Using COVID-19 online learning modules to examine concerns of university students returning to in-person learning: a mixed-methods study.

OBJECTIVE: Understand student concerns with returning to in-person instruction during the COVID-19 pandemic using an e-learning module. PARTICIPANTS: 925 undergraduate and graduate students returning to in-person instruction in Fall 2021. METHODS: Five modules educated students about COVID and the transition to in-person learning and collected quantitative and qualitative data related to concerns about COVID and in-person learning. RESULTS: 65% of students expressed comfort in returning to in-person learning and almost all students answered the scenario questions correctly. Identifying as female and African-American as well as living off campus were connected to a decrease in comfort level associated with the return to in-person learning. Six major themes emerged from the qualitative data analysis. CONCLUSIONS: Students were well-informed about the COVID-19 pandemic protection measures. These findings suggest that universities can do more to address concerns students have about in-person settings during the COVID-19 pandemic.

Exploring acculturative stress and family dynamics in African immigrant students in the US: implications for mental health.

OBJECTIVES: African immigrants represent a rapidly growing immigrant group in the US, yet relatively little is known about influences on the health of this group. This is a particularly important oversight since adaptation to life in the United States can have deleterious effects on health due to the stress associated with immigrant and minority status as well as separation from family abroad. The present study explores how African immigrants experience acculturative stress - the stress-inducing elements of life as an immigrant - and the mental health implications of these experiences in light of home country values and conceptions of health. DESIGN: Semi-structured, in-depth interviews were conducted with a purposive sample of sub-Saharan African immigrant students attending a metropolitan university in the northeastern United States (N = 26). Data were analyzed thematically using NVivo 12. RESULTS: African immigrant students first experience acculturative stress through schools and neighborhoods where they encounter othering processes, including discrimination and racism. Family responsibilities to loved ones in the US and Africa also represent a source of stress that contributes to feelings of isolation and depression experienced while managing college responsibilities. Since these emotional and mental states are not within the purview of how health is viewed in their home countries, many suffer and may not get the care they need to effectively manage their mental health. CONCLUSION: Findings emphasize shared experiences of navigating cultural dynamics, family pressures, and discrimination that contribute to the stress experienced by African immigrants. Findings also underscore the need for the development of culturally sensitive interventions in university settings so that African immigrant students can be upwardly mobile and healthy in the long-term.

Maternal and child patterns of Medicaid retention: a prospective cohort study.

BACKGROUND: We sought to determine whether maternal Medicaid retention influences child Medicaid retention because caregivers play a critical role in assuring children's health access. METHODS: We conducted a longitudinal prospective cohort study of a convenience sample of 604 Medicaid-eligible mother-child dyads followed from the infant's birth through 24 months of age with parent surveys. Individual enrollment status was abstracted from administrative Medicaid eligibility files. Generalized estimating equations quantified the effect of maternal Medicaid enrollment status on child Medicaid retention, adjusting for relevant covariates. Because varying lengths of gaps may have different effects on child health outcomes, Medicaid enrollment status was further categorized by length of gap: any gap, > 14-days, and > 60-days. RESULTS: This cohort consists primarily of African-American (94%), unmarried mothers (88%), with a mean age of 23.2 years. In multivariable analysis, children whose mothers experienced any gaps in coverage had 12.6 times greater odds of experiencing gaps when compared to children whose mothers were continuously enrolled. Use of varying thresholds to define coverage gaps resulted in similar odds ratios (> 14-day gap = 11.8, > 60-day gap = 16.8). Cash assistance receipt and maternal knowledge of differences between Temporary Assistance to Needy Families and Medicaid eligibility criteria demonstrated strong protective effects against child Medicaid disenrollment. CONCLUSIONS: Medicaid disenrollment remains a significant policy problem and maternal Medicaid retention patterns show strong effects on child Medicaid retention. Policymakers need to invest in effective outreach strategies, including family-friendly application processes, to reduce enrollment barriers so that all eligible families can take advantage of these coverage opportunities.

Do changes in socio-demographic characteristics impact up-to-date immunization status between 3 and 24 months of age? A prospective study among an inner-city birth cohort in the United States.

INTRODUCTION: Low-income child populations remain under-vaccinated. Our objective was to determine differences in the relative importance of maternal health literacy and socio-demographic characteristics that often change during early childhood on up-to-date (UTD) immunization status among a low-income population. METHODS: We performed secondary data analysis of a longitudinal prospective cohort study of 744 Medicaid-eligible mother-infant dyads recruited at the time of the infant's birth from an inner-city hospital in the United States and surveyed every 6 months for 24 months. Our primary outcome was infant UTD status at 24 months abstracted from a citywide registry. We assessed maternal health literacy with the Test of Functional Health Literacy in Adults (short version). We collected socio-demographic information via surveys at birth and every 6 months. We compared predictors of UTD status at 3, 7, and 24 months. RESULTS: The cohort consisted of primarily African-American (81.5%) mothers with adequate health literacy (73.9%). Immunizations were UTD among 56.7% of infants at 24 months of age. Maternal health literacy was not a significant predictor of UTD immunization status. Instead, adjusted results showed that significant predictors of not-UTD status at 24 months were lack of a consistent health care location or "medical home" (OR 0.17, 95%CI 0.18-0.37), inadequate prenatal care (OR 0.48, 95%CI 0.25-0.95), and prior not-UTD status (OR 0.31, 95%CI 0.20-0.47). Notably, all upper confidence limits are less than 1.0 for these variables. Health care location type (e.g., hospital-affiliate, community-based, none) was a significant predictor of vaccine status at age 3 months, 7 months, and 24 months. CONCLUSIONS: Investing in efforts to support early establishment of a medical home to obtain comprehensive coordinated preventive care, including providing recommended vaccines on schedule, is a prudent strategy to improve vaccination status at the population level.

Commission on Cancer (CoC) CP3R Measures for Colon Cancer Evaluation of Delaware Cancer Registry Data.

This study evaluates the Delaware Cancer Registry's 2010-2014 colon cancer data using Cancer Program Practice Profile Reports (CP3R) quality of care measures developed by the American College of Surgeons Commission on Cancer. The CP3R measures assess: 1) the number of regional lymph nodes removed and pathologically examined for resected colon cancer (12RLN); and 2) the provision of adjuvant chemotherapy for Stage III patients (ACT). Research was conducted in the Delaware Health Information Network and with hospital cancer registries for cases missing values for provision of chemotherapy. Percentages of cases meeting the standard of care were calculated after stratification by sex and race.