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BMC Public Health ; 23(1): 1068, 2023 06 05.
Article in English | MEDLINE | ID: covidwho-20240510


COVID-19 testing is an important risk mitigation strategy for COVID-19 prevention in school settings, where the virus continues to pose a public health challenge for in-person learning. Socially vulnerable school communities with the highest proportion of low-income, minority, and non-English speaking families have the least testing access despite shouldering a disproportionate burden of COVID-19 morbidity and mortality. Through the Safer at School Early Alert (SASEA) program, we investigated community perceptions of testing in San Diego County schools, with a focus on barriers and facilitators from the perspective of socially vulnerable parents and school staff. Using a mixed-methods approach, we administered a community survey and conducted focus group discussions (FGDs) with staff and parents from SASEA-affiliated schools and childcares. We recruited 299 survey respondents and 42 FGD participants. Protecting one's family (96.6%) and protecting one's community (96.6%) were marked as key motivators to testing uptake. School staff in particular reported that the reassurance of a negative status mitigated concerns about COVID-19 infection in schools. Participants expressed that COVID-19-related stigma, loss of income as a result of isolation/quarantine requirements, and lack of multilingual materials were the most significant barriers to testing. Our findings suggest that the testing barriers faced by school community members are predominantly structural. Testing uptake efforts must provide support and resources to manage the social and financial consequences of testing while continuously communicating its benefits. There is a clear need to continue to incorporate testing as a strategy to maintain school safety and facilitate access for vulnerable community members.

COVID-19 Testing , COVID-19 , Humans , COVID-19/diagnosis , COVID-19/prevention & control , Focus Groups , Poverty , Parents
Transl Behav Med ; 2022 Oct 22.
Article in English | MEDLINE | ID: covidwho-2274916


Rapid identification and isolation/quarantine of COVID-19 cases or close contacts, respectively, is a vital tool to support safe, in-person learning. However, safe isolation or quarantine for a young child also necessitates home confinement for at least one adult caregiver, as well as rapid learning material development by the teacher to minimize learning loss. The purpose of this study is to better understand barriers and supports to student home confinement. We conducted a mixed-methods study using focus group discussions and a self-administered online survey with parents and staff members from 12 elementary schools and childcare sites across San Diego County serving low-income and socially vulnerable families. Focus group participants reported that mental distress and loneliness, learning loss, childcare, food, income loss, and overcrowded housing were major barriers related to home confinement. The experiences described by FGD participants were prevalent in a concurrent community survey: 25% of participants reported that isolation would be extremely difficult for a household member who tested positive or was exposed to COVID-19, and 20% were extremely concerned about learning loss while in isolation or quarantine. Our findings suggest that there are serious structural impediments to safely completing the entire recommended course of isolation or quarantine, and that the potential for isolation or quarantine may also lead to increased hesitancy to access diagnostic testing.

BACKGROUND: During the COVID-19 pandemic, home confinement (isolation and quarantine) are important public health tools to keep children learning in-person at schools. However, isolation or quarantine for young children also means that often their caregivers must also go into home confinement, as well as forcing teachers to adapt their lessons to online teaching. PURPOSE: The purpose of this study is to better understand what makes home confinement comfortable or difficult for students and their families. METHODS: We did focus group discussions and shared an online survey with parents and staff members from 12 elementary schools and childcare centers across San Diego County vulnerable families. RESULTS: Focus group participants said that mental distress and loneliness, learning loss, childcare, food, income loss, and overcrowded housing made home confinement hard to do. Also 25% of survey participants said that isolation would be difficult for a household member who tested positive or was exposed to COVID-19, and 20% were really concerned about their child's learning loss if the family had to isolate or do quarantine. CONCLUSIONS: Our study's results suggest that there are serious structural issues for school families to safely go into isolation or quarantine, and because of this may make families more hesitant to get tested for COVID-19.

J Prim Care Community Health ; 14: 21501319231159814, 2023.
Article in English | MEDLINE | ID: covidwho-2267571


OBJECTIVES: Vaccine hesitancy among essential workers remains a significant public health challenge. We examined psychological constructs of perceived susceptibility, threat, and self-efficacy and their associations with COVID-19 vaccine hesitancy among a racially and ethnically diverse essential workforce population. METHODS: We performed a cross-sectional survey of essential workers from September-December 2020 at a large Los Angeles safety-net medical center as part of a program offering free COVID-19 serology testing. Program participants completed a standardized survey at the time of phlebotomy. Hierarchical logistic regression was utilized to determine factors independently associated with vaccine hesitancy. RESULTS: Among 1327 persons who had serology testing, 1235 (93%) completed the survey. Of these, 958 (78%) were healthcare workers. Based on expressed intent, 22% were vaccine-hesitant 78% were vaccine acceptors. In our multivariate model, vaccine hesitancy was associated with female gender [aOR = 2.09; 95% CI (1.44-3.05)], African American race [aOR = 4.32; (2.16-8.62)], LatinX ethnicity [aOR = 2.47; 95% CI (1.51-4.05)] and history of not/sometimes receiving influenza vaccination [aOR = 4.39; 95% CI (2.98-6.48)]. Compared to nurses, vaccine hesitancy was lower among physicians [aOR = 0.09; 95% CI (0.04-0.23)], non-nursing/non-physician healthcare workers [aOR = 0.55; 95% CI (0.33-0.92)], and non-healthcare care workers [aOR = 0.53; 95% CI (0.36-0.78)]. CONCLUSIONS: Among a racially/ethnically diverse group of safety net medical center essential workers, COVID-19 vaccine hesitancy was associated with racial/ethnic minority groups, employment type, and prior influenza vaccination hesitancy. Interestingly, we found no association with the Health Belief Model construct measures of perceived susceptibility, threat, and self-efficacy. Psychological constructs not assessed may be drivers of vaccine hesitancy in our population.

COVID-19 , Influenza, Human , Female , Humans , COVID-19 Vaccines , Cross-Sectional Studies , Ethnicity , COVID-19/prevention & control , Minority Groups , Vaccination
Lancet Reg Health Am ; 19: 100449, 2023 Mar.
Article in English | MEDLINE | ID: covidwho-2240692


Background: Schools are high-risk settings for SARS-CoV-2 transmission, but necessary for children's educational and social-emotional wellbeing. Previous research suggests that wastewater monitoring can detect SARS-CoV-2 infections in controlled residential settings with high levels of accuracy. However, its effective accuracy, cost, and feasibility in non-residential community settings is unknown. Methods: The objective of this study was to determine the effectiveness and accuracy of community-based passive wastewater and surface (environmental) surveillance to detect SARS-CoV-2 infection in neighborhood schools compared to weekly diagnostic (PCR) testing. We implemented an environmental surveillance system in nine elementary schools with 1700 regularly present staff and students in southern California. The system was validated from November 2020 to March 2021. Findings: In 447 data collection days across the nine sites 89 individuals tested positive for COVID-19, and SARS-CoV-2 was detected in 374 surface samples and 133 wastewater samples. Ninety-three percent of identified cases were associated with an environmental sample (95% CI: 88%-98%); 67% were associated with a positive wastewater sample (95% CI: 57%-77%), and 40% were associated with a positive surface sample (95% CI: 29%-52%). The techniques we utilized allowed for near-complete genomic sequencing of wastewater and surface samples. Interpretation: Passive environmental surveillance can detect the presence of COVID-19 cases in non-residential community school settings with a high degree of accuracy. Funding: County of San Diego, Health and Human Services Agency, National Institutes of Health, National Science Foundation, Centers for Disease Control.

J Psychosoc Nurs Ment Health Serv ; 60(9): 24-28, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1753719


Anecdotal evidence suggests nurses are engaging in resilience-based strategies to mitigate increased levels of psychological distress and unmanaged negative emotions they have been experiencing. Nurses' levels of resilience during the coronavirus disease 2019 (COVID-19) pandemic have not been clearly articulated, specifically in relation to psychological distress and negative emotions. The purpose of the current mixed-methods non-experimental descriptive study was to examine nurses' resilience during the pandemic. Sixty RNs working in acute care hospitals on inpatient units designated to care for patients with COVID-19 completed the study survey and 20 of these RNs completed an interview. Findings indicate moderate levels of resilience among participants, with the need to increase resources and support emerging as a common theme among the qualitative data. Suggestions for integration of resilience-based strategies into the clinical setting, such as creation of a dedicated space for nurses to engage in mindfulness, relaxation, and meditation, were put forward. [Journal of Psychosocial Nursing and Mental Health Services, 60(9), 24-28.].

COVID-19 , Mindfulness , Nurses , Psychological Distress , Resilience, Psychological , Humans , Inpatients , Pandemics
Can J Nurs Res ; 53(1): 5-15, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1136160


BACKGROUND: The severity of the COVID-19 health crisis has placed acute care nurses in dire work environments in which they have had to deal with uncertainty, loss, and death on a constant basis. It is necessary to gain a better understanding of nurses' experiences to develop interventions supportive of their emotional well-being. PURPOSE: The purpose of this study is to explore how nurses are emotionally affected working in COVID-19 acute care hospital environments. The research question is: What is the emotional experience of nurses working in COVID-19 acute care hospital environments? METHODS: We employed a narrative methodology that focused on participants' stories. Twenty registered nurses, who worked in six hospitals in the Greater Toronto Area in Canada, participated in interviews. A narrative analysis was conducted with a focus on content and form of stories. RESULTS: We identified three themes about working in COVID-19 acute care hospital environments: the emotional experience, the agency of emotions, and how emotions shape nursing and practice. CONCLUSION: In moving forth with pandemic preparations, healthcare leaders and governments need to make sure that a nurse's sacrifice is not all-encompassing. Supporting nurses' emotional well-being and resilience is necessary to counterbalance the loss and trauma nurses go through.

COVID-19/nursing , Critical Care Nursing , Emotions , Nursing Staff, Hospital/psychology , COVID-19/epidemiology , Canada/epidemiology , Hospitals , Humans , Qualitative Research