adjusted hazard ratios (HRs) with confidence intervals (CIs) were estimated. RESULTS During 26.0 years median follow-up, 120 COPD cases occurred. Low SES was associated with increased COPD risk and high CRF was associated with reduced COPD risk. Compared with high SES-low CRF, low SES-low CRF was associated with an increased COPD risk 2.36 (95% CI: 1.44-3.87), with no evidence of an association for low SES-high CRF and COPD risk 1.46 (95% CI:0.82-2.60). CONCLUSION In middle-aged Finnish men, SES and CRF are each independently associated with COPD risk. However, high CRF levels offset the increased COPD risk related to low SES.
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Affiliation(s)
- Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK; Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, UK; Central Finland Health Care District Hospital District, Department of Medicine, Jyväskylä, Finland District, Jyväskylä, Finland.
| | - Sae Young Jae
- Department of Sport Science, University of Seoul, Seoul, Republic of Korea
| | - Timo H Mäkikallio
- Department of Medicine, University of Helsinki, Helsinki, Finland; Department of Medicine, South-Karelia Central Hospital, Lappeenranta, Finland
| | - Sudhir Kurl
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jari A Laukkanen
- Central Finland Health Care District Hospital District, Department of Medicine, Jyväskylä, Finland District, Jyväskylä, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland
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Zviedrite N, Hodis JD, Jahan F, Gao H, Uzicanin A. COVID-19-associated school closures and related efforts to sustain education and subsidized meal programs, United States, February 18-June 30, 2020. PLoS One 2021; 16:e0248925. [PMID: 34520475 PMCID: PMC8439454 DOI: 10.1371/journal.pone.0248925] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/06/2021] [Indexed: 01/03/2023] Open
Abstract
Pre-emptive school closures are frontline community mitigation measures recommended by the US Centers for Disease Control and Prevention (CDC) for implementation during severe pandemics. This study describes the spatiotemporal patterns of publicly announced school closures implemented in response to the coronavirus disease 2019 (COVID-19) pandemic and assesses how public K-12 districts adjusted their methods of education delivery and provision of subsidized meals. During February 18–June 30, 2020, we used daily systematic media searches to identify publicly announced COVID-19–related school closures lasting ≥1 day in the United States (US). We also collected statewide school closure policies from state government websites. Data on distance learning and subsidized meal programs were collected from a stratified sample of 600 school districts. The first COVID-19–associated school closure occurred on February 27, 2020 in Washington state. By March 30, 2020, all but one US public school districts were closed, representing the first-ever nearly synchronous nationwide closure of public K-12 schools in the US. Approximately 100,000 public schools were closed for ≥8 weeks because of COVID-19, affecting >50 million K-12 students. Of 600 districts sampled, the vast majority offered distance learning (91.0%) and continued provision of subsidized meal programs (78.8%) during the closures. Despite the sudden and prolonged nature of COVID-19–associated school closures, schools demonstrated flexibility by implementing distance learning and alternate methods to continue subsidized meal programs.
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Affiliation(s)
- Nicole Zviedrite
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Jeffrey D. Hodis
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, United States of America
| | - Ferdous Jahan
- Kāpili Services, LLC, Atlanta, Georgia, United States of America
| | - Hongjiang Gao
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Amra Uzicanin
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Siddiquea BN, Shetty A, Bhattacharya O, Afroz A, Billah B. Global epidemiology of COVID-19 knowledge, attitude and practice: a systematic review and meta-analysis. BMJ Open 2021; 11:e051447. [PMID: 34521674 PMCID: PMC8441223 DOI: 10.1136/bmjopen-2021-051447] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 08/06/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To assess the knowledge, attitude and practice (KAP) of the global general population regarding COVID-19. DESIGN Systematic review and meta-analysis. METHODS MEDLINE, Embase, CINAHL and PsycINFO were used to identify articles published between 1 January and 30 June 2021 assessing KAP regarding COVID-19 in the global general population. The quality of eligible studies was assessed. Random effects model was used to obtain the pooled proportion of each component of KAP of COVID-19. Heterogeneity (I2) was tested, and subgroup and correlation analyses were performed. RESULTS Out of 3099 records, 84 studies from 45 countries across all continents assessing 215 731 participants' COVID-19 KAP were included in this study. The estimated overall correct answers for knowledge, good attitude and good practice in this review were 75% (95% CI 72% to 77%), 74% (95% CI 71% to 77%) and 70% (95% CI 66% to 74%), respectively. Low-income countries, men, people aged below 30 years and people with 12 years of education or less had the lowest practice scores. Practice scores were below 60% in Africa and Europe/Oceania. Overall heterogeneity was high (I2 ≥98%), and publication bias was present (Egger's regression test, p<0.01). A positive significant correlation between knowledge and practice (r=0.314, p=0.006), and attitude and practice (r=0.348, p=0.004) was observed. CONCLUSIONS This study's findings call for community-based awareness programmes to provide a simple, clear and understandable message to reinforce knowledge especially regarding efficacy of the preventive measures in low and lower middle-income countries, and in Africa and Europe/Oceania, which will translate into good practice. Targeted intervention for men, people with low education, unemployed people and people aged below 30 years should be recommended. As most of the included studies were online surveys, underprivileged and remote rural people may have been missed out. Additional studies are needed to cover heterogeneous populations. PROSPERO REGISTRATION NUMBER CRD42020203476.
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Affiliation(s)
- Bodrun Naher Siddiquea
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Aishwarya Shetty
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Oashe Bhattacharya
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Afsana Afroz
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre of Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Saban M, Myers V, Peretz G, Avni S, Wilf-Miron R. COVID-19 morbidity in an ethnic minority: changes during the first year of the pandemic. Public Health 2021; 198:238-244. [PMID: 34487867 PMCID: PMC8437684 DOI: 10.1016/j.puhe.2021.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/07/2021] [Accepted: 07/16/2021] [Indexed: 11/08/2022]
Abstract
Objectives During the COVID-19 pandemic, ethnic minorities have been more susceptible to infection and demonstrated poorer outcomes. This study describes COVID-19 morbidity and mortality by ethnic group, represented by Arab and Jewish localities in Israel, during the different waves of the outbreak and addresses sociocultural aspects of the pandemic. Study design A retrospective national archive study was conducted in Israel. Methods Data were obtained from the Ministry of Health's database, including daily information on Arab, Jewish or mixed localities, from February 2020 to February 2021. Results During the first wave of the pandemic, the incidence of COVID-19 in Arab compared with Jewish localities was 67% lower and mortality was 85% lower, in addition to lower rates of severe disease requiring hospitalisation. During the second and third waves, these trends reversed, with the proportion of positive tests, incidence and mortality in Arab localities reaching and then surpassing rates in Jewish localities. By September 2020, COVID-19 mortality was twice as high in Arab compared with Jewish localities. Conclusions After low morbidity during the first wave of the COVID-19 pandemic, a surge in infections occurred in the Arab population during subsequent waves, to match and surpass the high incidence seen in the Jewish population. This unique pattern highlights the changing experiences of a minority group as the pandemic progressed and demonstrates how COVID-19 exacerbates existing disparities.
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Affiliation(s)
- M Saban
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - V Myers
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - G Peretz
- Strategic and Economic Planning Administration, Ministry of Health, Jerusalem, Israel
| | - S Avni
- Strategic and Economic Planning Administration, Ministry of Health, Jerusalem, Israel
| | - R Wilf-Miron
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel; School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Wang H. Why the Navajo Nation was hit so hard by coronavirus: Understanding the disproportionate impact of the COVID-19 pandemic. APPLIED GEOGRAPHY (SEVENOAKS, ENGLAND) 2021; 134:102526. [PMID: 36536835 PMCID: PMC9753121 DOI: 10.1016/j.apgeog.2021.102526] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 05/12/2023]
Abstract
The COVID-19 (SARS-CoV-2) pandemic of 2019-2020 has incurred astonishing social and economic costs in the United States (US) and worldwide. Native American reservations, representing a unique geography, have been hit much harder than other parts of the country. This study seeks to understand the reasons for the disproportionate impact of the pandemic on Native American communities by focusing on the Navajo Nation - the largest Native American reservation in the US. I first reviewed the historical pandemics experienced by Native Americans. Guided by the literature review, an institutional analysis focusing on the Navajo Nation suggests a lack of both institutional resilience and healthcare preparation. The analysis further identified four factors that could help explain the Navajo's slow response to the COVID-19 pandemic: prevalence of underlying chronic health conditions, lack of institutional resilience, the relationship between the federal government and tribal governments, and lack of social trust. Relevant policy implications are discussed. For instance, to better prepare Native American communities for shocking events like the COVID-19 pandemic in the future, policymaking should integrate informal institutions to build efficient formal institutions for self-governance. Promoting public health education and establishing collaborations between Native and non-Native communities are also necessary long-run strategies.
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Affiliation(s)
- Haoying Wang
- Department of Business and Technology Management, New Mexico Tech, 801 Leroy Pl, Socorro, NM, 87801, USA
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Mulpur E, Turner T. Reducing Barriers to Language Assistance During a Pandemic. J Immigr Minor Health 2021; 23:1126-1128. [PMID: 34328601 PMCID: PMC8322631 DOI: 10.1007/s10903-021-01251-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 11/28/2022]
Abstract
This “Notes from the Field” article discusses language assistance within healthcare during the COVID-19 public health crisis. Providing adequate language assistance within healthcare is fundamental. At Houston Methodist we learned that we could leverage existing technologies to address language needs of our COVID-19 patients with limited English proficiency during the pandemic when personal protective equipment was in limited supply across the United States. By leveraging the use of our existing technologies (ex. Telephone interpretation with wearable communication devices) we increased utilization of language assistance for our patients with limited English proficiency. We urge other healthcare organizations to re-evaluate their language assistance programs and leverage similar technologies to empower both clinicians and patients.
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Affiliation(s)
- Erin Mulpur
- Houston Methodist Global Health Care Services, Houston Methodist Hospital System, 6560 Fannin Street, Suite 570, Houston, TX, 77030, USA.
| | - Travis Turner
- Houston Methodist Global Health Care Services, Houston Methodist Hospital System, 6560 Fannin Street, Suite 570, Houston, TX, 77030, USA
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Islam SJ, Nayak A, Hu Y, Mehta A, Dieppa K, Almuwaqqat Z, Ko YA, Patel SA, Goyal A, Sullivan S, Lewis TT, Vaccarino V, Morris AA, Quyyumi AA. Temporal trends in the association of social vulnerability and race/ethnicity with county-level COVID-19 incidence and outcomes in the USA: an ecological analysis. BMJ Open 2021; 11:e048086. [PMID: 34301657 PMCID: PMC8300549 DOI: 10.1136/bmjopen-2020-048086] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/24/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic adversely affected the socially vulnerable and minority communities in the USA initially, but the temporal trends during the year-long pandemic remain unknown. OBJECTIVE We examined the temporal association of county-level Social Vulnerability Index (SVI), a percentile-based measure of social vulnerability to disasters, its subcomponents and race/ethnic composition with COVID-19 incidence and mortality in the USA in the year starting in March 2020. METHODS Counties (n=3091) with ≥50 COVID-19 cases by 6 March 2021 were included in the study. Associations between SVI (and its subcomponents) and county-level racial composition with incidence and death per capita were assessed by fitting a negative-binomial mixed-effects model. This model was also used to examine potential time-varying associations between weekly number of cases/deaths and SVI or racial composition. Data were adjusted for percentage of population aged ≥65 years, state-level testing rate, comorbidities using the average Hierarchical Condition Category score, and environmental factors including average fine particulate matter of diameter ≥2.5 μm, temperature and precipitation. RESULTS Higher SVI, indicative of greater social vulnerability, was independently associated with higher COVID-19 incidence (adjusted incidence rate ratio per 10 percentile increase: 1.02, 95% CI 1.02 to 1.03, p<0.001) and death per capita (1.04, 95% CI 1.04 to 1.05, p<0.001). SVI became an independent predictor of incidence starting from March 2020, but this association became weak or insignificant by the winter, a period that coincided with a sharp increase in infection rates and mortality, and when counties with higher proportion of white residents were disproportionately represented ('third wave'). By spring of 2021, SVI was again a predictor of COVID-19 outcomes. Counties with greater proportion of black residents also observed similar temporal trends in COVID-19-related adverse outcomes. Counties with greater proportion of Hispanic residents had worse outcomes throughout the duration of the analysis. CONCLUSION Except for the winter 'third wave', when majority of the white communities had the highest incidence of cases, counties with greater social vulnerability and proportionately higher minority populations experienced worse COVID-19 outcomes.
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Affiliation(s)
- Shabatun J Islam
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Aditi Nayak
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Yingtian Hu
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Anurag Mehta
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Katherine Dieppa
- City Operations, Getaround Incorporated, San Francisco, California, USA
| | - Zakaria Almuwaqqat
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Shivani A Patel
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Abhinav Goyal
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Samaah Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Alanna A Morris
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Arshed A Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
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Variations in Presentation and Management of COVID-19 Inpatients by Race and Ethnicity in a Large Texas Metroplex. Disaster Med Public Health Prep 2021; 17:e21. [PMID: 34247684 PMCID: PMC8438512 DOI: 10.1017/dmp.2021.224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to assess variations in presentation and outcomes of coronavirus disease 2019 (COVID-19) across race/ethnicity at a large Texas metroplex hospital. METHODS A retrospective cohort study was performed. RESULTS Although COVID-19 patients demonstrated significant socioeconomic disparities, race/ethnicity was not a significant predictor of intensive care unit (ICU) admission (P = 0.067) or case fatality (P = 0.078). Hospital admission varied by month, with incidence among Black/African-American and Hispanic/Latino patients peaking earlier in the pandemic timeline (P < 0.001). Patients reporting Spanish as their primary language were significantly more likely to be admitted to the ICU (odds ratio, 1.75; P = 0.007). CONCLUSIONS COVID-19 patients do not demonstrate significant racial/ethnic disparities in case fatality, suggesting that state-wide disparities in mortality rate are rooted in infection risk rather than hospital course. Variations in admission rates by race/ethnicity across the timeline and increased ICU admission among Spanish-speaking patients demonstrate the need to pursue tailored interventions on both a community and structural level to mitigate further health disparities throughout the pandemic and after.
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Abstract
Racialized populations have consistently been shown to have poorer health outcomes worldwide. This pattern has become even more prominent in the wake of the coronavirus disease 2019 (COVID-19) pandemic. In countries where race disaggregated data are routinely collected, such as the United States and the United Kingdom, preliminary reports have identified that racialized populations are at a heightened risk of COVID-19 infection and mortality. Similar patterns are emerging in Canada but rely on proxy measures such as neighbourhood diversity to account for race, in the absence of person-level data. It follows that the collection of race disaggregated data in Canada is a crucial element in identifying individuals at risk of poorer COVID-19 outcomes and developing targeted public health interventions to mitigate risk among Canada's racialized populations. Given this continuing gap, advocating for timely access to this data is of great importance owing to the challenges that the COVID-19 pandemic has highlighted amongst racialized populations in Canada and worldwide.
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John-Baptiste A, Moulin MS, Ali S. Are COVID-19 models blind to the social determinants of health? A systematic review protocol. BMJ Open 2021; 11:e048995. [PMID: 34226230 PMCID: PMC8260285 DOI: 10.1136/bmjopen-2021-048995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/18/2021] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Infectious disease models are important tools to inform public health policy decisions. These models are primarily based on an average population approach and often ignore the role of social determinants in predicting the course of a pandemic and the impact of policy interventions. Ignoring social determinants in models may cause or exacerbate inequalities. This limitation has not been previously explored in the context of the current pandemic, where COVID-19 has been found to disproportionately affect marginalised racial, ethnic and socioeconomic groups. Therefore, our primary goal is to identify the extent to which COVID-19 models incorporate the social determinants of health in predicting outcomes of the pandemic. METHODS AND ANALYSIS We will search MEDLINE, EMBASE, Cochrane Library and Web of Science databases from December 2019 to August 2020. We will assess all infectious disease modelling studies for inclusion of social factors that meet the following criteria: (a) focused on human spread of SARS-CoV-2; (b) modelling studies; (c) interventional or non-interventional studies; and (d) focused on one of the following outcomes: COVID-19-related outcomes (eg, cases, deaths), non-COVID-19-related outcomes (ie, impacts of the pandemic or control policies on other health conditions or health services), or impact of the pandemic or control policies on economic outcomes. Data will only be extracted from models incorporating social factors. We will report the percentage of models that considered social factors, indicate which social factors were considered, and describe how social factors were incorporated into the conceptualisation and implementation of the infectious disease models. The extracted data will also be used to create a narrative synthesis of the results. ETHICS AND DISSEMINATION Ethics approval is not required as only secondary data will be collected. The results of this systematic review will be disseminated through peer-reviewed publication and conference proceedings. PROSPERO REGISTRATION NUMBER CRD42020207706.
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Affiliation(s)
- Ava John-Baptiste
- Department of Anesthesia and Perioperative Medicine, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Interfaculty Program in Public Health, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Marc S Moulin
- Department of Anesthesia and Perioperative Medicine, Western University, London, Ontario, Canada
| | - Shehzad Ali
- Department of Anesthesia and Perioperative Medicine, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Interfaculty Program in Public Health, Western University, London, Ontario, Canada
- WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Ottawa, Ontario, Canada
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Spatio-Temporal Analysis of Influenza-Like Illness and Prediction of Incidence in High-Risk Regions in the United States from 2011 to 2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137120. [PMID: 34281057 PMCID: PMC8297262 DOI: 10.3390/ijerph18137120] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/27/2021] [Accepted: 06/29/2021] [Indexed: 01/04/2023]
Abstract
About 8% of the Americans contract influenza during an average season according to the Centers for Disease Control and Prevention in the United States. It is necessary to strengthen the early warning for influenza and the prediction of public health. In this study, Spatial autocorrelation analysis and spatial scanning analysis were used to identify the spatiotemporal patterns of influenza-like illness (ILI) prevalence in the United States, during the 2011-2020 transmission seasons. A seasonal autoregressive integrated moving average (SARIMA) model was constructed to predict the influenza incidence of high-risk states. We found the highest incidence of ILI was mainly concentrated in the states of Louisiana, District of Columbia and Virginia. Mississippi was a high-risk state with a higher influenza incidence, and exhibited a high-high cluster with neighboring states. A SARIMA (1, 0, 0) (1, 1, 0)52 model was suitable for forecasting the ILI incidence of Mississippi. The relative errors between actual values and predicted values indicated that the predicted values matched the actual values well. Influenza is still an important health problem in the United States. The spread of ILI varies by season and geographical region. The peak season of influenza was the winter and spring, and the states with higher influenza rates are concentrated in the southeast. Increased surveillance in high-risk states could help control the spread of the influenza.
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Prata Menezes N, Malone J, Lyons C, Cadet K, Dean L, Millett G, Baral S. Racial and ethnic disparities in viral acute respiratory infections in the United States: protocol of a systematic review. Syst Rev 2021; 10:196. [PMID: 34215337 PMCID: PMC8252979 DOI: 10.1186/s13643-021-01749-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 06/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic caused by SARS-CoV-2 has highlighted consistent inequities in incidence, disease severity, and mortality across racial and ethnic minority populations in the United States (US) and beyond. While similar patterns have been observed with previous viral respiratory pathogens, to date, no systematic review has comprehensively documented these disparities or potential contributing factors. In response, this review aims to synthesize data on racial and ethnic disparities in morbidity and mortality due to viral acute respiratory infections (ARI) other than SARS-CoV-2. This review will focus on understanding structural health and social factors to contextualize race and ethnicity driving these disparities in the US. METHODS We will conduct a systematic review of studies published from January 1, 2002, onward. Our search will include PubMed/MEDLINE, EBSCO Host-CINAHL Plus, PsycInfo, EMBASE, and Cochrane Library databases to identify relevant articles. We will include studies of any design that describe racial/ethnic disparities associated with viral ARI conducted in the US. Primary outcomes include incidence, disease severity or complication, hospitalization, or death attributed to ARI. Secondary outcomes include uptake of preventive interventions including vaccination, handwashing, social distancing, and wearing masks. Two reviewers will independently screen all citations, full-text articles, and abstract relevant data. Data characterizing individual-, community-, and structural-level factors associated with these disparities will be abstracted to better understand the underlying structural inequities contributing to racial disparities in ARI. We will assess the methodological quality of all studies and will conduct meta-analyses using random effects models if appropriate. DISCUSSION Findings from this systematic review will shed light on patterns of racial and ethnic disparities in viral ARI in the United States to support mathematical modeling of epidemic trajectories, intervention impact, and structural drivers of transmission, including structural racism. Moreover, data emerging from this review may reignite pandemic preparedness focused on communities with specific vulnerabilities related to living and working conditions given prevailing structural inequities, thus facilitating improved future pandemic responses to novel or endemic viral respiratory pathogens. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020219771.
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Affiliation(s)
- Neia Prata Menezes
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Jowanna Malone
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Carrie Lyons
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kechna Cadet
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lorraine Dean
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Gregorio Millett
- Public Policy Office, AmfAR, Foundation for AIDS Research, Washington, DC, USA
| | - Stefan Baral
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.,Center for Public Health and Human Rights, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Escobar M, Mendez AD, Encinas MR, Villagomez S, Wojcicki JM. High food insecurity in Latinx families and associated COVID-19 infection in the Greater Bay Area, California. BMC Nutr 2021; 7:23. [PMID: 34112257 PMCID: PMC8192129 DOI: 10.1186/s40795-021-00419-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Food insecurity impacts nearly one-in-four Latinx households in the United States and has been exacerbated by the novel coronavirus or COVID-19 pandemic. METHODS We examined the impact of COVID-19 on household and child food security in three preexisting, longitudinal, Latinx urban cohorts in the San Francisco Bay Area (N = 375 households, 1875 individuals). Households were initially recruited during pregnancy and postpartum at Zuckerberg San Francisco General Hospital (ZSFG) and UCSF Benioff prior to the COVID-19 pandemic. For this COVID-19 sub-study, participants responded to a 15-min telephonic interview. Participants answered 18 questions from the US Food Security Food Module (US HFSSM) and questions on types of food consumption, housing and employment status, and history of COVID-19 infection as per community or hospital-based testing. Food security and insecurity levels were compared with prior year metrics. RESULTS We found low levels of household food security in Latinx families (by cohort: 29.2%; 34.2%; 60.0%) and child food security (56.9%, 54.1%, 78.0%) with differences between cohorts explained by self-reported levels of education and employment status. Food security levels were much lower than those reported previously in two cohorts where data had been recorded from prior years. Reported history of COVID-19 infection in households was 4.8% (95% Confidence Interval (CI); 1.5-14.3%); 7.2% (95%CI, 3.6-13.9%) and 3.5% (95%CI, 1.7-7.2%) by cohort and was associated with food insecurity in the two larger cohorts (p = 0.03; p = 0.01 respectively). CONCLUSIONS Latinx families in the Bay Area with children are experiencing a sharp rise in food insecurity levels during the COVID-19 epidemic. Food insecurity, similar to other indices of poverty, is associated with increased risk for COVID-19 infection. Comprehensive interventions are needed to address food insecurity in Latinx populations and further studies are needed to better assess independent associations between household food insecurity, poor nutritional health and risk of COVID-19 infection.
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Affiliation(s)
- Milagro Escobar
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of California, 550 16th Street, 5th Floor, San Francisco, CA, 94158-0136, USA
| | - Andrea DeCastro Mendez
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of California, 550 16th Street, 5th Floor, San Francisco, CA, 94158-0136, USA
| | - Maria Romero Encinas
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of California, 550 16th Street, 5th Floor, San Francisco, CA, 94158-0136, USA
| | - Sofia Villagomez
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of California, 550 16th Street, 5th Floor, San Francisco, CA, 94158-0136, USA
| | - Janet M Wojcicki
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of California, 550 16th Street, 5th Floor, San Francisco, CA, 94158-0136, USA.
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Islam SJ, Nayak A, Hu Y, Mehta A, Dieppa K, Almuwaqqat Z, Ko YA, Patel SA, Goyal A, Sullivan S, Lewis TT, Vaccarino V, Morris AA, Quyyumi AA. Ecological Analysis of the Temporal Trends in the Association of Social Vulnerability and Race/Ethnicity with County-Level COVID-19 Incidence and Outcomes in the United States. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.06.04.21258355. [PMID: 34127982 PMCID: PMC8202439 DOI: 10.1101/2021.06.04.21258355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background The COVID-19 pandemic adversely affected the socially vulnerable and minority communities in the U.S. initially, but the temporal trends during the year-long pandemic remain unknown. Objective We examined the temporal association between the county-level Social Vulnerability Index (SVI), a percentile-based measure of social vulnerability to disasters, its subcomponents and race/ethnic composition with COVID-19 incidence and mortality in the U.S. in the year starting in March 2020. Methods Counties (n=3091) with ≥ 50 COVID-19 cases by March 6th, 2021 were included in the study. Associations between SVI (and its subcomponents) and county level racial composition with the incidence and death per capita were assessed by fitting a negative-binomial mixed-effects model. This model was also used to examine potential time varying associations between weekly number of cases/deaths and SVI or racial composition. Data was adjusted for percentage of population aged ≥65 years, state level testing rate, comorbidities using the average Hierarchical Condition Category (HCC) score, and environmental factors including average fine particulate matter (PM2.5), temperature and precipitation. Results Higher SVI, indicative of greater social vulnerability, was independently associated with higher COVID-19 incidence (adjusted incidence rate ratio [IRR] per-10 percentile increase:1.02, (95% CI 1.02, 1.03, p<0.001), and death per capita (1.04, (95% CI 1.04, 1.05, p<0.001). SVI became an independent predictor of incidence starting from March 2020, but this association became weak or insignificant by the winter, a period that coincided with a sharp increase in infection rates and mortality, and when counties with higher proportion of White residents were disproportionately represented ("third wave"). By Spring of 2021, SVI was again a predictor of COVID-19 outcomes. Counties with greater proportion of Black residents also observed similar temporal trends COVID-19-related adverse outcomes. Counties with greater proportion of Hispanic residents had worse outcomes throughout the duration of the analysis. Conclusion Except for the winter "third wave" when majority White communities had the highest incidence of cases, counties with greater social vulnerability and proportionately higher minority populations, experienced worse COVID-19 outcomes.
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Affiliation(s)
- Shabatun J. Islam
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Aditi Nayak
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Yingtian Hu
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Anurag Mehta
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | | | - Zakaria Almuwaqqat
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Shivani A. Patel
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Abhinav Goyal
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Samaah Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Tené T. Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Alanna A. Morris
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Arshed A. Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
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