"It all goes back to trust": a qualitative exploration of extension professionals' perceptions of COVID-19 vaccines in rural Florida

While urban communities experienced high levels of infection at the onset of the COVID-19 pandemic, rural communities experienced an increase of confirmed cases during the fall months of 2020. Rural Americans were also among the most hesitant to receive the COVID-19 vaccine. The purpose of this study was to explore the perceptions of [State] extension professionals related to the COVID-19 vaccines in rural communities. Qualitative methods were utilized to gather data from extension professionals in rural area of [State], where vaccine uptake was below average. Results revealed frustration with the vaccine process, vaccine norms, and skepticism and mistrust to all be contributing factors to vaccine hesitancy in rural communities. Extension professionals discussed not feeling comfortable discussing topics related to public health with their clientele, citing the topic being outside their expertise. Practical recommendations from this study included utilizing a grassroots approach rather than relying on mass media, providing messages related to the COVID-19 vaccine that focus on education, rather than promotion, and testing new messages before they are disseminated.

Occupational health and safety trainees reflect on their education and future careers during COVID-19

Background: The National Institute for Occupational Safety and Health (NIOSH) funded Education and Research Centers (ERCs), located at 18 universities, with the mission to train occupational safety and health (OSH) leaders. The Florida Sunshine ERC has trained hundreds of students since its inception in 1997 through seven programs that collaboratively foster interdisciplinary education and applied research and practice. The COVID-19 pandemic has presented practical challenges for educators, students, and trainees, forcing institutions to move to remote learning. The pandemic also magnifies the importance of public health and OSH. Purpose: This evaluation elicited feedback from ERC trainees early in the pandemic (2020) and again in 2021 on how the pandemic affected their training, professional development, career plans, and wellbeing. Methods: Open-ended surveys were collected and focus groups were held with currently enrolled trainees from seven Sunshine ERC programs. Descriptive statistics were calculated, and qualitative transcripts were analyzed using MAXQDA software. Results: Through survey responses (45 respondents) and focus group discussions (9 participants), ERC trainees shared their perspectives on pandemic impacts in their performance and wellbeing, transition to remote learning, their respective OSH fields, and career plans during the pandemic. Programs should consider enhancing OSH curricula to respond to training needs and issues related to occupational stress and well-being, pragmatism and disaster response, and even more interdisciplinary training to prepare for emerging population-wide threats. Conclusions: OSH training will require shifts in teaching modalities and content to prepare OSH professionals for the future. Evaluation results informed teaching and training modifications to ensure that ERC objectives continue to be met and that trainees are well-prepared and supported.

A framework for determining energy use in rural food delivery services: capturing system interdependencies through an agent-based discrete-event approach

Food e-commerce has seen significant growth over the past decade that accelerated after the onset of the COVID-19 pandemic. Last-mile transportation and logistics are widely considered the most expensive and least efficient portion of the supply chain and have multiple important energy trade-offs such as cargo capacity and consumer density. Last-mile transportation energy use in rural areas is underrepresented in the literature. This study proposes a hybrid agent-based and discrete event model framework for evaluating the last-mile transportation energy use of van- and car-based food delivery services in a rural community, based on meal-kit and grocery delivery operations, respectively. This framework quantifies last-mile energy use in rural areas, and is demonstrated here using a neighborhood outside of Austin, TX as an analytical testbed. The study focuses on the effects of consumer density, cargo limitations, and vehicle speed. For the conditions examined with this framework, diesel delivery vans use more total energy than passenger cars for the same trip, though a van delivering four orders uses less energy per-order than a car delivering one order. However, there are trade-offs between vehicle type and mileage, cargo capacity, route density, and speed that are particularly important for delivery services operating in rural areas. This framework can be used by service providers to assess route-specific trade-offs for each vehicle and gauge which is preferable for given operating conditions or to evaluate the energy, and thus also cost, impact of expanding their services to rural areas.

Programmatic impacts of utilizing various staffing options for COVID-19 contact tracers: recommendations and lessons learned

Background: The rapidly expanding COVID-19 pandemic created an immediate demand for the Department of Health in Hillsborough County (DOH-Hillsborough) Epidemiology Program to supplement its contact tracing workforce;and, because of the long duration of the response, a sustained workforce was needed. The DOH-Hillsborough Epidemiology Program's COVID-19 response, broadly referred to as "contact tracing", included case investigations, outbreaks, and identification and notifications to exposed individuals. To meet contact tracing staffing needs, several staffing options were utilized, including Core Epidemiology Staff, Reassigned DOH-Hillsborough staff (Reassigned Staff), Contracted staffing agency hires (Contract Staff), State of Florida hires (State Level Hires), County hires (DOH-Hillsborough Hires), and college and university faculty and students (University Partners). Purpose: To understand the differences in work output and efficiency across staffing groups (quantitative analysis) and to understand Core Epidemiology Staff recommendations when hiring temporary staff as contact tracers (qualitative analysis). Methods: A mixed-methods approached was used to assess each staffing group hired in Hillsborough County. Quantitative data was analyzed from 3/1/2020 through 1/31/2021, and included data from the state's personnel management system and the state's reportable disease database to represent work output. Qualitative interviews with DOH-Hillsborough Core Epidemiology Staff were conducted and analyzed to understand Core Epidemiology Staff recommendations when hiring surge staffing in the future. Results: During the evaluation period, 199 staff across the staffing groups worked a collective 132,252.50 hours. The number of hours worked per case and contact ranged from 10.16 in Core Epidemiology Staff to 0.67 in University Partners. During qualitative interviews with the Core Epidemiology Staff, five common themes emerged as ideal characteristics for temporary contact tracing staff. These included: communication skills, professionalism, public health knowledge, following official guidance, and flexibility. Two groups who emerged as the "best hires" for their seamless transition into their roles included University Partners and the State Level hires. Discussion: These mixed methods data can be used to develop best practices to inform future surge staffing needs.

Disparities in COVID-19 case counts and incidence in Florida by race and ethnicity at the county and state level

Background: In 2020, as COVID-19 spread across the United States, reports of disparities in COVID-19 incidence and mortality by race and ethnicity soon followed. This study assessed COVID-19 case counts and incidence by race and ethnicity at county and state levels focusing on Florida. Methods: Counts of COVID-19 were collected from June through December 2020. Chi square analyses assessed disparities in case distribution and linear regressions assessed disparities in incidence and potential interaction between predictors. Results: Race and ethnicity were significant predictors of COVID-19 incidence. Mean incidence was 4.9, 6.6, and 14.3 per 1,000 people among White, Black, and Other populations and 10.9 and 5.0 per 1,000 people among Hispanic and non-Hispanic populations. Incidence was greatest among the Other population (P=0.3825), and greater among Hispanic than non-Hispanic populations (P=0.0057). Conclusion: This study illustrates the disproportionate impact of COVID-19 upon racial and ethnic minorities and highlights the need to improve race and ethnicity data collection in disease reporting.

Racial disparities in air pollution burden and COVID-19 deaths in Louisiana, USA, in the context of long-term changes in fine particulate pollution. (Special Issue: Disparities during times of a pandemic and epidemic.)

Black Americans in Louisiana are disproportionately dying from COVID-19, and environmental disparities may be contributing to this injustice. While Black communities in Louisiana's industrialized regions (e.g., Cancer Alley, Calcasieu Parish) have been overburdened with pollution for decades, this disparity has not been evaluated by using recent data. Here, we explore statewide relationships among air pollution burden, race, COVID-19 death rates, and other health/socioeconomic factors. Measures of pollution burden included satellite-derived particulate matter (PM2.5) concentrations and health risks from toxic air pollution (i.e., respiratory hazard [RH] and immunological hazard [IH], estimated by the Environmental Protection Agency). In addition, we evaluate changes in emissions and ambient concentrations of fine PM2.5 in Louisiana over the past few decades. Our overall goal was to better understand Louisiana's burden of air pollution in the context of COVID-19. By all measures, a higher burden of air pollution was associated with larger percentages of Black residents and increased unemployment across Louisiana census tracts. Across parishes, higher COVID-19 death rates were associated with increased RH and IH and larger percentages of Black residents. These associations were not driven by diabetes, obesity, smoking, age, or poverty. Industrial sources comprised more of Louisiana's PM2.5 in 2017 versus 1990, as vehicle contributions declined 75% whereas industrial emissions remained about the same overall (despite variation in the interim). Ambient concentrations of PM2.5 decreased statewide from 2000 to 2015, but subsequently increased in south Louisiana, concurrent with an upward trend in industrial emissions. Our findings highlight the critical need to address Louisiana's pollution disparities and to recognize air pollution exposure as a risk factor for COVID-19.

Collegiate student-athlete psychological distress and counseling utilization during COVID-19

The onset of COVID-19 and cancellation of collegiate sports may have exacerbated student-athletes' psychological distress. Within a national sample of collegiate athletes (N = 5,755;66.7% women), we determined how gender and race related to rates of depression, stress, and counseling use at the beginning of the pandemic (April/May 2020). Overall, 26.5% (n = 1,526) and 10.6% (n = 612) endorsed clinical levels of depression and stress, respectively;25.1% (n = 1,443) and 69.7% (n = 4,014) reported subclinical levels. Few athletes (2.3%-17.1%) reported counseling use before or after the onset of COVID-19;those who did reported higher levels of depression and stress than those who never sought services. The female athletes reported higher rates of depression, stress, and counseling use than the male athletes. There were no race effects. Athletic departments must address their student-athletes' psychological distress by facilitating a higher use of mental health services.

Clinical spectrum of COVID-19 and plasma angiotensin II levels

Angiotensin II levels in COVID-19 are controversial. We studied 12 hospitalized patients, including their baseline levels of peripheral lymphocyte subsets (via flow cytometry) and plasma angiotensin II (via radioimmunoassay). Controls comprised radioimmunoassay's 124 healthy subjects. Angiotensin II levels (pg/ml) were elevated among patients versus controls (Mean +or- standard deviation: 98.8 +or- 146.9 versus 23.7 +or- 15.6, p < 0.0001;Median, interquartile range: 27, 20 to 116 versus 22, 14 to 28). Half the patients had lymphocytopenia (< 1000 cells/mm3), and the CD3+/CD4+ counts were negatively associated with body mass index, viral load, hospital stay and non-home discharge. Angiotensin II imbalance appears to be a biomarker for COVID-19 morbidity and merits further investigation.

Helping Louisiana's shrimp industry during the pandemic

This article reports on the inclusion of wild-caught shrimp in the USDA Agricultural Marketing Service (AMS) program to help Louisiana's shrimp industry during the COVID-19 pandemic. As a result of a quick Sea Grant mobilization, $50 million in cash from USDA was infused into the shrimping industry, and 7.6 million pounds of Louisiana shrimp were taken out of inventory and distributed nationwide.

Louisiana nurseries: a growing industry dealing with labor shortages

This article presents an overview of the growth of the Louisiana nursery industry and the labour challenges the industry is facing. Labour issues in the nursery industry are not easily solved, considering the nature and seasonality of employment and competition from other industries. Despite the benefits associated with the H-2A guest worker program, particularly securing seasonal workers in times of need, which allows nurseries to cope with labour shortages, few Louisiana nurseries rely on the H-2A program. Moreover, prolonged impact of the COVID-19 pandemic also raises concerns on ways the industry needs may change and how it will affect securing labour.

Failure to respond to a coral disease epizootic in Florida: causes and consequences

Stony coral tissue loss disease (SCTLD) was first observed in September 2014 near Virginia Key, Florida. In roughly six years, the disease spread throughout Florida and into the greater Caribbean basin. The high prevalence of SCTLD and high resulting mortality in coral populations, and the large number of susceptible species affected, suggest that this outbreak is one of the most lethal ever recorded. The initial recognition and management response to this catastrophic disease in Florida was slow, which delayed the start of monitoring programs and prevented coordinated research programs by at least two years. The slow management response was a result of several factors that operated concurrently. First, the Port Miami dredging project was ongoing during the coral disease epidemic and dredging rather than SCTLD was blamed by some managers and local environmental groups for the extreme coral losses reported in the project's compliance monitoring program. Second, this blame was amplified in the media because dredging projects are intuitively assumed to be bad for coral reefs. Third, during this same time State of Florida policy prohibited government employees to acknowledge global warming in their work. This was problematic because ocean warming is a proximal cause of many coral diseases. As a result, the well-known links between warming and coral disease were ignored. A consequence of this policy was that the dredging project provided an easy target to blame for the coral mortality noted in the monitoring program, despite convincing data that suggested otherwise. Specifically, results from the intensive compliance monitoring program, conducted by trained scientific divers, were clear. SCTLD that was killing massive numbers of corals throughout Florida was also killing corals at the dredge site - and in the same proportions and among the same suite of species. While eradication of the disease was never a possibility, early control measures may have slowed its spread or allowed for the rescue of significant numbers of large colonies of iconic species. This coral disease outbreak has similarities to the COVID-19 pandemic in the United States and there are lessons learned from both that will improve disease response outcomes in the future, to the benefit of coral reefs and human populations.

Anxiety symptoms among extension professionals' during the COVID-19 pandemic with the GAD-2. (Special Issue: Space, place, and COVID-19.)

According to the National Institute of Mental Health, anxiety disorders are a common mental health disorder but often remain undetected and undertreated. During the COVID-19 pandemic, Extension professionals have worked hard to address emerging issues that communities face, possibly impacting the amount of anxiety they experience. This study determined the prevalence of anxiety symptoms among Extension professionals in the United States. Participants from 24 states completed a survey containing the Generalized Anxiety Disorder 2-item (GAD-2) screener. Almost one-quarter of Extension professionals had a GAD-2 score greater than three, an indicator of anxiety with a possibility of generalized anxiety disorder, which is similar to that of the general population. Also, female and male Extension professionals were about equal in the prevalence of anxiety symptoms, which is contrary to the literature. Extension administrators should consider ways to help their employees with this anxiety, especially during and after traumatic events.

The effect of metformin use on mortality of COVID-19 patients with diabetes mellitus

Background: COVID-19 is a disease caused by infection with the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). COVID-19 is still a worldwide threat because of its high morbidity and mortality. This is influenced by the occurrence of hypertension, obesity, age and diabetes mellitus. However, currently there is still controversy in the results of research regarding the use of metformin in COVID-19 with type 2 diabetes mellitus (type 2 DM). This study was aimed to analyze the effect of metformin in COVID-19 patients with diabetes mellitus on mortality rates. Subjects and Method: This study was a systematic review and meta-analysis with the following PICO. P: COVID-19 patient with type-2 diabetes mellitus. I: administration of metformin therapy. C: therapy other than metformin and O: mortality. The articles used in this study were obtained from several databases, namely PubMed, Science Direct, Proquest, SpringerLink, Google Scholar and Scopus. The article search keywords were: "COVID-19" OR "coronavirus" AND "diabetes" AND "metformin" AND "mortality". Articles included are full-text English using a cohort study design from 2020 to 2021 and reporting the Odds Ratio in multivariate analysis. The selection of articles was carried out using the PRISMA flow chart. The articles were analyzed using the Review Manager 5.3 application.

Pandemic Response: LSU AgCenter takes virtual nutrition education to limited resource audiences

LSU AgCenter family and consumer sciences nutrition agents across Louisiana taught nutrition education classes to adults and children face-to-face in their communities and in schools. But because of the COVID-19 pandemic, in-person classes were halted in March 2020. To continue their outreach, the agents from the Supplemental Nutrition Assistance Program Education (SNAP-Ed), the Expanded Food and Nutrition Education Program (EFNEP) and the Flavors of Health program worked together to develop a virtual nutrition education program. To reach the specific audiences, the LSU AgCenter agents collaborated with community partners, such as local libraries, Head Start, WIC clinics and schools, to enroll participants for classes. Promotional videos featuring SNAP-Ed and EFNEP nutrition agents were produced to explain the benefits of attending the classes and how to register. Over time, EFNEP and SNAP-Ed nutrition agents and educators embraced virtual programming and were able to recruit and deliver nutrition education programs from their homes or offices. The benefit to offering virtual nutrition education classes was that AgCenter agents could remain visible in their community and still connect with their audiences while remaining safe during the pandemic.

PANDEMIC RESPONSE: LSU AgCenter agents teach nutrition through snacks

This article describes how the LSU AgCenter agents with the Expanded Food and Nutrition Education Program led a surprise "Snack Pack Cooking Class" for students at North Highlands Elementary School and Oak Park Microsociety Elementary School in Shreveport, Louisiana, in April and May of 2021. The AgCenter agents provided each student with a box of ingredients, a paper cookbook with recipes and handouts, and a paper chef's hat. Students prepared turkey ranch wraps, which served as the after-school snack, and an under-the-sea snack mix, which the students took home. The classes allowed for a hands-on, interactive experience, while adhering to COVID-19 guidelines. The students had to identify each food's category using the MyPlate guideline for nutrition. Of the 52 students, 50 reported that they tried a new vegetable because of the class. These 2 schools have participated in EFNEP nutrition lessons during after-school activities during this past school year hosted by the Fully Devoted Developers of Children Winners' Circle, a nonprofit group in Shreveport that partners with the AgCenter. This group provided funds for the classes and purchased picnic tables for the 2 schools.

Pandemic response: 4-H'ers learn about agriculture through seed-of-the-month club

The COVID-19 pandemic presented many challenges for the LSU AgCenter 4-H program. To meet social distancing guidelines and ensure the safety of youth and agents, many of programming efforts transitioned to a virtual format. However, the need remained for hands-on learning opportunities. 4-H programming is driven by the motto "learn by doing", and it was paramount that agents provide purposeful and engaging activities. The 4-H Seed-of-the-Month Club is a project club that emerged to meet that need. Agents created a nine-month seed subscription made available to youth across the region beginning in August 2020. With this project, participating youth were provided seeds of various plants, including pine seedlings, rainbow carrots, easter egg radishes, lettuce, green beans, okra, squash and coneflowers. Agents used the LSU AgCenter Louisiana planting guide to select the seeds to offer each month. In the future, agents and youth alike have expressed an interest in continuing to provide horticulture opportunities through the delivery mode of the Seed-of-the-Month Club. Participants were asked to provide top choices for their gardens by receiving carrots, lettuce and green bean seeds for the future.

Research update: "Growing" sustainable horticulture farmers

Various extension programs across the country offer educational and practical opportunities for new and beginning farmers. In recent years, Louisiana has experienced a boom in horticultural farm businesses managed by new and beginning farmers. Though access to land and credit are often cited as two primary challenges that new and beginning farmers face, access to market channels and business management skills are also key to building sustainable farm businesses. Moreover, strong social networks where new and beginning farmers can freely exchange ideas, network, share resources, and provide trainings are essential to the development of new and beginning farmers. This research focuses primarily on horticulture farmers' perceptions of business management skills and risk management. We used data collected as a part of the evaluation program for the Grow Louisiana Beginning Farmer Training Program (Grow Louisiana), an extension program offered by the Louisiana State University Agricultural Center. Grow Louisiana is a partnership of academic, cooperative extension, and nonprofit organizations to train fruit and vegetable farmers with less than 10 years of experience on small to mid-size farms in Louisiana. Focused on the southeastern region of Louisiana, the program emphasizes sustainable agricultural practices and local food systems. The year-long program offers participants training in whole-farm planning and risk management based on the following principles: (i) sustainable agriculture and business practices, (ii) resource optimization, (iii) objective decision making, and (iv) efficient work practices. The program trained 16 farmers per year and apart from educational training, promotes networking and mentoring among farmers across the state. This study used a mixed methods approach to analyze program evaluation data from the 3-year program (2018-2021). The first year the program was offered in person, the second year moved to a hybrid model when measures were taken to address participant safety due to the COVID-19 pandemic, and the third year was completed mostly online. Data were collected pre- and postprogram through needs assessments, interviews, and focus groups with participants. Findings add to existing literature and highlight the importance of business and marketing planning in the development and training of new and beginning farmers. Moreover, the study provides useful information for extension practices considering the variety of methods of delivery by year (i.e., in person, hybrid, online).

Research update: COVID-19 and marketing challenges for food producers in Louisiana

The COVID-19 pandemic disrupted the operations of many farm and food businesses across Louisiana. Producers had to adapt to changes or closures of market outlets, including farmers markets, farm-to-school programs, and restaurants. Using data collected from an online survey, this research examines pre- and post-pandemic marketing channels and challenges faced by food producers.

Proceedings from the 25th Annual Injury Free Coalition for KidsR Conference: Forging New Frontiers: Changing the Conversation on Gun Safety, Fort Lauderdale, Florida, USA, 4-6 December 2020

These proceedings contain 12 articles discussing how the COVID-19 pandemic has both impacted the epidemiology of childhood injury and uncovered health care disparities in childhood injury. The papers also highlight the research, education and advocacy efforts of the Injury Free Coalition for Kids in youth injury prevention.

COVID-19 rural health inequities: insights from a real-world scenario. (Special Issue: COVID-19 and health inequities: insights from communication research and practice.)

Background: During the pandemic, Mount Pleasant, Texas became a hotspot for Covid-19 cases in the Hispanic community employed by a local meat packing plant and many other industries. An important consideration for rural communities is the language barrier and lack of easily accessible Spanish information explaining Covid-19. In addition, rapidly changing discoveries about the virus and subsequent vaccines creates a sense of confusion within this population already burdened with difficulty understanding health information leading to even more confusion about prevention, treatment and vaccine acceptance.