Age, race/Hispanic origin, and COVID-19 mortality among sickle cell disease patients in the United States

The COVID-19 pandemic remains a global health challenge, with 6.7 million deaths worldwide as of January 2023. It has illuminated the health iniquities in underserved communities and populations like those with sickle cell disease (SCD). Researchers have associated the COVID-19 outcome among SCD patients in other regions of the globe. The purpose of this retrospective cross-sectional observational study was to investigate the relationship between age, race/Hispanic origin, and COVID-19 mortality among persons with SCD in the United States from January 2020 to March 2021. The Krieger ecosocial theory of disease distribution framed the study. Data were drawn from an existing Centers for Disease Control and Prevention provisional SCD death data set (N = 140). The binary logistic regression analysis result showed a statistically significant relationship between age and race/Hispanic origin and COVID-19 mortality. The variability between ages was 42.9%;race/Hispanic origin was 29.9%;and age and race/Hispanic origin were the highest, with 62.4% dying from COVID-19. Non-Hispanic Black patients were 9.6 times more likely to die overall but those aged 60+ were 17.5 times more likely to die from COVID-19 than the reference groups (0-19-year-old and other race). This study can benefit the research community, public health workers, medical professionals, and policymakers to understand better and influence policy on developing and prioritizing age- and race-tailored preventive protocols and medical care. They may minimize pain and suffering while mitigating mortality from COVID-19 and other unforeseen future pandemics within the SCD community at home and abroad and positively effect social change. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Digital mental health interventions for college students of color: Understanding uptake and enhancing engagement

College students of color have significant mental health needs, but they are less likely to receive treatment than their white counterparts (Lin et al., 2022). Given students of color are a high need, understudied, and underserved group, increased attention to their mental health and strategies targeting mental health equity are imperative. Digital mental health interventions (DMHI) have been proposed as mechanisms for disparity reduction, and research indicates DMHI are effective in college student populations (Lattie et al., 2019). However, less is known about DMHI preferences, needs, and usage among students of color. Addressing pertinent questions about DMHI reach and uptake for this population can support efforts to advance health equity. This dissertation comprised two studies that explored the following research questions: Can DMHI enhance racial/ethnic equity in college student mental health treatment receipt? (Study 1) What are key barriers to DMHI uptake for college students of color and what strategies might enhance DMHI uptake in this population? (Study 2). Study 1 evaluated racial/ethnic differences in mental health problems and treatment enrollment within a largescale screening and treatment research initiative on a diverse college campus. Results illustrated racial/ethnic differences in student depression, anxiety, and suicidality. Students of color were less likely to have received prior mental health treatment compared to white students but were no less likely to initiate digital and face-to-face treatment through the research initiative. DMHI uptake rates were comparable to prior studies, with just 8.7% of those eligible initiating use of the DMHI. Given these findings, Study 2 employed a modified Delphi design to generate expert consensus on barriers to DMHI uptake and strategies to improve uptake among college students of color. Cross-disciplinary experts (n=35) participated in a three-round survey. Results revealed important barriers to uptake, including factors associated with the user, program, technology, and environment. Strategies were coded within four implementation levels, including DMHI design, marketing and outreach, orientation and onboarding, and campus/community-level efforts. Analyses yielded a subset of promising strategies rated highly important and feasible. These findings provide guidance for future efforts focused on tailoring and implementing DMHI uptake strategies through co-creation with students of color. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Navigating parental involvement: Restoring bridges and inspiring change

It appears that the predominantly European centered educational system has failed Black students. There is a disparity in academic success for Black students in comparison to White students. In 2013, it was reported that 34% of Black students and 9% of White students scored below basic on the National Assessment of Educational Progress (National Education Policy and Practice and Priority Schools Department, 2015). In a study conducted by Stanford professor Reardon, average test scores of Black students were two grade levels lower than White students (Rabinovitz, 2016). Black students at the national level scored 30 points lower than their White peers in 2011, according to the National Center for Educational Statistics (Bohrnstedt et al., 2015). Nonacademic factors such as student motivational levels, work ethic, and family/parent support have emerged as possible causes (Ratcliff et al., 2016). Research by LaRocque et al. (2011) supports the need for collaboration of parents and teachers to increase student learning. The need to build relationships with Black families is especially crucial to improving the academic experiences of Black students. Epstein's Framework for Parental Involvement should also be held under the careful lens of Critical Race Theory (CRT) when used in school districts that serve predominately Black students. In this qualitative case study, I describe the process and challenges of initiating and maintaining parent/ teacher relationships in urban, middle schools to improve Black students' academic performance. Data was obtained from interviews with 6 Black and 5 White middle school educators. The data gathered was coded and analyzed to draw out the perceptions teachers have about parental involvement and student achievement. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Personal and professional reflections: Shame and race

In this chapter, I will discuss my understanding of shame and race having been born, and having lived and worked in racialised societies. I decided to write from my personal and professional experiences of seeing people who expressed their feelings of being made to feel ashamed and what actions they took to be relieved of these feelings. On refection, during this year of the enforced "lock down" caused by the pandemic of COVID-19, I have had more time to observe people whilst standing at the stipulated distance of two metres. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

An examination of the perceptions of digital religion across digital nativity, gender, & race in Philadelphia, Pennsylvania during COVID-19

Living in an accelerated global society where advanced technology leads to the interconnection of people, it is essential to recognize why change is necessary for maintaining sustainability within religious organizations. Americans are integrating digital technology, computer-based technology, and virtual technology into their lifestyles, revolutionizing society. Social cultures are evolving as technology impacts digital natives, gender, and race, influencing changes in behaviors, customs, and beliefs. The purpose of this research study was to analyze the perception of digital religion across digital natives, gender, and race in Philadelphia, Pennsylvania, during COVID-19. Digital Religion is a term that combines religion and online practices resulting in online religious activities. Church attendance is dwindling as men and women of various races and digital nativity disaffiliates from the church. Church leaders are contending with varying viewpoints and scarcity of modern technology. Technology use is prevalent among growing digital natives raised in a digitized world, who view electronics as essential and imperative. If millennials and digital natives prefer virtual reality, then the question becomes, how will church leaders in the 21st century successfully incorporate digital religion into their ministry to preserve religion? Some church leaders realize that sustainability requires successful entry into the digital world, while others remain egoistic and consider digitalization insignificant and irrelevant convinced that digital religion may misguide biblical principles and alter religious traditions. Despite varying viewpoints, technology use in The United States is increasing in every demographic including, but not limited to, age, ethnicity, and gender. To reduce the widening divide, faith-based organizations must embrace technology and implement new ways of propagating their message, marrying old ways with new ways to improve church attendance and increase growth in the future. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

An examination of the perceptions of digital religion across digital nativity, gender, & race in Philadelphia, Pennsylvania during COVID-19

Living in an accelerated global society where advanced technology leads to the interconnection of people, it is essential to recognize why change is necessary for maintaining sustainability within religious organizations. Americans are integrating digital technology, computer-based technology, and virtual technology into their lifestyles, revolutionizing society. Social cultures are evolving as technology impacts digital natives, gender, and race, influencing changes in behaviors, customs, and beliefs. The purpose of this research study was to analyze the perception of digital religion across digital natives, gender, and race in Philadelphia, Pennsylvania, during COVID-19. Digital Religion is a term that combines religion and online practices resulting in online religious activities. Church attendance is dwindling as men and women of various races and digital nativity disaffiliates from the church. Church leaders are contending with varying viewpoints and scarcity of modern technology. Technology use is prevalent among growing digital natives raised in a digitized world, who view electronics as essential and imperative. If millennials and digital natives prefer virtual reality, then the question becomes, how will church leaders in the 21st century successfully incorporate digital religion into their ministry to preserve religion? Some church leaders realize that sustainability requires successful entry into the digital world, while others remain egoistic and consider digitalization insignificant and irrelevant convinced that digital religion may misguide biblical principles and alter religious traditions. Despite varying viewpoints, technology use in The United States is increasing in every demographic including, but not limited to, age, ethnicity, and gender. To reduce the widening divide, faith-based organizations must embrace technology and implement new ways of propagating their message, marrying old ways with new ways to improve church attendance and increase growth in the future. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Digital mental health interventions for college students of color: Understanding uptake and enhancing engagement

College students of color have significant mental health needs, but they are less likely to receive treatment than their white counterparts (Lin et al., 2022). Given students of color are a high need, understudied, and underserved group, increased attention to their mental health and strategies targeting mental health equity are imperative. Digital mental health interventions (DMHI) have been proposed as mechanisms for disparity reduction, and research indicates DMHI are effective in college student populations (Lattie et al., 2019). However, less is known about DMHI preferences, needs, and usage among students of color. Addressing pertinent questions about DMHI reach and uptake for this population can support efforts to advance health equity. This dissertation comprised two studies that explored the following research questions: Can DMHI enhance racial/ethnic equity in college student mental health treatment receipt? (Study 1) What are key barriers to DMHI uptake for college students of color and what strategies might enhance DMHI uptake in this population? (Study 2). Study 1 evaluated racial/ethnic differences in mental health problems and treatment enrollment within a largescale screening and treatment research initiative on a diverse college campus. Results illustrated racial/ethnic differences in student depression, anxiety, and suicidality. Students of color were less likely to have received prior mental health treatment compared to white students but were no less likely to initiate digital and face-to-face treatment through the research initiative. DMHI uptake rates were comparable to prior studies, with just 8.7% of those eligible initiating use of the DMHI. Given these findings, Study 2 employed a modified Delphi design to generate expert consensus on barriers to DMHI uptake and strategies to improve uptake among college students of color. Cross-disciplinary experts (n=35) participated in a three-round survey. Results revealed important barriers to uptake, including factors associated with the user, program, technology, and environment. Strategies were coded within four implementation levels, including DMHI design, marketing and outreach, orientation and onboarding, and campus/community-level efforts. Analyses yielded a subset of promising strategies rated highly important and feasible. These findings provide guidance for future efforts focused on tailoring and implementing DMHI uptake strategies through co-creation with students of color. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Ethnicity and demographic factors as predictors of prolonged grief during COVID-19

The COVID-19 pandemic challenged bereaved families and friends in the rituals, final goodbyes, and support available during their time of loss. Research indicates that these practices are beneficial in the process of grief. The majority of people are resilient and adjust to the loss of a loved one. However, some will experience grief that does not abate with time. Prolonged grief disorder (PGD), recently approved for inclusion in the DSM-5-TR, is intense grief that can become distressing and disabling. Though limited, available studies posit that African Americans experience more prolonged grief than White Americans. This study used the PG-13-R scale to assess symptoms of prolonged grief between African Americans and White Americans (n = 206). This study also analyzed differences in prolonged grief symptoms between gender and age groups. Results of this study indicated no statistically significant difference between prolonged grief disorder scores for African Americans (M = 23.46, SD = 10.21) and White Americans (M = 24.80, SD = 9.09). There was a significant difference between females (M = 26.29, SD = 10.16), and males (M = 22.08, SD = 8.67), and between age groups. Specifically, the 18-35 group (M = 28.76, SD = 10.44) had significantly more prolonged grief than both the 36-64 group (M = 23.35, SD = 9.30) and the 65+ group (M = 20.26, SD = 7.13). (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Drinking among college student athletes during the COVID-19 pandemic.

Objective: To investigate demographics, sport type, athletic identity, and COVID-19 sport season cancelation in relation to alcohol consumption among college student athletes shortly after the pandemic emerged. Participants: College student athletes recruited from U.S. athletic departments. Methods: Survey data were collected from 5,915 college student athletes in April/May 2020. Results: Being female, Latinx, and in a relationship were associated with lower alcohol consumption. Among males, team sport participation was related to greater alcohol consumption. Among females, athletic identity was inversely related to drinking, which was moderated by sport type, such that alcohol consumption was lower as athletic identity strengthened in individual (vs. team) sport athletes. However, we did not find a relationship of COVID-19 sport season cancelation with drinking. Conclusions: Our gender-specific findings are novel and generalizable based on a large, national sample of college student athletes, and may inform strategies for alcohol consumption education among college team sport athletes.

Personal and professional reflections: Shame and race

In this chapter, I will discuss my understanding of shame and race having been born, and having lived and worked in racialised societies. I decided to write from my personal and professional experiences of seeing people who expressed their feelings of being made to feel ashamed and what actions they took to be relieved of these feelings. On refection, during this year of the enforced "lock down" caused by the pandemic of COVID-19, I have had more time to observe people whilst standing at the stipulated distance of two metres. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Facing social disparity and racial justice issues regarding Covid-19 and access to behavioral health care in the U.S

The Covid-19 pandemic exposed and amplified many problems in political and healthcare systems around the world, and the United States has been no exception. One such issue is racial injustice, including its impact as a social determinant of health and its manifestation in disparities in healthcare access-including behavioral healthcare. This paper examines this problem in detail and highlights the work of the Center for Practice Innovations. This intermediary organization provides training and implementation support to behavioral healthcare organizations across New York State. This work includes changes and awareness building related to racial injustice within its organization that will drive changes in training and supports provided to behavioral healthcare organizations across New York State. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (Italian) La pandemia di Covid-19 ha portato alla luce e amplificato molti problemi nei sistemi politici e sanitari in tutto il mondo, e gli Stati Uniti non hanno fatto eccezione. Uno di questi problemi e l'ingiustizia razziale, compreso il suo impatto come determinante sociale della salute e la sua manifestazione nelle disparita di accesso all'assistenza sanitaria - compresi i servizi di salute comportamentale. Questo documento esamina il problema nel dettaglio e evidenzia il lavoro del Center for Practice Innovations. Questa organizzazione intermediaria fornisce formazione e supporto nell'implementazione alle organizzazioni di assistenza sanitaria comportamentale in tutto lo Stato di New York. Questo lavoro include i cambiamenti e il consolidamento della consapevolezza relativi all'ingiustizia razziale all'interno della sua organizzazione, che guideranno i cambiamenti nella formazione e nei supporti forniti alle organizzazioni e servizi di salute comportamentale in tutto lo Stato di New York. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Racial and ethnic differences in COVID-19 outcomes, stressors, fear, and prevention behaviors among US women: Web-based cross-sectional study

Background: In the United States, racial and ethnic minorities are disproportionately affected by COVID-19, with persistent social and structural factors contributing to these disparities. At the intersection of race/ethnicity and gender, women of color may be disadvantaged in terms of COVID-19 outcomes due to their role as essential workers, their higher prevalence of pre-existing conditions, their increased stress and anxiety from the loss of wages and caregiving, and domestic violence. Objective: The purpose of this study is to examine racial and ethnic differences in the prevalence of COVID-19 outcomes, stressors, fear, and prevention behaviors among adult women residing in the United States. Methods: Between May and June 2020, women were recruited into the Capturing Women's Experiences in Outbreak and Pandemic Environments (COPE) Study, a web-based cross-sectional study, using advertisements on Facebook;491 eligible women completed a self-administered internet-based cross-sectional survey. Descriptive statistics were used to examine racial and ethnic differences (White;Asian;Native Hawaiian or other Pacific Islander;Black;Hispanic, Latina, or Spanish Origin;American Indian or Alaskan Native;multiracial or some other race, ethnicity, or origin) on COVID-19 outcomes, stressors, fear, and prevention behaviors. Results: Among our sample of women, 16% (73/470) reported COVID-19 symptoms, 22% (18/82) were concerned about possible exposure from the people they knew who tested positive for COVID-19, and 51.4% (227/442) knew where to get tested;yet, only 5.8% (27/469) had been tested. Racial/ethnic differences were observed, with racial/ethnic minority women being less likely to know where to get tested. Significant differences in race/ethnicity were observed for select stressors (food insecurity, not enough money, homeschooling children, unable to have a doctor or telemedicine appointment) and prevention behaviors (handwashing with soap, self-isolation if sick, public glove use, not leaving home for any activities). Although no racial/ethnic differences emerged from the Fear of COVID-19 Scale, significant racial/ethnic differences were observed for some of the individual scale items (eg, being afraid of getting COVID-19, sleep loss, and heart racing due to worrying about COVID-19). Conclusions: The low prevalence of COVID-19 testing and knowledge of where to get tested indicate a critical need to expand testing for women in the United States, particularly among racial/ethnic minority women. Although the overall prevalence of engagement in prevention behaviors was high, targeted education and promotion of prevention activities are warranted in communities of color, particularly with consideration for stressors and adverse mental health. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Alzheimer's Association report

This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report discusses the challenges of providing equitable health care for people with dementia in the United States. An estimated 6.2 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, the latest year for which data are available, making Alzheimer's the sixth-leading cause of death in the United States and the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated in 2020 by the COVID-19 pandemic. More than 11 million family members and other unpaid caregivers provided an estimated 15.3 billion hours of care to people with Alzheimer's or other dementias in 2020. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $256.7 billion in 2020. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes-costs that have been aggravated by COVID-19. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are more than three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 23 times as great. Total payments in 2021 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $355 billion. Despite years of efforts to make health care more equitable in the United States, racial and ethnic disparities remain-both in terms of health disparities, which involve differences in the burden of illness, and health care disparities, which involve differences in the ability to use health care services. Blacks, Hispanics, Asian Americans and Native Americans continue to have a higher burden of illness and lower access to health care compared with Whites. Such disparities, which have become more apparent during COVID-19, extend to dementia care. Surveys commissioned by the Alzheimer's Association recently shed new light on the role of discrimination in dementia care, the varying levels of trust between racial and ethnic groups in medical research, and the differences between groups in their levels of concern about and awareness of Alzheimer's disease. These findings emphasize the need to increase racial and ethnic diversity in both the dementia care workforce and in Alzheimer's clinical trials. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Distancing the socially distanced: Racial/ethnic composition's association with physical distancing in response to COVID-19 in the U.S

Social distancing prescribed by policy makers in response to COVID-19 raises important questions as to how effectively people of color can distance. Due to inequalities from residential segregation, Hispanic and Black populations have challenges in meeting health expectations. However, segregated neighborhoods also support the formation of social bonds that relate to healthy behaviors. We evaluate the question of non-White distancing using social mobility data from Google on three sites: workplaces, grocery stores, and recreational locations. Employing hierarchical linear modeling and geographically weighted regression, we find the relation of race/ethnicity to COVID-19 distancing is varied across the United States. The HLM models show that compared to Black populations, Hispanic populations overall more effectively distance from recreation sites and grocery stores: each point increase in percent Hispanic was related to residents being 0.092 percent less likely (p < 0.05) to visit recreational sites and 0.127 percent less likely (p < 0.01) to visit grocery stores since the onset of COVID-19. However, the GWR models show there are places where the percent Black is locally related to recreation distancing while percent Hispanic is not. Further, these models show the association of percent Black to recreation and grocery distancing can be locally as strong as 1.057 percent (p < 0.05) and 0.989 percent (p < 0.05), respectively. Next, the HLM models identified that Black/White residential isolation was related to less distancing, with each point of isolation residents were 11.476 percent more likely (p < 0.01) to go to recreational sites and 7.493 percent more likely (p < 0.05) to visit grocery stores compared to before COVID-19. These models did not find a measurable advantage/ disadvantage for Black populations in these places compared to White populations. COVID-19 policy should not assume disadvantage in achieving social distancing accrue equally to different racial/ethnic minorities. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Navigating parental involvement: Restoring bridges and inspiring change

It appears that the predominantly European centered educational system has failed Black students. There is a disparity in academic success for Black students in comparison to White students. In 2013, it was reported that 34% of Black students and 9% of White students scored below basic on the National Assessment of Educational Progress (National Education Policy and Practice and Priority Schools Department, 2015). In a study conducted by Stanford professor Reardon, average test scores of Black students were two grade levels lower than White students (Rabinovitz, 2016). Black students at the national level scored 30 points lower than their White peers in 2011, according to the National Center for Educational Statistics (Bohrnstedt et al., 2015). Nonacademic factors such as student motivational levels, work ethic, and family/parent support have emerged as possible causes (Ratcliff et al., 2016). Research by LaRocque et al. (2011) supports the need for collaboration of parents and teachers to increase student learning. The need to build relationships with Black families is especially crucial to improving the academic experiences of Black students. Epstein's Framework for Parental Involvement should also be held under the careful lens of Critical Race Theory (CRT) when used in school districts that serve predominately Black students. In this qualitative case study, I describe the process and challenges of initiating and maintaining parent/ teacher relationships in urban, middle schools to improve Black students' academic performance. Data was obtained from interviews with 6 Black and 5 White middle school educators. The data gathered was coded and analyzed to draw out the perceptions teachers have about parental involvement and student achievement. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Experiences and perceptions of parents of youth with disabilities toward school-based parent engagement strategies

Youth with disabilities continue to show poor in-school and post-school outcomes. Parent engagement remains as one key component to bring about positive outcomes in youth with disabilities. Despite schools' widely adapted strategies on parent engagement, parent perceptions on various parent engagement strategies is largely unknown. The purposes of this dissertation were (a) to identify parents' experiences and perceptions on the school-based parent engagementpractices in secondary transition, and (b) to understand the facilitators and barriers of parent engagement strategies for engaging parents of youth with disabilities. Using a nonprobability snowball sampling, this cross-sectional mixed-method survey study included 642 parents of youth with disabilities (ages 14-21) across the United States. Each parent reported their experience and perceived helpfulness toward each school-based parent engagement strategy, on a 5-point Likert scale, ranging from 1 (rarely experienced/not at all helpful) to 5 (always/extremely helpful). On average, participants reported they "sometimes" experienced each of the 23 strategies with the lowest rated strategies being (a) discussion of cultural values and beliefs and (b) connecting with service providers or agencies. Across the race/ethnicity groups, resultsrevealed racial differences in the perceptions of parents of youth with disabilities in secondary transition on the 23 school-based parent engagement strategies across five domains: knowledge and skills, communication, collaboration, relationships, and culturally responsive practice. Compared to parents of non-Hispanic White, parents of color reported lower scores across all five school-based parent engagement domains for both experiences and perceived usefulness. Toidentify further thoughts regarding parents' perceptions toward parent engagement, deductive, inductive, and thematic analysis of three open-ended questions uncovered four major themes pertaining to facilitators and barriers of parent engagement. The four themes included home-based factors, school-based factors, system-based factors, and existing situations (i.e., children's disabilities/characteristics, family's work, lack of transportation, time conflict, COVID-19, andweather). Implications for practice, limitations, and suggestions for future research are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Estimating influences of unemployment and underemployment on mental health during the COVID-19 pandemic: who suffers the most?

OBJECTIVES: The aim of the study was to evaluate whether unemployment and underemployment are associated with mental distress and whether employment insecurity and its mental health consequences are disproportionately concentrated among specific social groups in the United States during the COVID-19 pandemic. STUDY DESIGN: This is a population-based longitudinal study. METHODS: Data came from the Understanding America Study, a population-based panel in the United States. Between April and May 2020, 3548 adults who were not out of the labor force were surveyed. Analyses using targeted maximum likelihood estimation examined the association of employment insecurity with depression, assessed using the 2-item Patient Health Questionnaire, and anxiety, measured with the 2-item Generalized Anxiety Disorder scale. Stratified models were evaluated to examine whether employment insecurity and its mental health consequences are disproportionately concentrated among specific social groups. RESULTS: Being unemployed or underemployed was associated with increased odds of having depression (adjusted odds ratio [AOR] = 1.66, 95% confidence interval [CI] = 1.36-2.02) and anxiety (AOR = 1.50, 95% CI = 1.26, 1.79), relative to having a full-time job. Employment insecurity was disproportionately concentrated among Hispanics (54.3%), Blacks (60.6%), women (55.9%), young adults (aged 18-29 years; 57.0%), and those without a college degree (62.7%). Furthermore, Hispanic workers, subsequent to employment insecurity, experienced worse effects on depression (AOR = 2.08, 95% CI = 1.28, 3.40) and anxiety (AOR = 1.95, 95% CI = 1.24, 3.09). Those who completed high school or less reported worse depression subsequent to employment insecurity (AOR = 2.44, 95% CI = 1.55, 3.85). CONCLUSIONS: Both unemployment and underemployment threaten mental health during the pandemic, and the mental health repercussions are not felt equally across the population. Employment insecurity during the pandemic should be considered an important public health concern that may exacerbate pre-existing mental health disparities during and after the pandemic.

COVID-19 Cases and Death in Nursing Homes: The Role of Racial and Ethnic Composition of Facilities and Their Communities.

OBJECTIVES: To examine the extent to which the racial and ethnic composition of nursing homes (NHs) and their communities affects the likelihood of COVID-19 cases and death in NHs, and whether and how the relationship between NH characteristics and COVID-19 cases and death varies with the racial and ethnic composition of the community in which an NH is located. METHODS AND DESIGN: Centers for Medicare & Medicare Services Nursing Home COVID-19 data were linked with other NH- or community-level data (eg, Certification and Survey Provider Enhanced Reporting, Minimum Data Set, Nursing Home Compare, and the American Community Survey). SETTING AND PARTICIPANTS: NHs with more than 30 occupied beds (N=13,123) with weekly reported NH COVID-19 records between the weeks of June 7, 2020, and August 23, 2020. Measurements and model: Weekly indicators of any new COVID-19 cases and any new deaths (outcome variables) were regressed on the percentage of black and Hispanic residents in an NH, stratified by the percentage of blacks and Hispanics in the community in which the NH was located. A set of linear probability models with NH random effects and robust standard errors were estimated, accounting for other covariates. RESULTS: The racial and ethnic composition of NHs and their communities were both associated with the likelihood of having COVID-19 cases and death in NHs. The racial and ethnic composition of the community played an independent role in the likelihood of COVID-19 cases and death in NHs, even after accounting for the COVID-19 infection rate in the community (ie, daily cases per 1000 people in the county). Moreover, the racial and ethnic composition of a community modified the relationship between NH characteristics (eg, staffing) and the likelihoods of COVID-19 cases and death. CONCLUSIONS AND IMPLICATIONS: To curb the COVID-19 outbreaks in NHs and protect vulnerable populations, efforts may be especially needed in communities with a higher concentration of racial and ethnic minorities. Efforts may also be needed to reduce structural racism and address social risk factors to improve quality of care and population health in communities of color.