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1.
J Prim Care Community Health ; 13: 21501319221107984, 2022.
Article in English | MEDLINE | ID: covidwho-1910218

ABSTRACT

INTRODUCTION: The shift from in-person care to telemedicine made it challenging to provide guideline-recommended tobacco cessation care during the COVID-19 pandemic. We described quality improvement (QI) initiatives for tobacco cessation during the COVID-19 pandemic, focusing on African American/Black patients with high smoking rates. METHODS: The QI initiatives took place in the San Francisco Health Network, a network of 13 safety-net clinics in San Francisco, California between February 2020 and February 2022. We conducted direct patient outreach by telephone and increased staff capacity to increase cessation care delivery. We examined trends in tobacco screening, provider counseling, and best practice for cessation care (ie, the proportion of patients receiving at least 1 smoking cessation service during a clinical encounter). RESULTS: In-person visits at the onset of the pandemic was 20% in April 2020 and increased to 67% by February 2022. During this time, tobacco screening increased from 29% to 74%. From March 2020 to March 2021, 34% more patients received provider counseling by telephone than in-person. The trend reversed from April 2021 to February 2022, where 23% more patients received counseling in-person than by telehealth. Best practice care increased by 23% from June 2020 to February 2022: 24% for African American/Black patients and 23% for other patients. CONCLUSIONS: Telehealth adaptations to the EHR, targeted outreach to patients, and a multi-disciplinary medical team may be associated with increases in cessation care delivery during the COVID-19 pandemic.


Subject(s)
COVID-19 , Smoking Cessation , Telemedicine , Humans , Pandemics/prevention & control , Quality Improvement , Tobacco Use
2.
Cultur Divers Ethnic Minor Psychol ; 2022 Feb 28.
Article in English | MEDLINE | ID: covidwho-1713122

ABSTRACT

OBJECTIVES: Vicarious racism-witnessing or hearing about other individuals of one's ethnic/racial group being the target of racism-has been salient among Asian Americans during the coronavirus disease (COVID-19) pandemic. There is emerging evidence that such experiences adversely impact several health-related outcomes, including sleep. The present study examines associations between vicarious racism and subjective sleep duration and quality, and the potential moderating role of ethnic/racial identity (ERI). METHOD: Multivariable regression models assessed the association between vicarious racism, private regard, and centrality on self-reported sleep disturbance and duration. The sample consisted of an online sample of 600 Asian American adults (Mage = 38.55, SDage = 17.11; 65.17% female; 60% ≥ Bachelor's degree) recruited from May to June 2020. RESULTS: Vicarious racism was associated with compromised sleep quality and duration, including after adjustment for sociodemographic variables that have been linked to sleep. Private regard toward one's own ethnic/racial group and centrality of ethnicity/race to self-identity buffered the association between vicarious racism and sleep quality and duration. Adverse effects of high vicarious racism on sleep quality and duration were lessened among respondents reporting high levels of ERI private regard and centrality. CONCLUSIONS: Findings from this study extend research on racism and sleep by examining vicarious racism, an understudied facet of racism, and by focusing specifically on Asian Americans and in the context of the COVID-19 pandemic. Future research and practice should consider expanding research on discrimination to include a broader range of unjust experiences. Vicarious racism contributes to health hazards experienced by Asian Americans during the COVID-19 pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

3.
Am J Public Health ; 111(9): 1610-1619, 2021 09.
Article in English | MEDLINE | ID: covidwho-1666846

ABSTRACT

Objectives. To describe disparities in depression, anxiety, and problem drinking by sexual orientation, sexual behavior, and gender identity during the COVID-19 pandemic. Methods. Data were collected May 21 to July 15, 2020, from 3245 adults living in 5 major US metropolitan areas (Atlanta, Georgia; Chicago, Illinois; New Orleans, Louisiana; New York, New York; and Los Angeles, California). Participants were characterized as cisgender straight or LGBTQ+ (i.e., lesbian, gay, bisexual, and transgender people, and men who have sex with men, and women who have sex with women not identifying as lesbian, gay, bisexual, or transgender). Results. Cisgender straight participants had the lowest levels of depression, anxiety, and problem drinking compared with all other sexual orientation, sexual behavior, and gender identity groups, and, in general, LGBTQ+ participants were more likely to report that these health problems were "more than usual" during the COVID-19 pandemic. Conclusions. LGBTQ+ communities experienced worse mental health and problem drinking than their cisgender straight counterparts during the COVID-19 pandemic. Future research should assess the impact of the pandemic on health inequities. Policymakers should consider resources to support LGBTQ+ mental health and substance use prevention in COVID-19 recovery efforts.


Subject(s)
COVID-19/epidemiology , Mental Health/statistics & numerical data , Sexual Behavior/statistics & numerical data , Sexual and Gender Minorities/psychology , Adolescent , Adult , Aged , Alcoholism/epidemiology , Anxiety/epidemiology , Depression/epidemiology , Female , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2 , Socioeconomic Factors , United States , Urban Population/statistics & numerical data , Young Adult
4.
Innovation in aging ; 5(Suppl 1):1049-1049, 2021.
Article in English | EuropePMC | ID: covidwho-1601835

ABSTRACT

Black Americans have experienced multiple health threats during the COVID-19 pandemic, including greater risk of infection compared to Whites. In addition, older adults are more susceptible to worse disease consequences including hospitalization and mortality compared to those who are younger. Racism and economic costs are additional public health crises during this time that have disproportionately impacted Black Americans. Using data from the Uncovering COVID-19 Experiences and Realities (UnCOVER) Study, we examined depressive symptoms in relation to: (1) worry/fear of COVID-19;(2) work loss among household members (being laid off, reduced work hours);and (3) vicarious racism, a particularly salient source of psychosocial stress during the COVID-19 pandemic, including hearing about or seeing acts of racism committed against other race group members. Participants were Black Americans aged 50 years or older (n=300) from five cities (Atlanta, Chicago, Los Angeles, New Orleans, and New York) from May-July 2020. Depression was assessed using the Patient-Reported Outcomes Measurement Information System Short Form. In multivariable linear regression models, all three public health threats were significantly associated with depressive symptoms. When in the model simultaneously, worry/fear of COVID-19 (b=0.30, SE=0.12, p<0.01) and vicarious racism (b=0.62, SE=0.15, p<0.001) showed positive associations;work loss was no longer statistically significant (b=0.62, SE=0.43, p=0.15). When added, the corresponding three-way interaction term was significant (b=0.12, SE=0.04, p<0.01). Synergistic epidemics (“syndemics”) among older Black Americans amplify mental health tolls. Multi-pronged public health strategies are required to address depression in this population.

5.
American Journal of Public Health ; 111(10):1736-1740, 2021.
Article in English | ProQuest Central | ID: covidwho-1464330

ABSTRACT

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.

6.
Public Health Rep ; 136(4): 508-517, 2021.
Article in English | MEDLINE | ID: covidwho-1243754

ABSTRACT

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.


Subject(s)
African Americans/psychology , Anxiety/ethnology , Asian Americans/psychology , COVID-19/psychology , Depression/ethnology , Racism/psychology , Adult , Anxiety/etiology , Cross-Sectional Studies , Depression/etiology , Female , Humans , Linear Models , Male , Racism/statistics & numerical data , United States/epidemiology
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