As of 18 October 2020, over 39.5 million cases of coronavirus disease 2019 (COVID-19) and 1.1 million associated deaths have been reported worldwide. It is crucial to understand the effect of social ...determination of health on novel COVID-19 outcomes in order to establish health justice. There is an imperative need, for policy makers at all levels, to consider socioeconomic and racial and ethnic disparities in pandemic planning. Cross-sectional analysis from COVID Boston University's Center for Antiracist Research COVID Racial Data Tracker was performed to evaluate the racial and ethnic distribution of COVID-19 outcomes relative to representation in the United States. Representation quotients (RQs) were calculated to assess for disparity using state-level data from the American Community Survey (ACS). We found that on a national level, Hispanic/Latinx, American Indian/Alaskan Native, Native Hawaiian/Pacific Islanders, and Black people had RQs > 1, indicating that these groups are over-represented in COVID-19 incidence. Dramatic racial and ethnic variances in state-level incidence and mortality RQs were also observed. This study investigates pandemic disparities and examines some factors which inform the social determination of health. These findings are key for developing effective public policy and allocating resources to effectively decrease health disparities. Protective standards, stay-at-home orders, and essential worker guidelines must be tailored to address the social determination of health in order to mitigate health injustices, as identified by COVID-19 incidence and mortality RQs.
Introduction
Cancer clinical trials represent the “gold standard” for advancing novel cancer therapies. Optimizing trial participation is critical to ensuring the generalizability of findings across ...patients, yet trial enrollment rates, particularly among minority and socioeconomically disadvantaged populations, remain suboptimal.
Methods
We conducted in-depth interviews with oncologists at a large academic medical center to explore their (1) attitudes and perceived barriers to offering clinical trials to minority and socioeconomically disadvantaged patients, and (2) recommendations for improving the enrollment of minority and socioeconomically disadvantaged patients in cancer clinical trials.
Results
Of 23 medical oncologists approached, 17 enrolled (74% response rate; mean age = 47; female = 42%; White = 67%). Content analysis revealed several barriers to enrollment: (1) ethical dilemmas; (2) ambivalence about trial risks and benefits; and (3) concern about patient well-being. Concerns about the legitimacy of informed consent, perceived lack of equipoise, and fear of personal bias influenced clinicians’ decisions to recommend trials during treatment discussions. Concerns about creating an imbalance between trial risks and benefits among patients with high-level needs, including patients with literacy, psychiatric, and other socioeconomic vulnerabilities, impacted clinicians’ enthusiasm to engage in trial discussions. Clinicians identified patient, provider, and system-level solutions to address challenges, including increasing patient and clinician support as well as involving external personnel to support trial enrollment.
Conclusion
Findings reveal multi-level barriers to offering cancer clinical trials to underrepresented patients. Targeted solutions, including system level changes to support clinicians, patient financial support, and implementation of clinical trial navigation programs were recommended to help reduce access barriers and increase enrollment of underrepresented patients into cancer clinical trials.
As an advanced information technology, social media has increasingly become a significant and prevalent source of information for both firms and people, and has reshaped entrepreneurial activities. ...Our article draws on the information processing perspective to build a model to explore the relationship between social media use and entrepreneurial entry and whether the relationship differs for disadvantaged populations in terms of gender, ethnicity, geographic divide (rural versus urban), and regional marketization. Using a nationally representative survey of 22 614 adults in the China Family Panel Studies, we test our model quantitatively with regression analysis. The results reveal that social media use can have a positive effect on individuals' entrepreneurial entry and that the relationship between social media use and entrepreneurial entry is stronger for disadvantaged populations in terms of gender, rural versus urban divide, and regional marketization. Our identification of females, rural populations, and people in low marketization regions is among the first to distinguish the effect of social media on entrepreneurship for distinct populations. By highlighting the role of social media use in shaping entrepreneurial entry among disadvantaged populations, this study opens the black box of social media vis-à-vis entrepreneurial entry, and highlights that the role of social media use on entrepreneurial entry is stronger for disadvantaged populations, who have greater barriers to accessing entrepreneurship-related information in their offline environment.
The COVID-19 pandemic has disrupted day-to-day lives and infrastructure across the United States, including public transit systems, which saw precipitous declines in ridership beginning in March ...2020. This study aimed to explore the disparities in ridership decline across census tracts in Austin, TX and whether demographic and spatial characteristics exist that are related to these declines. Transit ridership data from the Capital Metropolitan Transportation Authority were used in conjunction with American Community Survey data to understand the spatial distribution of ridership changes caused by the pandemic. Using a multivariate clustering analysis as well as geographically weighted regression models, the analysis indicated that areas of the city with older populations as well as higher percentages of Black and Hispanic populations were associated with less severe declines in ridership, whereas areas with higher unemployment saw steeper declines. The percentage of Hispanic residents appeared to affect ridership most clearly in the center of Austin. These findings support and expand on previous research that found that the impacts of the pandemic on transit ridership have emphasized the disparities in transit usage and dependence across the United States and within cities.
To identify COVID-19 actionable statements (e.g., recommendations) focused on specific disadvantaged populations in the living map of COVID-19 recommendations (eCOVIDRecMap) and describe how health ...equity was assessed in the development of the formal recommendations.
We employed the PROGRESS-Plus framework to identify statements focused on specific disadvantaged populations. We assessed health equity considerations in the Evidence to Decision frameworks (EtD) of formal recommendations for certainty of evidence and impact on health equity criteria according to the GRADE criteria.
We identified 16% (124/758) formal recommendations and 24% (186/819) Good Practice Statements (GPS) that were focused on specific disadvantaged populations. Formal recommendations (40%, 50/124) and GPS (25%, 47/186) most frequently focused on children. Seventy-six percent (94/124) of the recommendations were accompanied with EtDs. Over half (55%, 52/94) of those considered Indirectness of the evidence for disadvantaged populations. Considerations in impact on health equity criterion most frequently involved implementation of the recommendation for disadvantaged populations (17%, 16/94).
Equity issues were rarely explicitly considered in the development COVID-19 formal recommendations focused on specific disadvantaged populations. Guidance is needed to support the consideration of health equity in guideline development during health emergencies.
Buses, bus stops, trains, and train platforms represent sites of shelter for many of the over 500,000 Americans who are unhoused every night. This study seeks to understand how transit agencies are ...responding to them. Based on interviews with staff members and partners at 10 different transit agencies and on program performance data, where available, we provide detailed case studies of four sets of strategies taken in response to homelessness on transit systems: hub of services, mobile outreach, discounted fares, and transportation to shelters. We analyze each strategy’s scope, implementation, impact, challenges, and lessons learned. Reviewing these strategies, we note that they may differ depending on the context, need, and available resources. We find value in transit agencies fostering external partnerships with social service organizations and other municipal departments and keeping law enforcement distinct from routine homeless outreach. We also underline the key need for funding from other levels of government to allow transit operators to adopt, expand, and refine homelessness response programs.
In the study of equity in public transit service distribution to disadvantaged groups, there is often a desire for a concise and relatable quantitative measure of equity. This ambition has often ...pushed researchers to develop methods for combining (or aggregating) various dimensions of disadvantage into a single, multi-faceted metric of potential transit demand (or need) among the disadvantaged population. These metrics then enable a somewhat straightforward analysis of the transit needs of the aggregate disadvantaged population to the transit service supplied in order to arrive at a measure of transit equity.
More recently, it has been proposed that such aggregated transit equity analysis may introduce veiled judgments or bias through the specific interpretation of key definitions and through the particular choices in the construction of a combined metric. It may also be the case that such an aggregate metric may mask or convolute important disparities in transit equity experienced by the various disadvantaged populations aggregated into a combined metric.
This research studies these issues through a clear discussion of the ambiguity and implied judgments often found in transit equity literature and then provides recommendations to mitigate these issues. Also, two common equity analysis methods are compared through a case study of public transit service in the city of Corvallis, Oregon, and a new transit service metric construction is introduced. By comparing the results of both the aggregated and disaggregated forms of disadvantaged group transit need within each analysis method, this study provides further evidence that important information may be concealed or easily misinterpreted when using aggregated descriptions of transit need.
•Clearly defining equity is essential for interpreting equity analysis results.•Implicit judgement and bias in metric construction is explored.•A new construction for a transit supply metric using road length is proposed.•The common Lorenz curve and Needs gap methods are compared.•Aggregated disadvantaged group metrics may mask or convolute transit inequity.
Although community engagement (CE) is widely used in health promotion, components of CE models associated with improved health are poorly understood. This study aimed to examine the magnitude of the ...impact of CE on health and health inequalities among disadvantaged populations, which methodological approaches maximise the effectiveness of CE, and components of CE that are acceptable, feasible, and effective when used among disadvantaged populations.
The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We carried out methodological assessments of the included studies using rating scales. The analysis focussed on model synthesis to identify the key CE components linked to positive study outcomes and comparative analysis between positive study outcomes, processes, and quality indicators of CE.
Out of 24 studies that met our inclusion criteria, 21 (87.5%) had positively impacted health behaviours, public health planning, health service access, health literacy, and a range of health outcomes. More than half of the studies (58%) were of good quality, whereas 71% and 42% of studies showed good community involvement in research and achieved high levels of CE, respectively. Key CE components that affected health outcomes included real power-sharing, collaborative partnerships, bidirectional learning, incorporating the voice and agency of beneficiary communities in research protocol, and using bicultural health workers for intervention delivery.
The findings suggest that CE models can lead to improved health and health behaviours among disadvantaged populations if designed properly and implemented through effective community consultation and participation. We also found several gaps in the current measurement of CE in health intervention studies, which suggests the importance of developing innovative approaches to measure CE impact on health outcomes in a more rigorous way.
The recent polycrisis (COVID-19, Ukraine war, climate change, economic crisis) has been associated with mental health through cumulative stress, with young people being particularly vulnerable. We ...surveyed 403 college students from Poland to examine their psychological responses to the experienced crises. The results showed that polycrisis was associated with worse mental health of college students from disadvantaged groups (based on gender, sexual orientation, and financial situation) compared to other college students, in four areas: sense of proximity to the crises, stress caused by the crises, sense of responsibility for mitigating the crises, and experiencing everyday moral dilemmas regarding the crises. These young adults also suffered more in terms of negative affectivity, depressive symptoms, and subjective physical and mental health. Our findings suggest that when discussing public mental health perspectives, it is important to consider consequences of cumulative stress and its greater impact on young people from disadvantaged groups.
Background: Clinical practice guidelines (CPGs) predominantly prioritise treatment and cost-effectiveness, which encourages a universal approach that may not address the circumstances of ...disadvantaged groups. We aimed to advance equity and quality of care for individuals experiencing homelessness and traumatic brain injury (TBI) by assessing the extent to which homelessness and TBI are integrated in CPGs for TBI and CPGs for homelessness, respectively, and the extent to which equity, including consideration of disadvantaged populations and the PROGRESS-Plus framework, is considered in these CPGs. Methods: For this systematic review, CPGs for TBI or homelessness were identified from electronic databases (MEDLINE, Embase, CINAHL, PsycINFO), targeted websites, Google Search, and reference lists of eligible CPGs on November 16, 2021 and March 16, 2023. The proportion of CPGs that integrated evidence regarding TBI and homelessness was identified and qualitative content analysis was conducted to understand how homelessness is integrated in CPGs for TBI and vice versa. Equity assessment tools were utilised to understand the extent to which equity was considered in these CPGs. This review is registered with PROSPERO (CRD42021287696). Findings: Fifty-eight CPGs for TBI and two CPGs for homelessness met inclusion criteria. Only three CPGs for TBI integrated evidence regarding homelessness by recognizing the prevalence of TBI in individuals experiencing homelessness and identifying housing as a consideration in the assessment and management of TBI. The two CPGs for homelessness acknowledged TBI as prevalent and recognised individuals experiencing TBI and homelessness as a disadvantaged population that should be prioritised in guideline development. Equity was rarely considered in the content and development of CPGs for TBI. Interpretation: Considerations for equity in CPGs for homelessness and TBI are lacking. To ensure that CPGs reflect and address the needs of individuals experiencing homelessness and TBI, we have identified several guideline development priorities. Namely, there is a need to integrate evidence regarding homelessness and TBI in CPGs for TBI and CPGs for homelessness, respectively and engage disadvantaged populations in all stages of guideline development. Further, this review highlights an urgent need to conduct research focused on and with disadvantaged populations. Funding: Canada Research Chairs Program (2019-00019) and the Ontario Ministry of Health and Long-Term Care (Grant #725A).
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