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3.
Am J Public Health ; 111(S3): S201-S203, 2021 10.
Article in English | MEDLINE | ID: covidwho-1496722

ABSTRACT

Structural racism is a root cause of poor health in the United States and underlies COVID-19-related disparities for Black and Latinx populations. We describe how one community-based organization responded to structural racism and COVID-19 in Florida. Informed by the literature on how public health practice changed from emphasizing prevention (Public Health 1.0) to collaboration between governmental and public health agencies (Public Health 2.0) and examining social determinants of health (Public Health 3.0), we call for a politically engaged Public Health 4.0. (Am J Public Health. 2021;111(S3):S201-S203. https://doi.org/10.2105/AJPH.2021.306408).


Subject(s)
African Americans/ethnology , COVID-19/economics , Healthcare Disparities/ethnology , Public Health , Racism/ethnology , Florida , Humans , Sexual and Gender Minorities/psychology , Social Determinants of Health , United States
4.
Acad Med ; 96(11): 1507-1512, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1493989

ABSTRACT

The harsh realities of racial inequities related to COVID-19 and civil unrest following police killings of unarmed Black men and women in the United States in 2020 heightened awareness of racial injustices around the world. Racism is deeply embedded in academic medicine, yet the nobility of medicine and nursing has helped health care professionals distance themselves from racism. Vanderbilt University Medical Center (VUMC), like many U.S. academic medical centers, affirmed its commitment to racial equity in summer 2020. A Racial Equity Task Force was charged with identifying barriers to achieving racial equity at the medical center and medical school and recommending key actions to rectify long-standing racial inequities. The task force, composed of students, staff, and faculty, produced more than 60 recommendations, and its work brought to light critical areas that need to be addressed in academic medicine broadly. To dismantle structural racism, academic medicine must: (1) confront medicine's racist past, which has embedded racial inequities in the U.S. health care system; (2) develop and require health care professionals to possess core competencies in the health impacts of structural racism; (3) recognize race as a sociocultural and political construct, and commit to debiologizing its use; (4) invest in benefits and resources for health care workers in lower-paid roles, in which racial and ethnic minorities are often overrepresented; and (5) commit to antiracism at all levels, including changing institutional policies, starting at the executive leadership level with a vision, metrics, and accountability.


Subject(s)
Academic Medical Centers/ethics , COVID-19/ethnology , Minority Groups/statistics & numerical data , Racism/ethnology , Schools, Medical/statistics & numerical data , Academic Medical Centers/organization & administration , African Americans/ethnology , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Delivery of Health Care/ethics , Female , Health Personnel/ethics , Humans , Male , SARS-CoV-2/genetics , Schools, Medical/ethics , United States/epidemiology
5.
Sch Psychol ; 36(5): 303-312, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1442725

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic swept the nation by surprise, leaving a deep-seated impact on individuals' social, mental, and physical health. Despite there being disparities between Black and White/non-Hispanic individuals, minimal research has been conducted to explore the effects of the virus on marginalized groups. This study aimed to investigate Black adolescents' perceptions of their experiences with COVID-19, including the challenges they encountered, the coping strategies they employed, and their use of religious/spiritual and school-based support. Twelve Black youth between the ages of 12 and 18 years were interviewed during the early stages of the pandemic (June and July of 2020). Participants struggled with adjusting to the changes in their daily routines, navigating virtual learning, and emerging mental health difficulties (e.g., anxiety). To cope with these challenges, participants relied on emotion and problem-focused coping strategies, including strategies that were religious/spiritual in nature. Participants also relied on social support from family, school personnel, and their religious community, though they lamented about the varied support received from the latter two. Findings from this research support calls for mental health providers to employ culturally affirming mental health services and engage in interagency collaboration to support Black youth. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Subject(s)
Adaptation, Psychological , Adolescent Behavior/ethnology , African Americans/ethnology , Behavioral Symptoms/psychology , COVID-19 , Religion and Psychology , Social Support , Adolescent , Child , Female , Humans , Male , Schools , United States/ethnology
6.
Acad Med ; 96(6): 798-801, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1243531

ABSTRACT

The glaring racial inequities in the impact of the COVID-19 pandemic and the devastating loss of Black lives at the hands of police and racist vigilantes have catalyzed a global reckoning about deeply rooted systemic racism in society. Many medical training institutions in the United States have participated in this discourse by denouncing racism, expressing solidarity with people of color, and reexamining their diversity and inclusion efforts. Yet, the stagnant progress in recruiting, retaining, and supporting racial/ethnic minority trainees and faculty at medical training institutions is well documented and reflects unaddressed systemic racism along the academic pipeline. In this article, the authors draw upon their experiences as early-career physicians of color who have led and supported antiracism efforts within their institutions to highlight key barriers to achieving meaningful progress. They describe common pitfalls of diversity and inclusion initiatives and call for an antiracist approach to systems change. The authors then offer 9 recommendations that medical training institutions can implement to critically examine and address racist structures within their organizations to actualize racial equity and justice.


Subject(s)
African Americans/psychology , COVID-19/psychology , Preceptorship/methods , Racism/prevention & control , African Americans/ethnology , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Cultural Diversity , Decision Making/ethics , Humans , Minority Groups/psychology , Preceptorship/statistics & numerical data , SARS-CoV-2/isolation & purification , Social Inclusion , Social Justice , United States/ethnology
7.
Transl Behav Med ; 11(3): 785-792, 2021 04 07.
Article in English | MEDLINE | ID: covidwho-1153242

ABSTRACT

Widespread uptake of the COVID-19 vaccine is critical to halt the pandemic. At present, little is known about factors that will affect vaccine uptake, especially among diverse racial/ethnic communities that have experienced the highest burden of COVID. We administered an online survey to a Qualtrics respondent panel of women ages 27-45 years (N = 396) to assess vaccine intentions and attitudes, and trusted vaccine information sources. 56.8% intended to be vaccinated and 25.5% were unsure. In bivariate analyses, a greater percentage of non-Latina White (NLW) and Chinese women reported that they would be vaccinated, compared with Latina and non-Latina Black (NLB) women (p < 0.001). Those who were uninsured, unemployed and those with lower incomes were less likely to say that they would be vaccinated. In analyses stratified by race/ethnicity, NLB women remained significantly less likely to report that they would be vaccinated compared with NLW women (adjusted odds ratio: 0.47; 95% confidence interval: 0.23, 0.94), controlling for age, marital status, income, education, employment, and insurance status. When analyses were additionally controlled for beliefs in vaccine safety and efficacy, racial/ethnic differences were no longer significant (adjusted odds ratio: 0.64; 95% confidence interval: 0.31, 1.34). Given that NLB women were less likely to report the intention to be vaccinated, targeted efforts will be needed to promote vaccine uptake. It will be critical to emphasize that the vaccine is safe and effective; this message may be best delivered by trusted community members.


Subject(s)
African Americans/ethnology , Asian Americans/statistics & numerical data , COVID-19 Vaccines , Health Knowledge, Attitudes, Practice/ethnology , Mass Vaccination/ethnology , /ethnology , Adult , Female , Humans , Intention , Middle Aged , United States/ethnology , Women
8.
Ann Behav Med ; 55(3): 179-191, 2021 03 20.
Article in English | MEDLINE | ID: covidwho-1135808

ABSTRACT

BACKGROUND: High stress prenatally contributes to poor maternal and infant well-being. The coronavirus disease 2019 (COVID-19) pandemic has created substantial stress for pregnant women. PURPOSE: To understand whether stress experienced by women pregnant at the beginning of the pandemic was associated with a greater prevalence of adverse perinatal outcomes. METHODS: Pregnant women across the USA aged ≥18 years old enrolled in a prospective cohort study during the pandemic onset (T1) in April-May 2020. This report focuses on the 1,367 participants who gave birth prior to July-August 2020 (T2). Hierarchical logistic regression models predicted preterm birth, small for gestational age infants, and unplanned operative delivery from T1 stress, sociodemographic, and medical factors. RESULTS: After controlling for sociodemographic and medical factors, preterm birth was predicted by high prenatal maternal stress, delivering an infant small for gestational age was predicted by interpersonal violence and by stress related to being unprepared for birth due to the pandemic, and unplanned cesarean or operative vaginal delivery was predicted by prenatal appointment alterations, experiencing a major stressful life event, and by stress related to being unprepared for birth due to the pandemic. Independent of these associations, African American women were more likely than other groups to deliver preterm. CONCLUSION: Pregnant women who are experiencing high stress during the COVID-19 pandemic are at risk of poorer perinatal outcomes. A longitudinal investigation is critical to determine whether prenatal maternal stress and resulting outcomes have longer-term consequences for the health and well-being of children born in the midst of the current pandemic.


Subject(s)
COVID-19 , Infant, Small for Gestational Age , Obstetric Labor Complications/epidemiology , Stress, Psychological/epidemiology , Adolescent , Adult , African Americans/ethnology , Exposure to Violence/statistics & numerical data , Female , Humans , Infant, Newborn , Pregnancy , Premature Birth/epidemiology , Prospective Studies , United States/epidemiology , Young Adult
10.
Am J Manag Care ; 27(2): e32-e33, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-1106774

ABSTRACT

The fall season was accompanied by an urgent warning from the CDC of an impending "twindemic" of coronavirus disease 2019 and influenza. Despite the warnings, Black women are not lining up for vaccinations.


Subject(s)
African Americans/ethnology , Healthcare Disparities/ethnology , Patient Acceptance of Health Care/ethnology , Vaccination , Women , Female , Humans , New York , Vulnerable Populations
11.
J Gerontol B Psychol Sci Soc Sci ; 76(3): e75-e80, 2021 02 17.
Article in English | MEDLINE | ID: covidwho-1087754

ABSTRACT

OBJECTIVES: The aim of this evidence-based theoretically informed article was to provide an overview of how and why the COVID-19 outbreak is particularly detrimental for the health of older Black and Latinx adults. METHODS: We draw upon current events, academic literature, and numerous data sources to illustrate how biopsychosocial factors place older adults at higher risk for COVID-19 relative to younger adults, and how structural racism magnifies these risks for black and Latinx adults across the life course. RESULTS: We identify 3 proximate mechanisms through which structural racism operates as a fundamental cause of racial/ethnic inequalities in COVID-19 burden among older adults: (a) risk of exposure, (b) weathering processes, and (c) health care access and quality. DISCUSSION: While the ongoing COVID-19 pandemic is an unprecedented crisis, the racial/ethnic health inequalities among older adults it has exposed are longstanding and deeply rooted in structural racism within American society. This knowledge presents both challenges and opportunities for researchers and policymakers as they seek to address the needs of older adults. It is imperative that federal, state, and local governments collect and release comprehensive data on the number of confirmed COVID-19 cases and deaths by race/ethnicity and age to better gauge the impact of the outbreak across minority communities. We conclude with a discussion of incremental steps to be taken to lessen the disproportionate burden of COVID-19 among older Black and Latinx adults, as well as the need for transformative actions that address structural racism in order to achieve population health equity.


Subject(s)
African Americans/ethnology , Aging/ethnology , COVID-19/ethnology , Health Services Accessibility/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Quality of Health Care/statistics & numerical data , Racism/ethnology , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/mortality , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Risk , United States/ethnology , Young Adult
12.
Breastfeed Med ; 16(2): 156-164, 2021 02.
Article in English | MEDLINE | ID: covidwho-1085365

ABSTRACT

Background: Although breastfeeding is optimal infant nutrition, disparities in breastfeeding persist in the African American population. AMEN (Avondale Moms Empowered to Nurse) launched a Peer-to-Peer support group to increase breastfeeding initiation and duration in an under-resourced African American urban community with low breastfeeding rates. Materials and Methods: A Community-Based Participatory Research (CBPR)-guided project was developed in partnership with a neighborhood church. Using modified Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) peer counseling materials, Avondale neighborhood breastfeeding moms were trained and designated Breastfeeding Champions. Community organizations and partnering agencies helped recruit local mothers. Support groups included childcare, transportation, refreshments, and incentives, plus stipends for Champions. A mixed-methods approach captured participation, feeding intention and practices, and program evaluation using electronic data capture. After adding another neighborhood with low breastfeeding rates, AMEN was modified to "All Moms Empowered to Nurse." Additional Champion moms were trained as Reaching Our Sisters Everywhere (ROSE) Community Transformers. During the COVID-19 pandemic, the group has met weekly by virtual platform. Results: Since May 2017, 67 AMEN support meetings have included 158 participants, with average attendance of 10 (range 5-19) per meeting. In addition to 8 Champions, 110 moms have attended, including 24% expecting mothers. Additional attendees include 13 family support persons, 23 guest speakers, and 12 from community outreach programs. Qualitative feedback from participants has been uniformly positive. Breastfeeding initiation rates have increased 12% in the initial neighborhood. Conclusions: Harnessing strength within the local community, Champion Breastfeeding Moms have successfully launched AMEN breastfeeding support groups in under-resourced African American urban neighborhoods, helping more mothers reach their breastfeeding goals.


Subject(s)
African Americans/ethnology , Breast Feeding , Community-Based Participatory Research , Mothers/education , Mothers/psychology , Peer Group , Program Evaluation , Adult , COVID-19/epidemiology , Female , Humans , Postnatal Care , Protestantism , Social Support , United States , Urban Population , Vulnerable Populations/ethnology
13.
J Neurointerv Surg ; 13(4): 304-307, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1013062

ABSTRACT

BACKGROUND: The coronavirus disease (COVID-19) pandemic has affected stroke care globally. In this study, we aim to evaluate the impact of the current pandemic on racial disparities among stroke patients receiving mechanical thrombectomy (MT). METHODS: We used the prospectively collected data in the Stroke Thrombectomy and Aneurysm Registry from 12 thrombectomy-capable stroke centers in the US and Europe. We included acute stroke patients who underwent MT between January 2017 and May 2020. We compared baseline features, vascular risk factors, location of occlusion, procedural metrics, complications, and discharge outcomes between patients presenting before (before February 2020) and those who presented during the pandemic (February to May 2020). RESULTS: We identified 2083 stroke patients: of those 235 (11.3%) underwent MT during the COVID-19 pandemic. Compared with pre-pandemic, stroke patients who received MT during the pandemic had longer procedure duration (44 vs 38 min, P=0.006), longer length of hospitalization (6 vs 4 days, P<0.001), and higher in-hospital mortality (18.7% vs 11%, P<0.001). Importantly, there was a lower number of African American patients undergoing MT during the COVID-19 pandemic (609 (32.9%) vs 56 (23.8%); P=0.004). CONCLUSION: The COVID-19 pandemic has affected the care process for stroke patients receiving MT globally. There is a significant decline in the number of African American patients receiving MT, which mandates further investigation.


Subject(s)
African Americans/ethnology , COVID-19/ethnology , Healthcare Disparities/trends , Pandemics , Stroke/ethnology , Thrombectomy/trends , Aged , Aged, 80 and over , COVID-19/therapy , Female , Hospital Mortality/trends , Hospitalization/trends , Humans , Internationality , Male , Middle Aged , Prospective Studies , Registries , Risk Factors , Stroke/therapy , Thrombectomy/methods , Treatment Outcome
15.
J Gerontol B Psychol Sci Soc Sci ; 76(3): e88-e92, 2021 02 17.
Article in English | MEDLINE | ID: covidwho-745822

ABSTRACT

OBJECTIVES: The disruption and contraction of older adults' social networks are among the less discussed consequences of the COVID-19 pandemic. Our objective was to provide an evidence-based commentary on racial/ethnic disparities in social network resources and draw attention to the ways in which disasters differentially affect social networks, with meaningful insight for the ongoing pandemic. METHODS: We draw upon prior research on social networks and past natural disasters to identify major areas of network inequality. Attention is given to how pre-pandemic racial/ethnic network disparities are exacerbated during the current crisis, with implications for physical and mental health outcomes. RESULTS: Evidence from the literature shows a robust association between strong social networks and physical and mental health outcomes. During times of crisis, access to social networks for older adults is disrupted, particularly for marginalized groups. We document pre-pandemic disparities in social networks resources and offer insight for examining the impact of COVID-19 on disrupting social networks among older adults. DISCUSSION: Importantly, racial/ethnic disparities in social networks both prior to and as a result of the pandemic intensify existing inequalities and demonstrate the necessity of better understanding social network inequalities for marginalized older adults, particularly in the context of the COVID-19 health crisis.


Subject(s)
African Americans/ethnology , Aging/ethnology , COVID-19 , Minority Groups/statistics & numerical data , Social Isolation , Social Networking , Socioeconomic Factors , Aged , Humans , United States/ethnology
16.
Psychol Trauma ; 12(5): 455-456, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-610270

ABSTRACT

A series of 15-min videos were produced to provide resources to pastors in African-American communities to aid them in conveying accurate public and mental health information about COVID-19. Video presenters included trusted experts in public and mental health and pastors with considerable experience responding to the needs of the African-American community during the COVID-19 pandemic. Four culturally specific core themes to consider when providing care to African Americans who are at increased risk during the pandemic were identified: ritual disruption, negative reactions for not following public health guidelines, trauma, and culture and trust. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Subject(s)
African Americans , Clergy , Consumer Health Information , Coronavirus Infections , Infection Control , Pandemics , Pneumonia, Viral , Psychological Trauma , Spirituality , Adult , African Americans/ethnology , COVID-19 , Humans , Internet , Psychological Trauma/ethnology , Trust , Video Recording
17.
JAMA Netw Open ; 3(6): e2012270, 2020 06 01.
Article in English | MEDLINE | ID: covidwho-599358

ABSTRACT

Importance: In late December 2019, an outbreak caused by a novel severe acute respiratory syndrome coronavirus 2 emerged in Wuhan, China. Data on the clinical characteristics and outcomes of infected patients in urban communities in the US are limited. Objectives: To describe the clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) and to perform a comparative analysis of hospitalized and ambulatory patient populations. Design, Setting, and Participants: This study is a case series of 463 consecutive patients with COVID-19 evaluated at Henry Ford Health System in metropolitan Detroit, Michigan, from March 9 to March 27, 2020. Data analysis was performed from March to April 2020. Exposure: Laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection. Main Outcomes and Measures: Demographic data, underlying comorbidities, clinical presentation, complications, treatment, and outcomes were collected. Results: Of 463 patients with COVID-19 (mean [SD] age, 57.5 [16.8] years), 259 (55.9%) were female, and 334 (72.1%) were African American. Most patients (435 [94.0%]) had at least 1 comorbidity, including hypertension (295 patients [63.7%]), chronic kidney disease (182 patients [39.3%]), and diabetes (178 patients [38.4%]). Common symptoms at presentation were cough (347 patients [74.9%]), fever (315 patients [68.0%]), and dyspnea (282 patients [60.9%]). Three hundred fifty-five patients (76.7%) were hospitalized; 141 (39.7%) required intensive care unit management and 114 (80.8%) of those patients required invasive mechanical ventilation. Male sex (odds ratio [OR], 2.0; 95% CI, 1.3-3.2; P = .001), severe obesity (OR, 2.0; 95% CI, 1.4-3.6; P = .02), and chronic kidney disease (OR, 2.0; 95% CI, 1.3-3.3; P = .006) were independently associated with intensive care unit admission. Patients admitted to the intensive care unit had longer length of stay and higher incidence of respiratory failure and acute respiratory distress syndrome requiring invasive mechanical ventilation, acute kidney injury requiring dialysis, shock, and mortality (57 patients [40.4%] vs 15 patients [7.0%]) compared with patients in the general practice unit. Twenty-nine (11.2%) of those discharged from the hospital were readmitted and, overall, 20.0% died within 30 days. Male sex (OR, 1.8; 95% CI, 1.1-3.1; P = .03) and age older than 60 years (OR, 5.3; 95% CI, 2.9-9.7; P < .001) were significantly associated with mortality, whereas African American race was not (OR, 0.98; 95% CI, 0.54-1.8; P = .86). Conclusions and Relevance: In this review of urban metropolitan patients with COVID-19, most were African American with a high prevalence of comorbid conditions and high rates of hospitalization, intensive care unit admission, complications, and mortality due to COVID-19.


Subject(s)
Betacoronavirus/genetics , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Respiration, Artificial/methods , Respiratory Insufficiency/therapy , Acute Kidney Injury/epidemiology , Adult , African Americans/ethnology , African Americans/statistics & numerical data , Aged , COVID-19 , Case-Control Studies , Comorbidity , Coronavirus Infections/blood , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/mortality , Cough/etiology , Dyspnea/etiology , Female , Fever/etiology , Hospitalization/statistics & numerical data , Humans , Intensive Care Units/statistics & numerical data , Length of Stay/trends , Male , Michigan/epidemiology , Middle Aged , Obesity/epidemiology , Pandemics , Pneumonia, Viral/blood , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/mortality , Prevalence , Respiration, Artificial/adverse effects , Respiratory Insufficiency/epidemiology , Respiratory Insufficiency/mortality , Retrospective Studies , SARS-CoV-2
18.
Psychol Trauma ; 12(5): 446-448, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-594955

ABSTRACT

The mental health consequences of the COVID-19 pandemic are particularly relevant in African-American communities because African-Americans have been disproportionately impacted by the disease, yet they are traditionally less engaged in mental health treatment compared with other racial groups. Using the state of Michigan as an example, we describe the social and psychological consequences of the pandemic on African-American communities in the United States, highlighting community members' concerns about contracting the disease, fears of racial bias in testing and treatment, experiences of sustained grief and loss, and retraumatization of already-traumatized communities. Furthermore, we describe the multilevel, community-wide approaches that have been used thus far to mitigate adverse mental health outcomes within our local African-American communities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Subject(s)
African Americans/ethnology , Community Mental Health Services , Coronavirus Infections/ethnology , Grief , Healthcare Disparities/ethnology , Mental Health Services , Pneumonia, Viral/ethnology , Psychological Trauma/ethnology , Religion and Psychology , Adult , COVID-19 , Humans , Michigan/ethnology , Pandemics , Psychological Trauma/therapy
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