Abstract
The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected racial and ethnic minority groups, with high rates of death in African American, Native American, and LatinX ...communities. Although the mechanisms of these disparities are being investigated, they can be conceived as arising from biomedical factors as well as social determinants of health. Minority groups are disproportionately affected by chronic medical conditions and lower access to healthcare that may portend worse COVID-19 outcomes. Furthermore, minority communities are more likely to experience living and working conditions that predispose them to worse outcomes. Underpinning these disparities are long-standing structural and societal factors that the COVID-19 pandemic has exposed. Clinicians can partner with patients and communities to reduce the short-term impact of COVID-19 disparities while advocating for structural change.
Coronavirus disease 2019 (COVID-19) pandemic in the United States exposed racial disparities in morbidity and mortality. African Americans, LatinX, and Native Americans are disproportionately impacted by the disease due to biomedical and social factors brought by structural injustices.
Tuberculosis (TB) poses a serious threat to public health throughout the world but disproportionately afflicts low-income nations. Persons in close contact with a patient with active pulmonary TB and ...those from endemic regions of the world are at highest risk of primary infection, whereas patients with compromised immune systems are at highest risk of reactivation of latent TB infection (LTBI). Tuberculosis can affect any organ system. Clinical manifestations vary accordingly but often include fever, night sweats, and weight loss. Positive results on either a tuberculin skin test or an interferon-γ release assay in the absence of active TB establish a diagnosis of LTBI. A combination of epidemiological, clinical, radiographic, microbiological, and histopathologic features is used to establish the diagnosis of active TB. Patients with suspected active pulmonary TB should submit 3 sputum specimens for acid-fast bacilli smears and culture, with nucleic acid amplification testing performed on at least 1 specimen. For patients with LTBI, treatment with isoniazid for 9 months is preferred. Patients with active TB should be treated with multiple agents to achieve bacterial clearance, to reduce the risk of transmission, and to prevent the emergence of drug resistance. Directly observed therapy is recommended for the treatment of active TB. Health care professionals should collaborate, when possible, with local and state public health departments to care for patients with TB. Patients with drug-resistant TB or coinfection with human immunodeficiency virus should be treated in collaboration with TB specialists. Public health measures to prevent the spread of TB include appropriate respiratory isolation of patients with active pulmonary TB, contact investigation, and reduction of the LTBI burden.
Underrepresentation of racial and ethnic minority populations in clinical research persists in the United States, highlighting the unmet ideals of generalizability and equity of research findings and ...products. Previous systematic reviews exploring various facets of this phenomenon concluded that community engagement with minority groups may effectively promote recruitment and retention, but the ways in which community-engaged approaches have been used for recruitment have not been examined. We performed a scoping review of the literature to identify studies of community-engaged recruitment processes. The search resulted in 2842 articles, of which 66 met inclusion criteria. These articles demonstrated a relatively large literature base of descriptive studies conveying details of community engagement approaches to enhance recruitment of minority research participants. We summarize key aspects of current practices across the spectrum of community engagement. A gap in the literature is the relative lack of the comparative studies among different engagement strategies.
The QuantiFERON-TB Gold Plus (QFT-Plus; Qiagen, Germantown, MD) interferon gamma release assay (IGRA) received FDA clearance in 2017 and will replace the prior version of the assay, the QFT-Gold ...In-Tube (QFT-GIT). Here, we compared performances of the QFT-Plus assay and the QFT-GIT version in a diverse patient population, including patients undergoing evaluation for or follow-up of latent tuberculosis infection (LTBI;
= 39) or active TB infection (
= 3), and in health care workers (HCWs;
= 119) at Mayo Clinic (Rochester, MN). Compared to the QFT-GIT, the QFT-Plus assay showed 91.2% (31/34) positive, 98.4% (124/126) negative, and 96.6% (156/161) overall qualitative agreement among the 161 enrolled subjects, with a Cohen's kappa value of 0.91 (excellent interrater agreement). Among the 28 patients diagnosed with LTBI at the time of enrollment, the QFT-GIT and QFT-Plus assays agreed in 24 (85.7%) patients; in all four discordant patients, the positivity of the QFT-GIT or QFT-Plus IGRA was associated with low-level interferon gamma (IFN-γ) reactivity, ranging from 0.36 IU/ml to 0.66 IU/ml. Additionally, we document a high degree of correlation between IFN-γ levels in the QFT-GIT TB antigen tube and each of the two QFT-Plus TB antigen tubes, as well as between the QFT-Plus TB1 and TB2 tubes (Pearson's correlation coefficients
> 0.95). Overall, we show comparable results between the QFT-GIT and QFT-Plus assays in our study population composed of subjects presenting with a diverse spectrum of TB infections. Our findings suggest that the necessary transition to the QFT-Plus assay will be associated with a minimal difference in assay performance characteristics.
The COVID-19 pandemic’s disproportionate impact on people from some racial and ethnic groups in the U.S. persisted throughout 2021. Black, Latinx, and American Indian persons have been hospitalized ...and died at a higher rate than White persons consistently from the start of the pandemic. Early data show that hospitalization and mortality rates for Black, Latinx, and American Indian children are higher than White children in a worrying trend. The pandemic has likely worsened the gaps in wealth, employment, housing, and access to health care: the social determinants of health that caused the disparities in the first place. School closures will have a long-lasting impact on the widening achievement gaps between Black and Latinx students and White students. In the earlier vaccination phase, Black and Latinx persons were being vaccinated at a lower rate than their proportion of cases due to vaccine hesitancy, misinformation, and barriers to access. Vaccine hesitancy rates among these groups have since decreased and are now comparable to White persons. Aggregated data make it challenging to paint a picture of the actual impact of COVID-19 on Asian Americans as they are a diverse group with significant disparities. All of this highlights that we have much work to do in dismantling systemic racism, engaging communities we serve, and advancing health equity to prepare us for future pandemics and a more just healthcare system.
It is challenging to develop health promotion interventions created in collaboration with communities affected by inequities that focus beyond individual behavior change. One potential solution is ...interventions that use digital stories (DS). Digital storytelling (DST) is an opportunity for reflection, connection with others, and the elevation of voices often absent from daily discourse. Consequently, public health researchers and practitioners frequently employ the DST workshop process to develop messaging that promotes health and highlights concerns in partnership with historically marginalized communities. With participants' permission, DS can reach beyond the storytellers through behavior or attitude change interventions for health promotion among communities who share the targeted health concern. Our goal was to synthesize the literature describing interventions that use DS for health promotion to identify gaps.
We conducted a scoping review. Our inclusion criteria were articles that: 1) described empirical research; 2) used DS that were developed using the StoryCenter DST method; 3) assessed an intervention that used DS to address the health promotion of viewers (individuals, families, community, and/or society) impacted by the targeted health issue 4) were written in English or Spanish. To synthesize the results of the included studies, we mapped them to the health determinants in the National Institute of Minority Health and Health Disparities (NIMHD) research framework. We assessed the number of occurrences of each determinant described in the results of each article.
Ten articles met the eligibility criteria. All the included articles highlighted health equity issues. Our mapping of the articles with definitive results to the NIMHD research framework indicates that interventions that use DS addressed 17 out of 20 health determinants. All mapped interventions influenced intentions to change health behaviors (NIMHD level/domain: Individual/Behavioral), increased health literacy (Individual/Health Care System), and/or stimulated conversations that addressed community norms (Community/Sociocultural Environment).
Interventions that use DS appear to positively affect the health promotion of participants across a range of health issues and determinants. Future research is needed in the Interpersonal, Community, and Societal levels and within the Biological, Physical/Built Environment, and Sociocultural Environment domains.
Abstract Background After settling in the United States (US), immigrants often accumulate obesity and cardiovascular risk factors. As mood is often associated with health behaviors in the US ...population, mood may be an important mediating factor in immigrant populations. Methods The Healthy Immigrant Community (HIC) study, set in southeast Minnesota, enrolled 475 adult participants in a weight loss intervention designed to reduce cardiovascular risk. Baseline questionnaires assessed mood, nutrition, physical activity, self-efficacy for healthy eating and physical activity, social support, and cohesion. A single-item mood rating of poor or fair was considered “negative”, while ratings of good, very good, or excellent were considered “positive”. Results Hispanic/Latino ( n = 268) and Somali ( n = 181) adults enrolled in HIC completed baseline measures and were included in this analysis. Participants endorsing negative mood compared to positive mood had lower healthy eating scores ( p = 0.02), lower physical activity levels ( p = 0.03), lower confidence in eating a healthy diet ( p = 0.001), and felt less of a sense of belonging to their community ( p = 0.01). Those endorsing negative mood reported receiving less social support to eat healthy ( p = < 0.001) and be physically active ( p = 0.01). They also accessed community resources for healthy eating ( p = 0.001) and physical activity ( p = < 0.01) less frequently than participants endorsing positive mood. Conclusions On self-report, negative mood was associated with less healthy nutrition, lower confidence in eating healthy, sedentary lifestyle, and perceived lack of belonging to the community. Integrating mood management and self-efficacy strategies may enhance the effectiveness of lifestyle interventions to reduce obesity and cardiovascular risk among immigrants who report negative mood. Trial registration ClinicalTrials.gov registration: NCT05136339; April 23, 2022.
Im/migrants (immigrants and migrants, including refugees, asylum seekers, and individuals without legal documentation) experience unique assets and needs in relation to coronavirus disease 2019 ...(COVID-19). Community-based participatory research (CBPR) is one way to engage im/migrant communities. Rochester Healthy Community Partnership (RHCP) is a CBPR partnership in Rochester, Minnesota. RHCP partners noted that credible COVID-19 information was not available to their communities. In response, RHCP formed a COVID-19 Task Force and adapted the Centers for Disease Control and Prevention's Crisis and Emergency Risk Communication (CERC) framework to create an intervention that prioritized im/migrant groups experiencing health disparities. In the CERC intervention, communication leaders delivered COVID-19 health messages to their social networks and documented related concerns. RHCP relayed these concerns to regional leaders to ensure that im/migrant experiences were included in decision making. Once vaccines were available, RHCP continued to deploy the CERC intervention to promote vaccination equity. The aims of this paper are to (1) describe the implementation of a bidirectional CERC intervention for vaccination equity, and (2) describe a community-engaged and community-based vaccine clinic intervention.
First, we surveyed participants (n = 37) to assess COVID-19 experiences, acceptability of the CERC intervention, and motivation to receive a COVID-19 vaccination. Second, we collaborated with community partners to hold vaccine clinics. We report descriptive statistics from each intervention.
When asked about the acceptability of the CERC intervention for vaccine equity, most participants either reported that they 'really liked it' or 'thought it was just ok'. Most participants stated that they would recommend the program to family or friends who have not yet received the COVID-19 vaccine. Almost all participants reported that they felt 'much more' or 'somewhat more' motivated to receive a COVID-19 vaccine after the intervention. We administered 1158 vaccines at the vaccination clinics.
We found that participants viewed the CERC intervention for vaccination equity as an acceptable way to disseminate COVID-19-related information. Nearly all participants reported that the intervention convinced them to receive a COVID-19 vaccine. In our experience, community-engaged and community-based clinics are a successful way to administer vaccines to im/migrant communities during a pandemic.
Somali immigrants and refugees to the United States are at high risk for obesity and related cardiovascular risk. Social network factors influence health behaviors and are important contributors to ...the obesity epidemic. The objective of this study was to describe social networks and obesity-related characteristics among adult Somali immigrants in a Minnesota city in order to inform a community-based, participatory, research-derived, social network intervention to decrease obesity rates.
Survey data (demographics, general health measures, and sociobehavioral and network measures) and height and weight measures (for calculating body mass index) were collected from adult Somali immigrants by bilingual study team members at community locations. Descriptive statistics were used to report the survey and biometric data. Logistic regression models were used to describe the basic associations of participants and network factors. Network data were analyzed to identify nodes and ties, to visualize the network, and to identify potential interventionists for a future social network intervention.
Of the 646 participants, 50% were overweight or affected by obesity. The network had 1703 nodes with 3583 ties between nodes, and modularity was high (0.75). Compared with respondents of normal weight, participants who were overweight or affected by obesity had more network members who were also overweight or obese (odds ratio OR, 2.90; 95% CI, 1.11-7.56; P = .03); this was most notable for men (OR, 4.58; 95% CI, 1.22-17.22; P = .02) and suggestive for those 50 years or older (OR, 24.23; 95% CI, 1.55-377.83; P = .03). Weight loss intention among participants who were overweight or affected by obesity was associated with number of family members and friends trying to lose weight, enabling functional network factors (social norms for weight loss, social support for healthy eating, and social cohesion), and less favorable obesogenic social norms.
In this community sample of Somali immigrants, distinct social networks are clustered by weight status, and social contacts and functional network characteristics are related to individuals' weight loss intentions. These factors should be considered in weight loss interventions and programs. A social network intervention targeting weight loss, within a community-based participatory research framework, is feasible in this vulnerable population.
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