To examine the associations between child and neighborhood characteristics and incidence of COVID-19 infection during the first 19 months of the pandemic. We utilized individual electronic health record data and corresponding census tract characteristics for pediatric SARS-CoV-2 cases (age <18 years) from March 23, 2020 to September 30, 2021 with molecular tests resulted at a children's health system in Colorado. We compared associations between individual SARS-CoV-2 cases and census tract SARS-CoV-2 positivity rates over three time periods (TP1: March-September 2020; TP2: October 2020-March 2021; TP3: April-September 2021) using multinomial logistic regression for individual associations and negative binomial regression for census tract associations. We included 7498 pediatric SARS-CoV-2 cases and data from 711 corresponding census tracts. Spanish preferred health care language was associated with SARS-CoV-2 positivity for TP1 (odds ratio [OR] 4.9, 95% confidence interval [CI] 3.7-6.5) and TP2 (OR 2.01, 95% CI 1.6-2.6) compared with TP3. Other non-English preferred health care language was associated with SARS-CoV-2 positivity in TP1 (OR 2.4, 95% CI 1.4-4.2). Increasing percentage internationally born in a census tract was associated with SARS-CoV-2 positivity for TP1 (multivariable incident rate ratio [IRR]=1.040, p<0.0001), TP2 (multivariable IRR=1.028, p<0.0001), and in all TP combined (multivariable IRR=1.024, p<0.0001). Our study is notable for the identification of COVID-19 disparities among children in immigrant families and communities, particularly early in the pandemic. Addressing disparities for immigrant communities requires targeted investments in public health infrastructure.

Purpose:Black pregnant individuals in Alabama are disproportionately affected by severe maternal morbidity and mortality (SMM). To understand why racial disparities in maternal health outcomes persist and identify potential strategies to reduce these inequities, we sought perspectives from obstetric health care providers, health administrators, and members of local organizations who provide pregnancy, delivery, and postpartum care services in Alabama.Methods:We conducted qualitative in-depth interviews with stakeholders (n=20), purposively recruited from community-based organizations, clinical settings, government organizations, and academic institutions. Interview guides were based on Howell's conceptual model of pathways to racial disparities in maternal mortality. Data were coded using a modified framework theory approach and analyzed thematically.Results:Racism, unjust laws and policies, and poverty/lack of infrastructure in communities emerged as major themes contributing to racial disparities in maternal health at the community and systems levels. Inadequate health insurance coverage was described as a strong driver of the disparities. Service providers suggested strategies for Alabama should be community focused, evidence based, and culturally sensitive. These should include Medicaid expansion, expanded parental leave, and removal of laws restricting choice. Community- and systems-level interventions should include community infrastructure improvements, choice in maternity services, and provision of digital communication options.Conclusions:Providers shared perspectives on community and structural areas of intervention to reduce racial inequities in SMM. These results can inform discussions with health system and community partners about Alabama and other Deep South initiatives to improve maternal health outcomes in black communities.

The Rosalind Franklin Society (RFS), in partnership with Mary Ann Liebert, Inc., publishers, enthusiastically congratulate our distinguished recipient of the 2022 annual RFS Award in Science for this journal, which recognizes the outstanding research and published work of women and underrepresented minority scientists, physicians, and engineers. Lily K. Villa, Shakthi Bharathi Murugesan, Lora A. Phillips, Alexandria J. Drake, and Nathan A. Smith, ?Mobile Pantries Can Serve the Most Food Insecure Populations,? Health Equity 6, no. 1 (December 2022): 49?54, http://doi.org/10.1089/heq.2021.0006. Abstract Food insecurity is a crisis in the United States and is particularly dire in Maricopa County, Arizona, where 1 in 5 children experience food insecurity, and >1 in 10 residents experience poverty. Mobile food pantries can help; however, there is minimal knowledge about how communities utilize these food distributors. Research on people aged 60+ years and immigrant populations shows that these populations are especially vulnerable to food insecurity. This study utilized data from a food pantry called ?Phoenix Rescue Mission? (PRM) on food insecure people's use of PRM's mobile and brick-and-mortar pantries, as well as census data. Using GIS mapping and a multinomial logistic regression model, this research identifies how different demographic groups engage with PRM's brick-and-mortar or mobile pantries. Findings indicate that people aged 60?80 years and immigrant people of color are more likely to use both mobile and brick-and-mortar pantries. This research suggests that mobile pantries can reach the most food insecure populations and local nonprofits and governments can consider implementing mobile pantries to reach food insecure communities. Biosketch Lily Villa is a PhD candidate who will defend her dissertation in spring 2023 in applied sociocultural anthropology. She engages her research for social justice activism. Her main area of research is intergenerational community development. Prior to graduate school, Villa worked for 10 years in social services for youth education and development. She also has a graduate certificate in nonprofit leadership and management, and she currently works for the Arizona Coalition to End Sexual and Domestic Violence as a grant management specialist. Villa has a deep passion for fighting against oppression. As an activist scholar, she is committed to helping build the resources necessary to ensure that everyone in Arizona can stay safe, healthy, and happy. All of her research is community-embedded, coauthored with local community leaders, and is an effort to move toward a kinder, more equitable, and loving world.

In September 2020, the Department of Veterans Affairs (VA) launched a novel volunteer research registry to rapidly recruit eligible study participants for research on SARS-CoV-2 and COVID-19 vaccines and treatments at VA Medical Centers selected as study sites for COVID-19 clinical trials. Targeted multimedia outreach campaigns were used to recruit diverse populations, including those historically under-represented in medical research. By November 2022, 58,561 volunteers were enrolled in the registry, 19% of whom were women, 9% Hispanic/Latino, and 8% Black. The registry's strategic approach to outreach proved successful in recruiting diverse volunteers, with geotargeted e-mails recruiting the most diversity.

Health EquityVol. 7, No. 1 Call for PapersOpen AccessCall for Special Collection Papers: How Stakeholders Are Working to Advance Health EquityDeadline for Manuscript Submission: April 19, 2023Guest Editors: Laurie Zephyrin and Claire-Cecile PierreGuest Editors: Laurie ZephyrinSenior Vice President, Advancing Health Equity, The Commonwealth Fund, New York, New York, USA.Search for more papers by this author and Claire-Cecile PierreAssociate Chief Medical Officer, Vice President of Community Health, Brigham and Women's Hospital, Boston, MA, USA.Search for more papers by this authorPublished Online:28 Mar 2023https://doi.org/10.1089/heq.2023.29013.cfpAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail The Commonwealth Fund's Advancing Health Equity program and the Health Equity Journal Editors invite paper submissions focused on the topic of Health Equity in the United States. Specifically, we invite the submission of content that covers the following areas: Changing Mindsets: Works that focus on:(1) how Americans develop their views as it relates to health care and health equity and(2) existing strategies that can actively shift mindsetsPromoting Antiracism in Health Delivery Systems: Works that highlight ways that health systems are modifying their operations to focus on health equityPromoting Antiracism in Health Policy: Works that support understanding(1) how current policies might be modified or built upon to advance health equity and(2) opportunities to develop new equity-centered policies.The focus of this Special Collection is to highlight recent efforts that are leading to(1)increased access to equitable care,(2)systems-level changes among provider organizations that are centering health equity; and(3)opportunities to modify and/or develop policies that will lead to advancement in health equity. In addition to these topics, the issue seeks to highlight health equity efforts that are also specific to perinatal health care, given the vast disparities in outcomes across races and ethnicities.Please visit our website at www.liebertpub.com/heq to view our Information for Authors.Editorial or technical questions? Contact Taylor Bowen (heq_eo@liebertpub.com)Thanks to a generous grant from the Commonwealth Fund, Article Processing Charges (APCs) will be waived for all articles published in this special issue.Visit the Instructions for Authors:www.liebertpub.com/heqSubmit your paper for peer review online:https://mc.manuscriptcentral.com/heqUpload your paper using the manuscript category:Special Issue: Advancing Health EquityFiguresReferencesRelatedDetails Volume 7Issue 1Mar 2023 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Guest Editors: Laurie Zephyrin and Claire-Cecile Pierre.Call for Special Collection Papers: How Stakeholders Are Working to Advance Health Equity.Health Equity.Mar 2023.216-217.http://doi.org/10.1089/heq.2023.29013.cfpcreative commons licensePublished in Volume: 7 Issue 1: March 28, 2023PDF download

Purpose:To examine racial/ethnic differences in dietary behaviors, diet quality, body mass, and the perceived availability of healthful foods in one's neighborhood among mothers from low-income California households.Methods:Cross-sectional telephone surveys of mothers from randomly sampled households with incomes ≤185% federal poverty level in 2018 and 2019 using a validated 24-h dietary recall assessment. Dietary outcomes were cups of fruits and vegetables, ounces of sugar-sweetened beverages, teaspoons of added sugars, and kilocalories consumed the previous day. Diet quality was assessed by calculating Health Eating Index-2015 scores. Supplemental survey items assessed mothers' weight and height. Body mass index (BMI) was calculated with a BMI of 30 or higher considered obese. Perceived availability of fresh fruits and vegetables and healthy foods in general within one's neighborhood was recorded.Results:The analytic sample of 9200 mothers was 66.3% Latina, 17.3% white, 12.6% African American, and 3.8% Asian American, Native Hawaiian, or Pacific Islander (AANHPI). African American mothers consumed the fewest cups of fruits and vegetables and the most teaspoons of added sugars, reported poor diet quality, and had the highest obesity rate, 54.7% versus 46.9% for Latinas, 39.9% for whites, and 23.5% for AANHPIs. Accordingly, a greater proportion of African Americans reported limited availability of fresh fruits and vegetables and healthy foods in general in their neighborhood.Conclusion:Findings are interpreted in light of recent calls for broader approaches to address health disparities, including strategies that focus on inequalities in racial/ethnic socioeconomic status and systemic racism.

Background:The grim inequity that Black women and infants are more than twice as likely to die during birth than their white counterparts is a public health crisis.Methods:Guided by principles of critical race theory, we used content analysis to analyze the themes of the presentation made by five Black community members on a 2020 Juneteenth panel, a holiday celebrating the emancipation of those who had been enslaved in the United States.Results:Panelists sparked the conversation by unpacking the traumatic experiences of health inequities and structural racism on Black families and diverse caregivers. As a part of qualitative content analysis, four major themes emerged: (1) the matrix of domination, (2) specific oppressions of the health care system, (3) empowerment reconceptualized, and (4) dimensions of racism. Participants also discussed how racial disparities may have exacerbated the complexities and challenges of elevating Black voices and creating birth equity.Discussion:Based on Black families' experiences, four areas must be addressed: health care system's policies of oppression that create barriers to listening to Black women, reconceptualizing retention for providers of color and support for Black women and their families, and racism.

Introduction:Breast cancer mortality rates are 40% higher in non-Hispanic Blacks (NHBs) than in non-Hispanic White (NHWs) in the United States. All women treated within the Murtha Cancer Center at Walter Reed National Military Medical Center (MCC/WRNMMC) have health insurance and are provided multidisciplinary health care. Pathological factors and outcomes of NHBs and NHWs treated within the MCC/WRNMMC were evaluated to determine whether equal-access health care reduces disparate phenotypes and survival between the racial groups.Methods:Between 2001 and 2018, 368 NHB and 819 NHW women were diagnosed with breast cancer at MCC/WRNMMC. Differences between NHBs and NHWs in epidemiological and pathological characteristics were evaluated. Overall and breast cancer-specific 5- and 10-year survival rates were compared between races.Results:Compared with NHWs, NHBs were significantly more likely to have a body mass index ≥30 kg/m2, to be unmarried, to have tumors of higher grade, later stage, with lymph node metastases, and to be hormone receptor negative (HR−)/human epidermal growth factor receptor 2 positive (HER2+) or triple negative. After adjustment for demographic factors, NHBs remained significantly more likely to have tumors diagnosed at a higher grade and later stage, and to be HR−/HER2+ or triple negative. Neither 5- nor 10-year overall or breast cancer-specific survival differed significantly between the racial groups after adjusting for demographic and pathological variables.Discussion:Despite having tumors with less favorable pathological characteristics, overall and disease-free survival disparities were not observed for NHBs treated at MCC/WRNMMC. These data suggest that survival disparities of NHBs with breast cancer can be diminished with provision of quality care.

Objective:This study examines the association between acculturative stress and psychological distress among Mexican immigrants living in New York City. It takes account factors such as language barriers, legal status, fear of deportation, and avoidance of social health and human services, and how these factors are implicated in the mental health status of the study population.Design:Study draws from a community-based sample of Mexican American adults from the Social Network of Mexican Americans study recruited from a church-based community center in the Bronx, New York. Eighty Mexican immigrants were included in this analysis. Descriptive statistics were used to display participants' characteristics. Pearson correlation and multiple regressions were run to determine the relationship between acculturative stress and psychological distress, and also with each of the items from the acculturative stress scale. Both scales have been validated among Spanish-speaking Latino immigrants.Results:A significant moderate positive relationship was found between acculturative stress and psychological distress. Within the acculturative stress scale, those items related to language discrimination, evasion of health services, and feeling guilty for leaving family/friends in home country had significant associations with increased psychological distress.Conclusion:The findings support the need for interventions that account for the major stressors associated with being a Mexican immigrant in the United States to prevent psychological distress, especially given the anti-immigration policies.

Problem:To the best of our knowledge, there are no standard accountability measures for diversity efforts at the departmental level. Therefore, the purpose of this study is to evaluate a multiprong report card as a structure for evaluation, tracking, and reporting as well as to examine any relationships between expenditures and outcomes.Approach:We instituted an intervention that offered leadership a report card of metrics related to diversity efforts. Included are diversity expenditures, benchmark demographic and departmental data, applications to support faculty salaries, participation in clerkship programs focused on attracting diverse candidates, and requests for candidate lists. The purpose of this analysis is to demonstrate the impact of the intervention.Outcomes:A significant relationship was found between faculty funding applications and under-represented minority (URM) representation in a department (0.19; confidence interval [95% CI] 0.17–0.21; p<0.001). An association was also found between total expenditures and URM representation in a department (0.002; 95% CI 0.002–0.003; p<0.001). Other outcomes include the following: (1) women, URM, and minority faculty have all increased in representation since tracking began; (2) diversity expenditures and faculty opportunity fund and presidential professorship applications have increased over time; and (3) a steady decline in departments with zero URM representation after the tracking of diversity expenditures in both clinical and basic science departments.Next Steps:Our findings suggest that standardized metrics for inclusion and diversity initiatives promote accountability and buy-in from executive leadership. Departmental detail enables tracking of progress longitudinally. Future work will continue to evaluate the downstream effects of diversity expenditures.