Invited Commentary: Some Social Epidemiologic Lessons From the COVID-19 Pandemic.

In their recent article, Dimitris et al. (Am J Epidemiol. 2022;191(6):980-986) presented a series of challenges modern epidemiology has faced during the coronavirus disease 2019 (COVID-19) pandemic, including challenges around the scientific progress, epidemiologic methods, interventions, equity, team science, and training needed to address these issues. Here, 2 social epidemiologists who have been working on COVID-19 inequities reflect on further lessons with an added year of perspective. We focus on 2 key challenges: 1) dominant biomedical individualistic narratives around the production of population health, and 2) the role of profit in policy-making. We articulate a need to consider social epidemiologic approaches, including acknowledging the importance of considering how societal systems lead to health inequities. To address these challenges, future (and current) epidemiologists should be trained in theories of population health distribution and political structures of governance. Last, we close with the need for better investment in public health infrastructure as a crucial step toward achieving population health equity.

Socioeconomic differences in the reduction of face-to-face contacts in the first wave of the COVID-19 pandemic in Germany.

BACKGROUND: The COVID-19 pandemic has led to physical distancing measures to control the spread of SARS-CoV-2. Evidence on contact dynamics in different socioeconomic groups is still sparse. This study aimed to investigate the association of socioeconomic status with private and professional contact reductions in the first COVID-19 wave in Germany. METHODS: Data from two especially affected municipalities were derived from the population-based cross-sectional seroepidemiological CORONA-MONITORING lokal study (data collection May-July 2020). The study sample (n = 3,637) was restricted to working age (18-67 years). We calculated the association of educational and occupational status (low, medium, high) with self-reported private and professional contact reductions with respect to former contact levels in the first wave of the pandemic. Multivariate Poisson regressions were performed to estimate prevalence ratios (PR) adjusted for municipality, age, gender, country of birth, household size, contact levels before physical distancing measures, own infection status, contact to SARS-CoV-2 infected people and working remotely. RESULTS: The analyses showed significant differences in the initial level of private and professional contacts by educational and occupational status. Less private contact reductions with lower educational status (PR low vs. high = 0,79 [CI = 0.68-0.91], p = 0.002; PR medium vs. high = 0,93 [CI = 0.89-0.97], p = 0.001) and less professional contact reductions with lower educational status (PR low vs. high = 0,87 [CI = 0.70-1.07], p = 0.179; PR medium vs. high = 0,89 [CI = 0.83-0.95], p = 0.001) and lower occupational status (PR low vs. high = 0,62 [CI = 0.55-0.71], p < 0.001; PR medium vs. high = 0,82 [CI = 0.77-0.88], p < 0.001) were observed. CONCLUSIONS: Our results indicate disadvantages for groups with lower socioeconomic status in private and professional contact reductions in the first wave of the pandemic. This may be associated with the higher risk of infection among individuals in lower socioeconomic groups. Preventive measures that a) adequately explain the importance of contact restrictions with respect to varying living and working conditions and b) facilitate the implementation of these reductions especially in the occupational setting seem necessary to better protect structurally disadvantaged groups during epidemics.

Health Impacts of the COVID-19 Lockdown Measure in a Low Socio-Economic Setting: A Cross-Sectional Study on Reunion Island.

In March 2020, the French government implemented nation-wide measures to reduce social contact and slow the progression of the emerging coronavirus responsible for COVID-19, the most significant being a complete home lockdown that lasted 8 weeks. Reunion Island is a French overseas department marked by large social inequalities. We draw the hypothesis that distancing and lockdown measures may have contributed to an increase in the social inequalities in health (SIH) on Reunion Island. The aim of our study was to describe the SIH during lockdown in the Reunionese population. We implemented a cross-sectional telephone survey conducted between 13 May and 22 July 2020, using a retrospective data collection on the lockdown period. A total of 892 adult participants (≥18 years) were recruited in the 114 large Reunionese neighborhoods using the quota method within the national "White Pages" telephone directory. Degraded psychological states, an increase in addictive behaviors, difficulties in accessing food, a decrease in physical activity, delayed medical appointments, violence against women, and health problems in children were driven by the socio-economic characteristics of the population, most often to the disadvantage of social groups exposed to poor living conditions. These results suggest that the COVID-19 lockdown contributed to an increase in SIH.

Real-Time Analysis of Predictors of COVID-19 Infection Spread in Countries in the European Union Through a New Tool.

Objectives: Real-time data analysis during a pandemic is crucial. This paper aims to introduce a novel interactive tool called Covid-Predictor-Tracker using several sources of COVID-19 data, which allows examining developments over time and across countries. Exemplified here by investigating relative effects of vaccination to non-pharmaceutical interventions on COVID-19 spread. Methods: We combine >100 indicators from the Global COVID-19 Trends and Impact Survey, Johns Hopkins University, Our World in Data, European Centre for Disease Prevention and Control, National Centers for Environmental Information, and Eurostat using random forests, hierarchical clustering, and rank correlation to predict COVID-19 cases. Results: Between 2/2020 and 1/2022, we found among the non-pharmaceutical interventions "mask usage" to have strong effects after the percentage of people vaccinated at least once, followed by country-specific measures such as lock-downs. Countries with similar characteristics share ranks of infection predictors. Gender and age distribution, healthcare expenditures and cultural participation interact with restriction measures. Conclusion: Including time-aware machine learning models in COVID-19 infection dashboards allows to disentangle and rank predictors of COVID-19 cases per country to support policy evaluation. Our open-source tool can be updated daily with continuous data streams, and expanded as the pandemic evolves.

Information-seeking, online search tools, and the formation of new norms in health behaviors during the COVID-19 pandemic

This dissertation focuses on how people search for information and how people rely on this information to inform their health behaviors and develop social norms. In academia and policy, the focus in research on information has most often studied the information that is sent to consumers, seeing people as passive receivers of information. This is otherwise known as information 'push'. But, information is also intentionally sought out by individuals;called information pull. My dissertation focuses on individuals as active agents in their search for information and how the information discovered through these push and pull processes relates to the creation of social norms.My first article tests the criterion validity of Google Search Trends as an indicator of computer-mediated information search. I attempt to validate Google Search Trends for use as indicators of attitudes, disease prevalence and political preferences using five different data sources. My analysis revealed no correlation among any of the Google Trends tested and their validated indicators. I demonstrate that there is no criterion validity of Google Trends for the selected cases and social scientists will find no replacement for high quality survey data with Google Trends. Instead, we must only use Google Trends to demonstrate interest or attention.Knowing that Google Trends data only encompasses a small portion of the information-seeking done by modern humans, my second article is motivated by the research question: How do computer-mediated or interpersonal information-seeking strategies vary across populations? Using original survey data of 948 Americans, I investigate their experiences seeking out information about COVID-19 vaccines. I investigate five distinct information seeking modalities, or methods of searching for information: personal connection, doctor, social networking site, online forum, and online search engine. I find that different exposure points, the ways people first are exposed to information without searching for it, and information search modalities hold real world consequences through their associations with COVID-19 vaccination intentions and rates. For example, I find that receiving or seeking out information from a doctor increases COVID-19 vaccination uptake while receiving information from a social networking site is associated with lower odds of vaccination.My final article takes a deeper dive into the formation of social norms governing health behaviors in cases of extreme uncertainty. I specifically use the cases of stay-at-home rates and vaccination rates as responses to public health recommendations to mitigate the COVID-19 pandemic. Using the theories of associative diffusion and the integrated theoretical framework of norms, I test models of behavioral adaption to public health recommendations and patterns of complex contagion (the need for repeated exposures to something novel for it to diffuse) using linear mixed effects models. My results show that complex contagion is a valid framework for the social contagion of new norms during COVID-19. However, I find an important novel moderating effect of signal discordance;if there is diversity in the information received by an ego, contagion is less likely to occur. This paper shows that the contagion process is not fully understood without looking at the context of each exposure to a contagion within the range of contagions one experiences.The introductory chapter provides a summary of the research and an explanation of how this research contributes to sociology, social science, and society. Namely, this paper provides important perspectives on search as an agentic process and how the micro-level information seeking process of an individual can lead to macro-level social norms. I show that information diffusion is disrupted when conflicting information and behaviors are simultaneously diffusing and therein contribute to research on diffusion, social networks, and social norms. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

What you should know about RACISM-20 in the U.S.: a fact sheet in the time of COVID-19

Drawing from social epidemiology literature on structural racism, and rooted in critical race theory and critical theory related to narrative power, this paper uses satire and humor as commentary on mainstream U.S. public health discourse related to the role of “race” (properly understood, racism) in shaping inequities observed via COVID-19. Taking the form of a “RACISM-20” fact sheet, this paper transposes structural racism and COVID-19. In doing so, it accentuates how individualist, ahistoric, and pathologizing “downstream” frames of health risks/solutions curtail productive dialogue and action to advance racial and health equity. In the spirit of “racial emancipatory humor”, this work represents a potential pedagogical tool to discuss and critique dominant frames of racial(ized) risks, “vulnerability”, and responsibility – both in the context of COVID-19 and within broader discourse of racial health inequities, including as related to racialized police violence. In this capacity, this “fact sheet” serves as an example health promotion product of critical resistance and counternarrative. [ FROM AUTHOR] Copyright of Critical Public Health is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Hands-off? Laissez-faire policies on Covid-19 may exacerbate health inequalities

Purpose>This paper establishes an association between income and the likelihood of seeking medical treatment for Covid-19 symptoms in some countries. We provide an explanation for this income effect based on the stringency of government response to the pandemic and the unequal distribution of agency among social classes.Design/methodology/approach>The paper makes use of data from the Six-Country Survey on Covid-19 to establish the existence of an income effect on health utilisation, and from the Oxford Covid-19 Government response tracker to show that this income effect is associated with the stringency of governmental response to the pandemic. Data from the 2011/12 “Health and Healthcare” round of the International Social Survey Programme is used to show that this income effect cannot be explained by pre-existing patterns. An explanation for the link between government stringency and the income effect is advanced on a theoretical basis.Findings>The authors find in Britain, the US, and – with greater uncertainty – in Japan that individuals who experience potential Covid-19 symptoms are less likely to seek medical treatment if they have a lower income. The authors also show that governments in these countries adopted a less stringent response to the pandemic than the countries in our sample which do not exhibit an income effect – China, Italy and South Korea. The authors argue that laissez-faire policies place the burden of action upon the individual, activating underlying differences in agency between the social classes, and making (high) low-income individuals (more) less likely to seek medical attention.Research limitations/implications>Since there was not a direct measure of agency in the data, it could not be empirically verified that agency mediates the effect of government stringency on health utilisation. Further research could make use of datasets which incorporate such a measure, if they become available. It could also extend the geographical scope of the findings, to see if the income effect manifests in other countries which adopted a laissez-faire response to the pandemic.Practical implications>Governments should intervene more stringently during pandemics to minimise inequality in health outcomes.Originality/value>This paper establishes an association between the stringency of government response to the Covid-19 pandemic and income inequality in health utilisation. This contributes to scholarly and policy debates around health inequality in the area of social epidemiology, and the sociology of inequality more generally. It is also of relevance to the general public, in the context of a deadly pandemic.

Socioeconomic inequalities in the prevalence and perceived dangerousness of SARS-CoV-2 infections in two early German hotspots: findings from a seroepidemiological study.

OBJECTIVE: Evidence on socioeconomic inequalities in infections with the novel coronavirus (SARS-CoV-2) is still limited as most of the available studies are ecological in nature and individual-level data is sparse. We therefore analysed individual-level data on socioeconomic differences in the prevalence and perceived dangerousness of SARS-CoV-2 infections in local populations. Data were obtained from a population-based seroepidemiological study of adult individuals in two early German SARS-CoV-2 hotspots (n = 3903). Infection was determined by IgG antibody ELISA, RT-PCR testing and self-reports on prior positive PCR tests. The perceived dangerousness of an infection and socioeconomic position (SEP) were assessed by self-reports. Logistic and linear regression were applied to examine associations of multiple SEP measures with infection status and perceptions of dangerousness. RESULTS: We found no evidence of socioeconomic inequalities in SARS-CoV-2 infections by education, occupation, income and subjective social status. Participants with lower education and lower subjective social status perceived an infection as more dangerous than their better-off counterparts. In successfully contained local outbreaks of SARS-CoV-2 in Germany, infections may have been equally distributed across the socioeconomic spectrum. But residents in disadvantaged socioeconomic groups might have experienced a higher level of mental distress due to the higher perceived dangerousness of an infection.

HOMELESSNESS DURING THE COVID-19 PANDEMIC. STRATEGIES AND ACTION PLANS OF THE BERLIN SENATE

One of the social groups particularly hard hit by the COVID-19 pandemic is people experiencing homelessness, as they are especially vulnerable to infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Still, the pandemic also drastically affected their livelihoods, as parts of municipal emergency assistance services have broken away. This article aims to highlight emergency responses of the Berlin Senate to people experiencing homelessness regarding COVID-19. The Senate is responding to the issue, among other things, by expanding and refiguring the existing contingent of shelters run by municipal emergency assistance services, preventing transmission of COVID-19 and treating those infected, and establishing mechanisms of tenant protection. The paper discusses to what extent Senate measures and interventions at the onset of the pandemic can address the emergent need for homeless assistance services in Berlin. © 2021, Insitute of Geography and Spatial Organization Polish Academy of Sciences. All rights reserved.

Disrupted daily routines mediate the socioeconomic gradient of depression amid public health crises: A repeated cross-sectional study.

OBJECTIVE: There is a socioeconomic gradient to depression risks, with more pronounced inequality amid macroenvironmental potential traumatic events. Between mid-2019 and mid-2020, the Hong Kong population experienced drastic societal changes, including the escalating civil unrest and the COVID-19 pandemic. We examined the change of the socioeconomic gradient in depression and the potential intermediary role of daily routine disruptions. METHOD: We conducted repeated territory-wide telephone surveys in July 2019 and July 2020 with 1112 and 2034 population-representative Cantonese-speaking Hong Kong citizens above 15 years old, respectively. Stratified by year, we examined the association between socioeconomic indicators (education attainment, household income, employment status and marital status) and probable depression (nine-item Patient Health Questionnaire [PHQ-9] ⩾ 10) using logistic regression. Differences in the socioeconomic gradient between 2019 and 2020 were tested. Finally, we performed a path analysis to test for the mediating role of daily routine disruptions. RESULTS: Logistic regression showed that higher education attainment in 2019 and being married in 2020 were protective against probable depression. Interaction analysis showed that the inverse association of higher education attainment with probable depression attenuated in 2020 but that of being married increased. Path analysis showed that the mediated effects through daily routine disruptions accounted for 95.9% of the socioeconomic gradient of probable depression in 2020, compared with 13.1% in 2019. CONCLUSION: From July 2019 to July 2020, the mediating role of daily routine disruptions in the socioeconomic gradient of depression in Hong Kong increased. It is thus implied that infection control measures should consider the relevant potential mental health impacts accordingly.

Social distancing and influenza mortality in 1918 did not increase suicide rates in the United States.

Recent research has suggested that the social distancing mandates introduced in the United States during the main waves of the 1918-20 influenza pandemic caused an increase in suicide rates. However, that finding relies on poor-quality, temporally mismatched data and has signs of omitted variable bias. Similarly, a long-standing finding that American suicide rates in 1918-20 were also boosted by the influenza mortality of the time has gone unquestioned in the literature, despite the original research admitting its risk of ecological fallacy. Using higher-powered mortality data, I cast doubt on both findings by analyzing the experiences of the pandemic in 43 of the largest American cities of the time. In line with some populations' experiences of COVID-19, I report tentative evidence that social distancing mandates during the 1918-20 pandemic may have been associated with decreased suicide rates. Larger, cross-national investigations of the effects of historical pandemics and social distancing mandates on mental health and suicide are needed.

Inequitable impact of infection: social gradients in severe COVID-19 outcomes among all confirmed SARS-CoV-2 cases during the first pandemic wave in Sweden.

BACKGROUND: The backdrop of the ubiquitous social inequalities has increasingly come into foreground in research on the COVID-19 pandemic, but the lack of high-quality population-based studies limits our understanding of the inequitable outcomes of the disease. The present study seeks to estimate social gradients in COVID-19 hospitalisations, intensive care admissions and death by education, income and country of birth, while taking into account disparities in comorbidities. METHODS: We used a register-based retrospective open cohort design enrolling all 74 659 confirmed SARS-CoV-2-positive cases aged >25 years in Sweden during the first wave of the pandemic (until 14 September 2020). Information was retrieved from multiple registers and linked by the unique Swedish personal identity number concerning COVID-19 case identification; COVID-19 hospitalisations, intensive care admissions and death; comorbidities as measured by the Charlson Comorbidity Index; and sociodemographic information. Social gradients were estimated by the Relative Index of Inequality (RII) using Cox regression. RESULTS: Adjusted analyses showed significant social gradients in COVID-19 hospitalisation, intensive care admission, across education, income and country of birth, which were unaffected by adjustment for comorbidities. Education and country of birth gradients were stronger for hospitalisation and intensive care admissions but small to non-existent for death. In contrast, income gradients were consistent across all three COVID-19 outcomes. CONCLUSION: Social gradients in severe COVID-19 outcomes are widespread in Sweden, but appear to be unrelated to pre-existing health disparities. Inequitable outcomes of SARS-CoV-2 infection may therefore be at least partially avoidable and could rely on equitable management of confirmed COVID-19 cases.

The Type I interferon antiviral gene program is impaired by lockdown and preserved by caregiving.

Previous research has linked perceived social isolation (loneliness) to reduced antiviral immunity, but the immunologic effects of the objective social isolation imposed by pandemic "shelter in place" (SIP) policies is unknown. We assessed the immunologic impact of SIP by relocating 21 adult male rhesus macaques from 2,000-m2 field cage communities of 70 to 132 other macaques to 2 wk of individual housing in indoor shelters. SIP was associated with 30% to 50% reductions in all circulating immune cell populations (lymphocytes, monocytes, and granulocytes), down-regulation of Type I interferon (IFN) antiviral gene expression, and a relative up-regulation of CD16- classical monocytes. These effects emerged within the first 48 h of SIP, persisted for at least 2 wk, and abated within 4 wk of return to social housing. A subsequent round of SIP in the presence of a novel juvenile macaque showed comparable reductions in circulating immune cell populations but reversal of Type I IFN reductions and classical monocyte increases observed during individual SIP. Analyses of lymph node tissues showed parallel up-regulation of Type I IFN genes and enhanced control of viral gene expression during juvenile-partnered SIP compared to isolated SIP. These results identify a significant adverse effect of SIP social isolation on antiviral immune regulation in both circulating immune cells and lymphoid tissues, and they suggest a potential behavioral strategy for ameliorating gene regulatory impacts (but not immune cell declines) by promoting prosocial engagement during SIP.

Socioeconomic patterns and COVID-19 outcomes before, during and after the lockdown in Italy (2020).

The objective was to investigate the association between deprivation and COVID-19 outcomes in Italy during pre-lockdown, lockdown and post-lockdown periods using a retrospective cohort study with 38,534,169 citizens and 222,875 COVID-19 cases. Multilevel negative binomial regression models, adjusting for age, sex, population-density and region of residence were conducted to evaluate the association between area-level deprivation and COVID-19 incidence, case-hospitalisation rate and case-fatality. During lockdown and post-lockdown, but not during pre-lockdown, higher incidence of cases was observed in the most deprived municipalities compared with the least deprived ones. No differences in case-hospitalisation and case-fatality according to deprivation were observed in any period under study.

[Social inequalities in the regional spread of SARS-CoV-2 infections]. / Soziale Ungleichheit in der regionalen Ausbreitung von SARS-CoV-2.

BACKGROUND AND OBJECTIVE: It has not been adequately answered whether the spread of SARS-CoV­2 is influenced by social and economic factors. Earlier studies generally looked at cumulative incidences up to the analysis date and did not take into account the development of the spread over time. This study therefore focuses on the regional dynamic of new infections and their relationship to socioeconomic factors. Based on the literature we describe the state of knowledge and present our own analyses of administrative data from Germany. METHODS: For this study, we examined regional progress data of reported COVID-19 cases for 401 cities and counties in Germany and associated them with socioeconomic characteristics of the areas. Age-standardized weekly incidence rates were calculated for the period from 3 February 2020 to 28 March 2021. Macroindicators were added from the INKAR database (e.g., income, employment rate, and crowding). RESULTS: While areas with higher incomes and lower poverty had higher incidences in the first and at the beginning of the second wave of the pandemic, they increased significantly in low-income regions from December 2020 on. Regions with a high proportion of gainfully employed people in general and especially those in the manufacturing sector had high incidences, especially in the second wave and at the beginning of the third wave. A low mean living space per inhabitant was related to higher incidence rates since November 2020. CONCLUSION: The regional temporal course of the pandemic correlates with social and economic indicators. A differentiated consideration of these differences could provide information on target group-specific protection and test strategies and help to identify social factors that generally favor infections. An English full-text version of this article is available at SpringerLink as Supplementary Information.

COVID-19 distribution in Bogotá, Colombia: effect of poverty during the first 2 months of pandemic.

BACKGROUND: The current SARS-CoV-2 pandemic has especially affected individuals living in conglomerate settings having poverty as common characteristic. However, evidence of the association between COVID-19 severity and social determinants is still scarce, particularly, for Latin American countries. The objective was to assess the effect of socioeconomic deprivation in the clinical severity of COVID-19 infection among different localities of Bogotá, Colombia. METHODS: Secondary analyses using data of SARS-CoV-2 infected cases in Bogotá from 6 March 2020 to 19 April 2020 were carried out. Direct and indirect indicators of deprivation at area level and individual demographic characteristics (age, sex and type of case) were included in the analyses. FINDINGS: 1684 COVID-19 cases were included in the study. There were 217 (12.9%; 95% CI 11.3 to 14.5) serious cases, of which 32.6% (95% CI 26.4 to 38.8) cases were deceased. In the multilevel logistic regression, age, sex (female), type of case (different of imported case), number of serious cases recorded the previous day and multidimensional poverty were associated with serious cases (median OR: 1.72, 95% CI 1.56 to 1.87). INTERPRETATION: This paper explored the association between COVID-19 severity and social determinants. Expressions of poverty were associated with more severe cases during first 2 months of pandemic. It is a clear syndemic for the joint presentation of COVID-19 and other comorbidities among more serious cases.

Participatory Approaches to Addressing Missing COVID-19 Race and Ethnicity Data.

Varying dimensions of social, environmental, and economic vulnerability can lead to drastically different health outcomes. The novel coronavirus (SARS-CoV-19) pandemic exposes how the intersection of these vulnerabilities with individual behavior, healthcare access, and pre-existing conditions can lead to disproportionate risks of morbidity and mortality from the virus-induced illness, COVID-19. The available data shows that those who are black, indigenous, and people of color (BIPOC) bear the brunt of this risk; however, missing data on race/ethnicity from federal, state, and local agencies impedes nuanced understanding of health disparities. In this commentary, we summarize the link between racism and COVID-19 disparities and the extent of missing data on race/ethnicity in critical COVID-19 reporting. In addition, we provide an overview of the current literature on missing demographic data in the US and hypothesize how racism contributes to nonresponse in health reporting broadly. Finally, we argue that health departments and healthcare systems must engage communities of color to co-develop race/ethnicity data collection processes as part of a comprehensive strategy for achieving health equity.

Trends in Suicide Mortality in 10 Years around the Great East Japan Earthquake: Analysis of Evacuation and Non-Evacuation Areas in Fukushima Prefecture.

This study analyzed the suicide mortality rate in 12 municipalities in Fukushima Prefecture designated as evacuation areas following the 2011 nuclear disaster. Changes in suicide rates were examined using an exponential smoothing time series model. In the evacuation areas, the suicide rate of men increased immediately after the disaster and then decreased from 47.8 to 23.1 per 100,000 during about 1½ years after the disaster. However, with the lifting of the evacuation order, it again exceeded that of non-evacuation areas and continued to do so for the next 3 years. On the other hand, the suicide rate in women in the evacuation areas increased later than that in men. These results indicate the need for continuous support following the lifting of the evacuation order. In addition, it is necessary to enhance social networks, which continue to confer protection, because of the isolation of the elderly as highlighted in our previous study.

Changes in the behavioural determinants of health during the COVID-19 pandemic: gender, socioeconomic and ethnic inequalities in five British cohort studies.

BACKGROUND: The COVID-19 pandemic is expected to have far-reaching consequences on population health. We investigated whether these consequences included changes in health-impacting behaviours which are important drivers of health inequalities. METHODS: Using data from five representative British cohorts (born 2000-2002, 1989-1990, 1970, 1958 and 1946), we investigated sleep, physical activity (exercise), diet and alcohol intake (N=14 297). We investigated change in each behaviour (pre/during the May 2020 lockdown), and differences by age/cohort, gender, ethnicity and socioeconomic position (childhood social class, education attainment and adult financial difficulties). Logistic regression models were used, accounting for study design and non-response weights, and meta-analysis used to pool and test cohort differences in association. RESULTS: Change occurred in both directions-shifts from the middle part of the distribution to both declines and increases in sleep, exercise and alcohol use. Older cohorts were less likely to report changes in behaviours while the youngest reported more frequent increases in sleep, exercise, and fruit and vegetable intake, yet lower alcohol consumption. Widening inequalities in sleep during lockdown were more frequent among women, socioeconomically disadvantaged groups and ethnic minorities. For other outcomes, inequalities were largely unchanged, yet ethnic minorities were at higher risk of undertaking less exercise and consuming lower amounts of fruit and vegetables. CONCLUSIONS: Our findings provide new evidence on the multiple changes to behavioural outcomes linked to lockdown, and the differential impacts across generation, gender, socioeconomic circumstances across life, and ethnicity. Lockdown appeared to widen some (but not all) forms of health inequality.

Deterioration of mental health and insufficient Covid-19 information among disadvantaged immigrants in the greater Paris area.

OBJECTIVES: The aim of this study is to provide information on changes in mental health among disadvantaged immigrants from Sub-Saharan Africa in the Greater Paris area and their level of information about Covid-19. METHODS: Prior to the Covid-19 epidemic, the Makasi community-based cohort followed 850 immigrants from sub-Saharan Africa in the Greater Paris area. Between the 1st of April and the 7th of June 2020, all participants scheduled for a follow-up survey were systematically included into an additional COVID-19-related wave of data collection (N = 100). We compared participants' type of housing, level of food insecurity, work and mental health (PHQ9) before and during the first COVID-19-related lockdown, using paired-Mc Nemar chi-2 tests. We next described their level of information on Covid-19 and policy measures, broken down by sex. RESULTS: Among the 100 participants, 68% had no legal residence permit. Food insecurity was more often reported during lockdown than before (62% vs 52%). 9% of participants had a score indicative of severe depression (PHQ9) before lockdown and 17% afterwards (p = 0.17). Only 51% knew about the possibility of asymptomatic transmission of the COVID-19 virus. CONCLUSIONS: This study brings original information on a hard-to-reach population group. Our results suggest that the lockdown had a detrimental impact on various economic and mental health aspects among disadvantaged migrants residing in the Greater Paris area.