Incidence of long COVID and associated psychosocial characteristics in a large U.S. city.

PURPOSE: Persistent residual effects from Coronavirus Disease-2019 (COVID-19) have been observed with varying definitions of "Long COVID" and little comprehensive examination. This study examined the incidence and psychosocial correlates of Long COVID using different definitions. METHODS: Data were analyzed from a citywide sample of 3595 adults with lab-confirmed cases of COVID-19 that were surveyed over 3 months. Rates of Long COVID were examined in terms of Post-Acute COVID (PAC), defined as at least one symptom lasting for 4 weeks, and three levels of Post-COVID Syndrome (PCS) that included experiencing at least one symptom for 3 months (PCS-1), experiencing three or more symptoms for 3 months (PCS-2), or experiencing at least one of the same symptoms for 3 months (PCS-3). RESULTS: Among the 686 participants who completed baseline, 1-month, and 3-month follow-up assessments, 75.7% had PAC, 55.0% had PSC-1, 26.5% had PSC-2, and 19.0% had PSC-3. Comparing participants with PAC and PSC-3 in the total sample with inverse probability weighting, multivariable analyses revealed being female, Asian or Native American, greater reported longlines, and less social support were predictive of PCS-3. CONCLUSION: Residual effects of COVID-19 are very common and nearly one-fifth of our sample met the most restrictive definition of Long COVID warranting concern as a public health issue. Some demographic and social factors may predispose some adults to Long COVID, which should be considered for prevention and population health.

Incidence and psychiatric predictors of Long COVID beyond 3 months in a city-wide community sample in Texas.

BACKGROUND: Studies have emerged about a syndrome of persistent symptoms of Coronavirus Disease-2019 (COVID-19) infection called 'Long COVID', which have mostly focused on the first 3 months. This study examined rates and predictors of Long COVID symptoms lasting beyond 3 months (termed Long2 COVID). METHODS: A longitudinal cohort study using a population-based sample of 511 adults in San Antonio, Texas with laboratory-confirmed cases of COVID-19 were assessed for Long2 COVID. Inverse probability weighting was used. RESULTS: In the sample, 19.18-59.10% met criteria for Long2 COVID depending on the definition. In general, Long COVID symptoms decreased after 3 months with the notable exception of an observed increase in loss of taste and smell. White Hispanic (adjusted odds ratio (aOR) = 7.66; 95% confidence interval (CI) = 1.78, 32.87) background and baseline depression symptoms (aOR = 1.30; 95% CI = 1.03, 1.65) were predictive of Long2 COVID. Long2 COVID was also associated with greater anxiety symptoms 6 months after onset of COVID-19. CONCLUSIONS: A sizable proportion report COVID-19 symptoms lasting more than 3 months and some symptoms even increased over time. Adults who are Hispanic white adults or have depression may be at greater risk for Long2 COVID. Further research is needed on why some adults experience Long COVID and how to reduce the duration of illness.

The Role of Location in the Spread of SARS-CoV-2: Examination of Cases and Exposed Contacts in South Texas, Using Social Network Analysis.

OBJECTIVE: This study sought to better understand the types of locations that serve as hubs for the transmission of COVID-19. METHODS: Contact tracers interviewed individuals who tested positive for SARS-CoV-2 between November 2020 and March 2021, as well as the people with whom those individuals had contact. We conducted a 2-mode social network analysis of people by the types of places they visited, focusing on the forms of centrality exhibited by place types. RESULTS: The most exposed locations were grocery stores, commercial stores, restaurants, commercial services, and schools. These types of locations also have the highest "betweenness," meaning that they tend to serve as hubs between other kinds of locations since people would usually visit more than 1 location in a day or when infected. The highest pairs of locations were grocery store/retail store, restaurant/retail store, and restaurant/grocery store. Schools are not at the top but are 3 times in the top 7 pairs of locations and connected to the 3 types of locations in those top pairs. CONCLUSIONS: As the pandemic progressed, location hotspots shifted between businesses, schools, and homes. In this social network analysis, certain types of locations appeared to be potential hubs of transmission.

City-wide study of laboratory-confirmed COVID-19 cases in San Antonio: An investigation of stressful events accompanying infection and their relation to psychosocial functioning.

Little is known about how Coronavirus Disease-2019 (COVID-19) infection is associated with stressful events (SEs) and stress-related psychological symptoms. This study examined the prevalence of SEs and incidence of stress-related symptoms accompanying COVID-19 infection. The association between these stress-related symptoms and psychosocial functioning were also examined. A city-wide sample of 3,595 adults with lab-informed cases of COVID-19 infection in San Antonio, Texas completed an online assessment of their psychological health and well-being after completing contact tracing activities in 2021-2022. A total 88.3% of participants reported exposure to SEs related to COVID-19 infection and their "worst" SEs were related to physical symptoms, fear of infecting others, financial problems, being isolated/quarantined, and loss of a loved one. Based on these SEs, 14.8% of the sample screened positive for substantial stress-related psychological problems related to COVID-19 infection. These psychological symptoms were strongly associated with worse psychosocial functioning. Together, these findings suggest SEs were commonly experienced by adults infected with COVID-19. Only a relatively small proportion reported substantial psychological symptoms related to their infection, but those who did had a high likelihood of impaired psychosocial functioning. Targeted support for individuals at high-risk of psychological symptoms following COVID-19 infection may help mitigate long-term psychological effects.

Understanding and Addressing COVID-19 Vaccine Hesitancy Among Healthcare Providers in Bexar County, Texas.

Introduction: COVID-19 challenged our healthcare systems and unsurprisingly, so did its vaccine. Chief among these were the uniquely politicized nature and logistical difficulties surrounding its deployment. Understanding provider attitudes toward the COVID-19 vaccines and their willingness/ability to deliver them is essential to developing an ideal vaccine distribution plan for Bexar County, Texas. Methods: An electronic survey was sent to providers serving adult patients across Bexar County. Membership includes representation from local hospitals, Bexar County Medical Society, and the San Antonio Metropolitan Health District's vaccination program. The survey measured provider attitudes toward the vaccines and asked logistical questions regarding patient hesitancy and clinic infrastructure. Results: Responses were collected from 66 ZIP codes (90% of ZIP codes in the county), and 377 providers answered the survey. Respondents who were unlikely to recommend the vaccine (3%) shared concerns involving distrust of the vaccine manufacturing process. Recommendations made by physicians to support their vaccine administration efforts included broadening the reporting timeframe (n=35), providing trained support staff (n=18), and improving logistical support (n=14). Furthermore, responses showed that only 14.44% of provider facilities were able to meet originally published refrigeration requirements to store Pfizer's vaccines compared with 87.47% for Moderna's vaccines. Conclusions: Survey results were used to improve the efficiency of vaccination programs and address vaccine hesitancy through various avenues of information delivery. It is recommended to replicate the outcomes and applications of this study in other populations to improve the efficiency of vaccination programs and reduce vaccine hesitancy.

A Model of Culex quinquefasciatus Abundance Constructed Using Routine Surveillance and Treatment Data in Tarrant County, Texas.

Mosquito surveillance and pesticide treatment data can be combined in statistical models to provide insight into drivers of mosquito population dynamics. In cooperation with the county-based public health authority, multiple municipalities in Tarrant County, Texas, supplied surveillance and pesticide treatment data available from the 2014 mosquito season for analysis. With these data, general linear mixed modeling was used to model population dynamics of Culex quinquefasciatus, the primary vector for West Nile virus. Temporally lagged pesticide treatment information, weather data, and habitat variables were used as predictors of log + 1 transformed mosquito count data, and Akaike information criteria corrected for small sample sizes (AICc)-based model selection and multimodel averaging was used to produce a final model of mosquito abundance. The model revealed that mosquito counts were driven mainly by seasonally fluctuating temperature, precipitation, human population density, and treatment. In particular, interactions between temperature and treatment, and precipitation and human population density significantly contributed to the interpretation of the effects of the nonweather variables.

Challenges with hepatitis B vaccination of high risk adults - A pilot program.

BACKGROUND: Acute hepatitis B virus (HBV) infections in the United States occur predominantly among persons aged 30-59 years. The Centers for Disease Control and Prevention (CDC) recommends vaccination of adults at increased risk for HBV infection. Completing the hepatitis B (HepB) vaccine dose-series is critical for optimal immune response. OBJECTIVES: CDC funded 14 health departments (awardees) from 2012 to 2015 to implement a pilot HepB vaccination program for high-risk adults. We evaluated the pilot program to assess vaccine utilization; vaccine dose-series completion, including by vaccination location type; and implementation challenges. METHODS: Awardees collaborated with sites providing health care to persons at increased risk for HBV infection. Awardees collected information on doses administered, vaccine dose-series completion, and challenges completing and tracking vaccinations, including use of immunization information systems (IIS). Data were reported by each awardee in aggregate to CDC. RESULTS: Six of 14 awardees administered 47,911 doses and were able to report patient-level dose-series completion. Among persons who received dose 1, 40.4% received dose 2, and 22.3% received dose 3. Local health department clinics had the highest 3-dose-series completion, 60.6% (531/876), followed by federally qualified health centers at 38.0% (923/2432). While sexually transmitted diseases (STD) clinics administered the most doses in total (17,173 [35.8% of 47,911 doses]), 3-dose-series completion was low (17.1%). The 14 awardees reported challenges regarding completing and tracking dose-series, including reaching high-risk adults for follow-up and inconsistencies in use of IIS or other tracking systems across sites. CONCLUSIONS: Dose-series completion was low in all settings, but lowest where patients may be less likely to return for follow-up (e.g., STD clinics). Routinely assessing HepB vaccination needs of high-risk adults, including through use of IIS where available, may facilitate HepB vaccine dose-series completion.

Paternal race/ethnicity and very low birth weight.

BACKGROUND: The purpose was to examine the association between paternal race/ethnicity and very low birth weight stratified by maternal race/ethnicity. METHODS: Birth data for Tarrant County, Texas 2006-2010 were analyzed. Very low birth weight was dichotomized as yes (<1,500 g) and no (≥1,500 g). Paternal race/ethnicity was categorized as Caucasian, African American, Hispanic, other, and missing. Missing observations (14.7%) were included and served as a proxy for fathers absent during pregnancy. Potential confounders included maternal age, education, and marital status, plurality, previous preterm birth, sexually transmitted disease during pregnancy, smoking during pregnancy, and Kotelchuck Index of prenatal care. Logistic regressions were stratified by maternal race/ethnicity. Odds ratios and 95% confidence intervals were calculated. RESULTS: Of 145,054 births, 60,156 (41.5%) were Caucasian, 22,306 (15.4%) African American, 54,553 (37.6%) Hispanic, and 8,039 (5.5%) other mothers. There were 2,154 (1.5%) very low birth weights total, with 3.1% for African American mothers and 1.2% for all other race/ethnicities. Among Caucasian mothers, African American paternal race was associated with increased odds of very low birth weight (OR = 1.52; 95% CI:1.08-2.14). Among Hispanic mothers, African American paternal race (OR = 1.66; 95% CI:1.01-2.74) and missing paternal race/ethnicity (OR = 1.65; 95% CI:1.15-2.36) were associated with increased odds of very low birth weight. CONCLUSIONS: Paternal race/ethnicity is an important predictor of very low birth weight among Caucasian and Hispanic mothers. Future research should consider paternal race/ethnicity and further explore the association between paternal characteristics and very low birth weight.

Effectiveness of a school district closure for pandemic influenza A (H1N1) on acute respiratory illnesses in the community: a natural experiment.

BACKGROUND: Following detection of pandemic influenza A H1N1 (pH1N1) in Dallas/Fort Worth, Texas, a school district (intervention community, [IC]) closed all public schools for 8 days to reduce transmission. Nearby school districts (control community [CC]) mostly remained open. METHODS: We collected household data to measure self-reported acute respiratory illness (ARI), before, during, and after school closures. We also collected influenza-related visits to emergency departments (ED(flu)). RESULTS: In both communities, self-reported ARIs and ED(flu) visits increased from before to during the school closure, but the increase in ARI rates was 45% lower in the IC (0.6% before to 1.2% during) than in the CC (0.4% before to 1.5% during) (RRR(During)(/Before) = 0.55, P < .001; adjusted OR(During/Before) = 0.49, P < .03). For households with school-aged children only (no children 0-5 years), IC had even lower increases in adjusted ARI than in the CC (adjusted OR(During/Before) = 0.28, P < .001). The relative increase of total ED(flu) visits in the IC was 27% lower (2.8% before to 4.4% during) compared with the CC (2.9% before to 6.2% during). Among children aged 6-18 years, the percentage of ED(flu) in IC remained constant (5.1% before vs 5.2% during), whereas in the CC it more than doubled (5.2% before vs 10.9% during). After schools reopened, ARI rates and ED(flu) visits decreased in both communities. CONCLUSIONS: Our study documents a reduction in ARI and ED(flu) visits in the intervention community. Our findings can be used to assess the potential benefit of school closures during pandemics.

Outbreak of cryptosporidiosis associated with a man-made chlorinated lake--Tarrant County, Texas, 2008.

In July 2008, clusters of laboratory-confirmed cryptosporidiosis cases and reports of gastrointestinal illness in persons who visited a lake were reported to Tarrant County Public Health. In response, epidemiologic, laboratory, and environmental health investigations were initiated. A matched case-control study determined that swallowing the lake water was associated with illness (adjusted odds ratio = 16.3; 95% confidence interval: 2.5-infinity). The environmental health investigation narrowed down the potential sources of contamination. Laboratory testing detected Cryptosporidium hominis in case-patient stool specimens and Cryptosporidium species in lake water. It was only through the joint effort that epidemiologic, laboratory, and environmental health investigators could determine that >1 human diarrheal fecal incidents in the lake likely led to contamination of the water. This same collaborative effort will be needed to develop and maintain an effective national Model Aquatic Health Code.

Having a personal healthcare provider and receipt of adequate cervical and breast cancer screening.

INTRODUCTION: The purpose of this study was to assess the relationship between having a personal health care provider and adequate cervical and breast cancer screening behavior. METHODS: Cross-sectional data were obtained from the 2004 Behavior Risk Factor Surveillance System. For cervical cancer, female respondents 18 years of age and older who did not have hysterectomy were included (n = 130,359); for breast cancer, female respondents 40 years of age or older were included (n = 129,929). Multiple logistic regression analyses were performed to determine the association between having a personal health care provider, specific demographics, and health insurance status with adequate cervical and breast cancer screening behavior. RESULTS: Approximately 9% and 14% of the study population for the breast cancer and cervical cancer analyses, respectively, did not have a personal health care provider. Having at least one personal health care provider was significantly associated with adequate cervical cancer screening behavior (odds ratio, 2.37; 95% CI, 2.08-2.70) and breast cancer screening behavior (odds ratio, 2.86; 95% CI, 2.54-3.24) in multivariate analyses. Both multivariate analyses were adjusted for age, race/ethnicity, education, income, and health insurance. CONCLUSION: Having at least one personal health care provider was associated with adequate cervical and breast cancer screening behavior. Efforts to increase primary care access are a necessary part of the plan to increase preventive health services utilization.

Racial and ethnic differences in cardiovascular disease risk factors: a systematic review.

OBJECTIVE: This systematic review was undertaken to expand our understanding of the factors associated with racial/ethnic disparities in cardiovascular disease (CVD) risk factors (hypertension, diabetes, obesity, hypercholesterolemia, no leisure-time physical activity, and smoking), to assess the potential differences in the CVD risk factors by race/ethnicity, and to update and expand on existing reviews. METHODS: English-language, population-based CVD studies published between 1995 to present, which included one or more ethnic comparison in an adult population were reviewed. RESULTS: Sixteen studies were included in this review. Most of the studies found hypertension to be significantly higher in Blacks than Whites. Minority status was also significantly associated with diabetes. No one racial/ethnic minority population was consistently found to have a higher or lower prevalence of obesity or hypercholesterolemia. Mexican Americans had a significantly lower prevalence of smoking than Whites and Blacks; American Indian/Alaskan Natives (AIANs) had significantly higher prevalence of smoking compared to Whites. Mexican Americans had the highest prevalence of no leisure-time physical activity, followed by AIANs and Blacks. CONCLUSION: Cardiovascular diseases are the leading cause of death in the United States, and disproportionate rates are seen in racial and ethnic minority populations. Systematically assessing and quantifying modifiable CVD risk factors is therefore crucial in these populations. Better understanding and awareness of the disparities of CVD risk factors by race and ethnicity may help clinicians and public health professionals develop culturally sensitive interventions, prevention programs, and services specifically targeted toward risk burdens in each of these populations.

Racial and ethnic differences in the effects of regular providers and self-management education on diabetes preventive care.

OBJECTIVE: To examine the effects of having regular healthcare providers and diabetes self-management education (DSME) on the receipt of diabetes preventive care among all groups and by race/ethnicity. DATA SOURCE: The 2004 Behavioral Risk Factor Surveillance Survey. METHODS: Logistic regression analyses were performed for the full sample and separately for Blacks, Hispanics, and Whites. RESULTS: Among all persons, having at least one regular provider and DSME were significantly associated with higher odds of receipt of a glycosylated hemoglobin (HbA1C) test, foot exam, and dilated eye exam in the past year. Results from analyses stratified by race/ethnicity reveal differential effects of having a regular provider and DSME. Among Whites, having at least one regular provider helps assure that diabetes patients receive each of the three recommended preventive services. Among Blacks, having at least one regular provider was significantly associated with receipt of an HbA1C but not other preventive services. Among Hispanics, having a regular provider was significantly associated with receipt of an HbA1C test and dilated eye exam, but not a foot exam. Independent of having a regular provider, DSME appears to be beneficial for Whites and Blacks but not Hispanics. For Whites, DSME was significantly associated with all three types of diabetes preventive care. For Blacks, DSME was significantly associated with the receipt of a foot exam but not an HbA1C test and a dilated eye exam. However, among Hispanics, DSME was not significantly associated with any of the three preventive services. CONCLUSION: Access to personal healthcare providers should be promoted among Whites, Blacks, and Hispanics to assure patients with diabetes receive recommended secondary preventive services. Diabetes self-management programs should also be expanded among Whites and Blacks but may need to be modified to benefit Hispanics.