Understanding Mobility Change in Response to COVID-19: A Los Angeles Case Study.

The COVID-19 pandemic has affected people's lives throughout the world. Governments have imposed restrictions on business and social activities to reduce the spread of the virus. In the US, the pandemic response has been largely left to state and local governments, resulting in a patchwork of policies that frequently changed. We examine travel behavior across income and race/ethnic groups in Los Angeles County over several stages of the pandemic. We use a difference-in-difference model based on mobile device data to compare mobility patterns before and during the various stages of the pandemic. We find a strong relationship between income/ethnicity and mobility. Residents of low-income and ethnic minority neighborhoods reduced travel less than residents of middle- and high-income neighborhoods during the shelter-in-place order, consistent with having to travel for work or other essential purposes. As public health rules were relaxed and COVID vaccines became available, residents of high-income and White neighborhoods increased travel more than other groups, suggesting more discretionary travel. Our trip purpose model results show that residents of low-income and ethnic minority neighborhoods reduced work and shopping travel less than those of White and high-income neighborhoods during the shelter-in-place order. Results are consistent with higher-income workers more likely being able to work at home than lower-income workers. In contrast, low-income/minorities apparently have more constraints associated with work or household care. The consequence is less capacity to avoid virus risk. Race and socioeconomic disparities are revealed in mobility patterns observed during the COVID-19 pandemic.

Food Insecurity and Food Allergy in Children of an Urban Minority Community: A Cross-Sectional Study

Rationale: Childhood food insecurity was exacerbated during the COVID-19 pandemic, with burdens falling disproportionately on minority children. This study aims to describe the prevalence of food insecurity in food-allergic children of an urban minority community and examine the association between food insecurity and food allergy. Methods: We conducted a retrospective review of electronic medical records of all patients aged 6 months to 18 years seen in a primary care pediatric clinic at NYC Health + Hospitals/Kings County, from 10/2020 to 06/2022. Pediatricians at this clinic in Central Brooklyn routinely screen for food insecurity using the Hunger Vital Sign™, a validated tool recommended by the American Academy of Pediatrics. Data was collected based on ICD-10 diagnosis codes for food insecurity (Z59.41) and food allergy (Z91.01). Logistic regression was used for analysis. Results: Among 7,856 children included in the study, 84.9% were Black or African American, 6.0% Hispanic/Latinx, 1.2% white, and 1.1% were Asian/Pacific Islander. Of 275 children diagnosed with a food allergy by a primary care pediatrician, 4.7% screened positive for food insecurity. Of 7,581 children without a diagnosed food allergy, 2.6% screened positive for food insecurity (p=0.029). Children with food allergy (adjusted odds ratio: 2.14, 95% confidence interval: 1.19-3.85) were significantly more likely to be food insecure than those without a food allergy, adjusted for age, gender, and race/ethnicity. Conclusions: Childhood food allergy is associated with increased odds of food insecurity. This study highlights the importance of assessing and addressing food insecurity in children with food allergies.

106. Adolescent Social Networks and School Engagement Across the High School Transition

Purpose: Attending and meaningfully engaging in school is a critical component of adolescence with broad implications for future health and well-being. Social network analysis offers powerful techniques to examine how the quality and structure of social relationships affect adolescent health and education. Peer and adult relationships impact adolescent health-affecting behaviors such as substance use and violence involvement, with potential for beneficial or deleterious effects. Social networks may similarly confer risk or protection for school engagement, an urgent issue of adolescent health considering COVID-19-related school disruptions. We describe adolescent social network quality and structure and examine associations between social network characteristics and school engagement during the transition from middle to high school. Methods: We analyzed data from an ongoing randomized trial of the Advancement via Individual Determination (AVID) college readiness program across 5 public high schools in Southern California. Participants completed baseline surveys at the end of 8th/beginning of 9th grade and follow-up surveys at the end of 9th grade. The Student Engagement Instrument assessed school engagement and egocentric social network surveys assessed adolescent social network quality (e.g., network composition, peer behavior) and structure (e.g., centrality, density). Multilevel mixed-effects models examined associations between baseline social network characteristics and concurrent and future school engagement. Models were adjusted for gender, ethnicity, prior AVID participation, study arm, and baseline school engagement as appropriate. Results: Baseline participants (n=431) were 60.6% female and 82.8% identified as Latinx. 418 participants completed follow-up surveys;retention rate=97.0%. Mean school engagement was 3.26 at baseline (SD=0.53;range 1-4) and 3.14 at follow-up (SD=0.52). Across all individuals in participants' social networks, 68.7% were peers, 24.5% were adults, and 55.4% were identified as sources of support. Across all peers in participants' social networks, 9.1% engaged in substance use and 82.6% were highly engaged in school. Overall social network characteristics associated with concurrent school engagement included a greater proportion of coaches (β=3.01;95%CI 0.01-6.02) and sources of support (β=0.20;95%CI 0.03-0.37). Peer social network characteristics associated with concurrent school engagement included a greater proportion of peers highly engaged in school (β=0.40;95%CI 0.20-060), a lower proportion of peers who use substances (β=-0.25;95%CI -0.50-0.00), and lower peer network density (β=-0.40;95%CI -0.72–0.08). Overall social network characteristics associated with future school engagement included a greater proportion of teachers (β=0.94;95%CI 0.05-1.82) and sources of support (β=0.28;95%CI 0.11-0.44). Peer social network characteristics associated with future school engagement included a greater proportion of peer sources of support (β=0.17;95%CI 0.03-0.32) and a lower proportion of peers who disrupt class (β=-0.29;95%CI -0.56–0.03). Conclusions: Building or bolstering connections to supportive peers and adults may serve to enhance adolescents' school engagement. Similar to other adolescent health-affecting behaviors, school engagement may be positively or negative influenced by the behaviors of peers in adolescents' social circles. Network-based interventions that target multiple associated social network-mediated behaviors, such as school engagement and substance use, may be particularly beneficial to adolescent health. Sources of Support: NIH/NICHD (T32HD071834), UPMC Children's Hospital of Pittsburgh Scholar Award, NIH/NIDA (1K23DA040733-01A1), Robert Wood Johnson Foundation (E4A 74086).

Fear, Political Legitimization, and Racism: Examining Anti-Asian Xenophobia During the COVID-19 Pandemic

Unfortunately, there is a long history linking pandemics to Anti-Asian prejudice and xenophobia;these negative outcomes have been particularly pronounced during the COVID-19 pandemic. Some scholars have suggested that these relationships are driven by fear, wherein individuals respond to disease threat by "othering” that threat. Other research has implicated the role of the state, including the political rhetoric of former President Trump, in exacerbating bias by enabling a divisive political environment. Yet, very few existing studies have been able to assess the nature of these impacts or examine the mechanisms behind observed increases in xenophobia. To that end, this research presents results from a survey administered in May 2020 to respondents residing in the U.S., which assessed COVID-19-related attitudes and behaviors, as well as anti-Asian prejudicial attitudes. Using these data, we assessed the direct and interactive relationship between perceptions of risk (i.e., fear), exposure to COVID-19 information, support for Trump, and anti-Asian prejudice. Results reveal that fear—and support for Trump—are associated with increased anti-Asian prejudice, but that exposure to more information about COVID-19 is associated with decreased prejudice;we also note complex interactions between each of these factors. © The Author(s) 2022.

Health inequalities and diabetes

Inequalities in health care exist in many countries in the world. In 2008 the then UK Secretary of State for Health commissioned the Marmot review, ‘Fair Society, Healthy Lives', to propose strategies to address health inequalities in the UK. Most of Marmot's proposals were not acted upon and in 2020, 10 years after the initial recommendations were published, Marmot found that there had been no improvement and some things were worse. In diabetes care inequalities are widespread, impacting on prevention, treatment, access to technology, screening for complications, risk of complications, morbidity and mortality. Ethnicity is a major risk factor, starkly demonstrated by the increased COVID-19 related mortality in people from minority ethnic groups with diabetes. Disadvantaged groups include, but are not limited to, those with social deprivation, intellectual and physical disabilities and severe mental illness. The decision to shelve the long-awaited white paper on tackling health inequalities, taken recently by the last Secretary of State for Health amid protests from a coalition of medical organisations, makes it unlikely that the government will take the actions proposed by Marmot. In the absence of a national strategy, responsibility to recognise and address inequalities in diabetes care falls on health care professionals, in teams and as individuals. Copyright © 2023 John Wiley & Sons.

Anti-Asian Discourse in Quora: Comparison of Before and During the COVID-19 Pandemic with Machine- and Deep-Learning Approaches

The current study attempts to compare anti-Asian discourse before and during the COVID-19 pandemic by analyzing big data on Quora, one of the most frequently used community-driven knowledge sites. We created two datasets regarding "Asians” and "anti-Asians” from Quora questions and answers between 2010 and 2021. A total of 1,477 questions and 5,346 answers were analyzed, and the datasets were divided into two time periods: before and during the COVID-19 pandemic. We conducted machine-learning-based topic modeling and deep-learning-based word embedding (Word2Vec). Before the pandemic, the topics of physical difference and racism were prevalent, whereas, after the pandemic, the topics of hate crime, the need to stop Asian hate crimes, and the need for the Asian solidarity movement emerged. Above all, the semantic similarity between Asian and Black people became closer, while the similarity between Asian people and other racial/ethnic groups was diminished. The emergence of negative and radical language, which increased saliently after the outbreak of the pandemic, and the considerably wider semantic distance between Asian and White people indicates that the relationship between the two races has been weakened. The findings suggest a long-term campaign or education system to reduce racial tensions during the pandemic. © The Author(s) 2022.

Food Insecurity and Health Behaviors Among a Sample of Undergraduate Students at an Urban University

Students at universities are experiencing food insecurity, which may be associated with health behaviors. In a pilot study to build a survey that assesses food insecurity and health behaviors among undergraduates, we distributed the survey before (Wave 1;fall 2019) and during (Wave 2;summer 2020) COVID-19. During Wave 1, 41% of students reported food insecurity and 61% met criteria for poor sleep. In Wave 2, 26% reported food insecurity and 49% met criteria for poor sleep. Students experiencing food insecurity were more likely to report poor sleep. This survey will inform recruitment and design of a scaled-up multi-campus study. (100/100 words). © 2022 Taylor & Francis Group, LLC.

The Persistence of Ethnopopulist Support: The Case of Rodrigo Duterte's Philippines

The past few years have seen an emergence of populist leaders around the world, who have not only accrued but also maintained support despite rampant criticism, governance failures, and the ongoing COVID pandemic. The Philippines' Rodrigo Duterte is the best illustration of this trend, with approval ratings rarely dipping below 80 percent. What explains his high levels of robust public support? We argue that Duterte is an ethnopopulist who uses ethnic appeals in combination with insider vs. outsider rhetoric to garner and maintain public support. Moreover, we argue that ethnic affiliation is a main driver of support for Duterte, and more important than alternative factors such as age, education, gender, or urban vs. rural divides. We provide evidence of Duterte's marriage of ethnic and populist appeals, then evaluate whether ethnicity predicts support for Duterte, using 15 rounds of nationally representative public opinion data. Identifying with a non-Tagalog ethnicity (like Duterte) leads to an 8 percent increase in approval for Duterte, significantly larger than any other explanatory factor. Among Duterte supporters, a non-Tagalog ethnicity is associated with 19 percent increase in strong versus mild support. Ethnicity is the only positive and significant result, suggesting that it strongly explains why Duterte's support remains robust. Alternative explanations, such as social desirability bias and alternative policy considerations, do not explain our results.

142. The Reach, Implementation, and Effectiveness of Virtual Sex Education for Youth in Foster Care

Purpose: Youth in foster care have high rates of adverse sexual health outcomes and are important targets for evidence-based sex education. With the COVID-19 pandemic, sexual health programming was moved to a virtual format. However, few data existed to guide this transition. While it lowers expenses and can potentially broaden geographic reach, it is unclear if virtual programming meets the needs of youth in foster care or other vulnerable populations. We conducted a mixed-methods analysis comparing the reach, implementation, and effectiveness of virtual vs in-person sex education for youth in foster care before and during the COVID-19 pandemic. Methods: Indiana Proud and Connected Teens (IN-PACT) provides evidenced-based sex education programs to system-involved youth. The data used in this study focused exclusively on foster-care programming and includes attendance records, facilitator session reviews (n=64) from 2020-2021 virtual programs, and youth surveys from 2018-2020 in-person (n=965) and virtual (n=50) programs. Reach was measured using youth baseline survey demographics and sexual behaviors;implementation by free responses from facilitators on challenges and adaptation for virtual teaching;and effectiveness by attendance records and youth behavior intention on follow-up surveys. Results: Reach: Youth demographic diversity was maintained for virtual programming in ethnicity, race, sex, and sexual orientation. However, youth in virtual programs had lower rates of self-reported risk behaviors including lower rates of involvement with juvenile justice (35.0% vs 59.4%, p<0.01) to have ever had sex (44.4% vs 78.8%, p<0.001) or contributed to a pregnancy (4.4% vs 23.4%, p<0.05). And though not statistically significant, virtual youth reported higher rates of condom use (44.4% vs 30.4%, p=0.371) and lower rates of substance use before sex in the past 3 months (15.6% vs 28.5%, p=0.114) as compared to in-person youth. Implementation: Technical challenges included connection difficulties and learning curves to using Zoom. Virtual facilitators incorporated more technology than they did in-person by playing videos on complicated topics such as conception and STIs. In terms of curriculum, hands-on condom demonstrations were changed to facilitator-run experiments such as having youth use socks at home to simulate condoms on their arms. Breakout rooms were utilized to maintain small group work but were cumbersome. Relational challenges included awkward silences, disengagement, and a decrease in group trust due to cameras being turned off during sensitive topics and less connection between youth and facilitators. Effectiveness: Attendance records show that fewer virtual youth completed 100% of programming, as compared to in-person youth (23% vs 54%). More virtual youth answered yes to the question "As a result of this program, will you abstain from sex for the next three months?” as compared to in-person youth (55% vs 45%, p=0.462). However, virtual youth were significantly less likely to have baseline sexual experience. Conclusions: In-person sexual health programming had a wider reach, experienced fewer implementation challenges, and was potentially more effective than virtual programming for youth in foster care. If virtual programming becomes necessary again, sex educators and researchers can use these data to redesign virtual programming that maximizes reach, implementation, and effectiveness. Sources of Support: HHS 90AK0041-02-00 to Health Care Education and Training Inc.

140. Acceptability of Mail-In Self-Collection for Gonorrhea and Chlamydia Screening in Primary Care Clinics

Purpose: The United States has seen a rise in sexually transmitted infections (STIs);the need to increase access for screening is essential to reverse this trend, especially for vulnerable populations such as LGBT+ individuals, people of color, or those at a low socioeconomic status. This study's primary objective is to assess preferences for mail-in STI screening among participants assigned female at birth already established with a primary care clinic. The study aims to provide insight into the need for clinicians to adopt mail-in testing for patients to improve screening access. Methods: Participants were recruited for this cross-sectional study from a clinical database of established patients with a focus on USPSTF recommendations for STI screening such as assigned female at birth (AFAB) and aged 18–24 years. Recruitment was done through a mailer from September to October 2021, inviting participants to complete an online survey. Statistical analyses were conducted using SAS software (SAS Institute Inc., Cary NC), version 9.4. Results: Overall, there was as a higher preference for home testing (61/88 = 0.69, 95% CI 0.59-0.79) among respondents. LGBT+ identity, age, recent clinical encounter, relationship status, living situation, or race and/or ethnicity, were not statistically significant associated with preference for home testing. However, there were lower odds for preferring home collection among participants with less education (OR 0.25, 95% CI 0.08-0.77, p<0.05), who lacked insurance (OR 0.19, 95% CI 0.06-0.67, p<0.05), or were unemployed (OR 0.28, 95% CI 0.08-0.95;p<0.05). Conclusions: Results from this survey indicate the desire for home testing among individuals from all demographics, influenced by social determinants of health such as education level and employment and insurance status. with overall acceptability for self-collection STI screening through mail-in methods (61/88=0.69;95% CI 0.59-0.79). The rising rates of STIs among young adults and delays in routine STI services secondary due to the ongoing COVID-19 pandemic and budget cuts emphasize the importance of new approaches to STI screening. Primary care clinics can expand needed screening by integrating such methods into workflows for established patients. These findings indicate a need for innovative outreach efforts to curb rising rates of STIs in the United States with additional consideration for research specific to LGBT+ health care needs, updated USPSTF recommendations for screening, and inclusive public health messaging. Sources of Support: Dr. Tana Chongsuwat was supported by the University of Wisconsin Primary Care Research Fellowship, funded by grant T32HP10010 from the Health Resources and Services Administration. The study was funded by a small grant by the University of Wisconsin Department of Pediatrics.

The Presence of Non-pharmaceutical Interventions Correlates with Decreased Rates of Asthma Exacerbations and RSV infections in Arkansas

Rationale: To reduce transmission of SARS-CoV-2, non-pharmaceutical interventions (NPIs), including school closures, hand hygiene, mask mandates, and social distancing, were enforced in Arkansas from 3/2020-2/2021. We hypothesized that the presence of NPIs would correlate with a decrease in asthma exacerbations and viral infections. Methods: Demographic information was collected on subjects with asthma exacerbations or viral infections from 3/2018-5/2022, including age, race, ethnicity, and sex. To evaluate the effects of NPIs, three periods were considered: pre- (03/2018-02/2020), during (03/2020-02/2021), and post- (03/2021-05/2022) NPIs. ANOVA analysis and generalized linear models were performed to determine statistical significance. The stringency of NPIs was evaluated using publicly available data (Oxford Covid-19 Government Response Tracker), which allows for direct comparison of Arkansas NPI status to exacerbation data during the same time periods. Results: 5055 asthma exacerbations (3322 unique subjects) occurred between 3/2018-5/2022. Asthma exacerbations decreased from 3/2020-3/2021 and returned to pre-pandemic numbers by summer 2021 (p<0.0001). Similar downward trends occurred for respiratory syncytial virus (RSV) with out-of-season return in summer 2021 (p<0.0001). Rhinovirus was present throughout NPIs. The mean age of exacerbations decreased by 0.9 years when comparing the during NPIs and after NPIs periods (p = 0.0002). An increase in the proportion of exacerbations was noted for non-black and other/unknown ethnicity subjects during and after NPIs. Conclusions: Fewer asthma exacerbations occurred during the most significant NPI employment period (03/2020-02/2021), and an increase in exacerbations was seen as mitigation strategies were relaxed, which correlated with timing of increasing RSV infections.

136. Telemedicine for Adolescent and Young Adult Long-acting Reversible Contraception Initial Follow-up Visit: Outcomes Over 1 Year

Purpose: Telemedicine for adolescent and young adult (AYA) care, including long-acting reversible contraception (LARC) care, was quickly implemented in response to the COVID-19 pandemic. Therefore, outcomes of telemedicine LARC care is understudied. We compare outcomes of AYAs receiving LARC follow-up care via telemedicine and in-person over 1 year. Methods: This cohort study includes patients who had LARC, intrauterine device (IUD) or implant, inserted between 4/1/20-3/31/21 and attended an initial LARC follow-up visit at 4 US Adolescent Medicine clinics. Initial LARC follow-up visit was defined as the first visit within 12 weeks of insertion. Eligible patients were 13-26 years old, had LARC inserted without sedation, and had LARC in place for at least 12 weeks. We compared outcomes over 1 year between patients attending the initial follow-up visit via telemedicine (telemedicine attendees) to those who completed the visit in-person (in-person attendees). Outcomes included patient-reported side effects, medical menstrual management, acne management, IUD malposition or expulsion, sexually transmitted infection (STI) testing and results, and LARC removal. Descriptive statistics described the sample and compared groups. Adjusted Poisson regression examined factors associated with number of visits and adjusted logistic regression models examined the association between initial visit modality and initiation of medical menstrual management. Site-specific institutional review board approvals were obtained. Results: Our study included 194 AYAs, ages 13.9-25.7 years (mean 18.7 years, SD = 2.3) who attended an initial follow-up visit. Most AYAs (n = 168, 86.6%) attended only one visit in the 12 weeks post-insertion. Telemedicine attendees comprised 40.2% of the sample. Telemedicine and in-person attendees were similar with regards to site of LARC insertion (p =.43), age (p =.17), race/ethnicity (p =.25), prior pregnancy (p =.95), complex medical diagnoses (p =.32), menstrual diagnoses (p =.11), and reason for LARC (p =.82). In-person attendees were more likely to have the IUD than telemedicine attendees (p =.003). Bivariate analyses showed similar frequency of patient-reported symptoms over 1 year between groups. Outcomes of menstrual management (OR = 1.02, CI: 0.40-2.60), number of visits attended (RR = 1.08, CI: 0.99-1.19), acne management (p =.28), IUD expulsion (p =.13), IUD malposition (p =.51), and LARC removal (p =.95) were similar between groups. In-person attendees were more likely to have STI testing done (p =.001) than telemedicine attendees. However, no positive STI tests were captured in either group. Conclusions: Roughly two-fifths of patients presenting to an initial LARC follow-up visit did so via telemedicine. Type of LARC may influence modality of follow-up visit. Except for STI testing, outcomes over 1 year were similar regardless of the first visit modality. Reassuringly, no positive STI tests were detected in either group over 1 year of follow-up. More research is needed to determine if the decrease in STI testing for patients seeking care via telemedicine is clinically significant. Telemedicine may play an important role in AYA LARC follow-up care, and more research is needed in this area. Sources of Support: N/a.

Examining virtual research recruitment and participant diversity in a multi-center birth cohort, Childhood Allergy and the NeOnatal Environment" (CANOE)

Rationale: Recruitment for a NIH/ECHO-supported multi-center birth cohort, "Childhood Allergy and the NeOnatal Environment” (CANOE) stopped due to the COVID-19 pandemic. Redesign of study procedures emphasized virtual and socially distanced activities. We hypothesized that "virtual” recruitment methods (social media, websites, email) would surpass "traditional” methods (in-clinic, telephone, flyers/print materials) and increase enrollment of families from diverse backgrounds and communities. Methods: Pregnant women (n=439, target 500) were recruited from four academic medical centers in Detroit MI, Madison WI, Nashville TN, and St. Louis MO. We collected demographic and social information by questionnaires and examined race, ethnicity, age, parity, and employment status in relation to recruitment method using chi-square tests. Results: In-clinic and telephone recruitment comprised 55% of enrollment, followed by print materials (17%), and social media and email (15%). The cohort includes families self-identifying as Caucasian/White (63%), African American/Black (27%), Hispanic/Latino (3.3%), Asian (3.5%), and mixed races (1.2%). This reflects site demographics for White and Black patients, while other populations are not as well recruited into this cohort. Recruitment method success did not vary by race, ethnicity, maternal age, or employment status (p=ns for each comparison). Most (63%) multigravida mothers (9.1% of participants) were recruited in clinic, while primigravida participants were recruited more evenly via all methods. Conclusions: "Virtual” recruitment methods comprised a smaller proportion of cohort enrollment than hypothesized and study recruitment method did not vary by race/ethnicity;however, consideration of combined, varied, and novel recruitment methods may add to the development of best practices for more representative research study recruitment.

Cultural and Social Factors in Care Delivery Among African American Caregivers of Persons With Dementia: A Scoping Review.

Cultural and social factors significantly influence the care provided to persons with dementia. This scoping review aimed to map emerging evidence on the influence of cultural and social factors on care delivery among Africa American caregivers of persons with dementia, especially during the COVID-19 pandemic. Using a systematic scoping review approach, we identified 21 studies on cultural and social factors influencing care delivery. The search included EMBASE, CINAHL, the Cochrane Database of Systematic Reviews, JBI Evidence Synthesis, and Epistemonicos. A narrative synthesis of the data revealed that cultural and social factors greatly influence African American caregivers of persons with dementia and COVID-19 in care delivery, who perceive caregiving as a responsibility and not just a job. These caregivers are additionally guided by their racial identity and faith beliefs, integrating family values and culture into caregiving. African American caregivers showed compassion and resilient care selfperceptions. Supporting compassionate care delivery by African American caregivers requires an understanding of the social and cultural factors which drive their commitment to quality care for older adults with dementia in a pandemic environment.

College students' underlying perceptions of COVID-19 threat, healthcare discrimination, and healthcare system inequities associated with self-rated health across racial/ethnic groups in the U.S.

Background: COVID-19-related health perceptions may differentially impact college students' stress, and in turn, their mental and physical health. This study examined racial/ethnic differences in college students' underlying perceptions of COVID-19 threat, healthcare discrimination, and U.S. healthcare system inequities and their associations with self-rated mental and physical health. Methods: Four-hundred-thirty-two university students completed an online survey (December 2020-December 2021). Latent class analyses identified classes of perceived COVID-19 threat (i.e., severity, susceptibility), healthcare discrimination, and U.S. healthcare system inequities. Regression analyses examined whether class membership varied by race/ethnicity and was associated with self-rated mental and physical health. Results: Class 1 members (27.3% of the sample) were more likely to identify as Hispanic or Latino, Non-Hispanic Asian, Non-Hispanic Black or African American, and Non-Hispanic Multiracial vs. Non-Hispanic White (vs. Class 4). Class 1 had high perceived COVID-19 threat, medium perceived healthcare discrimination, and high perceived U.S. healthcare system inequities, as well as higher odds of poorer mental and physical health (vs. Class 4). Conclusions: College students' underlying perceptions of COVID-19 threat, healthcare discrimination, and U.S. healthcare system inequities were associated with poorer health. Given that students with these perceptions were more likely to belong to minoritized racial/ethnic groups, concerns over COVID-19 risk and healthcare may partially explain racial/ethnic disparities in college students' health. This study contributes to a limited body of evidence on college students' perceptions of the U.S. healthcare system and suggests important ways that structural inequalities and racial/ethnic disparities in COVID-19 risk, healthcare discrimination, and concerns over U.S. healthcare system inequity may affect college students' health.

Knowledge, perceived risk, and attitudes towards COVID-19 protective measures amongst ethnic minorities in the UK: A cross-sectional study.

Background: Minority ethnic groups are at increased risk of COVID-19 related mortality or morbidity yet continue to have a disproportionally lower uptake of the vaccine. The importance of adherence to prevention and control measures to keep vulnerable populations and their families safe therefore remains crucial. This research sought to examine the knowledge, perceived risk, and attitudes toward COVID-19 among an ethnically diverse community. Methods: A cross-sectional self-administered questionnaire was implemented to survey ethnic minority participants purposefully recruited from Luton, an ethnically diverse town in the southeast of England. The questionnaire was structured to assess participants knowledge, perceived risk, attitudes toward protective measures as well as the sources of information about COVID-19. The questionnaire was administered online via Qualtrics with the link shared through social media platforms such as Facebook, Twitter, and WhatsApp. Questionnaires were also printed into brochures and disseminated via community researchers and community links to individuals alongside religious, community and outreach organisations. Data were analysed using appropriate statistical techniques, with the significance threshold for all analyses assumed at p = 0.05. Findings: 1,058 participants (634; 60% females) with a median age of 38 (IQR, 22) completed the survey. National TV and social networks were the most frequently accessed sources of COVID-19 related information; however, healthcare professionals, whilst not widely accessed, were viewed as the most trusted. Knowledge of transmission routes and perceived susceptibility were significant predictors of attitudes toward health-protective practises. Conclusion/recommendation: Improving the local information provision, including using tailored communication strategies that draw on trusted sources, including healthcare professionals, could facilitate understanding of risk and promote adherence to health-protective actions.

Trends in Incident Pediatric Diabetes and the COVID-19 Pandemic

Objectives To identify trends in presentation and incidence of pediatric new-onset type 1 diabetes (T1D) and type 2 diabetes (T2D) during the COVID-19 pandemic. Methods Demographics, anthropometrics, and initial labs from patients ages 0-21 who presented with new-onset diabetes to a pediatric tertiary care center were recorded over a three-year time period from April 1, 2018 until March 31, 2021. Time periods were separated as follows: April 1, 2018- March 31, 2019, April 1, 2019- March 31, 2020, and April 1, 2020- March 31, 2021. The final time period represents the COVID-19 pandemic. Microsoft Excel (2016) was used to calculate descriptive statistics (eg. Mean, standard deviations) and perform statistical analysis of continuous variables (eg. ANOVA). Statistical analysis of categorical variables (eg. sex, race, ethnicity) was performed by Chi-squared test or Fisher's exact test using R studio version 3.5.2. Cochran Armitage tests were performed to assess for trends in severity of diabetic patients from 2018 to 2020 and to determine if COVID-19 impacted diabetes severity using R (version 1.4.1106) and the DescTools package. Results In total, 207 patients were diagnosed with incident diabetes from April 2018 through March 2021, 108 with T1D and 86 with T2D. During the pandemic incident cases of pediatric T1D increased from 31 in each of the prior two years to 46;an increase of 48%. The number of patients with T1D presenting with mild diabetic ketoacidosis (DKA) significantly increased from 6% to 23% (p-value = 0.027). Incident cases of pediatric T2D increased by 231% from 2019 to 2020. The rate of patients with T2D presenting in DKA increased overall from 12% (n=2) in 2018 and 6% (n=1) in 2019, to 23% in 2020 (n=12), an increase of 91.7% from 2018 to 2020 . Furthermore, patients with T2D presenting with mild DKA increased by 116%. Prior to the pandemic, incident cases of T2D accounted for 35% of all newly diagnosed pediatric diabetes cases. During the pandemic, for the first time, incident cases of T2D accounted for more than half of the all newly diagnosed pediatric diabetes cases (53%). Conclusions There were more incident pediatric T1D and T2D cases as well as an increase in DKA at presentation during the COVID-19 pandemic. More importantly, incident T2D cases were higher than the incident T1D during the pandemic. This clearly suggests a disruption and change in the childhood diabetes trends with profound individual and community health consequences.

Inequities in timely cancer treatment after testing positive for COVID-19: Findings from the ASCO Survey on COVID-19 in Oncology (ASCO) Registry

Introduction: There is a disproportionately greater burden of COVID-19 among non-Hispanic Black (NHB) and Hispanic individuals, who also shoulder an inordinate burden of poor cancer outcomes. Understanding patient- and area-level factors contributing to these inequities at the intersection of COVID-19 and cancer is critical. As such, the objective of this study was to evaluate inequities in receipt of timely cancer treatment following a confirmed positive test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-the virus that causes COVID-19. Method(s): This retrospective cohort study is comprised of 2,686 non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic cancer patients from the American Society for Clinical Oncology COVID-19 Registry (ASCO Registry), for whom relatively complete data were available at entry into the registry (at the date of confirmed positive SARS-CoV-2 test) up to the end of the follow-up period (~6-9 months post confirmed positive SARS-CoV-2 test). Data were collected from April 2020 to November 2021. Relative risk (RR) estimates (generated using the generalized linear model procedure with a Poisson distribution, log link, and robust error variances) were used to examine multivariable-adjusted associations between patient-level sociodemographic and clinical factors and area-level social determinants of health (SDOH), separately, with timely (on schedule or within 14 days of schedule) and delayed (>=14-day delay) receipt of cancer treatment. Kaplan-Meier curves were plotted to investigate the time (in days) to restart cancer treatment post-COVID-19 infection. Result(s): After correction for multiple comparisons, for drug-based therapy, NHB race (RR, 0.69 [95% CI, 0.55-0.87];P=.002) and male sex (RR, 0.82 [95% CI, 0.71-0.95];P=.009) were associated with 31% and 18% reductions in timely treatment receipt. NHB race (RR, 1.41 [95% CI, 1.17-1.71];P<.001) was also associated with a 41% increased risk of >=14-day delays in treatment receipt. NHB patients further experienced longer delays, on average, in restarting drug-based therapy relative to NHW and Hispanic patients (mean days: 54.7 vs. 36.6 and 36.7, P=.001). Hispanic ethnicity was marginally associated with a lower likelihood of timely drug-based therapy receipt (RR, 0.79 [95% CI, 0.61-1.02];P=.075) and a greater risk of delayed receipt of drug-based therapy (RR, 1.31 [95% CI, 1.04-1.67];P=.024). Residents of areas with higher proportions of NHWs (>=77.4% vs. <77.4%) had a 31% higher likelihood of timely drug-based therapy receipt (RR, 1.31 [95% CI, 1.18-1.47];P<.001) and 21% significantly lower risk of delayed drug-based therapy (RR, 0.79 [95% CI, 0.69- 0.90];P=.001). Conclusion(s): NHB cancer patients, males, and residents of areas that are more racially and ethnically diverse experienced delayed drug-based cancer treatment following COVID19 infection. These delays will likely exacerbate persistent cancer survival inequities in the United States.

Are there racial disparities in the incidence of venous thromboembolism (VTE) in hospitalized cancer patients with COVID-19?

Background: Both cancer and COVID-19 have been reported to be associated with an increased risk of VTE. Severe disease needing hospitalization is also associated with an increased risk of VTE. There is a paucity of data evaluating the effects of race on this risk, with the limited available data suggesting that such a correlation exists. Given the increased prevalence of comorbidities and risk factors for VTE in African Americans (AA), we sought to evaluate if there are racial disparities in the incidence of VTE in the hospitalized subset of COVID-19 patients with cancer. Method(s): This was a retrospective chart review of unvaccinated cancer patients hospitalized with COVID-19 at a major tertiary health facility. Only cancer patients who were on active systemic chemotherapy were included. The primary study outcomes were development of DVT or PE (VTE) within 30 days of COVID-19 diagnosis. Secondary outcomes included mortality, hospital length of stay, mechanical ventilation, ICU admission, and need for vasopressors. Mean and standard deviation were reported for continuous variables;proportions were reported for categorical variables. To compare between races, the Chi-square test was used for categorical variables and the t-test was used for continuous variables. Multivariable logistic regression was then conducted to assess the relationship between race and selected factors. All statistical tests were 2-sided with an alpha (significance) level of 0.05. Result(s): A total of 73 patients were included in our analysis. The median age of the cohort was 70 years (interquartile range [IQR] 64-79). Gender breakdown: 58.9% males, 41.1 females. 31.5% were Caucasian, 64.4% African American, 1.4% Hispanic, and 2.7% other races/ethnicities. There were 8 DVT/PE patients in the cohort. Of 23 Caucasians in our cohort, 3 (13.0%) had VTE. Of 47 African Americans, 5 (10.6%) had DVT/PE. There was no significant difference between the incidence of VTE and race (p > 0.05). Multivariable logistic regression did not show a significant relationship between race and VTE, controlling for age, ICU stay, intubation, vasopressor use, serum ferritin and serum IL-6 levels. Notably, all patients included in this study were on enoxaparin prophylaxis for VTE. The only variable associated with DVT/PE was age and the presence of hemoglobinopathy. Incidence of VTE was significantly associated with increasing age (p < 0.03) and the presence of hemoglobinopathy (p < 0.01). Hemoglobinopathy was only seen in AA cancer patients with VTE (n = 4), and none in Caucasian patients. Conclusion(s): Contrary to what has been reported in the literature, we did not detect racial disparity in the incidence of VTE in hospitalized cancer patients with COVID 19. Prophylactic anticoagulation likely had a protective effect. However, racial disparity was observed in AA cancer patients with hemoglobinopathy with increased VTE risk despite prophylactic anticoagulation. This warrants further evaluation in future studies.

Pivot to SPARCC diversity in the clinical cancer research workforce, implementation and evaluation of an academic enrichment pathway before, during, and after the COVID-19 global pandemic

Academic pipeline programs are designed to mitigate systemic barriers that have historically excluded individuals due to deep-rooted, structural inequities. The Student-centered Pipeline to Advance Research in Cancer Careers (SPARCC) was developed in 2018 to diversify the clinical research health professions workforce and has graduated three cohorts of scholars from 20192021. Due to COVID-19 and safety concerns, SPARCC evolved, pivoting to establish effective learning environments virtually and in-person to ensure the original curriculum of academic, research, and professional identity development were upheld. The program aims to a.) immerse students in the clinical cancer research environment, supporting immediate employment as a clinical research professional (CRP) and b.) to provide structured support and guidance for individuals intending to pursue advanced professional degrees. SPARCC programmatic evaluations included a multifactorial strategy utilizing the same three evaluative instruments each year. These included a 17-item knowledge, attitudes, and practices (KAP) survey specific to clinical cancer research, daily workshop evaluations, and clinical practicum rotation evaluations. The SPARCC KAP was distributed immediately prior to the start of the program, upon graduation from the program, and six months later. After exploratory factor analysis, items were grouped into three factors: knowledge of clinical research practice, knowledge of research practice, and knowledge of culturally responsive cancer care. Mixed ANOVAS were used to assess changes in factors based on time (pre-, post-, and 6-month follow up;within) and cohort (year of participation;between). Over three years 156 students applied, 65% of whom identified belonging to an underrepresented ace or ethnicity. Thirty-six scholars matriculated through the program: 14(39%) White;13(36%) Black;3(8%) Asian;3(8%) Native American;1 3%) Native American/Black;1(3%) Black/Asian;1(3%) Pacific Islander. Forty-four percent (16 scholars) identified as Hispanic/Latino/a. Six scholars (17%) entered the clinical research workforce within six months of graduating from the SPARCC program, all who identified as belonging to underrepresented groups. The KAP evaluations revealed that scholars' knowledge increased significantly after participation in the program in each of the three factors: knowledge of clinical research practice (p < .007);knowledge of research practice (p < .007);and knowledge of culturally responsive cancer care (p < .007). Within six months of graduation from SPARCC, 17% of scholars entered the clinical research workforce, and nearly 60% were enrolled in graduate-research degree programs or medical school. SPARCC demonstrated curricular flexibility and ingenuity when pivoting from entirely in-person to entirely virtual, and finally to a hybrid program over the first three years of the program. Through didactic, clinical, research, and career professional identity exploration, robust learning experiences engaged scholars despite limitations on in-person contact.