A review of state regulations for child care: Preventing, recognizing and reporting child maltreatment.

BACKGROUND: Prior to the COVID-19 pandemic, nearly 60% of children under 5 years of age were cared for in out-of-home child care arrangements in the United States. Thus, child care provides an opportunity to identify and address potential child maltreatment. However, during the pandemic, rates of reporting child maltreatment decreased-likely because children spent less time in the presence of mandated reporters. As children return to child care, states must have regulations in place to help child care providers prevent, recognize and report child maltreatment. However, little is known about the extent to which state regulations address child maltreatment. Therefore, the purpose of this cross-sectional study was to assess state regulations related to child maltreatment and compare them to national standards. METHOD: We reviewed state regulations for all 50 states and the District of Columbia for child care centres ('centres') and family child care homes ('homes') through 31 July 2021 and compared these regulations to eight national health and safety standards on child maltreatment. We coded regulations as either not meeting, partially meeting or fully meeting each standard. RESULTS: Three states (Colorado, Utah and Washington) had regulations for centres, and one state (Washington) had regulations for homes that at least partially met all eight national standards. Nearly all states had regulations consistent with the standards requiring that caregivers and teachers are mandated reporters of child maltreatment and requiring that they be trained in preventing, recognizing and reporting child maltreatment. One state (Hawaii) did not have regulations consistent with any of the national standards for either centres or homes. CONCLUSIONS: Generally, states lacked regulations related to the prevention, recognition and reporting of child maltreatment for both centres and homes. Encouraging states to adopt regulations that meet national standards and further exploring their impact on child welfare are important next steps.

A multivariate spatiotemporal model for tracking COVID-19 incidence and death rates in socially vulnerable populations.

Recent studies have produced inconsistent findings regarding the association between community social vulnerability and COVID-19 incidence and death rates. This inconsistency may be due, in part, to the fact that these studies modeled cases and deaths separately, ignoring their inherent association and thus yielding imprecise estimates. To improve inferences, we develop a Bayesian multivariate negative binomial model for exploring joint spatial and temporal trends in COVID-19 infections and deaths. The model introduces smooth functions that capture long-term temporal trends, while maintaining enough flexibility to detect local outbreaks in areas with vulnerable populations. Using multivariate autoregressive priors, we jointly model COVID-19 cases and deaths over time, taking advantage of convenient conditional representations to improve posterior computation. As such, the proposed model provides a general framework for multivariate spatiotemporal modeling of counts and rates. We adopt a fully Bayesian approach and develop an efficient posterior Markov chain Monte Carlo algorithm that relies on easily sampled Gibbs steps. We use the model to examine incidence and death rates among counties with high and low social vulnerability in the state of Georgia, USA, from 15 March to 15 December 2020.

Bayesian negative binomial regression with spatially varying dispersion: Modeling COVID-19 incidence in Georgia.

Overdispersed count data arise commonly in disease mapping and infectious disease studies. Typically, the level of overdispersion is assumed to be constant over time and space. In some applications, however, this assumption is violated, and in such cases, it is necessary to model the dispersion as a function of time and space in order to obtain valid inferences. Motivated by a study examining spatiotemporal patterns in COVID-19 incidence, we develop a Bayesian negative binomial model that accounts for heterogeneity in both the incidence rate and degree of overdispersion. To fully capture the heterogeneity in the data, we introduce region-level covariates, smooth temporal effects, and spatially correlated random effects in both the mean and dispersion components of the model. The random effects are assigned bivariate intrinsic conditionally autoregressive priors that promote spatial smoothing and permit the model components to borrow information, which is appealing when the mean and dispersion are spatially correlated. Through simulation studies, we show that ignoring heterogeneity in the dispersion can lead to biased and imprecise estimates. For estimation, we adopt a Bayesian approach that combines full-conditional Gibbs sampling and Metropolis-Hastings steps. We apply the model to a study of COVID-19 incidence in the state of Georgia, USA from March 15 to December 31, 2020.

Alcohol consumption and alcohol home delivery laws during the COVID-19 pandemic.

Background: Alcohol consumption in the U.S. is a public health problem that has been exacerbated by the COVID-19 pandemic. Relatedly, many states have responded to COVID-19 by relaxing their alcohol laws, making it possible for adults to have alcohol delivered to their homes. This study sought to understand the impact of allowing alcohol home delivery on self-reported adult alcohol consumption in the US. Methods: In May 2020, we surveyed a convenience sample of U.S. adults over 21 years of age recruited through social media and listservs. Eight hundred and thirty-two participants completed the online survey: 84% were female, 85% were White, and 72% were between the ages of 26 and 49. Results: Twenty-one percent of participants who consumed alcohol in the past month had at least some alcohol delivered, with 60% having it delivered from liquor stores, restaurants, or bars. The remainder of the participants purchased the alcohol in-person or owned it pre-COVID-19. Participants who reported having alcohol delivered also reported consuming more drinks (ß = 13.3; 95% CI [8.2, 18.4]; p < .000) and drinking on more days (ß = 5.0; 95% CI [2.9, 7.0]; p < .000) over the past month than participants who obtained alcohol through other methods. Participants who had alcohol delivered were nearly two times more likely to report engaging in binge drinking than those who obtained alcohol through other methods (OR = 1.96; 95% CI [1.3, 3.1]; p = .003). Conclusions: Obtaining alcohol through home delivery was associated with greater alcohol consumption including binge drinking. As states consider permanently allowing alcohol home delivery, it is important to consider the potential public health implications.

US state variations in food bank donation policy and implications for nutrition.

Food insecurity has increased dramatically in 2020 as a result of the COVID-19 public health and economic crisis. Many more families in the United States are turning to the charitable food system to help meet their needs. However, little is known about the policies that influence food bank donations and whether they promote healthy food donations. The purpose of this study was to explore state variation in food donation policies and secondarily to assess whether policies promoted the donation of healthy foods and beverages. We reviewed donation policies for all states in the United States and Washington, DC (hereafter "states") in fall 2020. Two reviewers independently assessed donation policies using two legal databases; we reconciled discrepancies via team discussion. We then grouped them into 10 distinct categories based on common purpose and theme. We identified 252 state policies from 51 states. Policies fell into all 10 categories. The largest category was "liability protection," with all states having a policy in this category. The second largest category was date labeling; 32 states had requirements or policies restricting the donation of past-dated foods. However, across all categories, we found that only two policies explicitly promoted the donation of healthy foods and beverages. Although all states had some policies governing food donations, few promoted healthier foods and beverages. States could encourage healthy donations through policy to help ensure that all families have access to nutritious foods and beverages.

Connecting Families to Food Resources amid the COVID-19 Pandemic: A Cross-Sectional Survey of Early Care and Education Providers in Two U.S. States.

Early care and education (ECE) settings are important avenues for reaching young children and their families with food and nutrition resources, including through the U.S. federally funded Child and Adult Care Food Program (CACFP). Researchers conducted a cross-sectional survey of ECE providers in two U.S. states in November 2020 to identify approaches used to connect families with food and nutrition resources amid the COVID-19 pandemic. Logistic regression models were used to estimate odds of sites reporting no approaches and adjusted Poisson models were used to estimate the incidence rate ratio of the mean number of approaches, comparing sites that participate in CACFP to those that did not. A total of 589 ECE sites provided responses. Of those, 43% (n = 255) participated in CACFP. CACFP participating sites were more likely to report using any approaches to connecting families to food resources and significantly more likely to report offering "grab and go" meals, providing meal delivery, distributing food boxes to families, and recommending community food resources than non-CACFP sites. This study suggests that CACFP sites may have greater capacity to connect families to food resources amid emergencies than non-CACFP participating sites.

Spatial and temporal trends in social vulnerability and COVID-19 incidence and death rates in the United States.

BACKGROUND: Socially vulnerable communities may be at higher risk for COVID-19 outbreaks in the US. However, no prior studies examined temporal trends and differential effects of social vulnerability on COVID-19 incidence and death rates. Therefore, we examined temporal trends among counties with high and low social vulnerability to quantify disparities in trends over time. METHODS: We conducted a longitudinal analysis examining COVID-19 incidence and death rates from March 15 to December 31, 2020, for each US county using data from USAFacts. We classified counties using the Social Vulnerability Index (SVI), a percentile-based measure from the Centers for Disease Control and Prevention, with higher values indicating more vulnerability. Using a Bayesian hierarchical negative binomial model, we estimated daily risk ratios (RRs) comparing counties in the first (lower) and fourth (upper) SVI quartiles, adjusting for rurality, percentage in poor or fair health, percentage female, percentage of smokers, county average daily fine particulate matter (PM2.5), percentage of primary care physicians per 100,000 residents, daily temperature and precipitation, and proportion tested for COVID-19. RESULTS: At the outset of the pandemic, the most vulnerable counties had, on average, fewer cases per 100,000 than least vulnerable SVI quartile. However, on March 28, we observed a crossover effect in which the most vulnerable counties experienced higher COVID-19 incidence rates compared to the least vulnerable counties (RR = 1.05, 95% PI: 0.98, 1.12). Vulnerable counties had higher death rates starting on May 21 (RR = 1.08, 95% PI: 1.00,1.16). However, by October, this trend reversed and the most vulnerable counties had lower death rates compared to least vulnerable counties. CONCLUSIONS: The impact of COVID-19 is not static but can migrate from less vulnerable counties to more vulnerable counties and back again over time.

Associations Between Governor Political Affiliation and COVID-19 Cases, Deaths, and Testing in the U.S.

INTRODUCTION: The response to the COVID-19 pandemic became increasingly politicized in the U.S., and the political affiliation of state leaders may contribute to policies affecting the spread of the disease. This study examines the differences in COVID-19 infection, death, and testing by governor party affiliation across the 50 U.S. states and the District of Columbia. METHODS: A longitudinal analysis was conducted in December 2020 examining COVID-19 incidence, death, testing, and test positivity rates from March 15, 2020 through December 15, 2020. A Bayesian negative binomial model was fit to estimate the daily risk ratios and posterior intervals comparing rates by gubernatorial party affiliation. The analyses adjusted for state population density, rurality, Census region, age, race, ethnicity, poverty, number of physicians, obesity, cardiovascular disease, asthma, smoking, and presidential voting in 2020. RESULTS: From March 2020 to early June 2020, Republican-led states had lower COVID-19 incidence rates than Democratic-led states. On June 3, 2020, the association reversed, and Republican-led states had a higher incidence (risk ratio=1.10, 95% posterior interval=1.01, 1.18). This trend persisted through early December 2020. For death rates, Republican-led states had lower rates early in the pandemic but higher rates from July 4, 2020 (risk ratio=1.18, 95% posterior interval=1.02, 1.31) through mid-December 2020. Republican-led states had higher test positivity rates starting on May 30, 2020 (risk ratio=1.70, 95% posterior interval=1.66, 1.73) and lower testing rates by September 30, 2020 (risk ratio=0.95, 95% posterior interval=0.90, 0.98). CONCLUSIONS: Gubernatorial party affiliation may drive policy decisions that impact COVID-19 infections and deaths across the U.S. Future policy decisions should be guided by public health considerations rather than by political ideology.

Alcohol Consumption during the COVID-19 Pandemic: A Cross-Sectional Survey of US Adults.

Emerging but limited evidence suggests that alcohol consumption has increased during the COVID-19 pandemic. This study assessed: (1) whether drinking behaviors changed during the pandemic; and, (2) how those changes were impacted by COVID-19-related stress. We conducted a cross-sectional online survey with a convenience sample of U.S. adults over 21 years in May 2020. We conducted adjusted linear regressions to assess COVID-19 stress and alcohol consumption, adjusting for gender, race, ethnicity, age, and household income. A total of 832 responded: 84% female, 85% White, and 72% ages 26-49. Participants reported consuming 26.8 alcohol drinks on 12.2 of the past 30 days. One-third of participants (34.1%) reported binge drinking and 7.0% reported extreme binge drinking. Participants who experienced COVID-19-related stress (versus not) reported consuming more drinks (ß = 4.7; CI (0.2, 9.1); p = 0.040) and a greater number of days drinking (ß = 2.4; CI (0.6, 4.1); p = 0.007). Additionally, 60% reported increased drinking but 13% reported decreased drinking, compared to pre-COVID-19. Reasons for increased drinking included increased stress (45.7%), increased alcohol availability (34.4%), and boredom (30.1%). Participants who reported being stressed by the pandemic consumed more drinks over a greater number of days, which raises concerns from both an individual and public health perspective.

Associations between governor political affiliation and COVID-19 cases, deaths, and testing in the United States.

INTRODUCTION: The response to the COVID-19 pandemic became increasingly politicized in the United States (US) and political affiliation of state leaders may contribute to policies affecting the spread of the disease. This study examined differences in COVID-19 infection, death, and testing by governor party affiliation across 50 US states and the District of Columbia. METHODS: A longitudinal analysis was conducted in December 2020 examining COVID-19 incidence, death, testing, and test positivity rates from March 15 through December 15, 2020. A Bayesian negative binomial model was fit to estimate daily risk ratios (RRs) and posterior intervals (PIs) comparing rates by gubernatorial party affiliation. The analyses adjusted for state population density, rurality, census region, age, race, ethnicity, poverty, number of physicians, obesity, cardiovascular disease, asthma, smoking, and presidential voting in 2020. RESULTS: From March to early June, Republican-led states had lower COVID-19 incidence rates compared to Democratic-led states. On June 3, the association reversed, and Republican-led states had higher incidence (RR=1.10, 95% PI=1.01, 1.18). This trend persisted through early December. For death rates, Republican-led states had lower rates early in the pandemic, but higher rates from July 4 (RR=1.18, 95% PI=1.02, 1.31) through mid-December. Republican-led states had higher test positivity rates starting on May 30 (RR=1.70, 95% PI=1.66, 1.73) and lower testing rates by September 30 (RR=0.95, 95% PI=0.90, 0.98). CONCLUSION: Gubernatorial party affiliation may drive policy decisions that impact COVID-19 infections and deaths across the US. Future policy decisions should be guided by public health considerations rather than political ideology.

Stay-at-home orders and firearms in the United States during the COVID-19 pandemic.

Firearms are a leading cause of death and injury in the United States, and this trend has continued during the COVID-19 pandemic. We sought to identify whether states designated gun retailers as essential businesses in their stay-at-home orders and characterize other references that could affect firearm acquisition during the COVID-19 pandemic. In this cross-sectional policy review, we assessed stay-at-home orders issued in March or April 2020. Orders were reviewed in their entirety, and any reference to firearms, firearm retailers, shooting ranges, or other relevant elements was documented. Forty-three states and the District of Columbia issued stay-at-home orders. Most considered federal firearm licensees to be among essential businesses or made provisions for them to remain open during widespread business closures. Others referenced the US Department of Homeland Security's Cybersecurity and Infrastructure Security Agency (CISA) advisory memorandum on essential critical infrastructure workers which named workers supporting firearm manufacturing and retail among essential workers. Therefore, stay-at-home orders issued in most states included provisions for firearms retailers to remain open, at least in some capacity. Only four states and the District of Columbia did not include federal firearms licensees among essential businesses or include provisions for them to be open. Meanwhile, an all-time high in firearm background checks indicates firearm sales have markedly increased. Given the associations between firearm access and injury risk, the effects of continued firearm access facilitated by these orders should be the focus of future research.