Overview and Methods for the Youth Risk Behavior Surveillance System - United States, 2021.

The Youth Risk Behavior Surveillance System (YRBSS) is the largest public health surveillance system in the United States, monitoring a broad range of health-related behaviors among high school students. The system includes a nationally representative Youth Risk Behavior Survey (YRBS) and separate school-based YRBSs conducted by states, tribes, territories, and local school districts. In 2021, these surveys were conducted during the COVID-19 pandemic. The pandemic underscored the importance of data in understanding changes in youth risk behaviors and addressing the multifaceted public health needs of youths. This overview report describes 2021 YRBSS survey methodology, including sampling, data collection procedures, response rates, data processing, weighting, and analyses. The 2021 YRBS participation map, survey response rates, and a detailed examination of student demographic characteristics are included in this report. During 2021, in addition to the national YRBS, a total of 78 surveys were administered to high school students across the United States, representing the national population, 45 states, two tribal governments, three territories, and 28 local school districts. YRBSS data from 2021 provided the first opportunity since the onset of the COVID-19 pandemic to compare youth health behaviors using long-term public health surveillance. Approximately half of all student respondents represented racial and ethnic minority groups, and approximately one in four identified as lesbian, gay, bisexual, questioning, or other (a sexual identity other than heterosexual) (LGBQ+). These findings reflect shifts in youth demographics, with increased percentages of racial and ethnic minority and LGBQ+ youths compared with previous YRBSS cycles. Educators, parents, local decision makers, and other partners use YRBSS data to monitor health behavior trends, guide school health programs, and develop local and state policy. These and future data can be used in developing health equity strategies to address long-term disparities so that all youths can thrive in safe and supportive environments. This overview and methods report is one of 11 featured in this MMWR supplement. Each report is based on data collected using methods presented in this overview. A full description of YRBSS results and downloadable data are available (https://www.cdc.gov/healthyyouth/data/yrbs/index.htm).

Dipeptidyl Peptidase-1 Inhibition in Patients Hospitalized with COVID-19: a Multicentre Randomized Double-Blind Placebo Controlled Trial

Background: Neutrophil serine proteases (NSPs) are involved in the pathogenesis of COVID19 and are increased in severe and fatal infection. We investigated whether treatment with Brensocatib, an inhibitor of dipeptidyl peptidase-1, an enzyme responsible for the activation of NSPs, would improve outcomes in hospitalized patients with COVID19. Method(s): In a randomized, double-blind, placebo-controlled trial, 406 hospitalized patients with COVID19 with at least one risk factor for severe disease were randomized 1:1 to once-daily Brensocatib 25mg (n=192) or placebo (n=214) for 28 days. Primary outcome was the 7-point World Health Organisation Clinical Status scale at day 29. Secondary outcomes included time to clinical improvement, national early warning score, new oxygen and ventilation use, neutrophil elastase activity in blood and mortality. Finding(s): Brensocatib treatment was associated with worse clinical status at day 29 (adjusted odds ratio 0 72, 95%CI 0 57-0 92) compared to placebo. The adjusted hazard ratio (aHR) for time to clinical improvement was 0 87 (95%CI 0 76-1 00) and time to hospital discharge was 0 98 (95%CI 0 84-1 13). During the 28-day follow-up period, 23 (11%) and 29 (15%) patients died in the placebo and Brensocatib treated groups respectively). Oxygen and new ventilation use were greater in the Brensocatib treated patients. Neutrophil elastase activity in blood was significantly reduced in the Brensocatib group from baseline to day 29. Prespecified subgroup analyses of the primary outcome supported the primary results.

EQUITY PARTNERSHIPS IN ACTION Vaccines and Public Health

During the COVID-19 pandemic, partnerships to advance equity were critical in developing and implementing vaccine allocation and distribution plans. This chapter provides an overview of one recent equity partnership focused on COVID-19 vaccination equity in Virginia. Health inequities existed among racial groups and socially vulnerable populations before the COVID-19 pandemic. The pandemic exacerbated these inequities—disproportionately and negatively affecting communities of color. The primary task of this partnership was the development of a community-based approach that ensured Virginia's vaccine allocation strategy focused on equity. The partnership's contributions and activities positively impacted Virginia's vulnerable communities. Strong equity partnerships can offer robust solutions—increasing the positive effect on socially vulnerable groups by combining resources and knowledge while focusing on a shared goal. Although much work remains in the fight against the COVID-19 pandemic, the longer-term goal is to eliminate health disparities and disparate treatment of vulnerable communities. The partnership profiled in this chapter offers an instructive example that is widely applicable. © 2023 selection and editorial matter, Elsie L. Harper-Anderson, Jay S. Albanese and Susan T. Gooden;individual chapters, the contributors.

LOWER INCIDENCE OF COVID-19 BUT HIGHER MORTALITY IN PATIENTS WITH INFLAMMATORY ARTHRITIS COMPARED TO CONTROLS IN WALES, UNITED KINGDOM: A POPULATION EPIDEMIOLOGICAL STUDY

Background/Aims To investigate whether inflammatory arthritis (rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS)) and/or their treatments predisposes patients with an increased risk of contracting COVID-19 and/or more severe infection. Methods A retrospective, population-based cohort study using linked, Welsh anonymised electronic health data from SAIL Databank, comprising primary care, secondary care, rheumatology clinic data, Office of National Statistics Mortality data and laboratory COVID-19-related datasets. Individuals aged 18 years or over who tested positive for COVID-19 in Wales for the period of analysis from 1st March 2020 to 12th May 2021 with READ Codes present for RA, PsA and AS in their primary care records formed the study population cases. The controls were individuals without IA codes present in their records. Results Over 3 million COVID-19 tests had been administered in Wales, UK during the study period. A total of 1966 IA patients and 166,602 controls had tested positive for COVID-19 and were included in analysis. The incidence rate was 3.5% (1966/56,914) for IA patients and 6% in controls (166,602/2,760,442) (Chi Square: p-value is<0.00001). Individuals with IA were older and significantly more comorbid compared to controls. Significantly more patients with IA were hospitalised (difference: 13.9%;95% CI: 12-15.8) or deceased (difference: 8%;95% CI: 6.7-9.5) following COVID-19 infection compared to controls. In a cox proportional hazard model, adjusted for significant covariates, IA was not associated with higher risk of death following COVID infection (HR: 0.42, 95% CI: 0.14 to 1.29). Significant risk factors associated with increased risk of death included shielded status (HR: 1.38, 95% CI: 1.27 to 1.50), increasing age (HR: 1.08;95% CI: 1.07-1.08), smoking (HR: 1.24;95% CI: 1.15-1.35), diabetes (HR: 1.31;95% CI: 1.22-1.41), hypertension (HR: 1.15;95% CI: 1.07-1.23), cancer (HR: 1.07;95% CI: 1.00-1.15) and previous serious infections (HR: 1.13;95% CI: 1.06-1.21) were associated with increased risk of death in IA patients compared to controls. Hospitalisations 1-year prior to COVID-19 were associated with a more than threefold increased risk of death in IA patients compared to controls (HR: 3.15;95% CI: 2.89-3.44). Conclusion Conclusion: IA patients had a lower risk of contracting COVID, probably as a result of shielding. IA was not directly associated with increased risk of death compared to controls following COVID-19 infection. Rather, being older and vulnerable with more comorbidities were associated with increased risk. This has implications on identifying individuals with IA most at risk. In addition, identifying those who were hospitalised 1-year prior to COVID-19 is a quick and economical way of identifying those most at risk from COVID-19.

Disruptions to School and Home Life Among High School Students During the COVID-19 Pandemic - Adolescent Behaviors and Experiences Survey, United States, January-June 2021.

Youths have experienced disruptions to school and home life since the COVID-19 pandemic began in March 2020. During January-June 2021, CDC conducted the Adolescent Behaviors and Experiences Survey (ABES), an online survey of a probability-based, nationally representative sample of U.S. public- and private-school students in grades 9-12 (N = 7,705). ABES data were used to estimate the prevalence of disruptions and adverse experiences during the pandemic, including parental and personal job loss, homelessness, hunger, emotional or physical abuse by a parent or other adult at home, receipt of telemedicine, and difficulty completing schoolwork. Prevalence estimates are presented for all students and by sex, race and ethnicity, grade, sexual identity, and difficulty completing schoolwork. Since the beginning of the pandemic, more than half of students found it more difficult to complete their schoolwork (66%) and experienced emotional abuse by a parent or other adult in their home (55%). Prevalence of emotional and physical abuse by a parent or other adult in the home was highest among students who identified as gay, lesbian, or bisexual (74% emotional abuse and 20% physical abuse) and those who identified as other or questioning (76% and 13%) compared with students who identified as heterosexual (50% and 10%). Overall, students experienced insecurity via parental job loss (29%), personal job loss (22%), and hunger (24%). Disparities by sex and by race and ethnicity also were noted. Understanding health disparities and student disruptions and adverse experiences as interconnected problems can inform school and community initiatives that promote adolescent health and well-being. With community support to provide coordinated, cross-sector programming, schools can facilitate linkages to services that help students address the adverse experiences that they faced during the ongoing COVID-19 pandemic. Public health and health care professionals, communities, schools, families, and adolescents can use these findings to better understand how students' lives have been affected during the pandemic and what challenges need to be addressed to promote adolescent health and well-being during and after the pandemic.

Perceived Racism and Demographic, Mental Health, and Behavioral Characteristics Among High School Students During the COVID-19 Pandemic - Adolescent Behaviors and Experiences Survey, United States, January-June 2021.

Perceived racism in school (i.e., a student's report of being treated badly or unfairly because of their race or ethnicity) is an important yet understudied determinant of adolescent health and well-being. Knowing how perceived racism influences adolescent health can help reduce health inequities. CDC's 2021 Adolescent Behaviors and Experiences Survey (ABES), an online survey of a probability-based, nationally representative sample of U.S. public- and private-school students in grades 9-12 (N = 7,705), was conducted during January-June 2021 to assess student behaviors during the COVID-19 pandemic. CDC analyzed data from ABES to measure perceived racism and the extent to which perceptions of racism are associated with demographic, mental health, and behavioral characteristics. Mental health and behavioral characteristics analyzed included mental health status; virtual connection with others outside of school; serious difficulty concentrating, remembering, or making decisions; and feeling close to persons at school. Demographic characteristics analyzed included sex, race and ethnicity, and grade. Prevalence of perceived racism and associations between perceived racism and demographic, mental health, and behavioral characteristics are reported overall and stratified by race and ethnicity. Approximately one third (35.6%) of U.S. high school students reported perceived racism. Perceived racism was highest among Asian (63.9%), Black (55.2%), and multiracial students (54.5%). Students who reported perceived racism had higher prevalences of poor mental health (38.1%); difficulty concentrating, remembering, or making decisions (44.1%); and not feeling close to persons at school (40.7%). Perceived racism was higher among those students who reported poor mental health than those who did not report poor mental health during the pandemic among Asian (67.9% versus 40.5%), Black (62.1% versus 38.5%), Hispanic (45.7% and 22.9%), and White students (24.5% versus 12.7%). A better understanding of how negative health outcomes are associated with student experiences of racism can guide training for staff and students to promote cultural awareness and antiracist and inclusivity interventions, which are critical for promoting safe school environments for all students.

Overview and Methodology of the Adolescent Behaviors and Experiences Survey - United States, January-June 2021.

Many U.S. schools closed nationwide in March 2020 to prevent the spread of COVID-19. School closures and online-only instruction have negatively affected certain students, with studies showing adverse effects of the pandemic on mental health. However, little is known about other experiences such as economic and food insecurity and abuse by a parent, as well as risk behaviors such as alcohol and drug use among youths across the United States during the pandemic. To address this gap, CDC developed the one-time, online Adolescent Behaviors and Experiences Survey (ABES), which was conducted during January-June 2021 to assess student behaviors and experiences during the COVID-19 pandemic among high school students, including unintentional injury, violence, tobacco product use, sexual behaviors, and dietary behaviors. This overview report of the ABES MMWR Supplement describes the ABES methodology, including the student questionnaire and administration, sampling, data collection, weighting, and analysis. ABES used a stratified, three-stage cluster probability-based sampling approach to obtain a nationally representative sample of students in grades 9-12 attending public and private schools. Teachers of selected classes provided students with access to the anonymous online survey while following local consent procedures. Data were collected using a 110-item questionnaire during January-June 2021 in 128 schools. A total of 7,998 students submitted surveys, and 7,705 of these surveys had valid data (i.e., ≥20 questions answered). The school response rate was 38%, the student response rate was 48%, and the overall response rate was 18%. Information on mode of instruction and school-provided equipment was also collected from all sampled schools. This overview report provides student- and school-level characteristics obtained from descriptive analyses, and the other reports in the ABES MMWR Supplement include information on substance use, mental health and suicidality, perceived racism, and disruptions to student life among high school students. Findings from ABES during the COVID-19 pandemic can help guide parents, teachers, school administrators, community leaders, clinicians, and public health officials in decision-making for student support and school health programs.

TEMPORARY REMOVAL: The CDC’s Adolescent Behaviors and Experiences Survey – Using intersectionality and school connectedness to understand health disparities during the COVID-19 Pandemic

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The lived experience of UK health communication professionals during the Covid-19 pandemic

Purpose - This research explores approaches to, impacts of and reflections on the Covid-19 pandemic for professional communicators in the English National Health Service. It was undertaken in order to understand and analyse their lived experience and make recommendations for improving future system-wide performance. Design/methodology/approach - Given the work pressure and additional commitments that communication practitioners have when working in crisis, the researchers chose a single data collection method. Qualitative and quantitative data collection was undertaken using an extensive self-completion survey instrument. Findings - Ten distinct themes covering four time phases: crisis preparedness, entering the crisis, pandemic peak and post "first-wave" are discussed. They examine crisis readiness, to shifts in priorities and communication approaches to system-wide leadership and integration and the re-positioning of communication as a central player in pandemics. Practical implications - The research outlines a number of areas for improvement along with practical recommendations for actions in the health system in readiness for future pandemics. Originality/value - This is the first time the lived experience of communicators working through a pandemic at all levels in a national health system has been researched in the public relations literature.

Acute Pulmonary Emboli and Covid-19

Introduction An increased risk of pulmonary emboli (PE) has been reported in COVID-19 disease, possibly as a result of a hypercoagulable state. Superadded PE's may exacerbate respiratory failure and lead to increased morbidity and mortality. The objective of this study was to review the detection rates for PE in patients with COVID-19 undergoing CTPA scanning. Secondary objectives were to explore correlations between PE diagnosis, serum markers and radiological COVID-19 severity. Methods A total of 325 patients had a CTPA performed between 30/03/2020-15/05/2020. Data was retrospectively collected on patient demographics, COVID-19 status, radiological severity (British Society of Thoracic Imaging classification), PE location and biochemical markers (D-Dimer, Troponin-I, CRP, Ferritin). Results 122/325 patients were diagnosed with COVID-19 either radiologically (n=20, 16%) or by RT-PCR (n=102, 84%). The PE detection rate on imaging was significantly higher in those with COVID-19 than those without (32/122 [26%] and 27/203 [13%] respectively [p=0.005]). 617 patients were hospitalised with COVID-19 during this period (total PE incidence 5.2% [32/617]). Radiological severity of COVID-19 lung disease was not associated with PE detection (p=0.94). Initial quantitative D-Dimer's were significantly higher in COVID-19 patients with PE than those without (median 4390 [range 761-20,000] and 930 [range 110-20,000] respectively [p<0.001]). Higher D-Dimer levels were associated with increased PE detection rates on CT imaging (Abstract P253 figure 1). COVID-19 associated PE's were more likely to be unilateral (16/32 compared to 5/27 in COVID-19 negative group [p=0.025]) and trended towards more distal vessels (p=0.09). Accounting for age, an additional PE diagnosis did not significantly affect in-hospital COVID-19 mortality (OR 1.54 [CI 0.52-3.94], [p=0.38]). Conclusion Our results demonstrate increased detection of PE in COVID-19. Emboli are more likely to be unilateral, and more distally located. We postulate this may be due to higher rates of in-situ thrombosis rather than distant embolisation of clots. The radiological severity of COVID-19 lung disease does not appear to be strongly linked to PE detection rates which may suggest the hypercoagulable state in COVID-19 is independent from the inflammatory lung process. Patients with COVID-19 and co-existent PE's have significantly higher DDimer's, and further evaluation is needed into their use as a screening tool.

Bacterial and fungal respiratory co-infection among patients admitted to ICU with COVID-19: A retrospective cohort study in a UK hospital

Introduction and Objectives Bacterial and fungal co-infections contribute to mortality and morbidity to patients with Influenza. We aimed to evaluate respiratory tract flora, degree of co-infection and outcomes of patients admitted with COVID- 19 to ICU in a UK hospital. Productive cough is rare in COVID-19 and therefore identification of co-pathogens requires invasive sampling which is non-practical outside of ICU. Methods A retrospective cohort of patients admitted to ICU with confirmed SARS-CoV-2 infection was identified. Demographic data, co-morbidities, microbiology results from respiratory samples, clinical biomarkers and clinical outcomes were analysed. Respiratory samples were divided into early samples within 5 days of hospital admission that would represent community acquired organisms and late samples that would represent hospital acquired organisms. Results 77 patients were admitted to ICU with COVID-19 from February to June 2020. Respiratory samples were collected by non-directed bronchoalveolar lavage(NBL)(171 samples) and BAL from 61 patients. 37/61(60.7%) patients isolated a pathogen. 39 patients had an early sample with 14/ 39(35.9%) isolating a pathogen. Table 1 lists organisms isolated from early and late samples. On antimicrobial susceptibility testing of early respiratory isolates 2/7 Staphylococcus aureus were methicillin resistant and 2/5 Haemophilus influenza isolates were co-amoxiclav resistant. 29/77(37.7%) patients died during their admission to hospital. There was no significant correlation between in hospital mortality and isolation of a pathogen in early or any respiratory sample (Fisher's exact test p=0.512 and p=1.0 respectively). Conclusions A higher proportion of bacterial co-pathogens were seen in our study population compared to previously reported non-UK data1. Identifying true co-infection is complicated by fever, chest x-rays infiltrates and high CRP being characteristic of severe COVID-19. Staphylococcus aureus was commonly isolated in both early and late respiratory samples and supports empiric antibiotic regimens with staphylococcal activity for secondary bacterial pneumonia in COVID-19 as currently recommended by NICE2. However the proportion of resistant organisms isolated needs to be studied in larger cohorts to ensure guideline recommended antibiotics are appropriate.

P253 Acute pulmonary emboli and COVID-19

P253 figure 1).COVID-19 associated PE’s were more likely to be unilateral (16/32 compared to 5/27 in COVID-19 negative group [p=0.025]) and trended towards more distal vessels (p=0.09). Accounting for age, an additional PE diagnosis did not significantly affect in-hospital COVID-19 mortality (OR 1.54 [CI 0.52–3.94], [p=0.38]).Abstract P253 Figure 1(a): Initial D-Dimer levels in COVID-19 patients without (L) and with (R) PE diagnosis on CTPA. (b): Proportion of CTPA’s diagnosing a PE at specified D-Dimer ranges[Figure omitted. See PDF]ConclusionOur results demonstrate increased detection of PE in COVID-19. Emboli are more likely to be unilateral, and more distally located. We postulate this may be due to higher rates of in-situ thrombosis rather than distant embolisation of clots. The radiological severity of COVID-19 lung disease does not appear to be strongly linked to PE detection rates which may suggest the hypercoagulable state in COVID-19 is independent from the inflammatory lung process. Patients with COVID-19 and co-existent PE’s have significantly higher D-Dimer’s, and further evaluation is needed into their use as a screening tool.