Parental Decisions on Return to Youth Sport During a Global Pandemic: Examining Parental Decisions by Race, Gender, and Socio-Economic Status

The onset of COVID-19 altered the way parents make decisions on safe activities for their children. Given the impact of this global pandemic, it is important to consider what decisions parents make when faced with the obstacle of keeping a child safe while letting them pursue extracurricular activities, such as sports. To this end, we examine decision-making of parents regarding whether or not they are comfortable allowing their children to participate in sport activities. For this purpose, we conducted two waves of surveys with youth sport parents in spring 2020 and fall 2020. The findings suggest that Black parents and female parents were more comfortable allowing their children to participate and that, in general, parents became more comfortable with local youth sport participation as the pandemic continued.

Rural-Urban Differences in Workers' Access to Paid Sick Leave

Paid sick leave (PSL) is associated with health care access and health outcomes. The COVID-19 pandemic highlighted the importance of PSL as a public health strategy, yet PSL is not guaranteed in the United States. Rural workers may have more limited PSL, but research on rural PSL has been limited. We estimated unadjusted and adjusted PSL prevalence among rural versus urban workers and identified characteristics of rural workers with lower PSL access using the 2014–2017 Medical Expenditure Panel Survey. We found rural workers had lower access to PSL than urban workers, even after adjusting for worker and employment characteristics. Paid sick leave access was lowest among rural workers who were Hispanic, lacked employer-sponsored insurance, and reported poorer health status. Lower rural access to PSL poses a threat to the health and health care access of rural workers and has implications for the COVID-19 public health emergency and beyond.

COVID-19 job and income loss and mental health: the mediating roles of financial assets and well-being and the moderating role of race/ethnicity

Prior research shows unemployment has a negative effect on mental health, yet whether this relationship is affected by financial factors is unknown. For example, having money in savings may mitigate the impact of job loss on mental health. We use structural equation modeling with data from the Socio-Economic Impacts of COVID-19 Survey with a nationally representative sample (N = 3,341) to examine COVID-19 related job loss and mental health as partially mediated by liquid assets and Financial Well-Being (FWB) and moderated by race and ethnicity as moderators. More than a quarter (28.34%) of participants said they experienced a job or income loss due to COVID-19, which was associated with greater psychological distress as measured by the PHQ-4. The structural model had excellent fit (RMSEA = 0.021);FWB partially mediated the relationship between job/income loss and mental health (p <.001), accounting for 49% of the total effect. However, liquid financial assets did not partially mediate this relationship. Black participants experienced very different direct and indirect effects. Social workers should assess and intervene concerning financial factors when individuals experience job loss. Job loss is different among Black individuals who face greater challenges related to structural racism yet also have greater resilience.

Racial Differences in Attitudes Toward the COVID-19 Vaccine in Pregnant and Postpartum Women...Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) Convention, 25-29 June, 2022, Aurora, Colorado

The article offers information on racial differences in attitudes toward the Covid-19 vaccine in pregnant and postpartum women. It mentions that burden of Covid-19 infections and deaths disproportionately affects racial and ethnic minority communities, including pregnant women. It discusses that Covid-19 vaccines have been approved and recommended for use during pregnancy.

States of Emergency

We are wrestling with so many heavy dilemmas in our country and world right now, and "lil' Rhody" as people fondly refer to our lovely Ocean State, is not exempt. The children's mental health crisis is one that impacts us all. Between 2009 and 2019, the rate of Rhode Island students reporting feeling "sad or hopeless" for a 2‐week period within the past year rose from 25% to almost 33%. And in 2019, 17% of middle schoolers and 13% of high schoolers "seriously considered suicide" within the past year (YRBS). In general, rates like these are disproportionally higher for those most at risk — people of color, LGBTQ, and those with disabilities. The inequality and injustice in our society is not only a barrier, but also a cause for those most at risk for physical and mental health issues, especially those of the BIPOC community. Much like lack of green spaces, housing, and adequate food options in marginalized communities, there are also fewer resources and many structural barriers to healthcare (including mental healthcare) for these children from communities of color.

Critical Race Theory for Public Health Students to Recognize and Eliminate Structural Racism

Common approaches to medical and public health pedagogy that are grounded in the biomedical model and social determinants of health theory often fail to address structural racism as a root cause of health inequities.1 Structural racism refers to how societies foster discrimination through inequitable systems.2 These pedagogical approaches tend to promote reductionist views of disease, suggest that social determinants of health are immutable, and neglect the role of White power and privilege in driving unfair differences in health outcomes.1 Critical theoretical frameworks for public health education are needed to enhance understanding of how the field may be failing to address and eliminate health inequities and that contextualize health within power structures that marginalize and oppress.1 With its emphasis on the evolving practice of interrogating the roles of race and racism in society, critical race theory (CRT) is an important framework for informing how and what we teach the next generation of public health leaders to eradicate health inequities and drive social change.3 Striking racial disparities in rates of COVID-19 morbidity and mortality,4 recent surges in cases of police brutality against people of color, and public debate over teaching about racism have brought renewed attention to CRT. KEY TENETS OF CRITICAL RACE THEORY CRT provides a paradigm for equipping public health students with the knowledge and skills needed to recognize and eliminate social structures, practices, and discourses that perpetuate racism and health disparities.1,3,5 Key tenets of CRT include recognizing that race is socially constructed;understanding that racism is embedded throughout institutions, systems, structures, and policies;and embracing the lived experiences of people of color, including their experiences of oppression.1,3 Intersectionality involves conceptualizing and understanding how an individual's multiple marginalized social identities (e.g., related to gender identity, race, socioeconomic status) and intersecting structures of power and inequality shape their worldviews and lived experiences.1,8 Application of CRT to health instruction involves attending to how an individual's or group's unique "layered identities" converge with systems of oppression (e.g., racism, sexism) to better understand their health outcomes.1 APPLICATION TO PUBLIC HEALTH EDUCATION The following are our three teaching recommendations for public health faculty. Are there learning goals or objectives that are explicitly linked to antiracism and equity? A statement in the beginning of a syllabus conveying a commitment to equity and antiracism has been linked to student perceptions of a warm and supportive learning environment.8 This statement can include a proclamation of the instructor's respect for diversity, their expectations with respect to classroom climate, and a note that micro- and macroaggressions will not be tolerated.8 This statement can also be used to contextualize the course readings and materials, such as by acknowledging the subjectivity of science and the potential for overt and covert biases in course material.8,10 Similarly, we should explore how to "decolonize" our public health syllabi by disavowing those structures that reinforce superiority and exclusion, promoting critical consciousness, and centering the public health work of those from marginalized backgrounds.8 Account for Intersectionality Intersectionality is a key aspect of CRT that involves reflecting on identity and its relationship to power.11 Individuals' multiple socially constructed identities (e.g., race, sex, sexual orientation) exist within a matrix characterized by interlocking systems of oppression that may heighten their vulnerability to bias and how they experience that bias.1,8,11 We must define this concept in our course syllabi and commit to teaching approaches that promote "matrix thinking" through interrogation of how individuals' multiply marginalized identities converge with sociocultural systems that are mutable.11 Our courses must prioritize critical and multidimensional examination of how different forms of inequality, power structures, and oppression intersect to shape the health outcomes of all people and identify potential solutions to address these inequities.8,11 Wide-ranging social systems that inequitably distribute power and privilege need to be explicitly examined in all public health courses. In the field of health promotion, reflexivity provides a means of developing alternative modes of thinking related to social inequities, power dynamics, social justice, and contextually situated health issues.15 Reflexivity in action occurs when individuals engage in reflection while doing an action and adjust their practices accordingly (e.g., What am I learning about this population, and how might this learning affect the next steps of my action?);reflexivity on action occurs after an action has taken place and involves stepping back and reflecting on one's own actions (e.g., What could I have done differently?);and reflexivity underlying action involves questioning power dynamics or assumptions that underlie a field, such as public health (e.g., What power structures might this kind of practice be creating, supporting, or modifying?).15 As public health educators, we would benefit from institutional training on how to integrate this typology into our curricula to help students and ourselves become more skilled in contextualizing health decision-making and more attuned to potential biases and power imbalances.15 We can use CRT to train a legion of change agents to advance antiracismand health equity-centered programs, policies, and practices.

Improving Adult Immunization Rates Within Racial and Ethnic Minority Communities

Part 1: Quality Improvement, Recommended Vaccines, and Reducing Vaccine Disparities SUPPLEMENT SPONSOR: AMERICAN ACADEMY OF FAMILY PHYSICIANS This project is funded by a grant from the Centers for Disease Control and Prevention (CDC) National Center for Immunization and Respiratory Diseases.

Association between COVID-19 diagnosis and economic class, race/skin color and social distancing in Brazilian university students

Purpose: To determine the association between diagnosis of COVID-19 and the economic class, race/skin color, and adherence to social distancing in Brazilian university students. Methods: This is a nationwide cross-sectional study carried out with online questionnaires applied to Brazilian university students, at 94 universities in the public and private education network. Self-reported age, sex, economic class data, race/skin color, COVID-19 diagnosis, and adherence to social distancing measures were collected. Results: 5,984 individuals were evaluated. No significant association was found between the diagnosis of COVID-19 and economic class and race/skin color in the multivariable analysis. However, we observed that there were significant associations between the diagnosis of COVID-19 and partial adherence to social distancing, with leaving home only for going to work (PR: 1.35;95% CI: 1.10–1.66;p < 0.01) and with non-adherence to social distancing (PR: 1.96;95% CI: 1.29–2.97;p <0.01). Conclusion: The diagnosis of COVID-19 was associated with age, non-adherence and partial adherence to social distancing measures in Brazilian university students, but was not associated with race/skin color and economic class. © 2021 Faculdade de Medicina de Ribeirao Preto - U.S.P.. All rights reserved.

Immunisation: ‘if you were me, what would you do?’

The article informs about James works on an inpatient mental health ward and although we have been vaccinating healthcare staff since January 2020, and history of allergies or anaphylaxis and experience people who have allergies are safest having the AstraZeneca vaccine.

Far From a "White Problem": Responding to the Overdose Crisis as a Racial Justice Issue

The United States is in the midst of an overdose crisis of tremendous proportions. Even before overdose death rates spiked sharply during the COVID19 pandemic, the United States had twice the mortality rate of the second highest country, and 20 times the global average.1 Deaths from overdose have increased year after year-nearly uninterrupted-for the past four decades. During the pandemic, the United States crossed the grim milestone of 100 000 overdose deaths in a 12-month period. Although overdose deaths have increased for all racial/ethnic and socioeconomic groups, these increases have not been felt equally among all Americans. Overdose and addiction have long predominated among low-income communities,3 and during the "first wave" of the overdose crisis in the early 2000s, deaths were concentrated in low-income White communities.4However, the racial/ethnic profile of the US overdose crisis has changed sharply.5 In 2020, the overdose death rates of Black individuals overtook those of White individuals and now exceed them by nearly 20%. American Indians/Alaska Natives now have the highest overdose mortality rates of any group-30% higher than for White individuals. Far from a "White problem," overdose prevention is now a key racial justice issue. In this issue of AJPH, an analysis of a national data set by Pro et al. (p. S66) considers the individual- and state-level factors that help explain racial disparities in addiction treatment. Economic and community distress-including low education, high unemployment, and housing vacancy-had the strongest negative relationship to treatment success across all racial/ethnic groups. Black and American Indian/Alaska Native patients disproportionately presented for treatment in mid- to high-distress communities. Black patients were also much more likely to experience poor treatment outcomes. In addition, patients in states that have not expanded Medicaid were less likely to experience successful treatment.

Ethnic inequalities in mental health and socioeconomic status among older women living with HIV: results from the PRIME Study.

OBJECTIVES: Women living with HIV in the UK are an ethnically diverse group with significant psychosocial challenges. Increasing numbers are reaching older age. We describe psychological and socioeconomic factors among women with HIV in England aged 45-60 and explore associations with ethnicity. METHODS: Analysis of cross-sectional data on 724 women recruited to the PRIME Study. Psychological symptoms were measured using the Patient Health Questionnaire 4 and social isolation with a modified Duke-UNC Functional Social Support Scale. RESULTS: Black African (BA) women were more likely than Black Caribbean or White British (WB) women to have a university education (48.3%, 27.0%, 25.7%, respectively, p<0.001), but were not more likely to be employed (68.4%, 61.4%, 65.2%, p=0.56) and were less likely to have enough money to meet their basic needs (56.4%, 63.0%, 82.9%, p<0.001). BA women were less likely to report being diagnosed with depression than WB women (adjusted odds ratio (aOR) 0.40, p<0.001) but more likely to report current psychological distress (aOR 3.34, p<0.05). CONCLUSIONS: We report high levels of poverty, psychological distress and social isolation in this ethnically diverse group of midlife women with HIV, especially among those who were BA. Despite being more likely to experience psychological distress, BA women were less likely to have been diagnosed with depression suggesting a possible inequity in access to mental health services. Holistic HIV care requires awareness of the psychosocial needs of older women living with HIV, which may be more pronounced in racially minoritised communities, and prompt referral for support including psychology, peer support and advice about benefits.

Association of Race and Neighborhood Disadvantage with Patient Engagement in a Home-Based COVID-19 Remote Monitoring Program.

BACKGROUND: COVID-positive outpatients may benefit from remote monitoring, but such a program often relies on smartphone apps. This may introduce racial and socio-economic barriers to participation. Offering multiple methods for participation may address these barriers. OBJECTIVES: (1) To examine associations of race and neighborhood disadvantage with patient retention in a monitoring program offering two participation methods. (2) To measure the association of the program with emergency department visits and hospital admissions. DESIGN: Retrospective propensity-matched cohort study. PARTICIPANTS: COVID-positive outpatients at a single university-affiliated healthcare system and propensity-matched controls. INTERVENTIONS: A home monitoring program providing daily symptom tracking via patient portal app or telephone calls. MAIN MEASURES: Among program enrollees, retention (until 14 days, symptom resolution, or hospital admission) by race and neighborhood disadvantage, with stratification by program arm. In enrollees versus matched controls, emergency department utilization and hospital admission within 30 days. KEY RESULTS: There were 7592 enrolled patients and 9710 matched controls. Black enrollees chose the telephone arm more frequently than White enrollees (68% versus 44%, p = 0.009), as did those from more versus less disadvantaged neighborhoods (59% versus 43%, p = 0.02). Retention was similar in Black enrollees and White enrollees (63% versus 62%, p = 0.76) and in more versus less disadvantaged neighborhoods (63% versus 62%, p = 0.44). When stratified by program arm, Black enrollees had lower retention than White enrollees in the app arm (49% versus 55%, p = 0.01), but not in the telephone arm (69% versus 71%, p = 0.12). Compared to controls, enrollees more frequently visited the emergency department (HR 1.71 [95% CI 1.56-1.87]) and were admitted to the hospital (HR 1.16 [95% CI 1.02-1.31]). CONCLUSIONS: In a COVID-19 remote patient monitoring program, Black enrollees preferentially selected, and had higher retention in, telephone- over app-based monitoring. As a result, overall retention was similar between races. Remote monitoring programs with multiple modes may reduce barriers to participation.

Predictive Value of Sequential Organ Failure Assessment Score across Patients with and without COVID-19 Infection.

Rationale: Sequential organ failure assessment (SOFA) scores are commonly used in crisis standards of care policies to assist in resource allocation. The relative predictive value of SOFA by coronavirus disease (COVID-19) infection status and among racial and ethnic subgroups within patients infected with COVID-19 is unknown. Objectives: To evaluate the accuracy and calibration of SOFA in predicting hospital mortality by COVID-19 infection status and across racial and ethnic subgroups. Methods: We performed a retrospective cohort study of adult admissions to the University of Miami Hospital and Clinics inpatient wards (July 1, 2020-April 1, 2021). We primarily considered maximum SOFA within 48 hours of hospitalization. We assessed accuracy using the area under the receiver operating characteristic curve (AUROC) and created calibration belts. Considered subgroups were defined by COVID-19 infection status (by severe acute respiratory syndrome coronavirus 2 polymerase chain reaction testing) and prevalent racial and ethnic minorities. Comparisons across subgroups were made with DeLong testing for discriminative accuracy and visualization of calibration belts. Results: Our primary cohort consisted of 20,045 hospitalizations, of which 1,894 (9.5%) were COVID-19 positive. SOFA was similarly accurate for COVID-19-positive (AUROC, 0.835) and COVID-19-negative (AUROC, 0.810; P = 0.15) admissions but was slightly better calibrated in patients who were positive for COVID-19. For those with critical illness, maximum SOFA score accuracy at critical illness onset also did not differ by COVID-19 status (AUROC, COVID-19 positive vs. negative: intensive care unit admissions, 0.751 vs. 0.775; P = 0.46; mechanically ventilated, 0.713 vs. 0.792, P = 0.13), and calibration was again better for patients positive for COVID-19. Among patients with COVID-19, SOFA accuracy was similar between the non-Hispanic White population (AUROC, 0.894) and racial and ethnic minorities (Hispanic White population: AUROC, 0.824 [P vs. non-Hispanic White = 0.05]; non-Hispanic Black population: AUROC, 0.800 [P = 0.12]; Hispanic Black population: AUROC, 0.948 [P = 0.31]). This similar accuracy was also found for those without COVID-19 (non-Hispanic White population: AUROC, 0.829; Hispanic White population: AUROC, 0.811 [P = 0.37]; Hispanic Black population: AUROC, 0.828 [P = 0.97]; non-Hispanic Black population: AUROC, 0.867 [P = 0.46]). SOFA was well calibrated for all racial and ethnic groups with COVID-19 but estimated mortality more variably and performed less well across races and ethnicities without COVID-19. Conclusions: SOFA accuracy does not differ by COVID-19 status and is similar among racial and ethnic groups both with and without COVID-19. Calibration is better for COVID-19-infected patients and, among those without COVID-19, varies by race and ethnicity.

Lofty goals and strategic plans are not enough to achieve and maintain a diverse workforce: an American Association for the Surgery of Trauma Diversity, Equity, and Inclusion Committee conversation.

The American Association for the Surgery of Trauma Diversity, Equity, and Inclusion (DEI) Ad Hoc Committee organized a luncheon symposium with a distinguished panel of experts to discuss how to ensure a diverse surgical workforce. The panelists discussed the current state of DEI efforts within surgical departments and societal demographic changes that inform and necessitate surgical workforce adaptations. Concrete recommendations included the following: obtain internal data, establish DEI committee, include bias training, review hiring and compensation practices, support the department members doing the DEI work, commit adequate funding, be intentional with DEI efforts, and develop and support alternate pathways for promotion and tenure.

Persistent disparities in SARS-CoV-2 test percent positivity by neighborhood in New York City, March 1-July 25, 2020.

PURPOSE: To examine neighborhood-level disparities in SARS-CoV-2 molecular test percent positivity in New York City (NYC) by demographics and socioeconomic status over time to better understand COVID-19 inequities. METHODS: Across 177 neighborhoods, we calculated the Spearman correlation of neighborhood characteristics with SARS-CoV-2 molecular test percent positivity during March 1-July 25, 2020 by five periods defined by trend in case counts: increasing, declining, and three plateau periods to account for differential testing capacity and reopening status. RESULTS: Percent positivity was positively correlated with neighborhood racial and ethnic characteristics and socioeconomic status, including the proportion of the population who were Latino and Black non-Latino, uninsured, Medicaid enrollees, transportation workers, or had low educational attainment. Correlations were generally consistent over time despite increasing testing rates. Neighborhoods with high proportions of these correlates had median percent positivity values of 62.6%, 28.7%, 6.4%, 2.8%, and 2.2% in the five periods, respectively, compared with 40.6%, 11.7%, 1.7%, 0.9%, and 1.0% in neighborhoods with low proportions of these correlates. CONCLUSIONS: Disparities in SARS-CoV-2 molecular test percent positivity persisted in disadvantaged neighborhoods during multiple phases of the first few months of the COVID-19 epidemic in NYC. Mitigation of the COVID-19 burden is still urgently needed in disproportionately affected communities.

Racial and Ethnic Differences in Presentation and Outcomes for Patients Hospitalized With COVID-19: Findings From the American Heart Association's COVID-19 Cardiovascular Disease Registry.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has exposed longstanding racial and ethnic inequities in health risks and outcomes in the United States. We aimed to identify racial and ethnic differences in presentation and outcomes for patients hospitalized with COVID-19. METHODS: The American Heart Association COVID-19 Cardiovascular Disease Registry is a retrospective observational registry capturing consecutive patients hospitalized with COVID-19. We present data on the first 7868 patients by race/ethnicity treated at 88 hospitals across the United States between January 17, 2020, and July 22, 2020. The primary outcome was in-hospital mortality. Secondary outcomes included major adverse cardiovascular events (death, myocardial infarction, stroke, heart failure) and COVID-19 cardiorespiratory ordinal severity score (worst to best: death, cardiac arrest, mechanical ventilation with mechanical circulatory support, mechanical ventilation with vasopressors/inotrope support, mechanical ventilation without hemodynamic support, and hospitalization alone. Multivariable logistic regression analyses were performed to assess the relationship between race/ethnicity and each outcome adjusting for differences in sociodemographic, clinical, and presentation features, and accounting for clustering by hospital. RESULTS: Among 7868 patients hospitalized with COVID-19, 33.0% were Hispanic, 25.5% were non-Hispanic Black, 6.3% were Asian, and 35.2% were non-Hispanic White. Hispanic and Black patients were younger than non-Hispanic White and Asian patients and were more likely to be uninsured. Black patients had the highest prevalence of obesity, hypertension, and diabetes. Black patients also had the highest rates of mechanical ventilation (23.2%) and renal replacement therapy (6.6%) but the lowest rates of remdesivir use (6.1%). Overall mortality was 18.4% with 53% of all deaths occurring in Black and Hispanic patients. The adjusted odds ratios for mortality were 0.93 (95% CI, 0.76-1.14) for Black patients, 0.90 (95% CI, 0.73-1.11) for Hispanic patients, and 1.31 (95% CI, 0.96-1.80) for Asian patients compared with non-Hispanic White patients. The median odds ratio across hospitals was 1.99 (95% CI, 1.74-2.48). Results were similar for major adverse cardiovascular events. Asian patients had the highest COVID-19 cardiorespiratory severity at presentation (adjusted odds ratio, 1.48 [95% CI, 1.16-1.90]). CONCLUSIONS: Although in-hospital mortality and major adverse cardiovascular events did not differ by race/ethnicity after adjustment, Black and Hispanic patients bore a greater burden of mortality and morbidity because of their disproportionate representation among COVID-19 hospitalizations.

Social inequalities and COVID-19 mortality in the city of São Paulo, Brazil.

BACKGROUND: Heterogeneity in COVID-19 morbidity and mortality is often associated with a country's health-services structure and social inequality. This study aimed to characterize social inequalities in COVID-19 mortality in São Paulo, the most populous city in Brazil and Latin America. METHODS: We conducted a population-based study, including COVID-19 deaths among São Paulo residents from March to September 2020. Age-standardized mortality rates and unadjusted rate ratios (RRs) [with corresponding 95% confidence intervals (CIs)] were estimated by race, sex, age group, district of residence, household crowding, educational attainment, income level and percentage of households in subnormal areas in each district. Time trends in mortality were assessed using the Joinpoint model. RESULTS: Males presented an 84% increase in COVID-19 mortality compared with females (RR = 1.84, 95% CI 1.79-1.90). Higher mortality rates were observed for Blacks (RR = 1.77, 95% CI 1.67-1.88) and mixed (RR = 1.42, 95% CI 1.37-1.47) compared with Whites, whereas lower mortality was noted for Asians (RR = 0.63, 95% CI 0.58-0.68). A positive gradient was found for all socio-economic indicators, i.e. increases in disparities denoted by less education, more household crowding, lower income and a higher concentration of subnormal areas were associated with higher mortality rates. A decrease in mortality over time was observed in all racial groups, but it started earlier among Whites and Asians. CONCLUSION: Our results reveal striking social inequalities in COVID-19 mortality in São Paulo, exposing structural inequities in Brazilian society that were not addressed by the governmental response to COVID-19. Without an equitable response, COVID-19 will further exacerbate current social inequalities in São Paulo.