Barriers and Facilitators to Prevention and Care of COVID-19 Infection in Cincinnati Latinx Families: a Community-Based Convergent Mixed Methods Study.

BACKGROUND: Latinx populations have experienced disproportionately high case rates of COVID-19 across the USA. Latinx communities in non-traditional migration areas may experience greater baseline day-to-day challenges such as a lack of resources for immigrants and insufficient language services. These challenges may be exacerbated by the COVID-19 pandemic. OBJECTIVE: This article describes the results of an initial community health needs assessment to better understand the prevention and care of COVID-19 infection in the Cincinnati Latinx community. METHODS: We used convergent mixed methods to examine barriers and facilitators to COVID-19 prevention and care for those with infection. RESULTS: Latinx adults ≥ 18 years old completed 255 quantitative surveys and 17 qualitative interviews. Overarching mixed methods domains included knowledge, prevention, work, challenges, and treatment. Quantitative results largely reinforced qualitative results (confirmation). Certain quantitative and qualitative results, however, diverged and expanded insights related to caring for COVID-19 infection among Latinx adults (expansion). There were infrequent contradictions between quantitative and qualitative findings (discordance). Primary barriers for the Latinx community during the COVID-19 pandemic included insecurities in food, jobs, housing, and immigration. Key facilitators included having trusted messengers of health-related information. CONCLUSION: Public health interventions should be centered on community partnerships and the use of trusted messengers. Wraparound services (including resources for immigrants) are essential public health services. Close partnership with employers is essential as lack of sick leave and mask supplies were more frequent barriers than knowledge. These findings emerged from experiences during the COVID-19 pandemic but likely generalize to future public health crises.

Reducing Caregiver Hunger During Pediatric Hospitalization.

BACKGROUND AND OBJECTIVES: Pediatric hospitalizations are costly, stressful events for families. Many caregivers, especially those with lower incomes, struggle to afford food while their child is hospitalized. We sought to decrease the mean percentage of caregivers of Medicaid-insured and uninsured children who reported being hungry during their child's hospitalization from 86% to <24%. METHODS: Our quality improvement efforts took place on a 41-bed inpatient unit at our large, urban academic hospital. Our multidisciplinary team included physicians, nurses, social workers, and food services leadership. Our primary outcome measure was caregiver-reported hunger; we asked caregivers near to the time of discharge if they experienced hunger during their child's hospitalization. Plan-do-study-act cycles addressed key drivers: awareness of how to obtain food, safe environment for families to seek help, and access to affordable food. An annotated statistical process control chart tracked our outcome over time. Data collection was interrupted because of the COVID-19 pandemic; we used that time to advocate for hospital-funded support for optimal and sustainable changes to caregiver meal access. RESULTS: We decreased caregiver hunger from 86% to 15.5%. A temporary test of change, 2 meal vouchers per caregiver per day, resulted in a special cause decrease in the percentage of caregivers reporting hunger. Permanent hospital funding was secured to provide cards to purchase 2 meals per caregiver per hospital day, resulting in a sustained decrease in rates of caregiver hunger. CONCLUSIONS: We decreased caregivers' hunger during their child's hospitalization. Through a data-driven quality improvement effort, we implemented a sustainable change allowing families to access enough food.

Multilevel Analysis of Racial and Ethnic Disparities in COVID-19 Hospitalization among Children with Allergies.

Rationale: Previous studies have identified risk factors for coronavirus disease (COVID-19) hospitalization in children. However, these studies have been limited in their ability to disentangle the contribution of racial disparities, allergic comorbidities, and environmental exposures to the development of severe COVID-19 in at-risk children with allergies. Objectives: To examine racial and ethnic disparities in COVID-19 hospitalization and their links to potentially underlying allergic comorbidities and individual and place-based factors in children with allergies. Methods: This is an electronic health record-based retrospective study of children in 2020. The outcome was COVID-19 hospitalization categorized as no hospital care for patients with asymptomatic/mild illness, short stay for patients admitted and discharged within 24 hours, and prolonged stay for patients requiring additional time to discharge (more than 24 h). Mixed-effects and mediation models were used to determine relationships among independent variables, mediators, and COVID-19 hospitalization. Results: Among the 5,258 children with COVID-19 positive test or diagnosis, 10% required a short stay, and 3.7% required a prolonged stay. Black and Hispanic children had higher odds of longer stays than non-Hispanic White children (both P < 0.001). Children with obesity and eosinophilic esophagitis diagnoses had higher odds of short and prolonged stay (all P < 0.05). Area-level deprivation was associated with short stay (adjusted odds ratio [AOR], 15.49; 95% confidence interval [CI], 5.16-45.47 for every 0.1-unit increase) and prolonged stay (AOR, 11.82; 95% CI, 2.25-62.01 for every 0.1-unit increase). Associations between race/ethnicity and COVID-19 hospitalization were primarily mediated by insurance and area-level deprivation, altogether accounting for 99% of the variation in COVID-19 hospitalization. Conclusions: There were racial and ethnic differences in children with allergies and individual and place-based factors related to COVID-19 hospitalization. Differences were primarily mediated by insurance and area-level deprivation, altogether accounting for 99% of the variation in COVID-19 hospitalization. A better understanding of COVID-related morbidity in children and the link to place-based factors is key to developing prevention strategies capable of equitably improving outcomes.

Methods and tools for situational awareness and equitable decision-making during COVID-19

5 Figure 1Screenshot of PCCI community protection dashboard[Figure omitted. See PDF]ConclusionsThere was broad agreement amongst public health leaders and community leaders about the key elements of the data and learning systems required to manage current and future public health responses to COVID-19. These findings may be informative for guiding the use of data and learning in the management of future public health crises (figure 1).

Increasing Coronavirus Disease 2019 Vaccine Uptake in Pediatric Primary Care by Offering Vaccine to Household Members.

Pediatric primary care is a trusted source for treatment and information. In the 6 months after coronavirus disease 2019 vaccines became available for adolescents, we administered 2286 doses (1270 to patients; 1016 to household members) to 1376 individuals (64.1% Black; 10.1% Latinx), providing opportunities to address family concerns in a familiar location.