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1.
JAMA Psychiatry ; 79(9): 898-906, 2022 09 01.
Article in English | MEDLINE | ID: covidwho-1958659

ABSTRACT

Importance: The COVID-19 pandemic has coincided with an increase in depressive symptoms as well as a growing awareness of health inequities and structural racism in the United States. Objective: To examine the association of mental health with everyday discrimination during the pandemic in a large and diverse cohort of the All of Us Research Program. Design, Setting, and Participants: Using repeated assessments in the early months of the pandemic, mixed-effects models were fitted to assess the associations of discrimination with depressive symptoms and suicidal ideation, and inverse probability weights were applied to account for nonrandom probabilities of completing the voluntary survey. Main Outcomes and Measures: The exposure and outcome measures were ascertained using the Everyday Discrimination Scale and the 9-item Patient Health Questionnaire (PHQ-9), respectively. Scores for PHQ-9 that were greater than or equal to 10 were classified as moderate to severe depressive symptoms, and any positive response to the ninth item of the PHQ-9 scale was considered as presenting suicidal ideation. Results: A total of 62 651 individuals (mean [SD] age, 59.3 [15.9] years; female sex at birth, 41 084 [65.6%]) completed at least 1 assessment between May and July 2020. An association with significantly increased likelihood of moderate to severe depressive symptoms and suicidal ideation was observed as the levels of discrimination increased. There was a dose-response association, with 17.68-fold (95% CI, 13.49-23.17; P < .001) and 10.76-fold (95% CI, 7.82-14.80; P < .001) increases in the odds of moderate to severe depressive symptoms and suicidal ideation, respectively, on experiencing discrimination more than once a week. In addition, the association with depressive symptoms was greater when the main reason for discrimination was race, ancestry, or national origins among Hispanic or Latino participants at all 3 time points and among non-Hispanic Asian participants in May and June 2020. Furthermore, high levels of discrimination were as strongly associated with moderate to severe depressive symptoms as was history of prepandemic mood disorder diagnosis. Conclusions and Relevance: In this large and diverse sample, increased levels of discrimination were associated with higher odds of experiencing moderate to severe depressive symptoms. This association was particularly evident when the main reason for discrimination was race, ancestry, or national origins among Hispanic or Latino participants and, early in the pandemic, among non-Hispanic Asian participants.


Subject(s)
COVID-19 , Population Health , Adolescent , COVID-19/epidemiology , Depression/epidemiology , Depression/psychology , Female , Humans , Infant, Newborn , Pandemics , Suicidal Ideation , United States/epidemiology
2.
Prev Med Rep ; 26: 101730, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1671045

ABSTRACT

Emerging data suggest that adults with low income are at highest risk for COVID-19-related stressors and mental health disorders. This study aimed to determine if COVID-19-related stressors were associated with worsening depression and anxiety in a cohort of low-income adults one year after the start of the pandemic. Participants included 253 Medicaid and commercial accountable care organization recipients from 5 community health centers around Boston, MA who enrolled December 2019-March 2020 in a larger longitudinal study of a Medicaid program. Participants completed surveys at baseline and one-year follow-up that measured depression (Patient Health Questionnaire-8 [PHQ-8]) and anxiety (Generalized Anxiety Disorder-7 [GAD-7]) symptoms. Follow-up surveys assessed COVID-19-related stressors experienced over the prior 12 months. A stressor score included COVID-19-related infectious, social, and economic stressors categorized into tertiles (low, 0-3; medium, 4-6; high, 7-19). Mean age (SD) was 45.2 (11.5) years; 71.2% were female, 42.3% Hispanic and 14.6% Black. At baseline, 126 (49.8%) had moderate or severe depression (PHQ-8 ≥ 10), and 109 (43.1%) had moderate or severe anxiety (GAD-7 ≥ 10). The mean (SD) number of COVID-19 stressors was 4.9 (3.1); the most frequent were food insecurity (52.2%) and job or income loss (43.9%). Compared to the low tertile, those in high and medium tertiles had significantly greater one-year increases in depression and anxiety symptoms. Low-income adults facing multiple COVID-19-related stressors, particularly health-related social needs, had worsening mental health symptoms over one year. Interventions are urgently needed to address the dual burden of health-related social needs and poor mental health exacerbated by COVID-19.

3.
J Am Med Inform Assoc ; 28(9): 2013-2016, 2021 08 13.
Article in English | MEDLINE | ID: covidwho-1377973

ABSTRACT

Open discussions of social justice and health inequities may be an uncommon focus within information technology science, business, and health care delivery partnerships. However, the COVID-19 pandemic-which disproportionately affected Black, indigenous, and people of color-has reinforced the need to examine and define roles that technology partners should play to lead anti-racism efforts through our work. In our perspective piece, we describe the imperative to prioritize TechQuity-equity and social justice as a technology business strategy-through collaborating in partnerships that focus on eliminating racial and social inequities.


Subject(s)
COVID-19 , Racism , Humans , Pandemics , SARS-CoV-2 , Technology
4.
Ethn Dis ; 31(3): 407-410, 2021.
Article in English | MEDLINE | ID: covidwho-1318484

ABSTRACT

Purpose: Enhancing the bidirectional benefit of precision medicine research infrastructure may advance equity in research participation for diverse groups. This study explores the use of research infrastructure to provide human-centered COVID-19 resources to participants as a part of their research participation. Design: The All of Us New England (AoUNE) consortium research team developed standardized check-in telephone calls to ask participants about their well-being and share COVID-19 resources. Participants: A total of 20,559 participants in the AoUNE consortium received a COVID-19 check-in call. Methods: Research assistants called participants during March-April 2020, distributed COVID-19 resources to interested participants, and subsequently rated call tone. Results: Of the total cohort participants called, 8,512 (41%) spoke with a research team member. The majority of calls were rated as positive or neutral; only 3% rated as negative. African American and Black as well as Hispanic populations requested COVID-19 resources at higher rates than other groups. Conclusions: Calls made to AoUNE participants were received positively by diverse groups. These findings may have implications for participant-centered engagement strategies in precision medicine research.


Subject(s)
COVID-19 , Population Health , Humans , Precision Medicine , SARS-CoV-2
5.
BMC Public Health ; 21(1): 1166, 2021 06 17.
Article in English | MEDLINE | ID: covidwho-1274544

ABSTRACT

BACKGROUND: Influenza immunization is a highly effective method of reducing illness, hospitalization and mortality from this disease. However, influenza vaccination rates in the U.S. remain below public health targets and persistent structural inequities reduce the likelihood that Black, American Indian and Alaska Native, Latina/o, Asian groups, and populations of low socioeconomic status will receive the influenza vaccine. METHODS: We analyzed correlates of influenza vaccination rates using the 2019 Behavioral Risk Factor Surveillance System (BRFSS) in the year 2020. Our analysis compared influenza vaccination as the outcome of interest with the variables age, sex, race, education, income, geographic location, health insurance status, access to primary care, history of delaying care due to cost, and comorbidities such as: asthma, cardiovascular disease, hypertension, body mass index, cancer and diabetes. RESULTS: Non-Hispanic White (46.5%) and Asian (44.1%) participants are more likely to receive the influenza vaccine compared to Non-Hispanic Black (36.7%), Hispanic (33.9%), American Indian/Alaskan Native (36.6%), and Native Hawaiian/Other Pacific Islander (37.9%) participants. We found persistent structural inequities that predict influenza vaccination, within and across racial and ethnic groups, including not having health insurance [OR: 0.51 (0.47-0.55)], not having regular access to primary care [OR: 0.50 (0.48-0.52)], and the need to delay medical care due to cost [OR: 0.75 (0.71-0.79)]. CONCLUSION: As COVID-19 vaccination efforts evolve, it is important for physicians and policymakers to identify the structural impediments to equitable U.S. influenza vaccination so that future vaccination campaigns are not impeded by these barriers to immunization.


Subject(s)
COVID-19 , Influenza Vaccines , Influenza, Human , COVID-19 Vaccines , Hawaii , Humans , Influenza, Human/epidemiology , Influenza, Human/prevention & control , SARS-CoV-2 , Seasons , United States/epidemiology , Vaccination
6.
Journal of Health Care for the Poor and Underserved ; 32(2 Supplement):1-4, 2021.
Article in English | ProQuest Central | ID: covidwho-1208091

ABSTRACT

The e-learnings focused on sexual and reproductive health information to adolescents in Mexico and provided content around three themes: self-esteem, gender equality, and decision-making and self-efficacy and included digital tools and scenarios to help participants engage with the content. Gance-Cleveland and colleagues observed disparities in Hispanic perinatal outcomes, which lead to higher rates of obesity, diabetes, gestational diabetes, preterm birth, pregnancy-related hypertension, and infant deaths. The authors' examination of the acceptability and feasibility of mHealth tools designed to address the concerns of CSE-affected girls and women, including the study participants' desires for psychosocial support, health education, and digital assistance navigating complex judicial systems, exemplifies the potential to enhance the power and agency of marginalized populations with tools designed from the perspectives of those with lived experience of inequitable treatment. The authors used the COVID-19 Vulnerability Index to prioritize patients at high risk by location and then dispatched a mobile health clinic staffed with a registered nurse and community health worker to those neighborhoods, which provided COVID-19 testing, social needs screening (i.e., assess food availability, housing needs, financial situation), telemedicine services (i.e., basic clinical health screenings to the extent possible virtually), access to the electronic health record, and virtual visits with advanced practice providers.

7.
American Journal of Public Health ; 111(5):844-848, 2021.
Article in English | ProQuest Central | ID: covidwho-1194957

ABSTRACT

In the late 1980s, the hospital emergency incident command system (now HICS) was developed to align with the National Interagency Incident Management System, the federal plan for improving coordination among agencies in a broad range of large-scale emergencies.2 As HICS have been deployed over recent decades, we have deepened our understanding of the strengths and weaknesses of their structure for addressing the needs of diverse populations. Recurrent experiences with large-scale disasters, including the COVID-19 pandemic and Hurricanes Katrina, Maria, Harvey, and Sandy, have underscored the ways in which health care responses, emergency preparedness, and broader social determinants of health lead to preventable morbidity and mortality in marginalized communities.3 Here we share the case for embedding an equity element in HICS, our institutional experiences in operationalizing equity, and our recommendation for a structural change in the national HICS guidelines: including a defined equity officer (EO) and subject matter experts in health care equity to ensure that actions are taken to improve outcomes for diverse groups during public health emergencies or disasters. The absence of equity as an emergency management principle in responses to COVID-19 has resulted in a slow and incomplete hospital response to the disproportionate mortality and morbidity in several historically marginalized populations.4 For example, hospitals have access to detailed information on the demographic composition of their inpatient populations, the ability to screen patients for social needs, and the opportunity to conduct coordinated community outreach to address the needs of communities of color through HICS infrastructure. An after-action review is a structured process developed by the US Army to identify strengths and weaknesses in event response.10 This concept has been adapted as a critical step after public health emergencies to gather information on quantitative and qualitative issues to improve preparedness, mitigation, response, and recovery for future incidents.11 Our institution has conducted several after-action reviews within the past decade after local events including the Boston Marathon bombings and an active shooter incident in our hospital.1214 We have also facilitated reviews in the wake of other large-scale events such as the urban terror attacks in Paris and Brussels.15 Since our initial patient surge in Boston, Massachusetts, in April 2020 (and given the concern for future surges), we have conducted several debriefings with more than 150 staff members across an academic medical center and community hospital within our larger multihospital health care system.

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