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Worku F, Ugas M, Wheeler S, Siddiqi A, Papadakos J. A Cross-Sectional Study of COVID-19 Knowledge, Attitudes, and Practices Among Black Communities in the Greater Toronto Area. J Racial Ethn Health Disparities 2025; 12:2052-2068. [PMID: 38902465 DOI: 10.1007/s40615-024-02031-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/18/2024] [Accepted: 05/16/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION AND BACKGROUND COVID-19 preventative practices such as hand washing, social distancing, and mask wearing have been identified as ways to prevent the spread of COVID-19. However, social determinants can play a role in the ability of individuals and groups to adhere to recommended COVID-19 preventative practices. A cross-sectional study was undertaken to explore the COVID-19 knowledge, attitude, and practices (KAPs), and information sources used in the adult Black population within the Greater Toronto Area (GTA). METHODS An online questionnaire was completed by Black adults living in the GTA. Associations between KAPs, health literacy, and sociodemographic variables were assessed using descriptive tests. A multivariate logistic regression model was used to examine predictors of high preventative practices. RESULTS AND ANALYSIS Of the 169 respondents, most had high knowledge scores (80.5%), low attitudes (85.2%), and high COVID-19 preventative practices (82.2%). Hotspot status, working from home, and high health literacy were found to be independent predictors of high preventative practices. CONCLUSION AND IMPLICATIONS This study provides new knowledge that advances understanding of the COVID-19 KAPs of Black communities in a Canadian context. Our findings point to the inadequacy of current prevention strategies that focus narrowly on individual actions while overlooking the importance of systemic influences on health.
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Affiliation(s)
- Fiqir Worku
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Mohamed Ugas
- Cancer Health Literacy Research Centre, Cancer Education, Princess Margaret Cancer Centre, 585 University Avenue, ELLICSR PMB B-130, Toronto, ON, M5G 2N2, Canada
| | - Sarah Wheeler
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Population Health and Value-Based Health Systems, Ontario Health, Toronto, ON, Canada
| | - Arjumand Siddiqi
- Division of Epidemiology, Dalla Lana School of Public Health, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - Janet Papadakos
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- Cancer Health Literacy Research Centre, Cancer Education, Princess Margaret Cancer Centre, 585 University Avenue, ELLICSR PMB B-130, Toronto, ON, M5G 2N2, Canada.
- The Institute for Education Research (TIER), University Health Network, Toronto, Canada.
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Ye R, Wu Y, Sun C, Wang Q, Ma Y, Chen Y, Pappas L, Feng C, Rozelle S, Zhou H. Gap in protective behaviors between Han and minority ethnicities during COVID-19 pandemic in rural western China: A decomposition analysis. Prev Med Rep 2024; 39:102617. [PMID: 38370983 PMCID: PMC10873723 DOI: 10.1016/j.pmedr.2024.102617] [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] [Received: 08/07/2023] [Revised: 01/03/2024] [Accepted: 01/14/2024] [Indexed: 02/20/2024] Open
Abstract
Understanding the ethnic gap in protective behavior and its explanatory factors is a promising step for reducing pandemic-induced disparities. However, no studies have endeavored to identify the factors contributing to a gap in protective behaviors between Han and minority ethnicities during COVID-19 pandemic in rural China. We aimed to analyze the gap in protective behaviors between Han and minority residents in rural China. We conducted cross-sectional studies in multi-ethnic rural China in 2020. A total of 1640 participants from Han and minority groups were invited to participate. The decomposition method was applied to analyze the gap in protective behaviors and its associated factors between the Han and minority groups. Participants in the Han group had a higher protective behavioral score (9.26 ± 1.20) than the minority group (8.97 ± 1.50), yielding a significant gap in protective behaviors between Han and minority ethnicities of 0.29. Socio-demographic characteristics, health status, the degree of knowledge held about COVID-19, and psychological responses to COVID-19 explained 79.3 % (0.23/0.29) of the behavioral gap between the Han and minority groups. The difference in household asset levels was the largest explained contributor to the behavioral gap (52.17 %) (0.12/0.23), followed by fear felt for COVID-19 (-21.74 %) (-0.05/0.23). Differences in educational attainment, degree of knowledge held about COVID-19, and self-efficacy in response to COVID-19 each explained 17.4 % (0.04/0.23) of the behavioral gap. In conclusion, Han group show greater protective behaviors than minority ethnic groups. To drive better protective behavior in the most vulnerable communities, targeted, group-specific COVID-19 preventative messages deployed in public health communication strategies is suggested to enhance individual confidence in coping with the pandemic while creating a healthy amount of fear for public health crisis.
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Affiliation(s)
- Ruixue Ye
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuju Wu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chang Sun
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qingzhi Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yue Ma
- Stanford Center on China’s Economy and Institutions, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Yunwei Chen
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lucy Pappas
- Stanford Center on China’s Economy and Institutions, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Cindy Feng
- Stanford Center on China’s Economy and Institutions, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Scott Rozelle
- Stanford Center on China’s Economy and Institutions, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Huan Zhou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
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Araújo MVRD, Pereira-Borges RC. Racism, health and pandemic: a narrative review of the relationship between black population and COVID-19 events in 2020. CIENCIA & SAUDE COLETIVA 2024; 29:e11072023. [PMID: 38451653 DOI: 10.1590/1413-81232024293.11072023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/20/2023] [Indexed: 03/08/2024] Open
Abstract
This study aimed to analyze how scientific publications described and interpreted findings about the relationship between the Black population and events linked to COVID-19 in 2020. Narrative review with systematic search, in which a survey was conducted on articles published in 2020 in the Scopus, Medline/PubMed, and Web of Science databases. Initially, 665 articles were found, and after reading and applying the eligible criteria, the final number of 45 articles was reached. Epidemiological, observational studies, secondary data and developed in the United States predominated. Four groupings and respective findings emerged from the synthesis of information extracted: Main events in the Black population - high number of deaths and mortality rate; Direct relationships - poor health, housing, and work conditions; Intermediate relationships - low income and anti-Black prejudice; Comprehensive relationships - structural racism and social determinants of health. The identification of racial health disparities is an important finding about the dynamics of the pandemic among the Black population. However, multicausal explanations were limited. It is necessary to mobilize critical theoretical resources from ethnic and health studies to qualify research in order to support global actions to combat the SARS-CoV-2 epidemic in this group.
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Affiliation(s)
- Marcos Vinícius Ribeiro de Araújo
- Instituto Multidisciplinar de Reabilitação e Saúde, Universidade Federal da Bahia. R. Padre Feijó 312, casas 47 e 49, Canela. 40.110-170 Salvador BA Brasil.
| | - Ruan Carlos Pereira-Borges
- Programa de Residência Multiprofissional Hospital Metropolitano Odilon Behrens, Secretaria Municipal de Saúde de Belo Horizonte. Belo Horizonte MG Brasil
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Worku F, Bennett F, Wheeler S, Siddiqi A, Papadakos J. Exploring the COVID-19 Knowledge, Attitudes, and Practices (KAPs) in the Black Community: a Scoping Review. J Racial Ethn Health Disparities 2024; 11:273-299. [PMID: 36757610 PMCID: PMC9910259 DOI: 10.1007/s40615-023-01518-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/06/2023] [Accepted: 01/16/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION AND BACKGROUND Racial minorities have been the focal point of media coverage, attributing the disproportionate impact of COVID-19 to their individual actions; however, the ability to engage in preventative practices can also depend on one's social determinants of health. Individual actions can include knowledge, attitudes, and practices (KAPs). Since Black communities are among those disproportionately affected by COVID-19, this scoping review explores what is known about COVID-19 KAPs among Black populations. METHODS A comprehensive literature search was conducted in 2020 for articles written in English from the Medline, Embase, and PsycInfo databases. Reviews, experimental research, and observational studies were included if they investigated at least one of COVID-19 KAP in relation to the pandemic and Black communities in OECD peer countries including Canada, the United States, and the United Kingdom. RESULTS AND ANALYSIS Thirty-one articles were included for analysis, and all employed observational designs were from the United States. The following KAPs were examined: 6 (18.8%) knowledge, 21 (65.6%) attitudes, and 22 (68.8%) practices. Black communities demonstrated high levels of adherence to preventative measures (e.g., lockdowns) and practices (e.g., mask wearing), despite a strong proportion of participants believing they were less likely to become infected with the virus, and having lower levels of COVID-19 knowledge, than other racial groups. CONCLUSIONS AND IMPLICATIONS The findings from this review support that Black communities highly engage in COVID-19 preventative practices within their realm of control such as mask-wearing and hand washing and suggest that low knowledge does not predict low practice scores among this population.
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Affiliation(s)
- Fiqir Worku
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Avenue, Toronto, ON, M5T 3M7, Canada.
| | - Falan Bennett
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sarah Wheeler
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Avenue, Toronto, ON, M5T 3M7, Canada
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Janet Papadakos
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Avenue, Toronto, ON, M5T 3M7, Canada
- Cancer Health Literacy Research Centre, Princess Margaret Cancer Centre, Toronto, Canada
- The Institute for Education Research (TIER), University Health Network, Toronto, Canada
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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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Cohen J, van der Meulen Rodgers Y. An intersectional analysis of long COVID prevalence. Int J Equity Health 2023; 22:261. [PMID: 38093291 PMCID: PMC10717295 DOI: 10.1186/s12939-023-02072-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Long COVID symptoms - which include brain fog, depression, and fatigue - are mild at best and debilitating at worst. Some U.S. health surveys have found that women, lower income individuals, and those with less education are overrepresented among adults with long COVID, but these studies do not address intersectionality. To fill this gap, we conduct an intersectional analysis of the prevalence and outcomes of long COVID in the U.S. We posit that disparities in long COVID have less to do with the virus itself and more to do with social determinants of health, especially those associated with occupational segregation and the gendered division of household work. METHODS We use 10 rounds of Household Pulse Survey (HPS) data collected between June 2022 and March 2023 to perform an intersectional analysis using a battery of descriptive statistics that evaluate (1) the prevalence of long COVID and (2) the interference of long COVID symptoms with day-to-day activities. We also use the HPS data to estimate a set of multivariate logistic regressions that relate the odds of having long COVID and activity limitations due to long COVID to a set of individual characteristics as well as intersections by sex, race/ethnicity, education, and sexual orientation and gender identity. RESULTS Findings indicate that women, some people of color, sexual and gender minorities, and people without college degrees are more likely to have long COVID and to have activity limitations from long COVID. Women have considerably higher odds of developing long COVID compared to men, a disparity exacerbated by having less education. Intersectional analysis by gender, race, ethnicity, and education reveals a striking step-like pattern: college-educated men have the lowest prevalence of long COVID while women without college educations have the highest prevalence. Daily activity limitations are more evenly distributed across demographics, but a different step-like pattern is present: fewer women with degrees have activity limitations while limitations are more widespread among men without degrees. Regression results confirm the negative association of long COVID with being a woman, less educated, Hispanic, and a sexual and gender minority, while results for the intersectional effects are more nuanced. CONCLUSIONS Results point to systematic disparities in health, highlighting the urgent need for policies that increase access to quality healthcare, strengthen the social safety net, and reduce economic precarity.
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Affiliation(s)
- Jennifer Cohen
- Department of Global and Intercultural Studies, Miami University, Oxford, OH, USA.
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Kirchoff C, Penn A, Wang W, Babino R, De La Rosa M, Cano MA, Sanchez M. COVID-19 Vaccine Acceptance Among Latino/a Immigrants: The Role of Collective Responsibility and Confidence. J Immigr Minor Health 2023; 25:1246-1253. [PMID: 37402075 DOI: 10.1007/s10903-023-01513-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 07/05/2023]
Abstract
Research on COVID-19 vaccine hesitancy has been sparse among Latino/a immigrants, a population at high risk for infection. This exploratory study examines rates of vaccine acceptance and its association with psychological antecedents of vaccination among Latino/a immigrants. A cross-sectional telephone survey on perceptions of COVID-19 was administered between October 2020 to February 2021 in South Florida to 200 adult Latino/a immigrants. Descriptive statistics, bivariate analysis, and logistic regression were employed to determine the influence of independent variables on vaccine acceptance. Most participants indicated a willingness to get vaccinated. Participants with higher confidence (aOR = 10.2, 95% CI: 4.8-21.8) and collective responsibility scores were (aOR = 3.1, 95%CI:1.3-6.9) more likely to report vaccine acceptance than those with lower scores. No other psychological antecedents or demographic variables were significantly associated with vaccine acceptance. Study results provide insights into motivating factors for vaccination that can inform culturally tailored education campaigns to increase vaccine acceptability in this population.
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Affiliation(s)
- C Kirchoff
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St., AHC5, Miami, FL, 33199, USA
| | - A Penn
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St., AHC5, Miami, FL, 33199, USA.
| | - W Wang
- Center for Research on U.S. Latinos HIV/AIDS and Drug Abuse, Florida International University, 11200 SW 8th St., AHC5, Miami, FL, 33199, USA
| | - R Babino
- Center for Research on U.S. Latinos HIV/AIDS and Drug Abuse, Florida International University, 11200 SW 8th St., AHC5, Miami, FL, 33199, USA
| | - M De La Rosa
- Center for Research on U.S. Latinos HIV/AIDS and Drug Abuse, Florida International University, 11200 SW 8th St., AHC5, Miami, FL, 33199, USA
- School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St., AHC5, Miami, FL, 33199, USA
| | - M A Cano
- Center for Research on U.S. Latinos HIV/AIDS and Drug Abuse, Florida International University, 11200 SW 8th St., AHC5, Miami, FL, 33199, USA
- School of Public Health, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - M Sanchez
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St., AHC5, Miami, FL, 33199, USA
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Boguslawski SM, Joseph NT, Stanhope KK, Ti AJ, Geary FH, Boulet SL. Impact of the COVID-19 Pandemic on Prenatal Care Utilization at a Public Hospital. Am J Perinatol 2023; 40:1484-1494. [PMID: 35709724 DOI: 10.1055/a-1877-7951] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The aim of the study is to compare rates of prenatal care utilization before and after implementation of a telehealth-supplemented prenatal care model due to the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN Using electronic medical record data, we identified two cohorts of pregnant persons that initiated prenatal care prior to and during the COVID-19 pandemic following the implementation of telehealth (from March 1, 2019 through August 31, 2019, and from March 1, 2020, through August 31, 2020, respectively) at Grady Memorial Hospital. We used Pearson's Chi-square and two-tailed t-tests to compare rates of prenatal care utilization, antenatal screening and immunizations, emergency department and obstetric triage visits, and pregnancy complications for the prepandemic versus pandemic-exposed cohorts. RESULTS We identified 1,758 pregnant patients; 965 entered prenatal care prior to the COVID-19 pandemic and 793 entered during the pandemic. Patients in the pandemic-exposed cohort were more likely to initiate prenatal care in the first trimester (46.1 vs. 39.0%, p = 0.01), be screened for gestational diabetes (74.4 vs. 67.0%, p <0.001), and receive dating and anatomy ultrasounds (17.8 vs. 13.0%, p = 0.006 and 56.9 vs. 47.3%, p <0.001, respectively) compared with patients in the prepandemic cohort. There was no difference in mean number of prenatal care visits between the two groups (6.9 vs. 7.1, p = 0.18). Approximately 41% of patients in the pandemic-exposed cohort had one or more telehealth visits. The proportion of patients with one or more emergency department visits was higher in the pandemic-exposed cohort than the prepandemic cohort (32.8 vs. 12.3%, p < 0.001). Increases in rates of labor induction were also observed among the pandemic-exposed cohort (47.1 vs. 38.2%, p <0.001). CONCLUSION Rates of prenatal care utilization were similar before and during the COVID-19 pandemic. However, pregnant persons receiving prenatal care during the pandemic entered care earlier and had higher utilization of certain antenatal screening services than those receiving prenatal care prior to the pandemic. KEY POINTS · Patients initiated prenatal care earlier during the COVID-19 pandemic.. · Uptake of telehealth services was low.. · Rates of diabetes screening and ultrasound use increased during the pandemic..
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Affiliation(s)
- Shae M Boguslawski
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Naima T Joseph
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Kaitlyn K Stanhope
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Angeline J Ti
- Department of Family Medicine, Wellstar Atlanta Medical Center, Atlanta, Georgia
| | - Franklyn H Geary
- Department of Obstetrics and Gynecology, Morehouse School of Medicine, Atlanta, Georgia
| | - Sheree L Boulet
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
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Macias-Konstantopoulos WL, Collins KA, Diaz R, Duber HC, Edwards CD, Hsu AP, Ranney ML, Riviello RJ, Wettstein ZS, Sachs CJ. Race, Healthcare, and Health Disparities: A Critical Review and Recommendations for Advancing Health Equity. West J Emerg Med 2023; 24:906-918. [PMID: 37788031 PMCID: PMC10527840 DOI: 10.5811/westjem.58408] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 04/17/2023] [Accepted: 05/24/2023] [Indexed: 10/04/2023] Open
Abstract
An overwhelming body of evidence points to an inextricable link between race and health disparities in the United States. Although race is best understood as a social construct, its role in health outcomes has historically been attributed to increasingly debunked theories of underlying biological and genetic differences across races. Recently, growing calls for health equity and social justice have raised awareness of the impact of implicit bias and structural racism on social determinants of health, healthcare quality, and ultimately, health outcomes. This more nuanced recognition of the role of race in health disparities has, in turn, facilitated introspective racial disparities research, root cause analyses, and changes in practice within the medical community. Examining the complex interplay between race, social determinants of health, and health outcomes allows systems of health to create mechanisms for checks and balances that mitigate unfair and avoidable health inequalities. As one of the specialties most intertwined with social medicine, emergency medicine (EM) is ideally positioned to address racism in medicine, develop health equity metrics, monitor disparities in clinical performance data, identify research gaps, implement processes and policies to eliminate racial health inequities, and promote anti-racist ideals as advocates for structural change. In this critical review our aim was to (a) provide a synopsis of racial disparities across a broad scope of clinical pathology interests addressed in emergency departments-communicable diseases, non-communicable conditions, and injuries-and (b) through a race-conscious analysis, develop EM practice recommendations for advancing a culture of equity with the potential for measurable impact on healthcare quality and health outcomes.
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Affiliation(s)
- Wendy L Macias-Konstantopoulos
- Center for Social Justice and Health Equity, Department of Emergency Medicine, Boston, Massachusetts
- Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | | | - Rosemarie Diaz
- University of California-Los Angeles, Department of Emergency Medicine, Los Angeles, California
| | - Herbert C Duber
- University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington
- Washington State Department of Health, Tumwater, Washington
| | - Courtney D Edwards
- Samford University, Moffett & Sanders School of Nursing, Birmingham, Alabama
| | - Antony P Hsu
- Trinity Health Ann Arbor Hospital, Department of Emergency Medicine, Ypsilanti, Michigan
| | - Megan L Ranney
- Yale University, Yale School of Public Health, New Haven, Connecticut
| | - Ralph J Riviello
- University of Texas Health San Antonio, Department of Emergency Medicine, San Antonio, Texas
| | - Zachary S Wettstein
- University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington
| | - Carolyn J Sachs
- Ronald Reagan-UCLA Medical Center and David Geffen School of Medicine at University of California-Los Angeles, Department of Emergency Medicine, Los Angeles, California
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Liu LS, Jia X, Zhu A, Ran GJ, Johnston D, Siegert R, Gong Y, French N, Lu J. Measuring the missing: Knowledge, risk perceptions and self-protection practices of COVID-19 among the Asian population in New Zealand: An online survey. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2023:1-18. [PMID: 37361274 PMCID: PMC10193356 DOI: 10.1007/s10389-023-01926-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/28/2023] [Indexed: 06/28/2023]
Abstract
Aim Asians are the second largest and fastest growing non-European population in New Zealand but are under-researched in terms of their COVID-19 pandemic response. The paper aims to illustrates Asians' risk perceptions and knowledge of COVID-19, and self-protection practices to avoid infection and prevent community transmission. Subject and methods An online survey was used to collect data and received 402 valid responses. Data analyses included: 1) a descriptive analysis by using Chi-square tests and a Kruskal-Wallis rank sum tests to explore associations between responses and the four demographic variables (i.e. age, gender, country of origin/ethnicity, and region); and 2) a correlation analysis between different survey objectives. Results The descriptive analysis of the survey found that while ethnicity (within the Asian category) was the most influential variable that resulted in varying responses to many questions, gender and age were other two important variables in influencing the answering patterns. The correlation analysis found a positive correlation between the perceived 'dangerousness' of COVID-19 and respondents' overall compliance behaviour to New Zealand authorities' recommendations to prevent spread of COVID-19. Conclusion The majority of the respondents provided correct answers to the questions about the vulnerable populations, symptoms, asymptomatic transmission and potential sequelae of COVID-19; however, their understanding of the availability of a cure for, and the incubation period of COVID-19 was not consistent with the official information. The research also found that the higher perceived dangerousness of COVID-19, the better compliance to self-protection practices among the surveyed population.
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Affiliation(s)
- Liangni Sally Liu
- School of Humanities, Media and Creative Communication, Massey University, Auckland, New Zealand
| | - Xiaoyun Jia
- Institute of Governance & School of Politics and Public Administration, Shandong University, Qingdao, China
| | - Andrew Zhu
- Trace Research Ltd, Auckland, New Zealand
| | - Guanyu Jason Ran
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - David Johnston
- Joint Centre for Disaster Research, Massey University, Wellington, New Zealand
| | - Richard Siegert
- Department of Psychology & Neuroscience, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Yuan Gong
- School of Humanities, Media and Creative Communication, Massey University, Auckland, New Zealand
| | - Nigel French
- Infectious Diseases Research Centre, Hopkirk Research Institute, Massey University, Palmerston North, New Zealand
| | - Jun Lu
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
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11
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Hung M, Ocampo M, Raymond B, Mohajeri A, Lipsky MS. Telemedicine among Adults Living in America during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5680. [PMID: 37174198 PMCID: PMC10178773 DOI: 10.3390/ijerph20095680] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023]
Abstract
Background and Objectives Telemedicine can expand healthcare access to populations, but relying on technology risks a digital divide. Therefore, it is important to understand who utilizes telemedicine. This study explores telemedicine usage across socio-demographic groups in the United States during COVID-19. Methods Data came from the Household Pulse Survey (HPS) between 14 April 2021, to 11 April 2022. HPS is a rapid online response survey that assesses household experiences during COVID-19. We calculated descriptive statistics and used cross-correlation to test each pair of the time series curves. Results High school graduates used the least telemedicine (20.58%), while those with some college (23.29%) or college graduates (22.61%) had similar levels, and those with less than a high school education fluctuated over time. Black people had higher levels of use (26.31%) than Asians (22.01%). Individuals with disabilities (35.40%) used telemedicine more than individuals without disabilities (20.21%). Individuals 80 years or over (27.63%) used telemedicine more than individuals 18 to 29 years old (18.44%). Cross-correlations for the time series pairs across demographics revealed significant differences in telemedicine use for all demographic groups over time. Conclusions Overall, elderly, Black people, individuals with some college, and persons with disabilities report higher levels of telemedicine use. Telemedicine may improve healthcare access post-pandemic, but more research is needed to understand factors that drive differences among groups.
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Affiliation(s)
- Man Hung
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA; (M.O.); (B.R.); (A.M.); (M.S.L.)
- Division of Public Health, University of Utah, Salt Lake City, UT 84108, USA
- Department of Educational Psychology, University of Utah, Salt Lake City, UT 84109, USA
- College of Social Work, University of Utah, Salt Lake City, UT 84112, USA
- Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA
| | - Monica Ocampo
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA; (M.O.); (B.R.); (A.M.); (M.S.L.)
| | - Benjamin Raymond
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA; (M.O.); (B.R.); (A.M.); (M.S.L.)
| | - Amir Mohajeri
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA; (M.O.); (B.R.); (A.M.); (M.S.L.)
| | - Martin S. Lipsky
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA; (M.O.); (B.R.); (A.M.); (M.S.L.)
- Institute on Aging, Portland State University, Portland, OR 97201, USA
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12
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Lewek P, Banaś I, Witkowski K, Lewek J, Kardas P. The prevalence of symptoms and its correlation with sex in polish COVID-19 adult patients: Cross-sectional online open survey. Front Med (Lausanne) 2023; 10:1121558. [PMID: 37089602 PMCID: PMC10113468 DOI: 10.3389/fmed.2023.1121558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/23/2023] [Indexed: 04/08/2023] Open
Abstract
BackgroundThe understanding and treatment of COVID-19 has improved rapidly since December 2019 when SARS-CoV-2 was sequenced. However most papers on its symptomatology focus on hospitalized patients and address only a limited number of major presentations. Although differences depending on sex of COVID-19 patients have been previously confirmed (higher ICU admission and higher death rate for men), no publication has focused on sex-related differences in COVID-19 symptomatology.ObjectiveThe aim of the study was to present a reliable list of COVID-19 symptoms and identify any differences in symptom prevalence depending on sex.MethodsA sample of Polish patients suffering from COVID-19 were surveyed using a cross-sectional anonymous online survey in Polish available on a web-based surveying platform (Survey Monkey). The survey included 20 questions asking about COVID-19 symptoms, days of occurrence (from day 1 until day 14 and “15 days or more”) and patient characteristics including sex, age, height, weight, place of residence and type of therapy received during COVID-19. The survey was made available during the third COVID-19 wave in Poland. The link to the survey was distributed across social networks. Participation was open to anyone willing, without any incentives. The data was analyzed statistically.ResultsSurvey responses were collected from 2,408 participants (56.9% women) aged 18–90 (42 ± 12), 84.7% living in cities, who took part in the study between December 2020 and February 2021. Out of 54 predefined symptoms, the three most prevalent were fatigue (reported by 87.61% respondents), anosmia (73.74%) and headache (69.89%). Women were found to be more symptomatic than men, 31 symptoms occurred more often in women (including anosmia, headache and myalgias, p < 0.05). Subfebrility, fever and hemoptysis were more prevalent in men. Twelve symptoms (incl. hypothermia, sneezing and nausea) lasted longer in women than men (p < 0.05). Fatigue, cough, nasal dryness, xerostomia and polydipsia were the longest lasting symptoms of COVID-19 (lasted over 14 days).ConclusionOur study presents a wide range of symptoms, which may enable better recognition of COVID-19, especially in an outpatient setting. Understanding these differences in the symptomatology of community and hospitalized patients may help diagnose and treat patients faster and more accurately. Our findings also confirmed differences in symptomatology of COVID-19 between men and women, which may lay the foundation for a better understanding of the different courses of this disease in the sexes. Further studies are necessary to understand whether a different presentation correlates with a different outcome.
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Affiliation(s)
- Pawel Lewek
- Department of Family Medicine, Medical University of Lodz, Łódź, Poland
- *Correspondence: Pawel Lewek,
| | - Izabela Banaś
- Department of Family Medicine, Medical University of Lodz, Łódź, Poland
| | - Konrad Witkowski
- Department of Family Medicine, Medical University of Lodz, Łódź, Poland
| | - Joanna Lewek
- Department of Preventive Cardiology and Lipidology, Chair of Nephrology and Hypertension, Medical University of Lodz, Łódź, Poland
- Department of Cardiology and Adult Congenital Heart Diseases, Polish Mother's Memorial Hospital Research Institute (PMMHRI), Łódź, Poland
| | - Przemyslaw Kardas
- Department of Family Medicine, Medical University of Lodz, Łódź, Poland
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13
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Anand S, Cao E, Kimura R, Guo W, Bassi N. Asian American Vaccination, Testing, and Other Healthcare Knowledge & Behaviors during COVID-19, A Systematic Review. Pathog Glob Health 2023; 117:120-133. [PMID: 35892162 PMCID: PMC9970223 DOI: 10.1080/20477724.2022.2106110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Novel COVID-19 variants continue to endanger global public health. Increasing COVID-19 vaccination, healthcare-related preventative behaviors, and general knowledge rates are all critical in halting COVID-19 spread. We evaluated Asian American COVID-19 healthcare-related behaviors and knowledge, due to the dearth of knowledge in this area and the unique social factor of COVID-19 related discrimination; discriminatory acts during the pandemic may play a role in COVID-19 related behavior adherence. Following PRISMA-P protocol, we conducted a systematic review. The search strategy combined synonyms of health-care behaviors and knowledge. Reviewers synthesized key themes across articles and assessed studies utilizing modified Newcastle-Ottawa criteria. Of the 2,518 articles, 32 were selected. Asian Americans reported greater COVID-19 vaccination willingness and decreased COVID-19 testing relative to other racial groups. Common COVID-19 vaccination concerns included vaccination side effects, long-term safety, and distrust of COVID-19 information sources. Asian Americans had high COVID-19 preventative behavior rates including mask-wearing, handwashing, and social isolation compared to other ethnic groups. Asian Americans, conversely, had lower COVID-19-related healthcare knowledge and telemedicine adoption levels relative to other participants. This systematic review informs public health officials and clinicians of COVID-19 related healthcare knowledge and behaviors in the Asian American population. Equipped with this knowledge, public health officials can better target messaging about vaccine safety concerns to the Asian American community and recognize the importance of tailoring COVID-19 educational materials to the heterogeneous Asian American subpopulations. This systematic review also provides insight into the unique telemedicine challenges physicians may face when engaging with Asian American patients.
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Affiliation(s)
- Sahil Anand
- Department of Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - Evan Cao
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Reona Kimura
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - William Guo
- Department of Dermatology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Naresh Bassi
- Department of Medicine, University of Maryland Medical Center, Baltimore, MD, USA
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14
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Khunti K, Feldman EL, Laiteerapong N, Parker W, Routen A, Peek M. The Impact of the COVID-19 Pandemic on Ethnic Minority Groups With Diabetes. Diabetes Care 2023; 46:228-236. [PMID: 35944272 PMCID: PMC10090266 DOI: 10.2337/dc21-2495] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/10/2022] [Indexed: 02/03/2023]
Abstract
Major ethnic disparities in diabetes care, especially for intermediate outcomes and diabetes complications, were evident prior to the coronavirus disease 2019 (COVID-19) pandemic. Diabetes is a risk factor for severe COVID-19, and the combination of these ethnic disparities in diabetes care and outcomes may have contributed to the inequity in COVID-19 outcomes for people with diabetes. Overall, ethnic minority populations have suffered disproportionate rates of COVID-19 hospitalization and mortality. Results from the limited number of studies of COVID-19 in ethnic minority populations with diabetes are mixed, but there is some suggestion that rates of hospitalization and mortality are higher than those of White populations. Reasons for the higher incidence and severity of COVID-19-related outcomes in minority ethnic groups are complex and have been shown to be due to differences in comorbid conditions (e.g., diabetes), exposure risk (e.g., overcrowded living conditions or essential worker jobs), and access to treatment (e.g., health insurance status and access to tertiary care medical centers), which all relate to long-standing structural inequities that vary by ethnicity. While guidelines and approaches for diabetes self-management and outpatient and inpatient care during the pandemic have been published, few have recommended addressing wider structural issues. As we now plan for the recovery and improved surveillance and risk factor management, it is imperative that primary and specialist care services urgently address the disproportionate impact the pandemic has had on ethnic minority groups. This should include a focus on the larger structural barriers in society that put ethnic minorities with diabetes at potentially greater risk for poor COVID-19 outcomes.
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Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, U.K
| | - Eva L. Feldman
- Department of Neurology, School of Medicine, University of Michigan, Ann Arbor, MI
| | | | - William Parker
- Department of Pulmonary and Critical Care, University of Chicago, Chicago, IL
| | - Ash Routen
- Diabetes Research Centre, University of Leicester, Leicester, U.K
| | - Monica Peek
- Department of Medicine, University of Chicago, Chicago, IL
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15
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Schilling J, Moeller FG, Peterson R, Beltz B, Joshi D, Gartner D, Vang J, Jain P. Testing the Acceptability and Usability of an AI-Enabled COVID-19 Diagnostic Tool Among Diverse Adult Populations in the United States. Qual Manag Health Care 2023; 32:S35-S44. [PMID: 36579707 PMCID: PMC9811483 DOI: 10.1097/qmh.0000000000000396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Although at-home coronavirus disease-2019 (COVID-19) testing offers several benefits in a relatively cost-effective and less risky manner, evidence suggests that at-home COVID-19 test kits have a high rate of false negatives. One way to improve the accuracy and acceptance of COVID-19 screening is to combine existing at-home physical test kits with an easily accessible, electronic, self-diagnostic tool. The objective of the current study was to test the acceptability and usability of an artificial intelligence (AI)-enabled COVID-19 testing tool that combines a web-based symptom diagnostic screening survey and a physical at-home test kit to test differences across adults from varying races, ages, genders, educational, and income levels in the United States. METHODS A total of 822 people from Richmond, Virginia, were included in the study. Data were collected from employees and patients of Virginia Commonwealth University Health Center as well as the surrounding community in June through October 2021. Data were weighted to reflect the demographic distribution of patients in United States. Descriptive statistics and repeated independent t tests were run to evaluate the differences in the acceptability and usability of an AI-enabled COVID-19 testing tool. RESULTS Across all participants, there was a reasonable degree of acceptability and usability of the AI-enabled COVID-19 testing tool that included a physical test kit and symptom screening website. The AI-enabled COVID-19 testing tool demonstrated overall good acceptability and usability across race, age, gender, and educational background. Notably, participants preferred both components of the AI-enabled COVID-19 testing tool to the in-clinic testing. CONCLUSION Overall, these findings suggest that our AI-enabled COVID-19 testing approach has great potential to improve the quality of remote COVID testing at low cost and high accessibility for diverse demographic populations in the United States.
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Affiliation(s)
| | | | | | | | | | | | - Jee Vang
- George Mason University, Fairfax, VA
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16
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Zhao T, Su Q. Sex-related disparities in students' disaster responses in the post-COVID-19 era. INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2022; 83:103446. [PMID: 36411941 PMCID: PMC9670590 DOI: 10.1016/j.ijdrr.2022.103446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 11/05/2022] [Accepted: 11/11/2022] [Indexed: 06/16/2023]
Abstract
This study aimed to understand whether sex-related variations existed in responses to the pandemic as well as campus climate change of anti-epidemic measures. An online survey was distributed to full-time undergraduates in 13 postsecondary institutions located in an eastern province in China. First, we matched "similar" students in terms of a set of observational variables. Second, we compared female students with these "similar" male peers in terms of their responses to COVID-19 and responses to the campus climate change of anti-epidemic measures. Finally, the robustness of matching estimators was checked for the potential biases that might be caused by unobserved variables. The primary results showed that female students had higher awareness, preparedness, and fear, but lesser knowledge of the pandemic, and considered getting vaccinated of lesser necessity compared with male students. Also, we observed a pronounced pattern of sex-related difference in responding to campus climate changes; male students were more likely to be indifferent in keeping social distance, adopting other measures, and participating in campus activities. The findings inform postsecondary administrators and other related stakeholders to avoid making the existing sex-related disparities larger and help every student well prepare for and appropriately respond to COVID-19.
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Affiliation(s)
- Teng Zhao
- Zhejiang Academy of Higher Education, Hangzhou Dianzi University, 1158 No.2 Blvd, Hangzhou, Zhejiang, 310018, China
| | - Qiang Su
- Zhejiang Academy of Higher Education, Hangzhou Dianzi University, 1158 No.2 Blvd, Hangzhou, Zhejiang, 310018, China
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17
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Marie Reinhart A, Tian Y, Lilly AE. The role of trust in COVID-19 vaccine hesitancy and acceptance among Black and White Americans. Vaccine 2022; 40:7247-7254. [PMID: 36333223 PMCID: PMC9618447 DOI: 10.1016/j.vaccine.2022.10.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
Mass vaccination has been identified as the easiest way to combat the deadly spread of the coronavirus (COVID-19) disease, yet many Americans are still hesitant to be vaccinated. To understand motivations behind why someone is vaccine hesitant, we conceptualized a theoretical model in which demographic variables are positively associated with four types of trust (i.e., trust in institutions, physicians, non-discrimination, and social media). These trust variables, in turn, are positively associated with the outcome variable of vaccine acceptance. A multi-group structural equation modeling analysis of survey data from 1008 U.S. adults suggested that trust in institutions and physicians were important for both White and Black Americans in whether they were vaccine accepting or hesitant, while trust in non-discrimination was important for Black Americans and trust in social media was important for White Americans. Implications of the findings and how they can inform future vaccine campaigns are discussed.
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Affiliation(s)
| | - Yan Tian
- University of Missouri, Saint Louis, USA.
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18
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Wang Y, Reyes L, Greenfield EA, Allred SR. Municipal Ethnic Composition and Disparities in COVID-19 Infections in New Jersey: A Blinder-Oaxaca Decomposition Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13963. [PMID: 36360847 PMCID: PMC9656431 DOI: 10.3390/ijerph192113963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/30/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
COVID-19 has disproportionally impacted Latinx and Black communities in the US. Our study aimed to extend the understanding of ethnic disparities in COVID-19 case rates by using a unique dataset of municipal case rates across New Jersey (NJ) during the first 17 months of the pandemic. We examined the extent to which there were municipal-level ethnic disparities in COVID-19 infection rates during three distinct spikes in case rates over this period. Furthermore, we used the Blinder-Oaxaca decomposition analysis to identify municipal-level exposure and vulnerability factors that contributed to ethnic disparities and how the contributions of these factors changed across the three initial waves of infection. Two clear results emerged. First, in NJ, the COVID-19 infection risk disproportionally affected Latinx communities across all three waves during the first 17 months of the pandemic. Second, the exposure and vulnerability factors that most strongly contributed to higher rates of infection in Latinx and Black communities changed over time as the virus, alongside medical and societal responses to it, also changed. These findings suggest that understanding and addressing ethnicity-based COVID-19 disparities will require sustained attention to the systemic and structural factors that disproportionately place historically marginalized ethnic communities at greater risk of contracting COVID-19.
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Affiliation(s)
- Yuqi Wang
- Department of Social Work, China Youth University of Political Studies, Beijing 100089, China
| | - Laurent Reyes
- School of Social Welfare, University of California, Berkeley, CA 94720, USA
| | | | - Sarah R. Allred
- Department of Psychology, Rutgers University, Camden, NJ 08102, USA
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19
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Al-Ani RM. Ear, nose, and throat manifestations of COVID-19 and its vaccines. World J Clin Cases 2022; 10:8808-8815. [PMID: 36157654 PMCID: PMC9477042 DOI: 10.12998/wjcc.v10.i25.8808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/01/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a highly infectious disease and was designated a pandemic by the World Health Organization (WHO) on March 11, 2020. There are no classical manifestations of the disease. The most prevalent symptoms include fever, cough, dyspnea, myalgia and headache. The main route of transmission of the severe acute respiratory syndrome coronavirus-2 is through the upper respiratory tract. Therefore, it is not strange to find different ear, nose and throat (ENT) symptoms in individuals infected with this virus. Olfactory dysfunction is a common feature of COVID-19; either it is the only presenting symptom or it accompanies other manifestations of the disease. Other otolaryngological features such as sudden sensorineural hearing loss (SSNHL), dysphonia, nasal obstruction, sore throat, etc. are less frequent manifestations of COVID-19. These features, in addition, to being presented early in the disease process, certain long-standing symptoms like parosmia, dysphonia, and persistent deafness, are other characteristics of the disease. Geographical variation in otorhinolaryngological prevalence is another problem with this debilitating disease. Local and systemic adverse effects (local site injection pain, fever, myalgia, headache, and others) of the COVID-19 vaccines are more frequent than otolaryngological side effects (anosmia, hyposmia, Bell's palsy, SSNHL, etc.). We aimed in this review to summarize the early and persistent ENT symptoms of COVID-19 or after the various COVID-19 vaccines.
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Affiliation(s)
- Raid M Al-Ani
- Department of Surgery/Otolaryngology, University of Anbar, College of Medicine, Ramadi 31001, Anbar, Iraq
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20
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Greteman BB, Garcia-Auguste CJ, Gryzlak BM, Kahl AR, Lutgendorf SK, Chrischilles EA, Charlton ME. Rural and urban differences in perceptions, behaviors, and health care disruptions during the COVID-19 pandemic. J Rural Health 2022; 38:932-944. [PMID: 35466479 PMCID: PMC9115219 DOI: 10.1111/jrh.12667] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The objective of this study was to assess perceptions, health behaviors, and disruptions related to the COVID-19 pandemic in a largely rural, Midwestern state, and to examine differences between rural and urban respondents. METHODS A questionnaire was mailed August 2020 to a sample of 10,009 registered voters in Iowa ages 18-100 years, with oversampling from 6 select rural counties. Previously validated and tested items assessed COVID-19 precautions, health care disruptions, emotional reactions, health behavior changes, telehealth and experiences with the internet, and demographic characteristics. FINDINGS There were 4,048 respondents (40% response rate); 65% were rural and 35% were urban residents. The average age of respondents was 58.3 years and 45% of respondents identified as female. Rural respondents reported less concern about COVID-19 in their community (29% vs 40%, P<.001) and lower perceived importance of social distancing (51% vs 64%, P<.001). Urban respondents more often reported experiencing disruption to daily living, stronger negative emotional reactions, and displayed more pronounced behavior change compared to their rural counterparts. For example, urban respondents reported more pandemic-related job losses (6% vs 4%, P = .05), disruptions to daily activities (48% vs 35%, P<.001), and use of telehealth services during the pandemic (24% vs 16%, P<.001). CONCLUSIONS The majority of respondents reported disruptions to normal activities, medical appointment cancellations, and emotional distress during the first 6 months of the pandemic. The impact of the pandemic on urban residents appeared to be greater than for rural respondents. Timing of pandemic spread and varying beliefs are potential explanations.
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Affiliation(s)
- Breanna B. Greteman
- University of Iowa College of Public Health, S400 Department of Epidemiology, 145 N Riverside Dr, Iowa City, IA 52242
| | - Crystal J. Garcia-Auguste
- University of Iowa College of Public Health, S400 Department of Epidemiology, 145 N Riverside Dr, Iowa City, IA 52242
| | - Brian M. Gryzlak
- University of Iowa College of Public Health, S400 Department of Epidemiology, 145 N Riverside Dr, Iowa City, IA 52242
| | - Amanda R. Kahl
- University of Iowa College of Public Health, S400 Department of Epidemiology, 145 N Riverside Dr, Iowa City, IA 52242
| | - Susan K. Lutgendorf
- University of Iowa Department of Psychological and Brain Sciences, G60 Psychological and Brain Sciences Building, 340 Iowa Ave, Iowa City, IA 52242
| | - Elizabeth A. Chrischilles
- University of Iowa College of Public Health, S400 Department of Epidemiology, 145 N Riverside Dr, Iowa City, IA 52242
| | - Mary E. Charlton
- University of Iowa College of Public Health, S400 Department of Epidemiology, 145 N Riverside Dr, Iowa City, IA 52242
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21
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Li J, Martinez MC, Frosch DL, Matt GE. Effects of Smoking on SARS-CoV-2 Positivity: A Study of a Large Health System in Northern and Central California. Tob Use Insights 2022; 15:1179173X221114799. [PMID: 35966408 PMCID: PMC9373122 DOI: 10.1177/1179173x221114799] [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] [Received: 02/15/2022] [Revised: 07/03/2022] [Accepted: 07/03/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction COVID-19 continues to impact vulnerable populations disproportionally. Identifying
modifiable risk factors could lead to targeted interventions to reduce infections. The
purpose of this study is to identify risk factors for testing positive for
SARS-CoV-2. Methods Using electronic health records collected from a large ambulatory care system in
northern and central California, the study identified patients who had a test for
SARS-CoV-2 between 2/20/2020 and 3/31/2021. The adjusted effect of active and passive
smoking and other risk factors on the probability of testing positive for SARS-CoV-2
were estimated using multivariable logistic regression. Analyses were conducted in
2021. Results Of 556 690 eligible patients in our sample, 70 564 (12.7%) patients tested positive for
SARS-CoV-2. Younger age, being male, racial/ethnic minorities, and having mild major
comorbidities were significantly associated with a positive SARS-CoV-2 test. Current
smokers (adjusted OR: 0.69, 95% CI: 0.66-0.73) and former smokers (adjusted OR: 0.92,
95% CI: 0.89-0.95) were less likely than nonsmokers to be lab-confirmed positive, but no
statistically significant differences were found when comparing passive smokers with
non-smokers. The patients with missing smoking status (25.7%) were more likely to be
members of vulnerable populations with major comorbidities (adjusted OR ranges from
severe: 2.52, 95% CI = 2.36-2.69 to mild: 3.28, 95% CI = 3.09-3.48), lower income
(adjusted OR: 0.85, 95% CI: 0.85-0.86), aged 80 years or older (adjusted OR: 1.11, 95%
CI: 1.07-1.16), have less access to primary care (adjusted OR: 0.07, 95% CI: 0.07-0.07),
and identify as racial ethnic minorities (adjusted OR ranges from Hispanic: 1.61, 95% CI
= 1.56-1.65 to Non-Hispanic Black: 2.60, 95% CI = 2.5-2.69). Conclusions Our findings suggest that the odds of testing positive for SARS-CoV-2 were
significantly lower in smokers compared to nonsmokers. Other risk factors include
missing data on smoking status, being under 18, being male, being a racial/ethnic
minority, and having mild major comorbidities. Since those with missing data on smoking
status were more likely to be members of vulnerable populations with higher smoking
rates, the risk of testing positive for SARS-CoV-2 among smokers may have been
underestimated due to missing data on smoking status. Future studies should investigate
the risk of severe outcomes among active and passive smokers, the role that exposure to
tobacco smoke constitutes among nonsmokers, the role of comorbidities in COVID-19
disease course, and health disparities experienced by disadvantaged groups.
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Affiliation(s)
- Jiang Li
- Palo Alto Medical Foundation Research Institute, Center for Health Systems Research, Sutter Health, Palo Alto, CA, USA
| | - Meghan C Martinez
- Palo Alto Medical Foundation Research Institute, Center for Health Systems Research, Sutter Health, Palo Alto, CA, USA
| | - Dominick L Frosch
- Palo Alto Medical Foundation Research Institute, Center for Health Systems Research, Sutter Health, Palo Alto, CA, USA
| | - Georg E Matt
- College of Sciences, San Diego State University, San Diego, CA, USA
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22
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Mark E, Udod G, Skinner J, Jones M. Knowledge, attitudes, and practices [KAP] toward COVID-19: A cross-sectional study in the New York Metropolitan Area and California Bay Area. PLoS One 2022; 17:e0271212. [PMID: 35947556 PMCID: PMC9365154 DOI: 10.1371/journal.pone.0271212] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 06/24/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The 2019 novel coronavirus [COVID-19] pandemic has necessitated the implementation of public health initiatives [PHI] to slow viral spread. We evaluated the effectiveness of PHI through a survey of COVID-19 knowledge, attitudes and practices [KAP]. METHODS This cross-sectional study was conducted primarily during stay-at-home orders in New York and San Francisco. A volunteer sample of 675 U.S. participants completed a KAP questionnaire after electronic distribution. RESULTS Participants had good knowledge and practices, but poor attitudes. Predictors of higher knowledge scores included white ethnicity, non-essential worker status, and healthcare worker status. Correlates with positive attitude included male gender, residence in California, higher annual income, and not utilizing radio or social media. Higher practice scores were predicted by female gender, non-essential and healthcare worker status, and information source. CONCLUSIONS Differences in KAP were found among demographic variables. Determining what factors and sources of information drive reception of public health information can guide targeted intervention and advance equitable health education.
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Affiliation(s)
- Erica Mark
- University of Virginia School of Medicine, Charlottesville, Virginia, United States of America
| | - Galina Udod
- Downstate College of Medicine, State University of New York, Brooklyn, New York, United States of America
| | - Jayne Skinner
- Department of Medical Sciences, Brown University, Providence, Rhode Island, United States of America
| | - Marieke Jones
- Claude Moore Health Sciences Library, University of Virginia, Charlottesville, Virginia, United States of America
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23
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Huang HY, Li H, Hsu Y. Coping, COVID knowledge, communication, and HBCU student's emotional well-being: Mediating role of perceived control and social connectedness. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:2703-2725. [PMID: 35187691 PMCID: PMC9088254 DOI: 10.1002/jcop.22824] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/17/2021] [Accepted: 01/22/2022] [Indexed: 05/03/2023]
Abstract
The pandemic has disproportionately affected African American college students, who have experienced significant work-related, academic, financial, and socio-emotional challenges due to COVID-19. The purpose of the study is to investigate how African American students cope with the severe impact of COVID-19 on their emotional well-being leveraging the benefits of self-care coping measures, COVID-19 knowledge, and communication with others to enhance perceived control and social connectedness. A structural equation modeling and a path analysis of 254 responses from a Historically Black College and University showed that emotional well-being was positively predicted by self-care coping strategies, feelings of being in control in life, and social connectedness. In addition, respondents who adopted mind-body balance coping strategies, those who are knowledgeable about COVID-19, and those in more constant communication with others attained a strong sense of being in control, and in turn the empowerment increased their emotional well-being.
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Affiliation(s)
- Hsuan Yuan Huang
- School of Journalism and Graphic CommunicationFlorida A&M UniversityTallahasseeFloridaUSA
| | - Huijun Li
- Department of PsychologyFlorida A&M UniversityTallahasseeFloridaUSA
| | - Ying‐Chia Hsu
- Murrow College of CommunicationWashington State UniversityPullmanWashingtonUSA
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24
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Sansone NMS, Boschiero MN, Valencise FE, Palamim CVC, Marson FAL. Characterization of demographic data, clinical signs, comorbidities, and outcomes according to the race in hospitalized individuals with COVID-19 in Brazil: An observational study. J Glob Health 2022; 12:05027. [PMID: 35871427 PMCID: PMC9309002 DOI: 10.7189/jogh.12.05027] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Brazil is a multiracial country with five major official races: White, Black, individuals with multiracial backgrounds, Asian, and Indigenous. Brazil is also one of the epicentres of the Coronavirus Disease (COVID)-19 pandemic. Thus, we evaluated how the races of the Brazilian population contribute to the outcomes in hospitalized individuals with COVID-19, and we also described the clinical profile of the five official Brazilian races. Methods We performed an epidemiological analysis for the first 67 epidemiological weeks of the COVID-19 pandemic in Brazil (from February 22, 2020, to April 04, 2021) using the data available at OpenDataSUS of the Brazilian Ministry of Health, a data set containing data from Brazilian hospitalized individuals. We evaluated more than 30 characteristics, including demographic data, clinical symptoms, comorbidities, need for intensive care unit and mechanical ventilation, and outcomes. Results In our data, 585 655 hospitalized individuals with a positive result in SARS-CoV-2 real-time chain reaction (RT-PCR) were included. Of these total, 309 646 (52.9%) identified as White, 31 872 (5.4%) identified as Black, 7108 (1.2%) identified as Asian, 235 108 (40.1%) identified as individuals with multiracial background, and 1921 (0.3%) identified as Indigenous. The multivariate analysis demonstrated that race was significative to predict the death being that Black (OR = 1.43; 95% CI = 1.39-1.48), individuals with multiracial background (OR = 1.36; 95% CI = 1.34-1.38), and Indigenous (OR = 1.91; 95% CI = 1.70-2.15) races were more prone to die compared to the White race. The Asian individuals did not have a higher chance of dying due to SARS-CoV-2 infection compared to White individuals (OR = 0.99; 95% CI = 0.94-1.06). In addition, other characteristics contributed as such as being male (OR = 1.17; 95% CI = 1.16-1.19), age (mainly, +85 years old – OR = 23.02; 95% CI = 20.05-26.42) compared to 1-year-old individuals, living in rural areas (OR = 1.22; 95% CI = 1.18-1.26) or in peri-urban places (OR = 1.25; 95% CI = 1.11-1.40), and the presence of nosocomial infection (OR = 1.91; 95% CI = 1.82-2.01). Among the clinical symptoms, the main predictors were dyspnoea (OR = 1.25; 95% CI = 1.23-1.28), respiratory discomfort (OR = 1.30; 95% CI = 1.28-1.32), oxygen saturation <95% (OR = 1.40; 95% CI = 1.38-1.43). Also, among the comorbidities, the main predictors were the presence of immunosuppressive disorder (OR = 1.44; 95% CI = 1.39-1.49), neurological disorder (OR = 1.21; 95% CI = 1.17-1.25), hepatic disorder (OR = 1.41; 95% CI = 1.34-1.50), diabetes mellitus (OR = 1.40; 95% CI = 1.37-1.42), cardiopathy (OR = 1.13; 95%CI = 1.11-1.14), hematologic disorder (OR = 1.34; 95% CI = 1.24-1.43), Down syndrome (OR = 1.61; 95% CI = 1.43-1.81), renal disease (OR = 1.15; 95% CI = 1.11-1.18), and obesity (OR = 1.18; 95% CI = 1.15-1.21). Individuals on intensive care unit (OR = 2.25; 95% CI = 2.22-2.29) and on invasive (OR = 10.92; 95% CI = 10.66-11.18) or non-invasive (OR = 1.33; 95% CI = 1.30-1.35) mechanical ventilation were more prone to die. Conclusions Alongside several clinical symptoms and comorbidities, we associated race with an enhanced risk of death in Black individuals, individuals with multiracial backgrounds, and Indigenous peoples.
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Affiliation(s)
- Nathália MS Sansone
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, São Paulo, Brazil
- Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, São Paulo, Brazil
| | - Matheus N Boschiero
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, São Paulo, Brazil
- Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, São Paulo, Brazil
| | - Felipe E Valencise
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, São Paulo, Brazil
- Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, São Paulo, Brazil
| | - Camila VC Palamim
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, São Paulo, Brazil
- Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, São Paulo, Brazil
| | - Fernando AL Marson
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, São Paulo, Brazil
- Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, São Paulo, Brazil
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25
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Wang Z, Xiao H, Lin L, Tang K, Unger JM. Geographic social inequalities in information-seeking response to the COVID-19 pandemic in China: longitudinal analysis of Baidu Index. Sci Rep 2022; 12:12243. [PMID: 35851060 PMCID: PMC9293890 DOI: 10.1038/s41598-022-16133-2] [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: 02/03/2022] [Accepted: 07/05/2022] [Indexed: 11/26/2022] Open
Abstract
The outbreak of the COVID-19 pandemic alarmed the public and initiated the uptake of preventive measures. However, the manner in which the public responded to these announcements, and whether individuals from different provinces responded similarly during the COVID-19 pandemic in China, remains largely unknown. We used an interrupted time-series analysis to examine the change in Baidu Search Index of selected COVID-19 related terms associated with the COVID-19 derived exposure variables. We analyzed the daily search index in Mainland China using segmented log-normal regressions with data from Jan 2017 to Mar 2021. In this longitudinal study of nearly one billion internet users, we found synchronous increases in COVID-19 related searches during the first wave of the COVID-19 pandemic and subsequent local outbreaks, irrespective of the location and severity of each outbreak. The most precipitous increase occurred in the week when most provinces activated their highest level of response to public health emergencies. Search interests increased more as Human Development Index (HDI) -an area level measure of socioeconomic status—increased. Searches on the index began to decline nationwide after the initiation of mass-scale lockdowns, but statistically significant increases continued to occur in conjunction with the report of major sporadic local outbreaks. The intense interest in COVID-19 related information at virtually the same time across different provinces indicates that the Chinese government utilizes multiple channels to keep the public informed of the pandemic. Regional socioeconomic status influenced search patterns.
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Affiliation(s)
- Zhicheng Wang
- Vanke School of Public Health, Tsinghua University, No 30 Shuangqing Road, Beijing, 100084, China.,School of Medicine, Tsinghua University, Beijing, China.,China Development Research Foundation, Beijing, China
| | - Hong Xiao
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA. .,, Seattle, USA.
| | - Leesa Lin
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Sha Tin, Hong Kong Special Administrative Region, China
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, No 30 Shuangqing Road, Beijing, 100084, China.
| | - Joseph M Unger
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
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26
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Li H. Getting through a COVID-19 winter: Physical coldness increases the perceived risk of coronavirus disease. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022; 200:111799. [PMID: 35789922 PMCID: PMC9242932 DOI: 10.1016/j.paid.2022.111799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/11/2022] [Accepted: 06/27/2022] [Indexed: 11/19/2022]
Abstract
What factors influence how people perceive the risk of getting COVID-19? Extending beyond features of general health conditions, media coverage, and genetic susceptibility to disease, the present research investigates whether the immediacy of experience with temperature, a subtle yet pervasive environmental factor, can affect people's estimation of contagion probability. According to the attribute substitution model, people may rely on the visceral experience of coldness, a far easier quantity to evaluate, to estimate the contagion probability of the new coronavirus disease. Study 1 found that Chinese university students who perceived the indoor temperature to be lower believed that the coronavirus was more infectious. To provide causal evidence for the effect, Study 2 randomly assigned participants to different conditions. The results showed that participants in the cold condition reported a higher likelihood of contracting the coronavirus than participants in the control condition. Overall, these findings are consistent with the attribute substitution model: people tend to recruit simpler and more accessible information (e.g., local temperature) in place of more diagnostic but less tangible information (e.g., scientific data) in assessing the risk of disease transmission. Theoretical contributions and the significance of this research for policy makers are discussed.
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Affiliation(s)
- Heng Li
- Sichuan International Studies University, China
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27
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Cervantes L, Hazel CA, Mancini D, Pereira RI, Podewils LJ, Stella SA, Durfee J, Barshney A, Steiner JF. Perspectives of Latinx Individuals Who Were Unvaccinated And Hospitalized for COVID-19: A Qualitative Study. JAMA Netw Open 2022; 5:e2218362. [PMID: 35713898 PMCID: PMC9206184 DOI: 10.1001/jamanetworkopen.2022.18362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/05/2022] [Indexed: 11/24/2022] Open
Abstract
Importance Latinx individuals in the United States have lower COVID-19 vaccination rates and higher rates of COVID-19 infections, hospitalizations, and deaths than non-Latinx White individuals. Little is known about the perspectives of Latinx adults who had not received the COVID-19 vaccination and were hospitalized for COVID-19. Objective To describe the perspectives of Latinx individuals who were unvaccinated and subsequently hospitalized for COVID-19. Design, Setting, and Participants This qualitative study was conducted using semistructured phone interviews with 25 Latinx adults who were unvaccinated and survived a COVID-19 hospitalization in a public safety net hospital in Colorado from February to November 2021. Interviews were audio recorded, and transcripts were analyzed using thematic analysis. Main Outcomes and Measures Themes and subthemes of perspectives on vaccination. Results Among 25 adults (14 [56.0%] women, 11 [44.0%] men; mean [SD] age, 51 [15] years) who participated, all participants self-identified as Latino, Latina, or Latinx or Hispanic. There were 11 individuals who relied on emergency Medicaid (hospital coverage for Denver residents who are undocumented), while 10 individuals (40.0%) were essential workers and 13 individuals (52.0%) were unemployed. In interviews, 3 themes (with subthemes) were identified: factors associated with vaccination after hospitalization (subthemes: fear of death, avoiding hospitalization and reinfection, convinced COVID-19 is real, and responded to pressure from others), concerns about the COVID-19 vaccine (subthemes: experimental status and short timeline for production, contents of vaccine unknown or concerning, vaccine considered ineffective, worrisome immediate and long-term adverse effects, mixed and conflicting information, and government aimed to control or mark population through vaccination), and opportunities to improve vaccine uptake (subthemes; sharing personal experiences through social media, testimonials about minimal vaccine adverse effects, connecting with friends and family about the hospitalization experience, making the vaccine more accessible, and connecting with trusted sources of information). Conclusions and Relevance This study found that Latinx individuals who were unvaccinated and subsequently hospitalized for COVID-19 were motivated to engage in advocacy to encourage vaccination in their communities. These findings suggest that supporting patient advocacy after hospital discharge and continued efforts to create low-barrier, patient-informed public health strategies may be associated with increased vaccine uptake in Latinx communities.
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Affiliation(s)
- Lilia Cervantes
- Department of Medicine, Denver Health and Hospital Authority, Denver, Colorado
- Department of Medicine, University of Colorado, Aurora
| | | | - Diana Mancini
- Department of Medicine, Denver Health and Hospital Authority, Denver, Colorado
| | - Rocio I. Pereira
- Department of Medicine, Denver Health and Hospital Authority, Denver, Colorado
| | - Laura J. Podewils
- Office of Research, Denver Health and Hospital Authority, Denver, Colorado
| | - Sarah A. Stella
- Department of Medicine, Denver Health and Hospital Authority, Denver, Colorado
| | - Joshua Durfee
- Office of Research, Denver Health and Hospital Authority, Denver, Colorado
| | - Alana Barshney
- Office of Research, Denver Health and Hospital Authority, Denver, Colorado
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28
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Morales DX, Beltran TF, Morales SA. Gender, socioeconomic status, and COVID-19 vaccine hesitancy in the US: An intersectionality approach. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:953-971. [PMID: 35500003 PMCID: PMC9348198 DOI: 10.1111/1467-9566.13474] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 04/01/2022] [Indexed: 05/11/2023]
Abstract
Previous research on coronavirus disease 2019 (COVID-19) vaccine hesitancy lacks a gender perspective, and it is unclear whether gender intersects with socioeconomic status to co-produce inequalities in people's intent to take vaccines. The current study draws on intersectionality theory and uses data from the 2021 US Household Pulse Survey (n = 50,359). Both bivariate and multivariate statistical analyses were conducted. The results suggest that American women had a higher vaccine hesitancy rate than men. Gender interacts with socioeconomic status to shape people's vaccine hesitancy in a complex way. Specifically, women living in poverty or currently working were more vaccine-hesitant, while poverty and employment status did not affect men's vaccine hesitancy. However, not having a college education contributed to both women's and men's COVID-19 vaccine hesitancy. Moreover, women were more worried about the safety of the vaccine, but men's hesitancy tended to be driven by lower perceptions of COVID-19 dangers and belief in conspiratorial claims.
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Affiliation(s)
| | - Tyler Fox Beltran
- Department of Sociology and AnthropologyThe University of TexasEl PasoTexasUSA
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29
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Andersen JA, Rowland B, Ratcliff SM, Felix HC, McElfish PA. Relationship between Sociodemographic Factors, Perceived COVID-19 Risk, and Engagement with Health Protective Behaviors. South Med J 2022; 115:340-346. [PMID: 35504617 PMCID: PMC9042209 DOI: 10.14423/smj.0000000000001393] [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] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study describes the relationship between sociodemographic factors, chronic conditions, coronavirus disease 2019 (COVID-19) fears and stressors, and the perception of risk from COVID-19 and the use of health protective behaviors among Arkansans during the COVID-19 pandemic. METHODS Data collected from an online survey, administered in Arkansas between July and August 2020 (n = 1205), were used to estimate regressions. The data analysis was completed in April 2021. RESULTS Wearing a face mask was the most commonly reported behavior (97.4%), followed by handwashing (97.2%). Protective behaviors increased with higher levels of fear (β = 0.030, P < 0.001), more stressors (β = 0.057, P = 0.002), and age (β = 0.006, P = 0.030). Female (β = 0.510, P < 0.001) and Black (β = 0.268, P = 0.039) respondents reported engaging in more protective behaviors than males or other races/ethnicities. CONCLUSIONS In future pandemic planning, there will be a need to create messaging and interventions to increase health protective behaviors directed at young adults, men, and those with lower education levels. Providers will need to address fears related to COVID-19 and help their patients to manage those fears and anxieties.
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Affiliation(s)
- Jennifer A Andersen
- From the College of Medicine and the Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, the Department of Sociology, University of Nebraska-Lincoln, Lincoln, and the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock
| | - Brett Rowland
- From the College of Medicine and the Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, the Department of Sociology, University of Nebraska-Lincoln, Lincoln, and the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock
| | - Shawn M Ratcliff
- From the College of Medicine and the Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, the Department of Sociology, University of Nebraska-Lincoln, Lincoln, and the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock
| | - Holly C Felix
- From the College of Medicine and the Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, the Department of Sociology, University of Nebraska-Lincoln, Lincoln, and the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock
| | - Pearl A McElfish
- From the College of Medicine and the Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, the Department of Sociology, University of Nebraska-Lincoln, Lincoln, and the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock
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30
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Göktaş O, Ersoy C. Conocimiento, actitud y práctica frente al COVID-19: Investigación para desarrollar un instrumento de medición. Aten Primaria 2022; 54:102370. [PMID: 35777243 PMCID: PMC9050584 DOI: 10.1016/j.aprim.2022.102370] [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: 02/02/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the knowledge, attitudes, and behaviors of individuals about COVID-19 and to develop a valid and reliable scale that can measure these items about COVID-19 and other similar pandemic processes. Design Methodological scale study with a quantitative approach. Site Carried out at the Uludağ University Family Health Center in Bursa, Turkey. Participants 415 individuals in the first phase and 367 in the retest phase. Interventions Carried out between March 1, 2021, and April 30, 2021. Main measurements Reliability and factor analyses were performed and validity was evaluated. In factor analysis, a scale with 4 factors and 30 questions was obtained. Confirmatory factor analysis (CFA) was applied to the factor scores of the scale. Factors were named A-General Culture, B-Mask, Distance and Cleanliness, C-Mental Status, and D-Way of Information. A 3-point Likert-type scoring system was created for the responses. Results Cronbach's alpha value was 0.894. In factor modeling, 3 of the confirmatory factor analysis fit indices were good and 4 of them were acceptable, so our model was found to be appropriate. The scale was highly reliable, according to internal and external consistency coefficients. The scale was named the Turkey COVID-19 Attitude Scale. p values < 0.05 were considered statistically significant. Conclusions The valid and reliable Turkey COVID-19 Attitude Scale, which we developed to evaluate the knowledge, attitudes, and behaviors of individuals about COVID-19, can be used to guide research during COVID-19 and future pandemics.
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31
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Li J, Wang X, Yuan B. Population distribution by ethnicities and the disparities in health risk and coping in the United States during the pandemic: the spatial and time dynamics. Arch Public Health 2022; 80:93. [PMID: 35337382 PMCID: PMC8948454 DOI: 10.1186/s13690-022-00858-7] [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] [Received: 09/03/2021] [Accepted: 03/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background As a multi-ethnic country, the US is increasingly concerned about ethnic minorities facing disproportionate health risks of the coronavirus disease 2019 (COVID-19) pandemic. This study attempted to provide a macro picture of the associations between population distribution by ethnicity and the vulnerability to COVID-19 in terms of infection risk and vaccination coverage in the US. Methods This study used multi-source data from New York Times, County Health Rankings & Roadmap Program (2020), and the Center for Disease Control and Prevention. Multiple linear regressions were performed at equidistant time points (May 2020-Jan 2021, with one-month interval between each time point) to reveal the association between population distribution by ethnicities and the infection risk and the dynamics over time. Besides, multiple linear regressions were also conducted at equidistant time points (Jan 2021-Aug 2021) to reveal whether health disparities between ethnicities would hold true for the COVID-19 vaccination coverage (in total population, and among those > 12, > 18, and > 65 years of age). Results Both the COVID-19 confirmed cases (population standardized) and the vaccination coverage (in total population, and among those > 12, > 18, and > 65 years of age) were significantly associated with the population distribution by ethnicity (e.g., population percentage of ethnic minorities). Above associations were statistically significant for non-Hispanic blacks and Hispanics, but not for Asian Americans. Conclusions A proportion of socioeconomically-disadvantageous population could be a key intuitive reflection of the risk level of this public health crisis. The policy focusing on the vulnerable population is important in this pandemic.
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Affiliation(s)
- Jiannan Li
- Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University, Zhuhai, China
| | - Xinmeng Wang
- School of Tourism Management, Sun Yat-Sen University, West Xingang Rd. 135, Guangzhou, 510275, China
| | - Bocong Yuan
- School of Tourism Management, Sun Yat-Sen University, West Xingang Rd. 135, Guangzhou, 510275, China.
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32
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Gathecha E, Nguyen T, Kauffman R, Wright SM, Harris CM. Perspectives about COVID-19 among obese African Americans hospitalized during the pandemic. J Natl Med Assoc 2022; 114:340-345. [PMID: 35337663 PMCID: PMC8938938 DOI: 10.1016/j.jnma.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 02/04/2022] [Accepted: 02/28/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Evelyn Gathecha
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine,5200 Eastern Avenue East Tower 2nd Floor, Baltimore, MD 21224, United States.
| | - Thang Nguyen
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine,5200 Eastern Avenue East Tower 2nd Floor, Baltimore, MD 21224, United States
| | - Regina Kauffman
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine,5200 Eastern Avenue East Tower 2nd Floor, Baltimore, MD 21224, United States
| | - Scott M Wright
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine,5200 Eastern Avenue East Tower 2nd Floor, Baltimore, MD 21224, United States
| | - Ché Matthew Harris
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine,5200 Eastern Avenue East Tower 2nd Floor, Baltimore, MD 21224, United States
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Delude C, Abi‐Elias IH, Quinn CC, Adams AS, Magaziner JS, Ito K, Jain P, Gurwitz JH, Mazor KM. Stakeholders’ Views on Priorities Essential for Establishing a Supportive Environment for Clinical Trials in Nursing Homes. J Am Geriatr Soc 2022; 70:950-959. [PMID: 35188222 PMCID: PMC8986625 DOI: 10.1111/jgs.17710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND The U.S. clinical research enterprise in nursing homes was unprepared to mount clinical trials in nursing homes to address urgent questions relevant to prevention and treatment during the COVID-19 pandemic. We identify priorities essential for establishing a supportive environment for future clinical trials in nursing homes. METHODS Two cross-sectional online questionnaires were administered between January and February 2021. One was administered to nursing home providers, researchers, and policymakers; respondents rated the importance of attributes of researchers, facilities, leaders and staff for conducting clinical trials in nursing homes. Because importance may depend on trial type, respondents rated each attribute for efficacy trials (testing an intervention in ideal circumstances) and effectiveness trials (testing an intervention in "real world" circumstances). We calculated the attribute rating means and standard deviations, and used content analysis to characterize open-ended responses. The second questionnaire for resident family members and advocates included open-ended questions about nursing home research, and factors influencing willingness to participate. RESULTS The attributes rated as most essential for conducting efficacy and effectiveness trials in nursing homes are research team attributes, that is, that researchers recognize regulatory constraints; understand and adapt to nursing home workflow; and work collaboratively with nursing home leaders to identify priorities. Resident and facility diversity emerged as essential for effectiveness trials; important dimensions included resident race, ethnicity and income, as well as nursing home urban/rural location, quality ratings, geography, staffing ratios, size, and profit status. Caregivers and resident advocates stressed the importance of communication among participants, researchers, and nursing home leadership and staff at all stages of a trial. CONCLUSION Developing a robust U.S. clinical research enterprise capable of efficiently mounting future clinical trials in nursing homes will require a reimagining of the relationships that exist between researchers, facilities, nursing home leaders, and residents, with a research infrastructure specifically focused on supporting and fostering these connections.
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Affiliation(s)
| | | | | | | | | | - Kouta Ito
- Meyers Health Care Institute
- UMass Chan Medical School
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Healthcare Disparities and Outcomes of Cancer Patients in a Community Setting from a COVID-19 Epicenter. Curr Oncol 2022; 29:1150-1162. [PMID: 35200597 PMCID: PMC8870882 DOI: 10.3390/curroncol29020098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 01/08/2023] Open
Abstract
There have been numerous studies demonstrating how cancer patients are at an increased risk of mortality. Within New York City, our community hospital emerged as an epicenter of the first wave of the pandemic in the spring of 2020 and serves a unique population that is predominately uninsured, of a lower income, and racially/ethnically diverse. In this single institution retrospective study, the authors seek to investigate COVID-19 diagnosis, severity and mortality in patients with an active cancer diagnosis. Demographic, clinical characteristics, treatment, SARS-CoV-2 laboratory results, and outcomes were evaluated. In our community hospital during the first wave of the COVID-19 pandemic in the United States, patients with active cancer diagnosis appear to be at increased risk for mortality (30%) and severe events (50%) due to the SARS-CoV-2 infection compared to the general population. A higher proportion of active cancer patients with Medicaid insurance, Hispanic ethnicity, other race, and male sex had complications and death from COVID-19 infection. The pandemic has highlighted the health inequities that exist in vulnerable patient populations and underserved communities such as ours.
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Davis TC, Curtis LM, Wolf MS, Vanchiere JA, Bhuiyan MAN, Horswell R, Batio S, Arnold CL. COVID-19 Knowledge, Beliefs, and Behavior Among Patients in a Safety-Net Health System. J Community Health 2022; 47:437-445. [PMID: 35118553 PMCID: PMC8812349 DOI: 10.1007/s10900-021-01059-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 11/27/2022]
Abstract
Examine COVID-19 knowledge, concerns, behaviors, stress, and sources of information among patients in a safety-net health system in Louisiana. Research assistants surveyed participants via structured telephone interviews from April to October 2020. The data presented in this study were obtained in the pre-vaccine availability period. Of 623 adult participants, 73.5% were female, 54.7% Black, and 44.8% lived in rural small towns; mean age was 48.69. Half (50.5%) had spoken to a healthcare provider about the virus, 25.8% had been tested for COVID-19; 11.4% tested positive. Small town residents were less likely to be tested than those in cities (21.1% vs 29.3%, p = 0.05). Knowledge of COVID-19 symptoms and ways to prevent the disease increased from (87.9% in the spring to 98.9% in the fall, p < 0.001). Participants indicating that the virus had 'changed their daily routine a lot' decreased from 56.9% to 39.3% (p < 0.001). The main source of COVID-19 information was TV, which increased over time, 66.1-83.6% (p < 0.001). Use of websites (34.2%) did not increase. Black adults were more likely than white adults (80.7% vs 65.6%, p < 0.001) to rely on TV for COVID-19 information. Participants under 30 were more likely to get COVID-19 information from websites and social media (58.2% and 35.8% respectively). This study provides information related to the understanding of COVID-19 in rural and underserved communities that can guide clinical and public health strategies.
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Affiliation(s)
- Terry C. Davis
- Department of Medicine, Louisiana State University Health Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA 71130-3932 USA
| | - Laura M. Curtis
- Division of General Internal Medicine and Geriatrics, Northwestern Medicine, Feinberg School of Medicine, Chicago, USA
| | - Michael S. Wolf
- Division of General Internal Medicine and Geriatrics, Northwestern Medicine, Feinberg School of Medicine, Chicago, USA
| | - John A. Vanchiere
- Center for Emerging Viral Threats, Louisiana State University Health Shreveport, Shreveport, USA
| | | | | | - Stephanie Batio
- Division of General Internal Medicine and Geriatrics, Northwestern Medicine, Feinberg School of Medicine, Chicago, USA
| | - Connie L. Arnold
- Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, USA
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Beltran RM, Holloway IW, Hong C, Miyashita A, Cordero L, Wu E, Burris K, Frew PM. Social Determinants of Disease: HIV and COVID-19 Experiences. Curr HIV/AIDS Rep 2022; 19:101-112. [PMID: 35107810 PMCID: PMC8808274 DOI: 10.1007/s11904-021-00595-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The differential impact of the COVID-19 and HIV pandemics on marginalized communities has renewed calls for more robust and deeper investigation into structural and social causes of health inequities contributing to these infections, including underlying factors related to systematic racism. Using the Social Determinants of Health (SDOH) framework, we analyzed parallel and divergent factors associated with COVID-19 and HIV/AIDS and the prevalence of disparate disease in diverse communities. We utilized PRISMA guidelines to identify relevant literature (N = 210 articles) that resulted in a review of 125 articles included in our synthesis. RECENT FINDINGS With racial health inequities as a core contributor to disease vulnerability, we also identified other factors such as economic stability, social and community support, the neighborhood and built environment, healthcare access and quality, and education access and quality as important socioecological considerations toward achieving health equity. Our review identifies structural and systematic factors that drive HIV and COVID-19 transmission. Our review highlights the importance of not solely focusing on biomedical interventions as solutions to ending HIV and COVID-19, but rather call for building a more just public health and social service safety net that meets the needs of people at the intersection of multiple vulnerabilities.
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Affiliation(s)
- Raiza M Beltran
- David Geffen School of Medicine, Department of Infectious Diseases, UCLA Global HIV Prevention Research Program, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA.
- UCLA Hub for Health Intervention, Policy and Practice (HHIPP), CA, Los Angeles, USA.
| | - Ian W Holloway
- UCLA Hub for Health Intervention, Policy and Practice (HHIPP), CA, Los Angeles, USA
- Department of Social Welfare, School of Public Affairs, UCLA Luskin, Los Angeles, CA, USA
- California HIV/AIDS Research Program, Los Angeles, CA, USA
| | - Chenglin Hong
- UCLA Hub for Health Intervention, Policy and Practice (HHIPP), CA, Los Angeles, USA
- Department of Social Welfare, School of Public Affairs, UCLA Luskin, Los Angeles, CA, USA
- California HIV/AIDS Research Program, Los Angeles, CA, USA
| | - Ayako Miyashita
- UCLA Hub for Health Intervention, Policy and Practice (HHIPP), CA, Los Angeles, USA
- Department of Social Welfare, School of Public Affairs, UCLA Luskin, Los Angeles, CA, USA
| | - Luisita Cordero
- UCLA Hub for Health Intervention, Policy and Practice (HHIPP), CA, Los Angeles, USA
| | - Elizabeth Wu
- UCLA Hub for Health Intervention, Policy and Practice (HHIPP), CA, Los Angeles, USA
- Department of Social Welfare, School of Public Affairs, UCLA Luskin, Los Angeles, CA, USA
- California HIV/AIDS Research Program, Los Angeles, CA, USA
| | - Katherine Burris
- UNLV School of Public Health, UNLV Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV, USA
| | - Paula M Frew
- UNLV School of Public Health, UNLV Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV, USA
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Bateman LB, Hall AG, Anderson WA, Cherrington AL, Helova A, Judd S, Kimberly R, Oates GR, Osborne T, Ott C, Ryan M, Strong C, Fouad MN. Exploring COVID-19 Vaccine Hesitancy Among Stakeholders in African American and Latinx Communities in the Deep South Through the Lens of the Health Belief Model. Am J Health Promot 2022; 36:288-295. [PMID: 34719985 PMCID: PMC8770578 DOI: 10.1177/08901171211045038] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to qualitatively explore perceptions related to COVID-19 vaccination intention among African American and Latinx participants and suggest intervention strategies. APPROACH Ninety minute virtual focus groups (N = 8), segmented by county, race and ethnicity were conducted with stakeholders from 3 vulnerable Alabama counties. PARTICIPANTS Participants (N = 67) were primarily African American and Latinx, at least 19 years, and residents or stakeholders in Jefferson, Mobile, and Dallas counties. SETTING Focus groups took place virtually over Zoom. METHODS The semi-structured guide explored perceptions of COVID-19, with an emphasis on barriers and facilitators to vaccine uptake. Focus groups lasted approximately 90 minutes and were audio recorded, transcribed, and analyzed by a team of 3 investigators, according to the guidelines of Thematic Analysis using NVivo 12. To provide guidance in the development of interventions to decrease vaccine hesitancy, we examined how themes fit with the constructs of the Health Belief Model. RESULTS We found that primary themes driving COVID-19 vaccine hesitancy, ordered from most to least discussed, are mistrust, fear, and lack of information. Additionally, interventions to decrease vaccine hesitancy should be multi-modal, community engaged, and provide consistent, comprehensive messages delivered by trusted sources.
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Affiliation(s)
- Lori B Bateman
- School of Medicine, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Allyson G Hall
- School of Health Professions, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - William A Anderson
- School of Medicine, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrea L Cherrington
- School of Medicine, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anna Helova
- School of Public Health, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Suzanne Judd
- School of Public Health, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert Kimberly
- School of Medicine, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gabriela R Oates
- School of Medicine, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tiffany Osborne
- School of Medicine, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Corilyn Ott
- School of Medicine, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
- School of Nursing, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Melissa Ryan
- School of Medicine, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christian Strong
- School of Medicine, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mona N Fouad
- School of Medicine, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
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Norman S, Atabaki S, Atmore K, Biddle C, DiFazio M, Felten D, Fox E, Marschall D, Newman J, Robb A, Rowland C, Selekman R, Slovin A, Stein M, Strang J, Sable C. Home direct-to-consumer telehealth solutions for children with mental health disorders and the impact of Covid-19. Clin Child Psychol Psychiatry 2022; 27:244-258. [PMID: 34923834 DOI: 10.1177/13591045211064134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Delivery of mental health treatment in the home can close gaps in care. Telehealth also provides access to healthcare that has been disrupted due to the COVID-19 pandemic. In 2016, a home direct-to-consumer telehealth program was initiated. Mental health encounters made up a significant portion of all telehealth encounters and COVID-19 had a significant impact on accelerating the utilization of telehealth. Telemental health has been more successful at meeting targeted volumes than the overall health system. Of all the mental health diagnoses before and during COVID-19, attention deficit hyperactivity disorder, Autism Spectrum Disorder, and Anxiety Disorder were most common. The direct-to-consumer telehealth program saved patients a significant amount of travel miles and associated time, based on data from the period before COVID-19. Payment reimbursement for direct-to-consumer telehealth professional services was similar to reimbursement for in-person visits. This program demonstrates direct-to-consumer telehealth is a feasible and acceptable care modality for a variety of youth mental health disorders.
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Affiliation(s)
- Sierra Norman
- 12353University of Washington School of Medicine, Seattle, WA, USA
| | | | | | - Cara Biddle
- 8404Children's National Health System, Washington, DC, USA
| | - Marc DiFazio
- 8404Children's National Health System, Washington, DC, USA
| | - Daniel Felten
- 8404Children's National Health System, Washington, DC, USA
| | - Eduardo Fox
- 8404Children's National Health System, Washington, DC, USA
| | | | - Julie Newman
- 8404Children's National Health System, Washington, DC, USA
| | - Adelaide Robb
- 8404Children's National Health System, Washington, DC, USA
| | | | | | - Ariella Slovin
- 8404Children's National Health System, Washington, DC, USA
| | - Mark Stein
- 7274Seattle Children's Hospital, Seattle, WA, USA
| | - John Strang
- 8404Children's National Health System, Washington, DC, USA
| | - Craig Sable
- 8404Children's National Health System, Washington, DC, USA
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Pinheiro PS, Medina HN, Espinel Z, Kobetz EN, Shultz JM. New insights into the burden of COVID-19 mortality for U.S. Hispanics and Blacks when examined by country/region of origin: An observational study. LANCET REGIONAL HEALTH. AMERICAS 2022; 5:100090. [PMID: 36776453 PMCID: PMC9903763 DOI: 10.1016/j.lana.2021.100090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 10/19/2022]
Abstract
Background Florida's diverse population composition includes persons from throughout Latin America and the Caribbean. This facilitated an insightful examination of disparities in 2020 Florida COVID-19 deaths not only among racial/ethnic populations in the aggregate (non-Hispanic White, non-Hispanic Black, Hispanic) but also at the level of country/region of origin. Methods Age-adjusted mortality rates (AAMRs) for 2020 Florida COVID-19 deaths were calculated by race, ethnicity, and country/region of origin along with mean age at death, mean number of comorbidities, and percentage of decedents who had not completed secondary education. Regression-derived mortality rate ratios (MRRs) compared death rates for each racial/ethnic/country-of-origin population to non-Hispanic whites. Findings The overall AAMR (per 100,000) for 18,342 Florida COVID-19 deaths in 2020 was 55.4, with a much lower AAMR for non-Hispanic Whites (39.3) than for Hispanics (86.8) or Blacks (107.6). Marked differences in AAMRs were observed for specific Black and Hispanic ethnic groups from varied countries/regions of origin. COVID-19 decedents from Mexico and Central America had the highest AAMRs (170.7 and 168.8 per 100,000, respectively), lowest age at death, lowest educational level, and fewest comorbidities. Mean comorbidities were highest for Blacks (all origins) and Cuban Hispanics. Interpretation Florida Blacks and Hispanics experienced disproportionately high COVID-19 mortality rates throughout 2020, with notable variability based on country/region of origin. Inequities were particularly pronounced for Hispanic populations from Mexico and Central America. To better understand these heterogeneous COVID-19 mortality trends, more nuanced racial/ethnic analyses and detailed data on social determinants of health are needed. Funding Supplemental funding was provided by the Sylvester Comprehensive Cancer Center at University of Miami Miller School of Medicine. Research reported in this publication was also supported by the National Cancer Institute of the National Institutes of Health under Award Number P30CA240139.
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Affiliation(s)
- Paulo S. Pinheiro
- Sylvester Comprehensive Cancer Center, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14 St., Miami, FL 33136, USA
| | - Heidy N. Medina
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Zelde Espinel
- Sylvester Comprehensive Cancer Center, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Erin N. Kobetz
- Sylvester Comprehensive Cancer Center, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14 St., Miami, FL 33136, USA
| | - James M. Shultz
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Goldstein FC, Saurman JL, Rodriguez AD, Vickers KL. Knowledge About COVID-19 Symptoms, Transmission, and Prevention: The Relationship With Cognitive Status in Older Adults. Gerontol Geriatr Med 2022; 8:23337214221123708. [PMID: 36105375 PMCID: PMC9465561 DOI: 10.1177/23337214221123708] [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: 04/07/2022] [Revised: 08/10/2022] [Accepted: 08/17/2022] [Indexed: 11/18/2022] Open
Abstract
Objective: Advanced age poses an increased risk for cognitive
impairment, and therefore, poor knowledge regarding the risks associated with
COVID-19 may confer vulnerability. We administered a COVID-19 Knowledge
Questionnaire to older persons to evaluate the association between knowledge
regarding public health recommendations, and cognitive status as measured by the
Montreal Cognitive Assessment (MoCA). Method: Ninety-nine
participants completed a 22-item questionnaire about COVID-19 symptoms, risks,
and protective strategies, and they also completed the MoCA. Associations
between knowledge and cognitive status were examined via Spearman correlations.
Results: The mean (SD) age of participants was 72.6 (7.6)
years, and MoCA scores averaged 23.4 (4.5) points. Higher MoCA total scores were
significantly (p < .001) correlated with a greater number of
correct questionnaire responses. Higher Orientation and Memory Index scores were
moderately associated with an increased number of correct responses
(p < .001), with the Executive Index exhibiting a
significant albeit weaker association. MoCA Index scores assessing attention,
language, and visuospatial functioning were not significantly associated with
COVID-19 knowledge. Conclusions: Given the rapid transmission rate
of the SARS CoV-2 infections, COVID knowledge lapses will likely have
deleterious repercussions. Public health messages should ensure effective
acquisition and retention of COVID specific information, especially in
cognitively compromised older adults.
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Affiliation(s)
| | | | - Amy D Rodriguez
- Emory University School of Medicine, Atlanta, GA, USA.,Atlanta VA Medical Center, Decatur, GA, USA
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Mondal P, Sinharoy A, Sankoorikal BJ, Siddaiah R, Mazur L, Graff G. The Influence of Sociodemographic Heterogeneity on the Perceptions of COVID-19: A Countrywide Survey Study in the USA. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8922. [PMID: 34501512 PMCID: PMC8431068 DOI: 10.3390/ijerph18178922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/04/2021] [Accepted: 08/18/2021] [Indexed: 12/18/2022]
Abstract
Background: Sociodemographic factors such as age, race, education, family income, and sex have been reported to influence COVID-related perceptions, reflected by knowledge, stress, and preventive behavior. We conducted a US-based survey to estimate the difference in COVID-related perceptions among diverse sociodemographic groups and the influence of sociodemographic heterogeneity on COVID-related perceptions. Methods: The survey enquired about sociodemographic parameters and relevant information to measure knowledge, stress, and preventive behavior. COVID-perception scores among sociodemographic subgroups were compared with ANOVA (Bonferroni). The general linear model (GLM) was used to estimate the association among sociodemographic factors and COVID-related perceptions. Results: Females (75%) and White participants (78%) were the predominant (N = 3734). Females, White participants, wealthy, and educated participants demonstrated better knowledge, while participants of minority races, younger ages, low incomes, and females experienced high stress. Females, African-Americans, and educated participants better adopted preventive behaviors. Race, family income, and sex were the highest contributors to the predictive model. Sociodemographic determinants had statistically significant associations with knowledge (F-score = 7.72, p < 0.001; foremost predictor: race), stress (F-score = 16.46, p < 0.001; foremost predictor: income), and preventive behavior (GLM: F-score = 7.72, p < 0.001, foremost predictor: sex). Conclusion: Sociodemographic heterogeneity significantly influenced COVID-related perceptions, while race, family income, and sex were the strongest determinants of COVID-related perceptions.
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Affiliation(s)
- Pritish Mondal
- Division of Pediatric Pulmonology, Department of Pediatrics, Penn State College of Medicine, Hershey, PA 17033, USA; (B.-J.S.); (R.S.); (G.G.)
| | | | - Binu-John Sankoorikal
- Division of Pediatric Pulmonology, Department of Pediatrics, Penn State College of Medicine, Hershey, PA 17033, USA; (B.-J.S.); (R.S.); (G.G.)
| | - Roopa Siddaiah
- Division of Pediatric Pulmonology, Department of Pediatrics, Penn State College of Medicine, Hershey, PA 17033, USA; (B.-J.S.); (R.S.); (G.G.)
| | - Lauren Mazur
- Penn State College of Medicine, Hershey, PA 17033, USA;
| | - Gavin Graff
- Division of Pediatric Pulmonology, Department of Pediatrics, Penn State College of Medicine, Hershey, PA 17033, USA; (B.-J.S.); (R.S.); (G.G.)
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Xu J, Xiao W, Liang X, Shi L, Zhang P, Wang Y, Wang Y, Yang H. A meta-analysis on the risk factors adjusted association between cardiovascular disease and COVID-19 severity. BMC Public Health 2021; 21:1533. [PMID: 34380456 PMCID: PMC8355578 DOI: 10.1186/s12889-021-11051-w] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 05/12/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD), one of the most common comorbidities of coronavirus disease 2019 (COVID-19), has been suspected to be associated with adverse outcomes in COVID-19 patients, but their correlation remains controversial. METHOD This is a quantitative meta-analysis on the basis of adjusted effect estimates. PubMed, Web of Science, MedRxiv, Scopus, Elsevier ScienceDirect, Cochrane Library and EMBASE were searched comprehensively to obtain a complete data source up to January 7, 2021. Pooled effects (hazard ratio (HR), odds ratio (OR)) and the 95% confidence intervals (CIs) were estimated to evaluate the risk of the adverse outcomes in COVID-19 patients with CVD. Heterogeneity was assessed by Cochran's Q-statistic, I2test, and meta-regression. In addition, we also provided the prediction interval, which was helpful for assessing whether the variation across studies was clinically significant. The robustness of the results was evaluated by sensitivity analysis. Publication bias was assessed by Begg's test, Egger's test, and trim-and-fill method. RESULT Our results revealed that COVID-19 patients with pre-existing CVD tended more to adverse outcomes on the basis of 203 eligible studies with 24,032,712 cases (pooled ORs = 1.41, 95% CIs: 1.32-1.51, prediction interval: 0.84-2.39; pooled HRs = 1.34, 95% CIs: 1.23-1.46, prediction interval: 0.82-2.21). Further subgroup analyses stratified by age, the proportion of males, study design, disease types, sample size, region and disease outcomes also showed that pre-existing CVD was significantly associated with adverse outcomes among COVID-19 patients. CONCLUSION Our findings demonstrated that pre-existing CVD was an independent risk factor associated with adverse outcomes among COVID-19 patients.
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Affiliation(s)
- Jie Xu
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, China
| | - Wenwei Xiao
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, China
| | - Xuan Liang
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, China
| | - Li Shi
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, China
| | - Peihua Zhang
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, China
| | - Ying Wang
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, China
| | - Yadong Wang
- Department of Toxicology, Henan Center for Disease Control and Prevention, Zhengzhou, 450016, China
| | - Haiyan Yang
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, China.
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Lo CH, Nguyen LH, Drew DA, Warner ET, Joshi AD, Graham MS, Anyane-Yeboa A, Shebl FM, Astley CM, Figueiredo JC, Guo CG, Ma W, Mehta RS, Kwon S, Song M, Davies R, Capdevila J, Sudre CH, Wolf J, Cozier YC, Rosenberg L, Wilkens LR, Haiman CA, Marchand LL, Palmer JR, Spector TD, Ourselin S, Steves CJ, Chan AT. Race, ethnicity, community-level socioeconomic factors, and risk of COVID-19 in the United States and the United Kingdom. EClinicalMedicine 2021; 38:101029. [PMID: 34308322 PMCID: PMC8285255 DOI: 10.1016/j.eclinm.2021.101029] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND There is limited prior investigation of the combined influence of personal and community-level socioeconomic factors on racial/ethnic disparities in individual risk of coronavirus disease 2019 (COVID-19). METHODS We performed a cross-sectional analysis nested within a prospective cohort of 2,102,364 participants from March 29, 2020 in the United States (US) and March 24, 2020 in the United Kingdom (UK) through December 02, 2020 via the COVID Symptom Study smartphone application. We examined the contribution of community-level deprivation using the Neighborhood Deprivation Index (NDI) and the Index of Multiple Deprivation (IMD) to observe racial/ethnic disparities in COVID-19 incidence. ClinicalTrials.gov registration: NCT04331509. FINDINGS Compared with non-Hispanic White participants, the risk for a positive COVID-19 test was increased in the US for non-Hispanic Black (multivariable-adjusted odds ratio [OR], 1.32; 95% confidence interval [CI], 1.18-1.47) and Hispanic participants (OR, 1.42; 95% CI, 1.33-1.52) and in the UK for Black (OR, 1.17; 95% CI, 1.02-1.34), South Asian (OR, 1.39; 95% CI, 1.30-1.49), and Middle Eastern participants (OR, 1.38; 95% CI, 1.18-1.61). This elevated risk was associated with living in more deprived communities according to the NDI/IMD. After accounting for downstream mediators of COVID-19 risk, community-level deprivation still mediated 16.6% and 7.7% of the excess risk in Black compared to White participants in the US and the UK, respectively. INTERPRETATION Our results illustrate the critical role of social determinants of health in the disproportionate COVID-19 risk experienced by racial and ethnic minorities.
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Affiliation(s)
- Chun-Han Lo
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Long H Nguyen
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - David A Drew
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Erica T Warner
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA
- Harvard/MGH Center on Genomics, Vulnerable Populations, And Health Disparities, Massachusetts General Hospital, Boston, MA, USA
| | - Amit D Joshi
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Mark S Graham
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Adjoa Anyane-Yeboa
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Fatma M Shebl
- Medical Practice Evaluation Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Christina M Astley
- Computational Epidemiology Lab and Division of Endocrinology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Jane C Figueiredo
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles California, USA
| | - Chuan-Guo Guo
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Wenjie Ma
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Raaj S Mehta
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sohee Kwon
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Mingyang Song
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Carole H Sudre
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | | | - Yvette C Cozier
- Slone Epidemiology Center, Boston University, Boston, MA, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center, Boston University, Boston, MA, USA
| | - Lynne R Wilkens
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Christopher A Haiman
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
- Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Loïc Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Julie R Palmer
- Slone Epidemiology Center, Boston University, Boston, MA, USA
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
- Department of Ageing and Health, Guy's and St Thomas's NHS Foundation Trust, London, UK
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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44
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Analyzing Predictors of Control Measures and Psychosocial Problems Associated with COVID-19 Pandemic: Evidence from Eight Countries. Behav Sci (Basel) 2021; 11:bs11080106. [PMID: 34436096 PMCID: PMC8389271 DOI: 10.3390/bs11080106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/08/2021] [Accepted: 07/15/2021] [Indexed: 12/20/2022] Open
Abstract
COVID-19 has harshly impacted communities globally. This study provides relevant information for creating equitable policy interventions to combat the spread of COVID-19. This study aims to predict the knowledge, attitude, and practice (KAP) of the COVID-19 pandemic at a global level to determine control measures and psychosocial problems. A cross-sectional survey was conducted from July to October 2020 using an online questionnaire. Questionnaires were initially distributed to academicians worldwide. These participants distributed the survey among their social, professional, and personal groups. Responses were collected and analyzed from 67 countries, with a sample size of 3031. Finally, based on the number of respondents, eight countries, including Bangladesh, China, Japan, Malaysia, Mexico, Pakistan, the United States, and Zambia were rigorously analyzed. Specifically, questionnaire responses related to COVID-19 accessibility, behavior, knowledge, opinion, psychological health, and susceptibility were collected and analyzed. As per our analysis, age groups were found to be a primary determinant of behavior, knowledge, opinion, psychological health, and susceptibility scores. Gender was the second most influential determinant for all metrics except information about COVID-19 accessibility, for which education was the second most important determinant. Respondent profession was the third most important metric for all scores. Our findings suggest that health authorities must promote health educations, implement related policies to disseminate COVID-19-awareness that can prevent and control the spread of COVID-19 infection.
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45
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Sharafeldin N, Bates B, Song Q, Madhira V, Yan Y, Dong S, Lee E, Kuhrt N, Shao YR, Liu F, Bergquist T, Guinney J, Su J, Topaloglu U. Outcomes of COVID-19 in Patients With Cancer: Report From the National COVID Cohort Collaborative (N3C). J Clin Oncol 2021; 39:2232-2246. [PMID: 34085538 PMCID: PMC8260918 DOI: 10.1200/jco.21.01074] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Variation in risk of adverse clinical outcomes in patients with cancer and COVID-19 has been reported from relatively small cohorts. The NCATS' National COVID Cohort Collaborative (N3C) is a centralized data resource representing the largest multicenter cohort of COVID-19 cases and controls nationwide. We aimed to construct and characterize the cancer cohort within N3C and identify risk factors for all-cause mortality from COVID-19. METHODS We used 4,382,085 patients from 50 US medical centers to construct a cohort of patients with cancer. We restricted analyses to adults ≥ 18 years old with a COVID-19-positive or COVID-19-negative diagnosis between January 1, 2020, and March 25, 2021. We followed N3C selection of an index encounter per patient for analyses. All analyses were performed in the N3C Data Enclave Palantir platform. RESULTS A total of 398,579 adult patients with cancer were identified from the N3C cohort; 63,413 (15.9%) were COVID-19-positive. Most common represented cancers were skin (13.8%), breast (13.7%), prostate (10.6%), hematologic (10.5%), and GI cancers (10%). COVID-19 positivity was significantly associated with increased risk of all-cause mortality (hazard ratio, 1.20; 95% CI, 1.15 to 1.24). Among COVID-19-positive patients, age ≥ 65 years, male gender, Southern or Western US residence, an adjusted Charlson Comorbidity Index score ≥ 4, hematologic malignancy, multitumor sites, and recent cytotoxic therapy were associated with increased risk of all-cause mortality. Patients who received recent immunotherapies or targeted therapies did not have higher risk of overall mortality. CONCLUSION Using N3C, we assembled the largest nationally representative cohort of patients with cancer and COVID-19 to date. We identified demographic and clinical factors associated with increased all-cause mortality in patients with cancer. Full characterization of the cohort will provide further insights into the effects of COVID-19 on cancer outcomes and the ability to continue specific cancer treatments.
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Affiliation(s)
- Noha Sharafeldin
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | - Yao Yan
- University of Washington, Seattle, WA
- Sage Bionetworks, Seattle, WA
| | | | | | | | | | - Feifan Liu
- University of Massachusetts Medical School, Boston, MA
| | | | | | - Jing Su
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
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46
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Hendricks B, Paul R, Smith C, Wen S, Kimble W, Amjad A, Atkins A, Hodder S. Coronavirus testing disparities associated with community level deprivation, racial inequalities, and food insecurity in West Virginia. Ann Epidemiol 2021; 59:44-49. [PMID: 33812965 PMCID: PMC9558346 DOI: 10.1016/j.annepidem.2021.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE Social determinants of health and racial inequalities impact healthcare access and subsequent coronavirus testing. Limited studies have described the impact of these inequities on rural minorities living in Appalachia. This study investigates factors affecting testing in rural communities. METHODS PCR testing data were obtained for March through September 2020. Spatial regression analyses were fit at the census tract level. Model outcomes included testing and positivity rate. Covariates included rurality, percent Black population, food insecurity, and area deprivation index (a comprehensive indicator of socioeconomic status). RESULTS Small clusters in coronavirus testing were detected sporadically, while test positivity clustered in mideastern and southwestern WV. In regression analyses, percent food insecurity (IRR = 3.69×109, [796, 1.92×1016]), rurality (IRR=1.28, [1.12, 1.48]), and percent population Black (IRR = 0.88, [0.84, 0.94]) had substantial effects on coronavirus testing. However, only percent food insecurity (IRR = 5.98 × 104, [3.59, 1.07×109]) and percent Black population (IRR = 0.94, [0.90, 0.97]) displayed substantial effects on the test positivity rate. CONCLUSIONS Findings highlight disparities in coronavirus testing among communities with rural minorities. Limited testing in these communities may misrepresent coronavirus incidence.
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Affiliation(s)
- Brian Hendricks
- West Virginia University, Department of Epidemiology, Morgantown, WV; West Virginia Clinical and Translational Sciences Institute, Morgantown, WV.
| | - Rajib Paul
- University of North Carolina at Charlotte, Department of Public Health Sciences, Charlotte, NC
| | - Cassie Smith
- West Virginia University, Department of Epidemiology, Morgantown, WV
| | - Sijin Wen
- West Virginia University, Department of Biostatistics, Morgantown, WV
| | - Wes Kimble
- West Virginia Clinical and Translational Sciences Institute, Morgantown, WV
| | - Ayne Amjad
- West Virginia Department of Health and Human Resources Charleston, WV
| | - Amy Atkins
- West Virginia Department of Health and Human Resources Charleston, WV
| | - Sally Hodder
- West Virginia Clinical and Translational Sciences Institute, Morgantown, WV; West Virginia University School of Medicine, Morgantown, WV
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47
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Ash MJ, Berkley-Patton J, Christensen K, Haardörfer R, Livingston MD, Miller T, Woods-Jaeger B. Predictors of medical mistrust among urban youth of color during the COVID-19 pandemic. Transl Behav Med 2021; 11:1626-1634. [PMID: 34080637 PMCID: PMC8195192 DOI: 10.1093/tbm/ibab061] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The COVID-19 pandemic has disproportionately impacted communities of color and highlighted longstanding racial health inequities. Communities of color also report higher rates of medical mistrust driven by histories of medical mistreatment and continued experiences of discrimination and systemic racism. Medical mistrust may exacerbate COVID-19 disparities. This study utilizes the Behavior Model for Vulnerable Populations to investigate predictors of medical mistrust during the COVID-19 pandemic among urban youth of color. Minority youth (N = 105) were recruited from community organizations in Kansas City, Missouri to complete an online survey between May and June 2020. Multiple linear regressions were performed to estimate the effect of personal characteristics, family and community resources, and COVID-19 need-based factors on medical mistrust. Results indicated that loneliness, financial insecurity (e.g., job loss, loss of income) due to the COVID-19 pandemic, and eligibility for free or reduced lunch predicted medical mistrust. Insurance status, neighborhood median household income, social support, and perceived COVID-19 risk were not significantly associated with medical mistrust. Future research and policies are necessary to address systemic factors that perpetuate medical mistrust among youth of color.
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Affiliation(s)
- Marcia J Ash
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
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48
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Zhang J, Wu X, Chow TE. Space-Time Cluster's Detection and Geographical Weighted Regression Analysis of COVID-19 Mortality on Texas Counties. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5541. [PMID: 34067291 PMCID: PMC8196888 DOI: 10.3390/ijerph18115541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/28/2021] [Accepted: 05/20/2021] [Indexed: 01/30/2023]
Abstract
As COVID-19 run rampant in high-density housing sites, it is important to use real-time data in tracking the virus mobility. Emerging cluster detection analysis is a precise way of blunting the spread of COVID-19 as quickly as possible and save lives. To track compliable mobility of COVID-19 on a spatial-temporal scale, this research appropriately analyzed the disparities between spatial-temporal clusters, expectation maximization clustering (EM), and hierarchical clustering (HC) analysis on Texas county-level. Then, based on the outcome of clustering analysis, the sensitive counties are Cottle, Stonewall, Bexar, Tarrant, Dallas, Harris, Jim hogg, and Real, corresponding to Southeast Texas analysis in Geographically Weighted Regression (GWR) modeling. The sensitive period took place in the last two quarters in 2020 and the first quarter in 2021. We explored PostSQL application to portray tracking Covid-19 trajectory. We captured 14 social, economic, and environmental impact's indices to perform principal component analysis (PCA) to reduce dimensionality and minimize multicollinearity. By using the PCA, we extracted five factors related to mortality of COVID-19, involved population and hospitalization, adult population, natural supply, economic condition, air quality or medical care. We established the GWR model to seek the sensitive factors. The result shows that adult population, economic condition, air quality, and medical care are the sensitive factors. Those factors also triggered high increase of COVID-19 mortality. This research provides geographical understanding and solution of controlling COVID-19, reference of implementing geographically targeted ways to track virus mobility, and satisfy for the need of emergency operations plan (EOP).
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Affiliation(s)
- Jinting Zhang
- School of Resource and Environmental Science, Wuhan University, Wuhan 430079, China;
| | - Xiu Wu
- Department of Geography, Texas State University, San Marcos, TX 78666, USA;
| | - T. Edwin Chow
- Department of Geography, Texas State University, San Marcos, TX 78666, USA;
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49
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Reiter PL, Katz ML. Racial/Ethnic Differences in Knowledge, Attitudes, and Beliefs About COVID-19 Among Adults in the United States. Front Public Health 2021; 9:653498. [PMID: 34046389 PMCID: PMC8144327 DOI: 10.3389/fpubh.2021.653498] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/16/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Knowledge, attitudes, and beliefs are cognitive outcomes that serve as key determinants of engaging in health behaviors, likely including vaccination and other mitigation behaviors against coronavirus disease 2019 (COVID-19). Studies have begun examining people's knowledge, attitudes, and beliefs about COVID-19, but little is known about how these cognitive outcomes differ across racial/ethnic groups. Methods: An online survey was conducted with a convenience sample of adults ages 18 and older in the United States (n = 2,006) in May 2020, about 2 months after COVID-19 was declared a pandemic. Multivariable regression models were used to examine differences in knowledge, attitudes, and beliefs about COVID-19 across racial/ethnic groups (non-Latinx white, non-Latinx black, non-Latinx of another race, or Latinx). Results: Knowledge tended to be lower among non-Latinx blacks and Latinx participants compared to non-Latinx whites. For example, fewer non-Latinx blacks responded correctly that COVID-19 is not caused by the same virus that causes influenza (adjusted OR = 0.66, 95% CI: 0.49–0.90), and Latinx participants were less likely to respond correctly that people with COVID-19 do not always show symptoms of being sick (adjusted OR = 0.63, 95% CI: 0.45–0.87). For beliefs and attitudes, non-Latinx blacks (β = −0.09) and non-Latinx participants of another race (β = −0.05) reported lower perceived likelihood of getting COVID-19 in the future compared to non-Latinx whites, while Latinx participants reported greater perceived stigma of COVID-19 (β = 0.08) (all p < 0.05). Conclusions: Several differences in cognitive outcomes about COVID-19 exist across racial/ethnic groups, including gaps in knowledge and varied beliefs and attitudes. Results identify modifiable targets for public health programs promoting vaccination and other mitigation behaviors against COVID-19.
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Affiliation(s)
- Paul L Reiter
- College of Public Health, The Ohio State University, Columbus, OH, United States.,Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Mira L Katz
- College of Public Health, The Ohio State University, Columbus, OH, United States.,Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
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50
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Piyathilake CJ, Badiga S, Chappell AR, Johanning GL, Jolly PE. Racial differences in dietary choices and their relationship to inflammatory potential in childbearing age women at risk for exposure to COVID-19. Nutr Res 2021; 90:1-12. [PMID: 34049184 PMCID: PMC8143979 DOI: 10.1016/j.nutres.2021.04.004] [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] [Received: 11/16/2020] [Revised: 03/22/2021] [Accepted: 04/07/2021] [Indexed: 12/27/2022]
Abstract
Since the ongoing coronavirus disease 2019 (COVID-19) pandemic is linked to chronic inflammation, people with initial lower inflammatory status could have better outcomes from exposure to this disease. Because dietary habits are one of the most important modifiable risk factors for inflammation, identification of dietary components associated with inflammation could play a significant role in controlling or reducing the risk of COVID-19. We investigated the inflammatory potential of diets consumed by African American (AA) and Caucasian American (CA) women of childbearing age (n = 509) who are at high risk for exposure to COVID-19 by being residents of Birmingham, Alabama, a city severely affected by this pandemic. The overall pro- and anti- inflammatory scores were calculated using dietary intake data gathered using Block food frequency questionnaire. The proinflammatory potential of diets consumed by AAs was significantly higher compared to CAs. Several anti- and proinflammatory nutrients and food groups consumed differed by race. With consumption of a greater number of antioxidants and B-vitamins, CAs switched toward an anti-inflammatory score more effectively than AAs while AAs performed better than CAs in improving the anti-inflammatory score with the consumption of a greater number of minerals and vitamin D. Effective race-specific dietary modifications or supplementation with nutrients identified will be useful to improve proinflammatory diets toward anti-inflammatory. This approach could aid in controlling the current COVID-19 pandemic and future pandemics of a similar nature in women at risk for exposure.
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Affiliation(s)
- Chandrika J Piyathilake
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, AL, 35294, USA.
| | - Suguna Badiga
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Ashley R Chappell
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | | | - Pauline E Jolly
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, AL, 35294, USA
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