Improving Patient Outcomes in the Dual Crises of Climate Change and COVID-19: Proceedings of the Third Annual Clinical Climate Change Meeting, January 8, 2021.

The tremendous global toll of the COVID-19 pandemic does not fall equally on all populations. Indeed, this crisis has exerted more severe impacts on the most vulnerable communities, spotlighting the continued consequences of longstanding structural, social, and healthcare inequities. This disparity in COVID-19 parallels the unequal health consequences of climate change, whereby underlying inequities perpetuate adverse health outcomes disproportionately among vulnerable populations. As these two crises continue to unfold, there is an urgent need for healthcare practitioners to identify and implement solutions to mitigate adverse health outcomes, especially in the face of global crises. To support this need, the 2021 Clinical Climate Change Conference held a virtual meeting to discuss the implications of the convergence of the climate crisis and COVID-19, particularly for vulnerable patient populations and the clinicians who care for them. Presenters and panelists provided evidence-based solutions to help health professionals improve and adapt their practice to these evolving scenarios. Together, participants explored the community health system and national solutions to reduce the impacts of COVID-19 and the climate crisis, to promote community advocacy, and foster new partnerships between community and healthcare leaders to combat systemic racism and achieve a more just and equitable society.

Disparities in Marijuana and Tobacco Smoke Incursions Among New York City Families During Early Months of the COVID-19 Pandemic.

OBJECTIVES: Once the COVID-19 pandemic arrived in New York City (NYC), stay-at-home orders led to more time spent indoors, potentially increasing exposure to secondhand marijuana and tobacco smoke via incursions from common areas or neighbors. The objective of this study was to characterize housing-based disparities in marijuana and tobacco incursions in NYC housing during the pandemic. DESIGN: We surveyed a random sample of families from May to July 2020 and collected sociodemographic data, housing characteristics, and the presence, frequency, and pandemic-related change in incursions. SETTING: Five pediatric practices affiliated with a large NYC health care system. PARTICIPANTS: In total, 230 caregivers of children attending the practices. MAIN OUTCOME MEASURES: Prevalence and change in tobacco and marijuana smoke incursions. RESULTS: Tobacco and marijuana smoke incursions were reported by 22.9% and 30.7%, respectively. Twenty-two percent of families received financial housing support (public housing, Section-8). Compared with families in private housing, families with financial housing support had 3.8 times the odds of tobacco incursions (95% CI, 1.4-10.1) and 3.7 times the odds of worsening incursions during pandemic (95% CI, 1.1-12.5). Families with financially supported housing had 6.9 times the odds of marijuana incursions (95% CI, 2.4-19.5) and 5 times the odds of worsening incursions during pandemic (95% CI, 1.9-12.8). Children in financially supported housing spent more time inside the home during pandemic (median 24 hours vs 21.6 hours, P = .02) and were more likely to have asthma (37% vs 12.9%, P = .001) than children in private housing. CONCLUSIONS: Incursions were higher among families with financially supported housing. Better enforcement of existing regulations (eg, Smoke-Free Public Housing Rule) and implementation of additional policies to limit secondhand tobacco and marijuana exposure in children are needed. Such actions should prioritize equitable access to cessation and mental health services and consider structural systems leading to poverty and health disparities.