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JAMA Netw Open ; 4(9): e2122260, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1391521


Importance: Domestic violence (DV) has become a growing public health concern during the COVID-19 pandemic because individuals may be sheltering in place with abusers and facing mounting economic and health-related stresses. Objective: To analyze associations of the 2020 COVID-19 stay-at-home (SH) order with DV police reporting and resource availability, including differences by community area racial/ethnic composition. Design, Setting, and Participants: This longitudinal cohort study assessed DV police reports (January-June 2020) obtained from the Chicago, Illinois, Police Department and DV resource availability (March and August 2020) obtained from the NowPow community resource database, both for 77 community areas in Chicago. Data were analyzed July through December 2020. Exposures: The COVID-19 SH order effective March 21, 2020. Main Outcomes and Measures: Monthly rates of DV police reports and DV resource availability per 100 000 persons. Results: Of 77 community areas in Chicago, 28 (36.4%) were majority Black, 19 (24.7%) majority Hispanic/Latinx, 18 (23.4%) majority White, and 12 (15.6%) a different or no majority race/ethnicity, representing an estimated population of 2 718 555 individuals. For each community area, the SH order was associated with a decrease in the rate of DV police reports by 21.8 (95% CI, -30.48 to -13.07) crimes per 100 000 persons per month relative to the same months in 2019. Compared with White majority community areas, Black majority areas had a decrease in the rate of DV police reports by 40.8 (95% CI, -62.93 to -18.75) crimes per 100 000 persons per month relative to the same months in 2019. The SH order was also associated with a decrease in DV resource availability at a rate of 5.1 (95% CI, -7.55 to -2.67) resources per 100 000 persons, with the largest decreases for mental health (-4.3 [95% CI, -5.97 to -2.66] resources per 100 000 persons) and personal safety (-2.4 [95% CI, -4.40 to -0.41] resources per 100 000 persons). The Black majority south side of Chicago had a larger decrease in resource availability (-6.7 [95% CI, -12.92 to -0.46] resources per 100 000 persons) than the White majority north side. Conclusions and Relevance: In this longitudinal cohort study, the rate of DV police reports decreased after the SH order was implemented in Chicago. This decrease was largely observed in Black majority communities, whereas there was no significant change in White majority communities. These findings may reflect decreased DV incidence but may also reflect an exacerbation of underreporting. In addition, DV resource availability decreased disproportionately on the predominantly Black south side of Chicago.

Domestic Violence/statistics & numerical data , Police/statistics & numerical data , Adult , COVID-19/epidemiology , Chicago/epidemiology , Communicable Disease Control/legislation & jurisprudence , Domestic Violence/ethnology , Female , Humans , Longitudinal Studies , Male , Middle Aged , Pandemics , Residence Characteristics/statistics & numerical data , SARS-CoV-2
J Med Ethics ; 47(1): 7-11, 2021 01.
Article in English | MEDLINE | ID: covidwho-1066922


Clinical trials emerged in rapid succession as the COVID-19 pandemic created an unprecedented need for life-saving therapies. Fair and equitable subject selection in clinical trials offering investigational therapies ought to be an urgent moral concern. Subject selection determines the distribution of risks and benefits, and impacts the applicability of the study results for the larger population. While Research Ethics Committees monitor fair subject selection within each trial, no standard oversight exists for subject selection across multiple trials for the same disease. Drawing on the experience of multiple clinical trials at a single academic medical centre in the USA, we posit that concurrent COVID-19 trials are liable to unfair and inequitable subject selection on account of scientific uncertainty, lack of transparency, scarcity and, lastly, structural barriers to equity compounded by implicit bias. To address the critical gap in the current literature and international regulation, we propose new ethical guidelines for research design and conduct that bolsters fair and equitable subject selection. Although the proposed guidelines are tailored to the research design and protocol of concurrent trials in the COVID-19 pandemic, they may have broader relevance to single COVID-19 trials.

COVID-19 , Clinical Trials as Topic/ethics , Patient Selection/ethics , Bias , Bioethics , Humans , SARS-CoV-2
American Journal of Public Health ; 110(7):960-961, 2020.
Article in English | ProQuest Central | ID: covidwho-617565


In the United States, one in four women and one in seven men experience severe physical IPV at some point in their lives.2 Transgender individuals report even higher levels, with some studies quoting lifetime prevalence of IPV of up to 50%.3 Restricted economic resources, unemployment, and high stress levels all correlate with an increase in both the incidence and the severity of IPV. According to the Director for Shelter Services at the Domestic Violence and Child Advocacy Shelter of Cleveland, Ohio, for example, 40% ofcalls in February 2020 were classified as acute crises. Many public health experts and epidemiologists believe that several rounds ofshelter-in-place orders may be necessary until a vaccine can be reliably deployed or viral spread has subsided completely.