Prevalence of food insecurity and its association with depressive and anxiety symptoms in older adults during the COVID-19 pandemic in Mexico: A secondary analysis of ENCOVID-19 survey.

Introduction: COVID-19 infection has caused high rates of morbi-mortality in older adults (OAs). In addition, conditions such as depression, anxiety, unemployment, and poverty frequently contribute to this population being at higher risk of food insecurity (FI) during the COVID-19 pandemic. Objective: This study aimed to analyze the prevalence of FI and its association with depressive and anxiety symptoms in Mexican OAs during the COVID-19 pandemic. Methods: This study involved a secondary analysis of the National Survey on the Effects of COVID-19 on the Wellbeing of Mexican Households (ENCOVID-19), a series of cross-sectional telephone surveys conducted between April and October 2020. The OA subsample was 1,065. FI was measured by using the Latin American and Caribbean Food Security Scale (ELCSA), and depression and anxiety symptoms were measured by using the Depression Scale of the Center for Epidemiological Studies (CESD-7) and the Generalized Anxiety Disorder Scale (GAD-2), respectively. Socioeconomic status (SES), occupation, schooling, and pension were also evaluated. ANOVA was used to compare the variables between the different FI groups, and logistic regression was used to analyze the risk between FI and the anxiety and depression variables. Results: The mean age of the participants was 67.31 ± 6.4 years, and FI was classified as mild, moderate, and severe, with prevalences of 38.6, 15.04, and 8.16%, respectively. Overall, 28.01% of the OAs presented symptoms of anxiety and 39.09% of depression. In the comparison between groups, a higher prevalence of depressive symptoms was observed with a higher degree of FI, with 65.75% in moderate-to-severe, 10.39% in mild, and 9.40% without FI, p ≤ 0.000. Regarding anxiety symptoms, 48% of the OAs showed moderate-to-severe, 30.05% showed mild, and 15.38% were without FI, p ≤ 0.000. Using multiple logistic regression, an OR of 5.50 (95% CI 2.74-11.04) was observed for depressive symptoms when moderate-to-severe FI is present. In the case of the risk of anxiety symptoms, it was significant in all degrees of FI, in mild (OR = 2.43, 95% CI 1.66-3.59) and in moderate-to-severe (OR = 5.32, 95% CI 3.45-8.19). Conclusion: There is a high prevalence of FI in Mexican OAs during the COVID-19 pandemic. FI increases the risk of other conditions such as depression and anxiety. It is important to design and implement programs aimed at OAs with these conditions to reduce or prevent FI.

Adaptation of a community health outreach model during the COVID-19 pandemic: The case of the Mexican Consulates in the United States of America (preprint)

The Ventanillas de Salud (VDS – “Health Windows”) are a culturally sensitive outreach program within the 49 Mexican Consulates in the United States that provides information and health care navigation support to underserved and uninsured Mexican immigrants. During the COVID-19 pandemic the VDS rapidly transitioned to remote operations adding new services. Based on the EquIR implementation framework, this qualitative study investigates from an equity perspective how adaptations to improve emergency preparedness were performed. We conducted motivational interviews with three actors – six VDS coordinators, eight partner organizations, and ten VDS users– to document specific needs of the target population and identify implementation processes to adapt and continue outreach services. The VDS adapted their model by adding new services for emerging needs, by switching service provision modalities, and by expanding the network of partner organizations. According to the VDS staff, these adaptations increased their topics, depth, reach, and diversified their users. Users had mostly positive opinions about the VDS adaptation, although they highlighted some heterogeneity across service provision. The VDS is a public health intervention able to serve a marginalized population and its implementation offers valuable lessons to complement health systems and to improve preparedness and resiliency for future crises.

Associations of the COVID-19 Pandemic With Social Wellbeing Indicators in Mexico (preprint)

Background: Public health measures for COVID-19 containment have implied economic and social life disruptions, which have been particularly deleterious in low- and middle-income countries (LMIC) due to high rates of informal employment, overcrowding, and barriers to accessing health services, amongst others social determinants. Mexico, a LMIC, is a country with a high COVID-19 mortality in which there has been a very limited governmental response to help mitigate such COVID-related disruptions. This study analyzes the association of the first wave of the COVID-19 crisis in Mexico with four wellbeing indicators: income, employment, anxiety, and food security. Methods: : It uses pooled cross-sectional data (n=5,453) of five monthly nationally representative surveys collected between April and August 2020. Probit models are estimated to assess the association of the pandemic with job loss and anxiety; a multinomial logistic regression is estimated for food security, and an ordinary least squares regression assesses the association between the pandemic and changes in household’s income. Results: : Females were significantly associated with worse outcomes for the 4 wellbeing measures with an average reduction of 2.3% in household income compared to pre-COVID-19 levels, an increased probability (6.4 pp) if being in a household that had lost jobs, decreased probability of food security (6.9 pp), and an increased risk of anxiety symptoms (8.5 pp). In addition, those with lower SES and household with children also reported worse outcomes for employment, income and food security. The month variable was also statistically significant in these models suggesting that as more months of the pandemic elapsed the effects persisted. Conclusion: The currents study documents hos the COVID-19 pandemic is associated with different wellbeing indicators in a LMIC. It suggests the urgent need to take actions to support vulnerable groups, particularly women, households with children and those in the lowest SES. If policy actions are not taken, the pandemic will increase social and gender disparities, and will jeopardize childhood development

Breastfeeding Media Coverage and Beliefs During the COVID-19 Pandemic in Mexico: Implications for Breastfeeding Equity. (preprint)

Background: Breastfeeding offers short- and long- term health benefits to mothers and children and constitutes a priority for public health. Evidence shows that SARS-CoV-2 is not likely to be transmitted via breastmilk. Moreover, antibodies against SARS-CoV-2 are presumably contained in breastmilk of mothers with history of COVID-19 infection or vaccination. Direct breastfeeding is the preferred infant feeding option during the pandemic, but conflicting practices have been adopted, which could widen existing disparities in breastfeeding. This study aims to describe how was information about breastfeeding communicated in Mexican media during the pandemic and assess Mexican adults’ beliefs regarding breastfeeding among mothers infected with COVID-19.Methods: A retrospective content analysis of media coverage on breastfeeding in Mexico between March 1 and September 24, 2020, excluding advertisements, was done. For the content analysis, both a sentiment analysis and an analysis based on strengths, weaknesses, opportunities and threats for breastfeeding promotion were performed. Also, we incorporated a descriptive analysis from the July 2020 wave of the ENCOVID-19 survey, which included questions on beliefs about breastfeeding. This information was stratified by gender, age, and socioeconomic status.Results: 1014 publications on breastfeeding were identified in internet, newspapers, TV, and magazines. Most information was published during World Breastfeeding Week, celebrated in August. Based on the sentiment analysis, 57.2% of all information was classified as positive, and based on the SWOT analysis, most information was classified either as strengths or opportunities for breastfeeding promotion. However, the ENCOVID-19 data showed that 67.3% of people living in households with children under 3 years of age believe that mothers with COVID-19 should not breastfeed, and 19.8% stated that they simply didn’t know. These beliefs showed differences both by gender and by socioeconomic status.Conclusions: While the Mexican government endorsed the recommendations on breastfeeding during the COVID-19 pandemic, communication of those messages was sporadic, inconstant and unequal across types of media. Moreover, there were also negative messages for breastfeeding circulating on the media. There continues to be a widespread notion that mothers with COVID-19 should not breastfeed and, due to differences on beliefs by socioeconomic status, health inequities could be exacerbated.

Monthly prevalence of generalized anxiety disorder during the COVID-19 pandemic in Mexico (preprint)

AbstractObjective: Estimate the prevalence of generalized anxiety disorder (GAD) from April to June 2020. Methods: Repeated cross-sections design based in the ENCOVID-19 – a series of monthly mobile surveys with representative samples of Mexico (N= 833- 1,674). The questionnaire includes the GAD-2 scale, and, in July, the GAD-7 scale was added; we examined its internal validity with confirmatory factor analysis and its concurrent validity with sociodemographic variables. Using GAD-7 as criterion, we analyzed the predictive validity of the GAD-2. We estimated the monthly prevalence with the GAD-2. Results: The GAD-7 and the GAD-2 are reliable and valid. The GAD-2 has a sensitivity of 0.87 and a specificity of 0.90. The monthly prevalence remains high and stable, between 30.7 and 32.6%. GAD concentrated in women, unemployed and persons with low socioeconomic status. Conclusions: GAD is a public health problem that worsened during the COVID-19 pandemic. Resumen Objetivo: Estimar la prevalencia de ansiedad generalizada (GAD) entre abril y junio de 2020. Material y Métodos: Diseño transversal repetido basado en la ENCOVID-19 –serie de encuestas telefónicas mensuales con muestras representativas de México (N= 833- 1,674). El cuestionario incluye la escala GAD-2 y en julio se añadió la GAD-7; se examinó su validez interna con análisis factorial confirmatorio y su validez concurrente con variables sociodemográficas. Con la GAD-7 como criterio, se calculó la validez predictiva de la GAD-2. Se estimó la prevalencia mensual con la GAD-2. Resultados: La GAD-7 y la GAD-2 son confiables y válidas. La GAD-2 tiene una sensibilidad de 0.87 y una especificidad de 0.90. La prevalencia mensual se mantuvo alta y estable, entre 30.7 y 32.6%. El GAD se concentró en mujeres, personas desocupadas y de bajo nivel socioeconómico. Conclusiones: El GAD es un problema de salud pública que se agravó con la pandemia por COVID-19.

Measurement lessons of a repeated cross-sectional household food insecurity survey during the COVID-19 pandemic in Mexico (preprint)

Objective To validate the telephone modality of the Latin American and Caribbean Food Security Scale (ELCSA) included in three waves of a phone survey to estimate the monthly household food insecurity (HFI) prevalence during the COVID-19 pandemic in Mexico. Design We examined the reliability and internal validity of the ELCSA scale in three repeated waves of a cross-sectional surveys with Rasch models. We estimated the monthly prevalence of food insecurity in the general population and in households with and without children, and compared them with a national 2018 survey. We tested concurrent validity by testing associations of HFI with socioeconomic status and anxiety. Setting ENCOVID-19 is a monthly telephone cross-sectional survey collecting information on the well-being of Mexican households during the pandemic lockdown. Surveys used probabilistic samples and we used data from April (n=833), May (n=850), and June 2020 (n=1,674). Participants Mexicans 18 years or older who had a mobile telephone. Results ELCSA had adequate model fit and HFI was associated, within each wave, with more poverty and anxiety. The COVID-19 lockdown was associated with an important reduction in food security; decreasing stepwise from 38.9% in 2018 to 24.9% in June 2020 in households with children. Conclusions Telephone surveys are a feasible strategy to monitor food insecurity with ELCSA.