"Be honest and gain trust": a population health study to understand the factors associated with building trust in local government related to COVID-19 and vaccination in three historically disinvested neighborhoods in New York City.

Background: Distrust in government among people of color is a response to generations of systemic racism that have produced preventable health inequities. Higher levels of trust in government are associated with better adherence to government guidelines and policies during emergencies, but factors associated with trust and potential actions to increase trust in local government are not well understood. Methods: The COVID-19 Community Recovery study sampled participants from the New York City (NYC) Department of Health and Mental Hygiene's NYC Health Panel, a probability-based survey panel who complete health surveys periodically. Participants who lived in one of three historically disinvested communities in NYC where the NYC Department of Health and Mental Hygiene has dedicated resources to reduce health inequities were included. The cross-sectional survey was fielded from September 30 to November 4, 2021 and could be self-administered online or conducted via CATI (Computer Assisted Telephone Interviewing) in English, Spanish, and Simplified Chinese (Mandarin and Cantonese by phone). Demographic data were summarized by descriptive statistics. Crude and adjusted logistic regression analyses were used to assess factors predictive of trust in local government as a source of information about COVID-19 vaccines. Open-ended responses about strengthening residents' trust in local government were coded using an iteratively generated codebook. Results: In total, 46% of respondents indicated NYC local government was a trusted source of information about COVID-19 vaccines, relatively high compared to other sources. In bivariate analyses, race/ethnicity, age group, educational attainment, length of time living in NYC, and household income were significantly associated with identifying NYC government as a trusted source of information about COVID-19 vaccines. In multivariable logistic regression, no variables remained significant predictors of selecting local government as a trusted source of information. Key recommendations for local government agencies to build residents' trust include communicating clearly and honestly, addressing socioeconomic challenges, and enhancing public COVID-19 protection measures. Conclusion: Study findings demonstrate that nearly half of residents in three historically divested NYC communities consider local government to be a trusted source of information about COVID-19 vaccines. Strategies to increase trust in local government can help reduce community transmission of COVID-19 and protect public health.

Disruption of Healthcare in New York City During the COVID-19 Pandemic: Findings From Residents Living in North and Central Brooklyn, the South Bronx, and East and Central Harlem.

INTRODUCTION: The COVID-19 pandemic has disproportionately affected some New York City (NYC) neighborhoods that primarily consist of Black, Indigenous, and Latinx residents. In comparison to the rest of NYC, these neighborhoods experienced high hospitalization and COVID-related death rates, which has been attributed to a longstanding history of structural racism and disinvestment. While stay-at-home orders were implemented to reduce the spread of COVID-19, this may have also affected access and utilization of non-COVID related healthcare services. This study aims to assess the prevalence of and reasons for the disruption of non-COVID related healthcare services during the first 18 months of the pandemic. METHODS: From September 30, 2021 to November 4, 2021, the NYC Health Department administered the COVID-19 Community Recovery Survey to a subset of residents who were part of the NYC Health Panel a probability-based survey panel. This cross-sectional survey, which included closed and open-ended questions, was either self-administered online or completed via CATI (Computer Assisted Telephone Interviewing) in English, Spanish, and Simplified Chinese. Descriptive statistics were used to summarize responses and unweighted, weighted, age-adjusted percentages, and 95% Confidence Intervals (CIs) were calculated. RESULTS: With a response rate of 30.3% (N = 1358), more than half of participants (54%) reported disruption to either routine physical healthcare or mental health services. Concern about getting COVID-19 (61%), stay-at-home policies (40%), belief that care could safely be postponed (35%), and appointment challenges (34%) were among reasons for delaying routine healthcare. Concern about getting COVID-19 (38%) and reduced hours of service (36%) were primary reasons for delaying mental healthcare. Reported reasons for the sustained delay of care past 18 months involved COVID concerns, appointment, and insurance challenges. CONCLUSIONS: Due to the pandemic, some disruption to healthcare was expected. However, most study participants either avoided or experienced a delay in healthcare. The delay of non-COVID related healthcare throughout the pandemic may result in the further widening of the health inequity gap among NYC residents dealing with a higher chronic disease burden before the start of the COVID-19 pandemic in March 2020. Findings from this study can support equitable COVID-19 recovery, and guide efforts with health promotion.

Building a Functioning Multi-sector Coalition: A Case Study from the Jerome Avenue Public Health Taskforce.

As a result of the Jerome Avenue Corridor re-zoning in Bronx, New York, the Jerome Avenue Public Health Task-force was convened by local elected officials in December 2018. Facilitated by the New York City Department of Health and Mental Hygiene, the taskforce consists of a core group of 15 committed organizations from local civic, government, healthcare, and social service agencies, as well as neighborhood residents. Striving to address common challenges faced by diverse partners, the taskforce implemented intentional strategies to enable transparent communication and tackle power dynamics. Best practices and lessons learned from this high-functioning coalition can serve as a model for future multi-sector collective action dedicated to health and community planning.

Engaging businesses and faith-based organizations in public health interventions: Lessons learned from a COVID-19 and flu vaccine detailing program in the Northeast Bronx.

Objectives: The NYC Department of Health and Mental Hygiene conducted a COVID-19 and flu vaccine community detailing program to influential businesses and faith-based organizations in the Northeast Bronx in 2022 to increase COVID-19 and flu vaccine knowledge and uptake among residents of the area. Study design: program evaluation. Methods: The program was piloted in the Northeast Bronx, a geography selected based on prior low COVID-19 and flu vaccination rates and high COVID-19 case positivity rates. Barbershops, hair salons, beauty salons, nail salons and faith-based organizations were selected as potential partners because their owners or staff typically spend at least an hour in interactions with clients. From January 2022 through April 2022, two detailing visits were conducted by engagement staff: an initial visit to all potential partners in the selected geography, and a follow up visit to those who committed to be champions of health. Results: Out of 113 identified businesses/organizations, 70 met the criteria to be potential partners in the program. After being contacted by health department staff, 45 (64%) potential partners committed to be champions of health. During the four months of the pilot, zip codes with the highest level of program engagement experienced greater percent increases in COVID-19 vaccination rates during the program period compared to NYC and Bronx averages. Flu vaccination rates during the program period were not available. Conclusion: Supplementing other local public health efforts, the community detailing pilot program demonstrates a model of dissemination of health information through local business leaders, and provides lessons learned to increase champion commitment.

The Community Assessment to Inform Rapid Response (CAIRR): A Novel Qualitative Data Collection and Analytic Process to Facilitate Hyperlocal COVID-19 Emergency Response Operations in New York City.

All disasters are local but implementing a hyperlocal response in the midst of a public health emergency is challenging. The availability of neighborhood-level qualitative data that are both timely and relevant to evolving objectives and operations is a limiting factor. In 2020, the New York City Department of Health and Mental Hygiene (NYC DOHMH) responded to the COVID-19 emergency using a novel, hyperlocal approach. Key to the implementation of this approach was the creation of the Community Assessment to Inform Rapid Response (CAIRR), a process for rapid collection and analysis of neighborhood-specific, objective-focused, qualitative data to inform tailored response operations. This paper describes the process of developing the CAIRR and its contribution to the NYC DOHMH's hyperlocal response in order to guide other jurisdictions seeking to employ a hyperlocal approach in future disaster responses.

Making Injustice Visible: How a Health Department Can Demonstrate the Connection Between Structural Racism and the Health of Whole Neighborhoods.

CONTEXT: The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) has built a presence in Tremont, a historically redlined neighborhood located in Bronx, NYC. As part of an agency-wide commitment to explicitly name racism as a threat to healthy communities, DOHMH has sought opportunities to educate and engage in discussion about historical and current structural racism. PROGRAM: Between January and September 2018, DOHMH exhibited Undesign the Redline, a pictorial timeline and historical analysis of redlining, in its Tremont office. The exhibit exposed neglected history, making concrete the concept of structural racism. IMPLEMENTATION: DOHMH staff led 101 tours for 950 visitors, including employees, community partners, and residents. Tours were given in English and Spanish in three 2-month cycles over 8 months. Tour guides also facilitated interactive workshops with youth groups, community-based organizations, and teams from city agencies to engage participants in the design and ownership of new systems intended to "undesign" the consequences of redlining. EVALUATION: Immediate feedback was requested from all participants at the conclusion of each tour and was collected on a bulletin board. Longer-term impact was assessed through an electronic survey sent to all participants who provided valid contact information to better understand ways that the exhibit impacted personal and professional actions. Participants reported talking with family, friends, and coworkers, seeking more information, and applying an equity lens to professional projects after experiencing the exhibit. DISCUSSION: Hosting the exhibit in a local health department building offered a concrete opportunity to learn about and discuss structural racism. Exhibit tours had immediate- and long-term impacts on participants and contributed to sustainable changes internal to DOHMH work. This work presents a concrete practice to make injustice visible and engage in open conversation about structural racism to build community trust.