Public trust is earned: Historical discrimination, carceral violence, and the COVID-19 pandemic.

OBJECTIVE: To assess whether knowledge of Tuskegee, the U.S. Immigration and Customs Enforcement (ICE) agency's detainment of children, and satisfaction with the George Floyd death investigation were associated with trust in actors involved in the development and distribution of coronavirus vaccines. DATA SOURCES AND STUDY SETTING: National survey with a convenience sample of Black (n = 1019) and Hispanic (n = 994) adults between July 1 and 26, 2021. STUDY DESIGN: Observational study using stratified adjusted logistic regression models to measure the association between ratings of the trustworthiness of actors involved in the development and distribution of coronavirus vaccines. PRINCIPAL FINDINGS: Among Black respondents, lower satisfaction with the George Floyd death investigation was associated with lower trustworthiness ratings of pharmaceutical companies (ME: -0.09; CI: -0.15, 0.02), the FDA (ME: -0.07; CI: -0.14, -0.00), the Trump Administration (ME: -0.09; CI: -0.16, -0.02), the Biden Administration (ME: -0.07, CI: -0.10, 0.04), and elected officials (ME: -0.10, CI: -0.18, -0.03). Among Hispanic respondents, lower satisfaction was associated with lower trustworthiness ratings of the Trump Administration (ME: -0.14, CI: -0.22, -0.06) and elected officials (ME: -0.11; CI: -0.19, -0.02). Greater knowledge of ICE's detainment of children and families among Hispanic respondents was associated with lower trustworthiness ratings of state elected officials (ME: -0.09, CI: -0.16, 0.01). Greater knowledge of the US Public Health Service Study of Syphilis in Tuskegee was associated with higher trustworthiness ratings of their usual source of care (ME: 0.09; CI: 0.28, 0.15) among Black respondents (ME: 0.09; CI: 0.01, 0.16). CONCLUSIONS: Among Black respondents, lower satisfaction with the George Floyd death investigation was associated with lowered levels of trust in pharmaceutical companies, some government officials, and administrators; it was not associated with the erosion of trust in direct sources of health care delivery, information, or regulation. Among Hispanic respondents, greater knowledge of the ICE detainments was associated with lower trustworthiness ratings of elected state officials. Paradoxically, higher knowledge of the Study of Syphilis in Tuskegee was associated with higher trustworthiness ratings in usual sources of care.

Disparities in Telemedicine Use Among Louisiana Medicaid Beneficiaries During the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic led to an increased reliance on telemedicine. Whether this exacerbated existing disparities within vulnerable populations is not yet known. OBJECTIVES: Characterize changes in outpatient telemedicine evaluation and management (E&M) services for Louisiana Medicaid beneficiaries by race, ethnicity, and rurality during the COVID-19 pandemic. RESEARCH DESIGN: Interrupted time series regression models estimated pre-COVID-19 trends and changes in E&M service use at the April and July 2020 peaks in COVID-19 infections in Louisiana and in December 2020 after those peaks had subsided. SUBJECTS: Louisiana Medicaid beneficiaries continuously enrolled between January 2018 and December 2020 who were not also enrolled in Medicare. MEASURES: Monthly outpatient E&M claims per 1000 beneficiaries. RESULTS: Prepandemic differences in service use between non-Hispanic White and non-Hispanic Black beneficiaries narrowed by 34% through December 2020 (95% CI: 17.6%-50.6%), while differences between non-Hispanic White and Hispanic beneficiaries increased by 10.5% (95% CI: 0.1%-20.7%). Non-Hispanic White beneficiaries used telemedicine at higher rates than non-Hispanic Black (difference=24.9 claims per 1000 beneficiaries, 95% CI: 22.3-27.4) and Hispanic beneficiaries (difference=42.3 claims per 1000 beneficiaries, 95% CI: 39.1-45.5) during the first wave of COVID-19 infections in Louisiana. Telemedicine use increased slightly for rural beneficiaries compared with urban beneficiaries (difference=5.3 claims per 1000 beneficiaries, 95% CI: 4.0-6.6). CONCLUSIONS: The COVID-19 pandemic narrowed gaps in outpatient E&M service use between non-Hispanic White and non-Hispanic Black Louisiana Medicaid beneficiaries, though gaps in telemedicine use emerged. Hispanic beneficiaries experienced large reductions in service use and relatively small increases in telemedicine use.

Comparison of Screening Mammogram Rates Before vs During the COVID-19 Pandemic Among Medicaid Beneficiaries in Louisiana.

This cohort study investigates differences in screening mammography before vs during the COVID-19 pandemic by race and ethnicity among Medicaid beneficiaries in Louisiana.

Pre-COVID-19 Disparities in Telemedicine Use Among Louisiana Medicaid Beneficiaries.

Background: We examine trends in telemedicine use by race, geography, and age among Louisiana Medicaid beneficiaries in the months preceding the COVID-19 pandemic. Methods: Using Louisiana Medicaid claims data from January 2018 through February 2020, we calculated a relative ratio of telemedicine use as the share of telemedicine claims by race, age, and geography and conducted two-sample t-tests. Results: In 2018, White beneficiaries used telemedicine at a relative ratio of 1.92 compared with Black beneficiaries (p < 0.001) and 2.02 compared with Hispanic beneficiaries (p < 0.001). Rural beneficiaries used telemedicine at a relative ratio of 1.27 (p < 0.001) compared with urban beneficiaries. Children and adolescents used telemedicine at a higher rate than other age groups. Racial and geographic disparities narrowed in the first months of 2020. Conclusions: Telemedicine use in Louisiana Medicaid was low but growing before the pandemic with narrowing disparities by race and geography and emerging disparities by age.

COVID-19 and Routine Childhood and Adolescent Immunizations: Evidence from Louisiana Medicaid.

The COVID-19 pandemic disrupted routine vaccinations for children and adolescents. However, it remains unclear whether the impact has been different for children and adolescents from low-income families. To address this, we compared monthly routine vaccination use per 1000 vaccine-eligible children and adolescents enrolled in Louisiana Medicaid in the years before (2017-2019) and during the COVID-19 pandemic (2020). Compared to the 2017-2019 average vaccination rates, we found a 28% reduction in measles, mumps, and rubella (MMR), a 35% reduction in human papillomavirus (HPV), and a 30% reduction in tetanus, diphtheria, pertussis (Tdap) vaccinations in 2020. Vaccine uptake was lower in April 2020 after the declaration of a state of emergency and in late summer when back-to-school vaccinations ordinarily occur. We found little evidence of recovery in later months. Our findings suggest that a substantial number of disadvantaged children may experience longer periods of vulnerability to preventable infections because of missed vaccinations.

Making Equity the Priority

In 2016, public health leaders from the US Department of Health and Human Services began highlighting a concept called Public Health 3.0.1 Their idea was that the modern age of public health (Public Health 1.0) began around the dawn of the 20th century when scientists significantly advanced understanding of infectious diseases and developed vaccines and antibiotics to address them. The second wave-Public Health 2.0-was kicked off by the Institute of Medicine's 1988 report The Future of Public Health.2 Following that report, we saw the expansion of governmental agencies to coordinate and manage the public's health, organizations that have played a critical part in the response to COVID-19. Public Health 3.0 recognized that although individual behaviors drive health status, the physical and social determinants of those behaviors (neighborhood safety, education, availability of reliable transportation, quality of housing, and more) drive those behaviors.

Vulnerability and Resilience: Use and Misuse of These Terms in the Public Health Discourse

What are the hidden assumptions behind labeling a population as "vulnerable," and what are subsequent implications for targets for intervention? [...]what are the potential public health pitfalls, particularly when referring to racial/ethnic groups experiencing health inequities as "vulnerable communities," commonly in opposition to "resilient" (often in terms of "building resiliency")? [...]health inequities occurring along lines of race and ethnicity, class and socioeconomic status, sexual orientation and gender identity, immigration and documentation status, or place of residence (rural vs urban) have been well documented.4 However, labeling some groups as "vulnerable" may also lead to internalization of stereotypes among group members, which may unintentionally lead to increased disease risk through fatalism and diminished selfefficacy, and as such could be detrimental to health equity.5 For instance, stigmatizing public health messages may have resulted in beliefs about the inevitability of HIV infection, overestimation of risk, and fear among gay men in the United States, particularly during the 1990s, leading to internalized homophobia, worse mental health, and increased risk-taking.6 Another consequence of vulnerability labeling is masking health inequities in communities that are not considered "vulnerable," making it difficult for those groups to advocate for health protective resources. [...]the greater prevalence of underlying health conditions among non-Whites likely has contributed to increased biological susceptibility to severe disease, contributing to greater hospitalization risk.11 These existing racial/ethnic inequities in health represent population-level socially induced biological susceptibility created by the unjust distribution of hazards inimical to health versus health-protective factors occurring systematically along racial/ethnic lines (social determinants of health, including structural and personally mediated racism).12 For example, hazardous air pollution, which is worse in areas with greater percentages of Black or African American residents,10 increases the population-level risk of chronic diseases that have been shown to result in greater susceptibility to severe COVID-19.13 Racism is a unique source of threat, and a social toxin that can also more directly increase biological susceptibility. Research shows that racism compromises biological systems engaged in the stress response;repeated experiences of racism accumulate and result in "weathering," or premature physiological deterioration caused by the body being continually challenged.14 Racism has been shown to lead to accelerated aging at the cellular level, as indicated by the length of telomeres-repetitive sequences of DNA capping the ends of chromosomes that generallyshorten with age.14Telomere length is considered to be a marker of replicative history and cumulative biological "wear and tear";as an indicator of systemic aging, it has been linked to increased disease susceptibility and severity for a range of aging-related diseases, as well as mortality.14 Other research has shown that persistent exposure to racism is associated with greater allostatic load, a multisystem metric of biological dysregulation, as well as DNA methylation patterns reflective of accelerated epigenetic aging.14These studies indicate that racism becomes biologically embedded and thus plays a profound role in the creation of susceptibility.

Vicarious Racism and Vigilance During the COVID-19 Pandemic: Mental Health Implications Among Asian and Black Americans.

OBJECTIVES: Experiences of vicarious racism-hearing about racism directed toward one's racial group or racist acts committed against other racial group members-and vigilance about racial discrimination have been salient during the COVID-19 pandemic. This study examined vicarious racism and vigilance in relation to symptoms of depression and anxiety among Asian and Black Americans. METHODS: We used data from a cross-sectional study of 604 Asian American and 844 Black American adults aged ≥18 in the United States recruited from 5 US cities from May 21 through July 15, 2020. Multivariable linear regression models examined levels of depression and anxiety by self-reported vicarious racism and vigilance. RESULTS: Controlling for sociodemographic characteristics, among both Asian and Black Americans, greater self-reported vicarious racism was associated with more symptoms of depression (Asian: ß = 1.92 [95% CI, 0.97-2.87]; Black: ß = 1.72 [95% CI, 0.95-2.49]) and anxiety (Asian: ß = 2.40 [95% CI, 1.48-3.32]; Black: ß = 1.98 [95% CI, 1.17-2.78]). Vigilance was also positively related to symptoms of depression (Asian: ß = 1.54 [95% CI, 0.58-2.50]; Black: ß = 0.90 [95% CI, 0.12-1.67]) and anxiety (Asian: ß = 1.98 [95% CI, 1.05-2.91]; Black: ß = 1.64 [95% CI, 0.82-2.45]). CONCLUSIONS: Mental health problems are a pressing concern during the COVID-19 pandemic. Results from our study suggest that heightened racist sentiment, harassment, and violence against Asian and Black Americans contribute to increased risk of depression and anxiety via vicarious racism and vigilance. Public health efforts during this period should address endemic racism as well as COVID-19.

Observing an Anniversary: The 400 Years of Inequality Project

The 400 Years of Inequality Project was launched in 2016 by five partner organizations: the University of Orange, a people's university in Orange, New Jersey;the New School and Columbia University's Mailman School of Public Health, both in New York City;ONE DC, a Washington, DC-based organization working to advance racial and economic equity;and, Voices of a People's History, a not-for-profit organization located in Brooklyn, New York, that increases awareness of US history through public readings of historical speeches and other texts. AtTulane University's School of Public Health and Tropical Medicine, faculty, students, and community representatives discussed concerns related to mass incarceration. The School of Public Health at Boston University hosted a symposium on racism in housing and education, exhibited the 400 Years of Inequality Timeline in its Activist Lab (a venue for developing innovative ways to dismantle the injustices that produce and sustain inequities), and convened storytelling sessions on the topic of inequality with artist-in-residence RhodessaJones.