Exploring the role of the social vulnerability index in understanding COVID-19 immunization rates.

Communities that are historically marginalized and minoritized were disproportionately impacted by the COVID-19 pandemic due to long-standing social inequities. It was found that those who experience social vulnerabilities faced a heightened burden of COVID-19 morbidities and mortalities and concerningly lower rates of COVID-19 vaccination. The CDC's Social Vulnerability Index (CDC-SVI) is a pivotal tool for planning responses to health crises such as the COVID-19 pandemic. This study explores the associations between CDC-SVI and its corresponding themes with COVID-19 vaccine uptake in Nevada counties. Additionally, the study discusses the utility of the CDC-SVI in the context of equitable vaccine uptake in a pandemic setting. We examined the linear association between the 2020 CDC-SVI (including the composite score and the four themes) and COVID-19 vaccine uptake (including initial and complete vaccinations) for the seventeen Nevada counties. These associations were further examined for spatial-varied effects. Each CDC-SVI theme was negatively correlated with initial and complete COVID-19 vaccine uptake (crude) except for minority status, which was positively correlated. However, all correlations were found to be weak. Excessive vaccination rates among some counties are not explained by the CDC-SVI. Overall, these findings suggest the CDC-SVI themes are a better predictor of COVID-19 vaccine uptake than the composite SVI score at the county level. Our findings are consistent with similar studies. The CDC-SVI is a useful measure for public health preparedness, but with limitations. Further understanding is needed of which measures of social vulnerability impact health outcomes.

Healthy Foods in Convenience Stores: Benefits, Barriers, and Best Practices.

Accessing healthy food is a challenge for many. Healthy corner store initiatives have proven successful at promoting healthy food access nationwide. Recent data suggest that 11.8% of Clark County residents and 17.1% of Henderson, Nevada, residents experienced food insecurity. It is crucial to assess the current perceptions and practices of the community before pursuing policy change to ensure that pilot programs reflect its members' needs. This study aimed to identify which healthy foods consumers would like to see offered in convenience stores, assess purchasing behaviors, and explore barriers preventing store owners from carrying healthy foods. In doing so, this study aimed to ensure that the needs of owners and consumers are reflected in local policy changes. Project staff collected data through two approaches: (a) convenience store owner interviews (n = 2; who represented eight stores total) and (b) consumer intercept surveys (n = 88) within low-income census tracts of Henderson, Nevada. The cost of healthy foods-for storeowners and consumers-was a major factor when selecting items to stock. Storeowners also described key contextual barriers such as minimum purchasing requirements, city regulations limiting promotions, and healthy, fresh food not being in high enough demand for the many transient customers passing through. Survey respondents' most commonly reported barrier to accessing healthy food was their lack of availability in convenience stores, suggesting it would be beneficial if stores offered healthier options to increase access. The results of this study will inform the community's next steps to increase access to healthy foods, including implementing a pilot healthy corner store project and a City-sponsored marketing campaign. Our methods and lessons learned may be useful for other municipalities considering health corner and convenience store initiatives.

The Importance of Community Voice: Using Community-Based Participatory Research to Understand the Experiences of African American, Native American, and Latinx People During a Pandemic.

INTRODUCTION: Although the disproportionate impact of COVID-19 infection, hospitalization, and death rates on racial and ethnic minority communities in the US is known, information about how COVID-19 has affected these communities and how community context and perceptions can inform a better response to future health crises needs further exploration. To help achieve these objectives, we used a community-based participatory research approach to gain a better insight into African American, Native American, and Latinx communities. METHODS: From September through December 2020, we conducted 19 focus groups and recruited 142 participants. Participants were selected via a purposeful sampling technique. We used a phenomenology study design to conduct semistructured interviews, thematic analysis to code qualitative data, and descriptive statistics to summarize demographic data. RESULTS: Data analysis revealed the following 3 themes: 1) COVID-19 exacerbated mistrust, anxiety, and fear in racial and ethnic minority populations, affecting their mental health, 2) understanding sociocultural context is essential for emergency response, and 3) adapting communication strategies can help address community concerns. CONCLUSION: Amplifying the voices of people disproportionately affected by the COVID-19 pandemic can help to inform a better response to future health crises and ultimately reduce health inequity among racial and ethnic minority populations.

Impact of COVID-19 on Sexual and Gender Minority Communities: Focus Group Discussions.

BACKGROUND: People who identify as sexual and gender minorities (SGM) experienced disproportionate economic and mental health issues related to COVID-19 when compared to the general population. The purpose of this study was to better understand how COVID-19 has impacted the SGM community and ways to address vaccine hesitancy. METHODS: Three focus groups were conducted with 21 members of the SGM community between 5 November and 10 December 2020. A thematic analysis using the reflexive approach was applied to the transcripts of the focus groups. RESULTS: Four themes emerged: (1) Impact of COVID-19 on the Community, (2) Perceptions of Contact Tracing and Testing, (3) Perceptions of a Potential COVID-19 Vaccine, and (4) Decreasing Vaccine Hesitancy. The most relevant subthemes were that social isolation led to anxiety, stress, and fear in the SGM community during COVID-19; resilience and adaptation were positive outcomes of the pandemic; histories of medical racism contributed to hesitancy to get tested; and specific messaging from trusted messengers may be needed to encourage SGM communities to get vaccinated. These findings support other COVID-19 research on the SGM community during the start of the pandemic. CONCLUSIONS: This study provides insight into the impact of the early stages of COVID-19 on the SGM community, highlighting the unique hurdles faced by SGM individuals with regard to contact tracing and vaccine hesitancy.

Obesity in Early Childhood: Examining the Relationship among Demographic, Behavioral, Nutritional, and Socioeconomic Factors.

Background: The present study sought to explore the combined relationship of physical activity, screen time, consumption of sugar-sweetened beverages, infant feeding practices, and demographic factors with obesity in early childhood. Methods: The current study included cross-sectional Kindergarten Health Survey data collected annually from 2012 to 2016. The sample included 7814 kindergarten students, with a mean age of 5.02 [standard deviation = 0.33]. A Multinomial Logistic Regression using body mass index as the dependent variable and select demographic traits, dietary practices, sedentary behaviors, and physical activity indicators as independent variables was used to assess relationship of aforementioned factors to obesity. Results: Children were more likely to be obese if they were non-Caucasian, male, lived in rural areas, lived at or below the poverty level, had public insurance, or lived in single-parent households. Children who received less than 30 minutes of physical activity 3 or fewer days per week, had more than 2 hours of daily screen time, consumed any amount of soda, and consumed anything other than breast milk at 6 months of age also had a higher probability of being obese. Conclusions: The findings from this study suggest that investments in prevention strategies are needed to address the behavioral patterns and socioeconomic disparities before kindergarten. Efforts that increase access to nutritious food, physical activity, and overall family wellness and education, such as high-quality early childhood education, could be feasible prevention approaches.

Evaluation of the Blood Lead Screening Component of the Southern Nevada Childhood Lead Poisoning Prevention Program.

CONTEXT: While public health programs and policies have worked to reduce lead exposure, lead poisoning remains a major preventable public health concern in the United States. OBJECTIVE: In Clark County, Nevada, blood lead level (BLL) screening has historically been sparse. Thus, the purpose of this study was to evaluate the impact of the Southern Nevada Childhood Lead Poisoning & Prevention Program (CLPPP) in increasing screening efforts and identifying children with elevated blood lead levels (EBLLs). MAIN OUTCOMES: The proportion of children screened after the implementation of the CLPPP and the number of children identified with detectable BLLs. RESULTS: A total of 43 028 BLL results for children younger than 6 years were assessed from 2006 to 2011. More than 19% of children tested during the project period had a detectable BLL. The number of BLL tests for children younger than 6 years increased from 4180 in 2005-2006 to 9304 in just the second year of CLPPP implementation. Once the initial implementation grant was over and additional funding was unavailable, the BLL screening once again declined to 5541 in 2016-2017. CONCLUSION: Evaluation of CLPPP activities suggests that outreach and education efforts, funded by the Centers for Disease Control and Prevention, played a significant role in increasing blood lead screening in Southern Nevada. However, despite these efforts, less than 5% of all children younger than 6 years were screened, which has declined further after the end of federal support.

Determining Childhood Blood Lead Level Screening Compliance Among Physicians.

Childhood Lead Poisoning Prevention Programs throughout the U.S. have addressed childhood lead poisoning by implementing primary and secondary prevention efforts. While many programs have helped increase screening rates, in some states children under the age of six still have not been tested for lead. This study aims to identify the barriers to childhood blood lead testing and develop a strategy to increase the number of children tested. Clark County physicians who work with children six and under were surveyed about blood lead level (BLL) testing practices, particularly, adherence to Centers for Disease Control and Prevention (CDC) guidelines, and parental compliance with orders to have their children tested to determine their blood lead levels. In addition, select in-person interviews were conducted with physicians who reported high parental compliance to identify best practices and barriers. Of the 77 physicians that provided data, 48% indicated they did not follow CDC guideline compared to 52% who follow guidelines. 18 of the 30 (or 60%) physicians reported more than 80% of parents complied with doctor recommended BLL testing. Twelve physicians identified cost, lack of insurance, and absence of symptomology as persistent barriers to lead screening. This study identified barriers to childhood lead screening including inadequate parental adherence to physician-ordered screenings and physician non-compliance with screening recommendations are two primary contributors. Addressing these issues could increase screening in children and reduce the risk of lead poisoning.

The impacts of health insurance coverage on access to healthcare in children entering kindergarten.

To examine access to healthcare and health outcomes for kindergartners as they relate to insurance status and type. For the 2008, 2009, and 2010 school years, surveys were distributed to parents with a child entering kindergarten in the state of Nevada. Surveys asked parents to provide information about their child concerning their insurance status, routine medical care, medical conditions, and health behaviors. Compared to their insured peers, uninsured kindergartners were less likely to have had a check-up in the previous 12 months (p < .001; OR 6.14; 95 % CI 5.77-6.53), have a primary physician (p < .001; OR 14.32; 95 % CI 13.49-15.20), or have seen a dentist (p < .001; OR 3.93; 95 % CI 3.70-4.16), and were more likely to have a reported unmet medical need (p < .001; OR 2.60; 95 % CI 2.19-3.07). Additionally, compared to children with private insurance, those children with public insurance were less likely to have had a check-up (p < .001; OR 1.73; 95 % CI 1.59-1.89), have a primary care provider (p < .001; OR 3.87; 95 % CI 3.55-4.21), and were more likely to have unmet medical needs (p < .001; OR 2.27; 95 % CI 1.83-2.81). For children in early development-a deeply critical period-insurance status and type are predictors of important access to healthcare variables.