Association between distance to community health care facilities and COVID-19-related mortality across U.S. counties in the COVID-19-vaccine era.

OBJECTIVE: COVID-19 has caused tremendous damage to U.S. public health, but COVID vaccines can effectively reduce the risk of COVID-19 infections and related mortality. Our study aimed to quantify the association between proximity to a community healthcare facility and COVID-19 related mortality after COVID vaccines became publicly available and explore how this association varied across racial and ethnic groups. RESULTS: Residents living farther from a facility had higher COVID-19-related mortality across U.S. counties. This increased mortality incidence associated with longer distances was particularly pronounced in counties with higher proportions of Black and Hispanic populations.

Poverty and Suicidal Ideation Among Hispanic Mental Health Care Patients Leading up to the COVID-19 Pandemic.

Introduction: Suicide rates have risen in Hispanic communities since 2015, and poverty rates among Hispanics often exceed the national average. Suicidality is a complex phenomenon. Mental illness may not alone explain whether suicidal thoughts or behaviors will occur; it remains uncertain how poverty affects suicidality among Hispanic persons with known mental health conditions. Our objective was to examine whether poverty was associated with suicidal ideation among Hispanic mental healthcare patients from 2016 to 2019. Methods: We used de-identified electronic health record (EHR) data from Holmusk, captured using the MindLinc EHR system. Our analytic sample included 4,718 Hispanic patient-year observations from 13 states. Holmusk uses deep-learning natural language processing (NLP) algorithms to quantify free-text patient assessment data and poverty for mental health patients. We conducted a pooled cross-sectional analysis and estimated logistic regression models. Results: Hispanic mental health patients who experienced poverty had 1.55 greater odds of having suicidal thoughts in a given year than patients who did not experience poverty. Conclusion: Poverty may put Hispanic patients at greater risk for suicidal thoughts even when they are already receiving treatment for psychiatric conditions. NLP appears to be a promising approach for categorizing free-text information on social circumstances affecting suicidality in clinical settings.

Of Vaccine and Hesitancy

Vaccinated individuals-like Tolstoy's happy families-are all alike;each unvaccinated individual is hesitant for her own reason. Irrational and unreasonable conspiracy theories about COVID-19 and its vaccine abound among the anti-vaxxers. Contrary to popular belief, however, conspiracy theories are not the main driver of vaccine hesitancy. Whether an individual remains hesitant about receiving a COVID19 vaccine may depend on personal beliefs, informed by a background that is a totality of, for example, race (and its historical past), gender, education, life experience, and information consumption. This individualized background then forms a value system that informs the personal decision-making process as to whether to receive a COVID19 vaccine.

STOP COVID-19 CA: Community engagement to address the disparate impacts of the COVID-19 pandemic in California.

Objective: To describe the early activities and lessons of the Share, Trust, Organize, Partner COVID-19 California Alliance (STOP COVID-19 CA), the California awardee of the NIH-funded multi-state Community Engagement Alliance (CEAL) against COVID-19. The Alliance was established to ensure equity in Coronavirus-19 disease (COVID-19) research, clinical practice, and public health for communities most impacted by the COVID-19 pandemic. Study setting: The STOP COVID-19 CA Alliance network of 11 universities and affiliated partner community-based organizations (CBOs) across California. Study design: Mixed methods evaluation consisting of an analysis of activity (August 2020 to December 2021) detailed in reports submitted by community-academic teams and a survey (August 2021) of academic investigators and affiliated community-based organization (CBO) partners. Data collection: We summarized activities from the 11 community-academic teams' progress reports and described results from an online survey of academic investigators and CBO partners in the California Alliance. Principal findings: A review of progress reports (n = 256) showed that teams fielded surveys to 11,000 Californians, conducted 133 focus groups, partnered with 29 vaccine/therapeutics clinical trials, and led more than 300 town halls and vaccine events that reached Californians from communities disproportionately impacted by COVID-19. Survey responses from academic investigators and CBO partners emphasized the importance of learning from the successes and challenges of the California Alliance teams' COVID-19 initiatives. Both academic and CBO respondents highlighted the need for streamlined federal and institutional administrative policies, and fiscal practices to promote more effective and timely operations of teams in their efforts to address the numerous underlying health and social disparities that predispose their communities to higher rates of, and poor outcomes from, COVID-19. Conclusions: STOP COVID-19 CA represents a new and potentially sustainable statewide community engagement model for addressing health disparities in multiethnic/multicultural and geographically dispersed communities.

Reliability and validity of the post COVID-19 condition stigma questionnaire: A prospective cohort study

Summary Background Many of the 10–20% percent of COVID-19 survivors who develop Post COVID-19 Condition (PCC, or Long COVID) describe experiences suggestive of stigmatization, a known social determinant of health. Our objective was to develop an instrument, the Post COVID-19 Condition Stigma Questionnaire (PCCSQ), with which to quantify and characterise PCC-related stigma. Methods We conducted a prospective cohort study to assess the reliability and validity of the PCCSQ. Patients referred to our Post COVID-19 Clinic in the Canadian City of Edmonton, Alberta between May 29, 2021 and May 24, 2022 who met inclusion criteria (attending an academic post COVID-19 clinic;age ≥18 years;persistent symptoms and impairment at ≥ 12 weeks since PCR positive acute COVID-19 infection;English-speaking;internet access;consenting) were invited to complete online questionnaires, including the PCCSQ. Analyses were conducted to estimate the instrument's reliability, construct validity, and association with relevant instruments and defined health outcomes. Findings Of the 198 patients invited, 145 (73%) met inclusion criteria and completed usable questionnaires. Total Stigma Score (TSS) on the PCCSQ ranged from 40 to 174/200. The mean (SD) was 103.9 (31.3). Cronbach's alpha was 0.97. Test-retest reliability was 0.92. Factor analysis supported a 6-factor latent construct. Subtest reliabilities were >0.75. Individuals reporting increased TSS occurred across all demographic groups. Increased risk categories included women, white ethnicity, and limited educational opportunities. TSS was positively correlated with symptoms, depression, anxiety, loneliness, reduced self-esteem, thoughts of self-harm, post-COVID functional status, frailty, EQ5D5L score, and number of ED visits. It was negatively correlated with perceived social support, 6-min walk distance, and EQ5D5L global rating. Stigma scores were significantly increased among participants reporting employment status as disabled. Interpretation Our findings suggested that the PCCSQ is a valid, reliable tool with which to estimate PCC-related stigma. It allows for the identification of patients reporting increased stigma and offers insights into their experiences. Funding The Edmonton Post COVID-19 Clinic is supported by the University of Alberta and Alberta Health Services. No additional sources of funding were involved in the execution of this research study.

Immigrant Legal Status among Essential Frontline Workers in the United States during the COVID-19 Pandemic Era

Emerging evidence suggests that the COVID-19 pandemic has extracted a substantial toll on immigrant communities in the United States, due in part to increased potential risk of exposure for immigrants to COVID-19 in the workplace. In this article, we use federal guidance on which industries in the United States were designated essential during the COVID-19 pandemic, information about the ability to work remotely, and data from the 2019 American Community Survey to estimate the distribution of essential frontline workers by nativity and immigrant legal status. Central to our analysis is a proxy measure of working in the primary or secondary sector of the segmented labor market. Our results indicate that a larger proportion of foreign-born workers are essential frontline workers compared to native-born workers and that 70 percent of unauthorized immigrant workers are essential frontline workers. Disparities in essential frontline worker status are most pronounced for unauthorized immigrant workers and native-born workers in the secondary sector of the labor market. These results suggest that larger proportions of foreign-born workers, and especially unauthorized immigrant workers, face greater risk of potential exposure to COVID-19 in the workplace than native-born workers. Social determinants of health such as lack of access to health insurance and living in overcrowded housing indicate that unauthorized immigrant essential frontline workers may be more vulnerable to poor health outcomes related to COVID-19 than other groups of essential frontline workers. These findings help to provide a plausible explanation for why COVID-19 mortality rates for immigrants are higher than mortality rates for native-born residents.

Dwelling in times of COVID-19: An analysis on habitability and environmental factors of Spanish housing

In the wake of the SARS-CoV-2 pandemic, promoted by the World Health Organization (WHO), governments urged people to stay at home. For this reason, practically all human activity took place inside the houses. The research question established if housing quality responded to people's needs in the context of confinement. Specifically, the purpose was to taxonomize the dwelling stock occupied by confined households during the first COVID-19 wave in Spain, as well as to deepen in features and subjective perceptions on Indoor Environmental Quality (IEQ). As an exploratory study, an online questionnaire was disseminated in the Spring of 2020, obtaining 1,673 valid responses. A descriptive statistical analysis included sociodemographic, territorial and housing variables, related to indoor environmental quality, the availability of outdoor spaces, and the prospects for changes in. Also, a logistic regression stablished multivariate relations for the dependent variable “general dwelling satisfaction”. The results associated urban habitat, tenancy regime, higher incomes, and fewer cohabitants, with worse perceived IEQ, and lack of own outdoor space. Same variables showed relations with people's desire for domestic changes. In conclusion, it is remarkable the determining role of housing design for dwellers’ satisfaction, especially in uncertain times like COVID-19 pandemic. This not only conditioned the different ways of inhabiting and occupying dwellings, but also the people's capacity to face lockdown. The built environment, the habitat, and households’ circumstances also influenced. The latter did on people's perception of their experience, and how they lived and expressed it. Additionally, resilient building design and renovation opportunities were identified. © 2022

Social dimensions and preconditions of digitalization in healthcare: Implications of the COVID-19 syndemic

The manifold potentials and challenges of digitalization became apparent during the COVID-19 pandemic. This chapter will present and discuss the social aspects of digitalization in times of COVID-19 from different perspectives. In doing so, the focus will be on the following two aspects: (1) Interaction and handling of digital information place many demands on information users and on those who provide the information. This has been especially true since the COVID-19 pandemic, which was accompanied by an infodemic. This is where digital health literacy comes in, which is the ability to find, understand, assess, and apply digital information in the context of health. (2) The use of digital technologies on health-related topics is socially unequally distributed in society—both horizontally (gender, age, migration, place of residence) and vertically (socioeconomic status). For this reason, the digital health divide is a major obstacle for digital technologies in healthcare—during COVID-19 and beyond. © 2022 Elsevier Inc. All rights reserved.

Surveillance of COVID-19 outbreaks in prisons in the US South: The role of economic distress in the communities surrounding prison facilities.

Introduction: The US South is the epicenter of the epidemic of mass incarceration. Prisons have experienced substantial challenges in preventing COVID-19. Incarcerated individuals and prison staff are at a high risk for infection due to minimal available preventive measures. Prisons are not closed systems and many staff come from communities in close proximity to the facility. Characteristics of the communities immediately surrounding prisons are an overlooked but critical factor to better understand the role prisons play in pandemics. Methods: We used facility-level COVID-19 data from the COVID Prison Project to identify the number of unique outbreaks between May 2019 and May 2020. We used a county-level composite indicator of economic distress (DCI score) to identify the environment surrounding each prison (2015-2019). We modeled the number of outbreaks to DCI scores using negative binomial regression, adjusting for race/ethnicity (African American and Latino/Hispanic), age (65 and older), and rurality level. Results: Our sample included 570 prisons in 368 counties across 13 Southern states. We found that score was positively and significantly associated with prison COVID-19 outbreaks (aRR, 1.012; p < 0.0001), and rurality was potentially a stronger surrogate measure of economic distress (aRR, 1.35; p, 0.02). Economic stability is a key precursor to physical health. Poorer communities have been disproportionately impacted by the pandemic, and we found that prisons located in these communities were more susceptible to recurring outbreaks. Prison-based disease prevention interventions should consider the impact that the outside world has on the health of incarcerated individuals.

Social Determinants of Health Factors for Gene-Environment COVID-19 Research: Challenges and Opportunities.

The characteristics of a person's health status are often guided by how they live, grow, learn, their genetics, as well as their access to health care. Yet, all too often, studies examining the relationship between social determinants of health (behavioral, sociocultural, and physical environmental factors), the role of demographics, and health outcomes poorly represent these relationships, leading to misinterpretations, limited study reproducibility, and datasets with limited representativeness and secondary research use capacity. This is a profound hurdle in what questions can or cannot be rigorously studied about COVID-19. In practice, gene-environment interactions studies have paved the way for including these factors into research. Similarly, our understanding of social determinants of health continues to expand with diverse data collection modalities as health systems, patients, and community health engagement aim to fill the knowledge gaps toward promoting health and wellness. Here, a conceptual framework is proposed, adapted from the population health framework, socioecological model, and causal modeling in gene-environment interaction studies to integrate the core constructs from each domain with practical considerations needed for multidisciplinary science.

Precarious Work and Health Care among Working-Class Men in Buenos Aires, Argentina

Introduction: We analyze the relation between work and health drawing on the labor experiences of adult men who reside in a working-class neighborhood located in the periphery of Buenos Aires City. More specifically, we analyze how precarious jobs impact on their psychophysical health through work conditions that expose them to diverse risks and deprivations for quality of life and health care. Methodology: Data come from qualitative, in-depth, interviews that we conducted with adult men as part of a larger study on health care with residents of the neighborhood. Results: Precarious jobs affect health in various ways. Some of the interviewees have been exposed to physical and psychosocial risks due to the work conditions and environment in the workplace. The negative consequences that precarious jobs have for quality of life are also salient, by limiting their capability to plan ahead, organize everyday life and develop self-care practices. Conclusions: We highlight the importance of considering precarious work as a social determinant of health, since it is a multidimensional trait that helps to analyze its negative consequences on working-class men. We also point to the adverse consequences for health of precarious jobs throughout the life-course, in part, due to age-based chronic conditions but also due to the cumulative disadvantages produced by precarious and vulnerable work trajectories.

A time to act: Anti-racist paediatric research.

Research offers the potential for new treatments, programs and services, and underlies decisions about funding that can have profound implications for people's lives. When racism in research is not addressed, children and their families will be unjustly impacted by systemic discrimination, exclusion, and inequity. With a growing acknowledgement that racism is a social determinant of health, and as COVID-19 reveals staggering racial disparities, we believe now is the time for intentional anti-racism initiatives throughout the research ecosystem to prevent further harms in patient care and the lives and futures of children. We aim to highlight this need for justice, and conclude with a series of practical recommendations, ranging from the collection and use of race-based data, to equity, diversity, and inclusion (EDI) education, to mentorship opportunities.

Digital Disenfranchisement and COVID-19: Broadband Internet Access as a Social Determinant of Health.

According to the Pew Research Center, approximately one quarter of American adults do not have access to broadband internet. This number does not account for the millions of people who are underconnected or lacking a stable internet connection. Although digital disparity in America is not new, the COVID-19 (coronavirus disease 2019) pandemic has increased our societal dependence on the internet and widened the digital divide. Access to broadband internet has become a basic need in this connected society, linking people to vital resources, such as jobs, education, health care, food, and information. However, it is still an overlooked and understudied issue in public health. In this article, we highlight five key points for why advocating for the expansion of affordable and accessible internet for all should be a priority issue for public health and health promotion. Recent studies offer evidence that digital disenfranchisement contributes to negative health outcomes, economic oppression, and racial injustice. Now more than ever, health advocacy to promote digital equity and inclusion is critical to our meaningful progress toward health equity.