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1.
Pediatrics ; 148(3)2021 09.
Article in English | MEDLINE | ID: covidwho-1266575

ABSTRACT

OBJECTIVES: In fall 2020, community hubs opened in San Francisco, California, to support vulnerable groups of students in remote learning. Our objectives were to (1) describe adherence to coronavirus disease 2019 (COVID-19) mitigation policies in these urban, low-income educational settings; (2) assess associations between policy adherence and in-hub COVID-19 transmission; and (3) identify barriers to and facilitators of adherence. METHODS: We conducted a mixed-methods study from November 2020 to February 2021. We obtained COVID-19 case data from the San Francisco Department of Public Health, conducted field observations to observe adherence to COVID-19 mitigation policies, and surveyed hub leaders about barriers to and facilitators of adherence. We summarized quantitative data using descriptive statistics and qualitative data using thematic content analysis. RESULTS: A total of 1738 children were enrolled in 85 hubs (39% Hispanic, 29% Black). We observed 54 hubs (n = 1175 observations of children and 295 observations of adults). There was high community-based COVID-19 incidence (2.9-41.2 cases per 100 000 residents per day), with 36 cases in hubs and only 1 case of hub-based transmission (adult to adult). Sixty-seven percent of children and 99% of adults were masked. Fifty-five percent of children and 48% of adults were distanced ≥6 ft. Facilitators of mitigation policies included the following: for masking, reminders, adequate supplies, and "unmasking zones"; for distancing, reminders and distanced seating. CONCLUSIONS: We directly observed COVID-19 mitigation in educational settings, and we found variable adherence. However, with promotion of multiple policies, there was minimal COVID-19 transmission (despite high community incidence). We detail potential strategies for increasing adherence to COVID-19 mitigation.


Subject(s)
COVID-19/prevention & control , Education, Distance , Guideline Adherence , Students , Vulnerable Populations , Adolescent , Adult , African Americans/education , African Americans/statistics & numerical data , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/transmission , Child , Child, Preschool , Cohort Studies , Data Analysis , Data Collection , Education, Distance/organization & administration , Education, Distance/statistics & numerical data , Hand Disinfection , /statistics & numerical data , Humans , Incidence , Masks/statistics & numerical data , Physical Distancing , Poverty Areas , San Francisco/epidemiology , Students/statistics & numerical data , Symptom Assessment , Urban Population
2.
J Health Commun ; 25(10): 827-830, 2020 Oct 02.
Article in English | MEDLINE | ID: covidwho-1236160

ABSTRACT

In an era of Freddie Gray and Black Lives Matter, a long history of structural racism, combined with disproportionate rates of COVID-19, the African American community has seen a lot of reasons to demand social justice, equal treatment and immediate access to solutions to health disparities. Despite the promise of COVID-19 vaccines, the community is highly distrustful of the vaccine and institutions given a history of mistreatment and many other current concerns. Trusted messengers such as Black pastors are crucial to protecting the community that faces a disproportionate amount of disease. We present a framework to build trust and acceptance including understanding history and context; listening and empathy; engaging pastors as trusted messengers; creating partnerships with shared responsibility and power; and co-creation of solutions with faith leaders and their community, governments and institutions to create sustainable, long-term change. Efforts to support vaccine acceptance must be customized to the variety of needs and realities of the African American community, not just the topic of concern to the institution. Evaluations are needed to help ensure the community is engaged and feeling heard. Pastors and other religious leaders can work with government and institutions to bring information, facilitate discussion, build trust and develop measurable improvement efforts. Although acceptance of COVID-19 vaccines may not be achieved overnight, the process of focusing on issues that are important to the community is an important step in laying the foundation for both COVID-19 vaccines and future interventions.


Subject(s)
African Americans/psychology , COVID-19 Vaccines/therapeutic use , Clergy , Community Participation/methods , Health Status Disparities , Patient Acceptance of Health Care/ethnology , African Americans/education , African Americans/statistics & numerical data , Health Communication/methods , Humans , Patient Acceptance of Health Care/psychology , Patient Acceptance of Health Care/statistics & numerical data , Racism , Trust
3.
AMA J Ethics ; 23(3): E271-275, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1116156

ABSTRACT

The Flexner Report damaged and marginalized historically Black medical schools, which today produce more than their fair share of Black medical graduates. As physicians, graduates of Black medical schools have confronted head-on the inequities of American responses to COVID-19 that the pandemic has laid bare to the world. Black physicians' leadership roles in American health care and in American communities have informed the reimagination of health care and medical education as just and inclusive.


Subject(s)
African Americans/education , Racism/history , Research Report , Schools, Medical/history , History, 20th Century , Humans
5.
Matern Child Health J ; 25(1): 127-135, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-942591

ABSTRACT

OBJECTIVE: Low birthweight is one of the main causes of poor health outcomes among newborns, with Black women having a disproportionately high prevalence. A digital intervention targeted Black women in Orange County, Florida with information on positive pregnancy-related knowledge and attitudes related to low birthweight. This paper reports on campaign methods for the first 2.5 years of implementation. METHODS: Campaign content was tailored toward Black women, around a reproductive empowerment lens. Content focused on emphasizing healthy pregnancy-related behaviors and creating positive representations of Black women throughout the various stages of pregnancy through both static images and a web series. Digital metrics gauged campaign engagement. Three cross-sectional online surveys conducted in the intervention county examined Black women's pregnancy-related knowledge, attitudes, and behaviors. RESULTS: After two years of campaign implementation, social media accounts showed 1784 followers. While Facebook showed more average monthly impressions, Instagram showed more average monthly engagements. Survey results showed some increases in knowledge about prenatal care, weight gain, exercise, and the health impacts of low birthweight. CONCLUSIONS FOR PRACTICE: This study highlights the potential for a culturally-appropriate digital intervention to promote positive pregnancy outcomes among at-risk women. Digital interventions offer a potential way to achieve positive pregnancy-related behavior changes on a larger scale. This may be particularly important given that the COVID-19 pandemic may be changing the ways that pregnant women access information. Studies should examine the impact and feasibility of using culturally-appropriate digital interventions that directly address Black women and their specific experiences during pregnancy.


Subject(s)
African Americans/education , African Americans/psychology , Health Promotion/methods , Infant, Low Birth Weight , Pregnant Women/education , Prenatal Care/methods , Social Media , Adult , Cross-Sectional Studies , Feasibility Studies , Female , Florida/epidemiology , Humans , Pregnancy
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