Social Networks, Health Information Sharing, and Pandemic Perceptions among Young Adults in Hawai'i during the COVID-19 Pandemic.

Limited information exists about social network variation and health information sharing during COVID-19, especially for Native Hawaiians (NH), Other Pacific Islanders (OPI), and Filipinos, who experienced COVID-19 inequities. Hawai'i residents aged 18-35 completed an online survey regarding social media sources of COVID-19 information and social network health information measured by how many people participants: (1) talked to and (2) listened to about health. Regression models were fit with age, gender, race/ethnicity, chronic disease status, pandemic perceptions, and health literacy as predictors of information sources (logistic) and social network size (Poisson). Respondents were 68% female; 41% NH, OPI, or Filipino; and 73% conducted a recent COVID-19 digital search for themselves or others. Respondents listened to others or discussed their own health with ~2-3 people. Respondents who talked with more people about their health were more likely to have larger networks for listening to others. In regression models, those who perceived greater risk of acquiring COVID-19 discussed their health with more people; in discussing others' health, women and those with chronic diseases listened to a greater number. Understanding young adults' social networks and information sources is important for health literacy and designing effective health communications, especially to reach populations experiencing health inequities.

COVID-19 excess deaths in Eastern European countries associated with weaker regulation implementation and lower vaccination coverage.

Background: Since winter 2020, excess deaths due to COVID-19 have been higher in Eastern Europe than most of Western Europe, partly because regulatory enforcement was poor. Methods: This paper analysed data from 50 countries in the WHO European Region, in addition to data from USA and Canada. Excess mMortality and vaccination data were retrieved from "Our World In Data" and regulation implementation was assessed using standard methods. Multiple linear regression was used to assess the association between mortality and each covariate. Results: Excess mortality increased by 4.1 per 100 000 (P = 0.038) for every percentage decrease in vaccination rate and with 6/100 000 (p=0.011) for every decreased unit in the regulatory implementation score a country achieved in the Rule of Law Index. Conclusion: Degree of regulation enforcement, likely including public health measure enforcement, may be an important factor in controlling COVID-19's deleterious health impacts.

Next Gen Hawai'i: Collaborative COVID-19 Social Media Initiative to Engage Native Hawaiian, Other Pacific Islander, and Filipino Youth.

The Next Gen Hawai'i social media project was initiated in the fall of 2020 to address ongoing public health concerns and the need for accessible and reliable information across Hawai'i's diverse communities by strategically amplifying the voices of Hawai'i's youth in their Native languages. The collaborative effort arose from conversations within the Hawai'i's Native Hawaiian & Pacific Islander COVID-19 Response, Recovery, and Resilience Team, composed of diverse public and private organizations involved in statewide COVID-19 response efforts for Native Hawaiian and Pacific Islander communities. Next Gen Hawai'i's focus was on Native Hawaiian, Pacific Islander, Filipino, and other populations disproportionately suffering from COVID-19. Five social media platforms were developed to spread messaging to youth and young adults about COVID-19. Public Health Ambassadors (from high school to young adults) were recruited and engaged to create culturally and linguistically rooted messaging to promote public health and prevention-based social norms. This strength-based approach recognized youth as important community leaders and ambassadors for change and empowered them to create content for dissemination on platforms with national and global reach. Messaging was designed to build individual, community, and digital health literacy while integrating core cultural values and strengths of Native Hawaiian, Pacific Islander, and Filipino communities. Over 250 messages have been delivered across Next Gen Hawai'i social media channels on topics including vaccine information, mask-wearing, staying together over distances, mental health, and in-languages resources in Chuukese, Chamorro, Marshallese, Samoan, Hawaiian, Ilocano, Tagalog, and other Pacific-basin languages. Reach has included more than 75 000 views from various social media channels, media features, successful webinars, and relevant conference presentations. This Public Health Insights article provides an overview of Next Gen Hawai'i's activities and achievements as well as lessons learned for other youth-focused public health social media campaigns and organizations.

Disaggregating Data to Measure Racial Disparities in COVID-19 Outcomes and Guide Community Response - Hawaii, March 1, 2020-February 28, 2021.

Native Hawaiian and Pacific Islander populations have been disproportionately affected by COVID-19 (1-3). Native Hawaiian, Pacific Islander, and Asian populations vary in language; cultural practices; and social, economic, and environmental experiences,† which can affect health outcomes (4).§ However, data from these populations are often aggregated in analyses. Although data aggregation is often used as an approach to increase sample size and statistical power when analyzing data from smaller population groups, it can limit the understanding of disparities among diverse Native Hawaiian, Pacific Islander, and Asian subpopulations¶ (4-7). To assess disparities in COVID-19 outcomes among Native Hawaiian, Pacific Islander, and Asian populations, a disaggregated, descriptive analysis, informed by recommendations from these communities,** was performed using race data from 21,005 COVID-19 cases and 449 COVID-19-associated deaths reported to the Hawaii State Department of Health (HDOH) during March 1, 2020-February 28, 2021.†† In Hawaii, COVID-19 incidence and mortality rates per 100,000 population were 1,477 and 32, respectively during this period. In analyses with race categories that were not mutually exclusive, including persons of one race alone or in combination with one or more races, Pacific Islander persons, who account for 5% of Hawaii's population, represented 22% of COVID-19 cases and deaths (COVID-19 incidence of 7,070 and mortality rate of 150). Native Hawaiian persons experienced an incidence of 1,181 and a mortality rate of 15. Among subcategories of Asian populations, the highest incidences were experienced by Filipino persons (1,247) and Vietnamese persons (1,200). Disaggregating Native Hawaiian, Pacific Islander, and Asian race data can aid in identifying racial disparities among specific subpopulations and highlights the importance of partnering with communities to develop culturally responsive outreach teams§§ and tailored public health interventions and vaccination campaigns to more effectively address health disparities.

Health Literacy, Digital Health Literacy, and COVID-19 Pandemic Attitudes and Behaviors in U.S. College Students: Implications for Interventions.

The COVID-19 pandemic has been accompanied by rapidly emerging evidence, changing guidance, and misinformation, which present new challenges for health literacy (HL) and digital health literacy (DHL) skills. This study explored whether COVID-19-related information access, attitudes, and behaviors were associated with health literacy and digital health literacy among college students in the United States. Self-reported measures of health literacy, along with items on pandemic-related attitudes, behaviors, information sources, and social networks, were collected online using a managed research panel. In July 2020, 256 responses were collected, which mirrored the racial/ethnic and gender diversity of U.S. colleges. Only 49% reported adequate HL, and 57% found DHL tasks easy overall. DHL did not vary by HL level. In multivariable models, both HL and DHL were independently associated with overall compliance with basic preventive practices. Higher DHL, but not HL, was significantly associated with greater willingness to get a COVID-19 vaccine and the belief that acquiring the disease would negatively impact their life. On average, respondents discussed health with 4-5 people, which did not vary by HL or DHL measures. The usage of online information sources varied by HL and DHL. The study findings can inform future student-focused interventions, including identifying the distinct roles of HL and DHL in pandemic information access, attitudes, and behaviors.

Health promotion preparedness for health crises - a 'must' or 'nice to have'? Case studies and global lessons learned from the COVID-19 pandemic.

The current COVID-19 pandemic has exposed missing links between health promotion and national/global health emergency policies. In response, health promotion initiatives were urgently developed and applied around the world. A selection of case studies from five countries, based on the Socio-Ecological Model of Health Promotion, exemplify 'real-world' action and challenges for health promotion intervention, research, and policy during the COVID-19 pandemic. Interventions range from a focus on individuals/families, organizations, communities and in healthcare, public health, education and media systems, health-promoting settings, and policy. Lessons learned highlight the need for emphasizing equity, trust, systems approach, and sustained action in future health promotion preparedness strategies. Challenges and opportunities are highlighted regarding the need for rapid response, clear communication based on health literacy, and collaboration across countries, disciplines, and health and education systems for meaningful solutions to global health crises.

Reinventing health promotion for healthy default beverage laws in the face of COVID-19.

Shortly after a healthy default beverage (HDB) law took effect in Hawai'i, requiring restaurants that serve children's meals to offer healthy beverages with the meals, the COVID-19 pandemic struck. Efforts to contain the virus resulted in changes to restaurants' operations and disrupted HDB implementation efforts. Economic repercussions from containment efforts have exacerbated food insecurity, limited access to healthy foods, and created obstacles to chronic disease management. Promoting healthy default options is critical at a time when engaging in healthy behaviors is difficult, but important, to both prevent and manage chronic disease and decrease COVID-19 risk. This commentary discusses COVID-19's impact on restaurant operations and healthy eating, and the resulting challenges and opportunities for this promising health promotion intervention.

The lower COVID-19 related mortality and incidence rates in Eastern European countries are associated with delayed start of community circulation.

BACKGROUND: The purpose of this analysis was to assess the variations in COVID-19 related mortality in relation to the time differences in the commencement of virus circulation and containment measures in the European Region. METHODS: The data for the current analysis (N = 50 countries) were retrieved from the John Hopkins University dataset on the 7th of May 2020, with countries as study units. A piecewise regression analysis was conducted with mortality and cumulative incidence rates introduced as dependent variables and time interval (days from the 22nd of January to the date when 100 first cases were reported) as the main predictor. The country average life expectancy at birth and outpatient contacts per person per year were statistically adjusted for in the regression model. RESULTS: Mortality and incidence were strongly and inversely intercorrelated with days from January 22, respectively -0.83 (p<0.001) and -0.73 (p<0.001). Adjusting for average life expectancy and outpatients contacts per person per year, between days 33 to 50 from the 22nd of the January, the average mortality rate decreased by 30.1/million per day (95% CI: 22.7, 37.6, p<0.001). During interval 51 to 73 days, the change in mortality was no longer statistically significant but still showed a decreasing trend. A similar relationship with time interval was found for incidence. Life expectancy and outpatients contacts per person per year were not associated with mortality rate. CONCLUSION: Countries in Europe that had the earliest COVID-19 circulation suffered the worst consequences in terms of health outcomes, specifically mortality. The drastic social isolation measures, quickly undertaken in response to those initial outbreaks appear effective, especially in Eastern European countries, where community circulation started after March 11th. The study demonstrates that efforts to delay the early spread of the virus may have saved an average 30 deaths daily per one million inhabitants.

Organizational Health Literacy: Opportunities for Patient-Centered Care in the Wake of COVID-19.

BACKGROUND AND OBJECTIVES: The coronavirus disease-2019 (COVID-19) pandemic is transforming the health care sector. As health care organizations move from crisis mobilization to a new landscape of health and social needs, organizational health literacy offers practical building blocks to provide high-quality, efficient, and meaningful care to patients and their families. Organizational health literacy is defined by the Institute of Medicine as "the degree to which an organization implements policies, practices, and systems that make it easier for people to navigate, understand, and use information and services to take care of their health." METHODS: This article synthesizes insights from organizational health literacy in the context of current major health care challenges and toward the goal of innovation in patient-centered care. We first provide a brief overview of the origins and outlines of organizational health literacy research and practice. Second, using an established patient-centered innovation framework, we show how the existing work on organizational health literacy can offer a menu of effective, patient-centered innovative options for care delivery systems to improve systems and outcomes. Finally, we consider the high value of management focusing on organizational health literacy efforts, specifically for patients in health care transitions and in the rapid transformation of care into myriad distance modalities. RESULTS: This article provides practical guidance for systems and informs decisions around resource allocation and organizational priorities to best meet the needs of patient populations even in the face of financial and workforce disruption. CONCLUSIONS: Organizational health literacy principles and guidelines provide a road map for promoting patient-centered care even in this time of crisis, change, and transformation. Health system leaders seeking innovative approaches can have access to well-established tool kits, guiding models, and materials toward many organizational health literacy goals across treatment, diagnosis, prevention, education, research, and outreach.

Interdisciplinary Perspectives on Health Literacy Research Around the World: More Important Than Ever in a Time of COVID-19.

As we write our editorial for a health literacy special issue in the midst of the international COVID-19 crisis, we take this opportunity to highlight the importance of individual, community, and population health literacy. We are not only in a "pandemic" but also an "infodemic". Health literacy is more important than ever in the face of these global health threats, which have impacted outcomes across the levels of the socio-ecological model (SEM), including individual health behaviors, family relationships, organizational behavior, state policy-making, national mortality statistics, and the international economy in the span of weeks. Our special issue sought to pull together interdisciplinary threads guided by two principles. The first was defining health literacy as essential skills and situational resources needed for people to find, understand, evaluate, communicate, and use information and services in a variety of forms across various settings throughout their life course to promote health and wellbeing. The second was the idea that enhancing health literacy in populations and systems is critical to achieving health equity. In this time of public health need across traditional borders, the inter-sectoral and international perspectives of special issue articles are more urgent than ever. A greater understanding, appreciation, and application of health literacy can support policy action on multiple levels to address major public health challenges. Health literacy should be built deliberately as a population-level resource and community asset. We have summarized the set of articles in this special issue across the levels of the SEM, hoping their thoughtful considerations and interesting findings will help to support global health and wellness and inspire future research, policy, and practice in this global public health emergency and beyond.