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The emergence of the COVID-19 pandemic significantly changed the prenatal care experience, specifically regarding medical appointments and social opportunities. It is critical to capture this change through the narratives of pregnant people, particularly those of marginalized populations, whose voices may often be underrepresented in the literature. This mixed-methods paper summarizes the experiences of 40 pregnant Black/African American (AA) women during the COVID-19 pandemic. A cross-sectional, online survey was administered between 2020 and 2021 to assess prenatal health and the impacts of the COVID-19 pandemic on patients' pregnancy experience. Coping behaviors during the pandemic were self-reported using the COPE-IS. Univariate analyses were conducted. An additional analysis of participants (n = 4) was explored through a week-long qualitative exercise using a photo documentation procedure. Photo-Elicitation Interviews (PEI) were conducted to capture and center their pandemic pregnancy experiences. Sources of stress during the pandemic varied, with the most common being financial concerns (n = 19, 47.5%). Over half of the sample (n = 18, 54.5%) self-reported increases in their positive coping behaviors during the pandemic, such as communicating with friends and family, talking to healthcare providers, listening to music, and engaging in spiritual practices–such as prayer. The four PEI study participants reflected on the impacts of social distancing on their prenatal experience and mentioned hospital and provider-related weariness due to their race. The findings of this study suggest that during the COVID-19 pandemic, Black/AA pregnant women in Charlotte, NC used social support, mindfulness practices, self-advocacy, and health literacy to navigate challenges present during their prenatal health experience. This paper highlights the personal, social, and structural experiences of pregnant women during a public health crisis so that responsive and effective programs or policies can be planned in the future. [ABSTRACT FROM AUTHOR]

The differential impact of the COVID‐19 pandemic on communities of color in the United States along with the civil unrest taking place in 2020 in response to the killing of unarmed Black men and women by the police have increased awareness of the structural racism pervading US society. These developments have reraised the issue of reparations for Black Americans, usually proposed in the context of providing financial compensation for the injustices of slavery to the descendants of those who were enslaved. This paper will discuss the systematic racial inequality and structural racism in US society that have significantly disadvantaged racial and ethnic minorities while giving advantages to white Americans, which most recently have resulted in significantly higher mortality and morbidity among Black, Hispanic, and Native Americans during the pandemic. The paper will conceptualize reparations within the context of theories of reparative justice. It will also consider whether reparations are owed, and if so, by whom, to whom, and in what form. The final section will offer a proposal for collective reparations to the Black community and other people of color. [ABSTRACT FROM AUTHOR]

Objective The primary aim of this paper is to accelerate the number of randomized experimental studies of the reliability and validity in-home tele-neuropsychological testing (tele-np-t). Method We conducted a critical review of the tele-neuropsychology literature. We discuss this research in the context of the United States' public and private healthcare payer systems, including the Centers for Medicare & Medicaid Services (CMS) and Current Procedural Terminology (CPT) coding system's telehealth lists, and existing disparities in healthcare access. Results The number of tele-np publications has been stagnant since the onset of the COVID-19 pandemic. There are less published experimental studies of tele-neuropsychology (tele-np), and particularly in-home tele-np-t, than other tele-np publications. There is strong foundational evidence of the acceptability, feasibility, and reliability of tele-np-t, but relatively few studies of the reliability and validity of in-home tele-np-t using randomization methodology. Conclusions More studies of the reliability and validity of in-home tele-np-t using randomization methodology are necessary to support inclusion of tele-np-t codes on the CMS and CPT telehealth lists, and subsequently, the integration and delivery of in-home tele-np-t services across providers and institutions. These actions are needed to maintain equitable reimbursement of in-home tele-np-t services and address the widespread disparities in healthcare access. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic has had a disproportionate impact on the health of Black Americans, Latinx or Hispanic Americans, and American Indians. These disparities are deeply unjust, in part, because they are the causal result of racism at both the interpersonal and structural levels. This paper argues, however, that establishing a causal connection between racism and health disparities is not the only way to explain the injustice of these disparities. The COVID‐19 health disparities are arguably unjust because health equity is a "free‐standing" demand of justice, an obligation of reparative justice, a remedy to structural injustice, and part of dismantling pernicious racial concepts. Identifying multiple accounts of injustice may lower the evidentiary bar for our normative claims and help us to identify alternative policy pathways for ending health inequity. [ABSTRACT FROM AUTHOR]

Racism has resulted in significant disproportionality and disparity in the US child welfare system. Being Black is not an inherent risk factor for child abuse and neglect yet Black children are almost twice as likely to be victims of substantiated abuse and neglect claims compared to other racial groups. Addressing the disproportionality within the child welfare system due to systemic racism falls squarely under the purview of bioethics. In this paper, we briefly review the impact of racism on child welfare. We then discuss some ethical considerations that mandatory healthcare reporters should think through when determining whether to report potential abuse and neglect. Specifically, we discuss the need for a broader consideration of what constitutes harm. We then present a hypothetical composite case to illuminate where and how bias can enter the process of referral to child protective services (CPS). We encourage thoughtful reporting with consideration of social and historical context and alternative explanations for worrisome findings. We recommend using evidence, avoiding assumptions by seeking clarification from families and ensuring internal consistency. When contemplating CPS referral, medical providers should feel empowered to ask questions if there is concern for potential bias. The ultimate goal is to protect children from harm. If there are clear safety concerns—they must be addressed. However, in the many cases where the safety concern is less tangible, we need to expand our considerations of the harms that can befall children, especially children of color. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has underscored the lack of resources and oversight that hinders medical care for incarcerated people in the United States. The US Supreme Court has held that "deliberate indifference" to "serious medical needs" violates the Constitution. But this legal standard does not assure the consistent provision of health care services. This leads the United States to fall behind European nations that define universal standards of care grounded in principles of human rights and the ideal of equivalence that incarcerated and non-incarcerated people are entitled to the same health care. In this paper, we review a diverse legal and policy literature and undertake a conceptual analysis of policy issues related to the standard of care in correctional health; we then describe a framework for moving incrementally closer toward a universal standard. The expansion of Medicaid funding and benefits to corrections facilities, alongside a system of comprehensive and enforceable external oversight, would meaningfully raise the standard of care. Although these changes on their own will not resolve all of the thorny health problems posed by mass incarceration, they present a tangible opportunity to move closer to the human rights ideal. [ABSTRACT FROM AUTHOR]

Introduction: During COVID-19, healthcare providers reported decreased testing volumes, which meant fewer people knew their HIV status. To improve testing volumes, The County of Santa Clara Public Health Department offered a pilot HIV self-testing (HIVST) program for eligible populations. Material and methods: The purpose of this study was to understand overall reach of the intervention and effectiveness of strategies used to raise the program awareness from November 2021 to August 2022, using an observational study design. Participants were recruited through both in-person and digital outreach methods. Individuals completed an online survey in order to participate in the study. Research team collected and analyzed all responses using descriptive analysis. Results: A total of 458 individuals participated in the program. Of participants 232 that responded to optional questions the majority (77%) were identifying as male and 7% identifying as transgender, gender non-binary, or genderqueer. Social media advertisements on gay dating apps and outreach at community events were identified as effective methods for increasing awareness. Of the total participants, 21% had never taken an HIV test before, 58% selected this program for convenience reasons, and 41% received pre-exposure prophylaxis (PrEP) services. Conclusions: HIVST programs have the potential to address barriers in accessing testing services. Healthcare providers are encouraged to offer HIVSTs as options for patients. [ABSTRACT FROM AUTHOR]

Several proponents believe a universal healthcare system might have allowed the United States to navigate the COVID-19 pandemic more effectively, potentially leading to less devastating outcomes. Yet, comprehensive studies assessing this assertion on an international scale across multiple pandemic phases are sparse. This study evaluates the COVID-19 response efficacy in OECD countries, contrasting single-payer with multiple-payer healthcare frameworks. Data from different pandemic phases through to October 2023, suggest a single-payer system correlate with reduced death rates, diminished excess mortality, and overall lower cumulative excess mortality. Notably, among the high-income OECD nations, the U.S. ranks lowest in pandemic response. Such findings underscore the significant impact of disparities in healthcare access. Essentially, these inequities can debilitate a healthcare infrastructure to the extent that it lags nations with similar socio-economic, demographic, and health profiles. [ABSTRACT FROM AUTHOR]

Background: The objective of the study was to measure the risk of death due to COVID-19 in relation to individuals' characteristics, and severity of their disease during the dominant periods of Alpha, Delta, and Omicron variants have influenced mortality rates. Methods: This study was conducted using COVID-19 Centers for Disease Control and Prevention (CDC) Case Surveillance Public Data Taskforce for 57 states, and United States territories between January 1, 2020 and March 20, 2022. Multivariable binary Hyperbolastic regression of type I was used to analyzes the data. Results: Seniors and ICU-admitted patients had the highest risk of death. For each additional percent increase in fully vaccinated individuals, the odds of death deceased by 1%. The odds of death prior to vaccine availability, compared to post vaccine availability, was 1.27. When comparing the time periods each variant was dominant, the odds of death was 3.45-fold higher during Delta compared to Alpha. All predictor variables had P -values ≤.001. Conclusion: There was a noticeable difference in the odds of death among subcategories of age, race/ethnicity, sex, PMCs, hospitalization, ICU, vaccine availability, variant, and percent of fully vaccinated individuals. [ABSTRACT FROM AUTHOR]

Policy PointsDespite increased spending and consuming more health care services than any other country in the world, the United States global health rankings experience continued decline, including worsening performance in life expectancy and mortality owing to lack of investment in and strategies on the upstream determinants of health.These determinants of health are found in our access to adequate, affordable, and nutritious food options; safe housing, blue and green spaces; reliable and safe transportation; education and literacy; opportunities for economic stability; and sanitation, among other important factors and all share a common root driver in the political determinants of health.Health systems are increasingly investing in programs and exerting influence over policies to address these upstream determinants of health, including population health management, however these programs will continue to be hindered without addressing the political determinants through government, voting, and policy.Although these investments are laudable, it is important to understand what gives rise to the social determinants of health and—more importantly—why have they disproportionately and detrimentally affected historically marginalized communities and vulnerable populations for so long? Deeply entrenched and pervasive throughout society, the political determinants of health are the fundamental instigators of these unjust and inequitable outcomes. [ABSTRACT FROM AUTHOR]

Background: Prior studies have documented declines in pediatric asthma exacerbations and asthma-related health care utilization during the COVID-19 pandemic, but less is known about the incidence of asthma during the pandemic. Methods: We conducted a retrospective cohort study of children under age 18 without a prior diagnosis of asthma within a large US commercial claims database. Incident asthma was defined using a combination of diagnosis codes, location of services, and medication dispensing. Crude quarterly rates of asthma diagnosis per 1000 children were calculated, and the incidence rate ratio and 95% confidence interval were estimated for newly diagnosed asthma during versus before the pandemic using negative binomial regression, adjusted for age, sex, region, and season. Results: Compared with 3 years prior to the pandemic, crude incident diagnosis rates of asthma decreased by 52% across the first four quarters of the US pandemic. The covariate-adjusted pandemic-associated incidence rate ratio was 0.47 (95% confidence interval 0.43, 0.51). Conclusions: New diagnoses of childhood asthma in the US declined by half during the first year of the pandemic. These findings raise important questions whether pandemic-related changes in infectious or other triggers truly altered the incidence of childhood asthma beyond the well-described disruptions in healthcare access. [ABSTRACT FROM AUTHOR]

Background: The impact of the coronavirus disease 2019 (COVID) is worse among those with fewer financial resources, in jobs not amenable to remote work, and in denser living conditions. People of color are more likely to be among these vulnerable groups. Although race itself is a social construction and not based on underlying genetic/biological differences, this study investigated race/ethnicity differences in the negative repercussions of COVID and in the benefits of psychological and social resources. Methods: This cross-sectional, web-based study (n = 4817) was administered to a heterogeneous United States sample in Spring/Summer 2020. Information was gathered on the following COVID-specific variables: Infection Status, Coping with Lockdown, Social Support, Post-traumatic Growth, Interpersonal Conflict, Worry about Self, Financial Impact on Family, Lack of Money, Inadequate Access to Healthcare, and Housing Instability. Resilience was operationalized as the ability to maintain a sense of wellness in the face of the pandemic, using the DeltaQuest Wellness measure. Multivariate linear regression (adjusting for demographics) and propensity-matched cohort analysis (matched on demographics) evaluated the impact of COVID-specific variables on Wellness in separate models for Whites and Non-Whites. Findings: Both sets of models retained the same COVID-specific variables and explained about half of the variance in wellness. Coping with Lockdown, Social Support, and Post-traumatic Growth were associated with higher levels of Wellness in both Whites and Non-Whites, while Interpersonal Conflict and Worry about Self were associated with lower levels of Wellness. While these associations are similar, Non-Whites reported worse levels of some positive resources (e.g., social support) and more challenging levels of negative stressors (e.g., interpersonal, worry, financial). Non-Whites also reported much higher levels of post-traumatic growth. Conclusion: COVID was a source of worry and even conflict, but also unlocked people's resources in use of health-enhancing behavioral strategies, social support, and renewed gratitude for sources of personal meaning and value. The similar relationships between Whites and Non-Whites on wellness and COVID-specific stressors across racial groups underscore that race is a social construction, not a biological fact. Focusing on a renewed appreciation for sources of personal meaning, and particularly faith, seemed to buffer much of the COVID-related stress for Non-Whites. [ABSTRACT FROM AUTHOR]

Background: Mental health impacts of the COVID-19 pandemic are well recognized, but little is known about the pandemic experience among people experiencing mental health symptoms. Methods: In June 2020, a national sample of 5023 U.S. adults, including 785 scoring ⩾10 on the PHQ-8 for symptoms of depression, completed survey measures related to their pandemic experience. Results: After adjusting for sociodemographic characteristics, aspects of the COVID-19 pandemic experience for which participants scoring PHQ-8 ⩾ 10 had the greatest increase in odds of reporting moderate/severe negative impacts included: mental health treatment access (odds ratio [OR], 95% confidence interval [CI] = 8.81, 6.70-11.57), family stress/discord (OR, 95% CI = 5.21, 4.24-6.42), food access (OR, 95% CI = 3.76, 2.97-4.77), and income/employment (OR, 95% CI = 3.19, 2.66-3.83). They were also significantly more likely to report increased use of prescription painkillers (OR, 95% CI = 8.46, 4.50-15.92) and other drugs (OR, 95% CI = 4.43, 2.85-6.89), and less trust in healthcare authorities/providers, family/friends, and employers, and more trust in websites/blogs/social media, for COVID-19 information (P -values <.05). Conclusions: The interplay among depressive symptoms, substance use, lack of trust in healthcare authorities, and negative impact of the pandemic on family, finances, and access to mental health treatment and food indicate the need for robust social and behavioral health safety nets to buffer communities from the shadow epidemics of depression, family violence, and overdose deaths during public health disasters. [ABSTRACT FROM AUTHOR]

This study examines the risk-related factors during the pandemic and protective factors that might reduce its effects on family functioning in a sample of 161 low-income Hispanic parents in the United States, recruited from an ongoing longitudinal intervention study. They were surveyed about family functioning six months into the pandemic. We focused on the associations between social (e.g., exposure to the virus) and economic (e.g., job loss) pandemic-related risks on parental stress, parenting, and children's socioemotional problems and skills, as well as the degree to which coparenting support, parents' positivity, economic support, and access to services and information mitigated (protected) the negative effects of these stressors on family functioning. We found that increases in economic risk were associated with more child competence skills, whereas increases in social risk were associated with less parental engagement. Positivity and economic support moderated the effects of economic risk on parental stress and engagement. These findings show that to intervene effectively with low-income Hispanic families, we need to strengthen and support the resources for coping with adversity. [ABSTRACT FROM AUTHOR]

The Pacific Islander population in the United States continues to grow due to outmigration and a unique immigration arrangement. Under the Compacts of Free Association (COFA), citizens from three Remote Oceania countries can travel to the United States to live and work without restriction. Given the special status of COFA migrants, there is a growing interest among policymakers and researchers to better understand this population, which has often been overlooked. Unfortunately, the COVID-19 pandemic has recently spotlighted this community due to their exceedingly high rates of infection, hospitalization, and morbidity. This study examines how migration is experienced during a pandemic via a case study of first-generation Micronesians living in Oregon's Willamette Valley, one of the largest Micronesian communities in the United States. Interviews reveal how social determinants of health – such as economic stability, non-discrimination and equal treatment, access to healthcare, employment, and housing – may contribute to unequal health outcomes between Pacific Islander immigrants and other racial and ethnic populations. These determinants also contribute to human dignity. Using the emergent Migration with Dignity framework, this study assesses how the pandemic has challenged the six dimensions of dignity and disrupted the migration experience, including the push-pull factors for deciding to emigrate to and stay in the United States. Finally, the study assesses resources available for COFA citizens and avenues for improved support. [ABSTRACT FROM AUTHOR]

Introduction: Good preconception and interconception health are fundamental to optimizing women’s health and reducing risk factors for adverse maternal–infant outcomes. Although rural women in the United States tend to experience health disparities, no published qualitative studies have focused on their preconception/interconception health. The purpose of this study was to determine what rural, Midwestern women perceive to be their most pressing health needs and effective ways to provide outreach and education regarding preconception/interconception health and care. Methods: Non-pregnant, reproductive-age women in Hardin County, Ohio, regardless of parity, were recruited through convenience sampling. Semi-structured interviews with four domains (beliefs and behaviors; perceived needs; knowledge and information sources; barriers to care) were conducted in May–June 2021 until saturation was reached. Qualitative methods were used to analyze data and determine themes. Binomial tests were used to compare selected demographic characteristics of participants to the county’s reproductive-age residential female population. Results: Nineteen women aged 20–44 years were individually interviewed. Comparing race/ethnicity, education, and insurance status, participants appeared to be representative of the county population. Four themes were identified: (1) needs regarding healthcare and other resources; (2) lack of preconception/interconception care and perceived unimportance due to intergenerational knowledge transfer and paucity of healthcare providers; (3) difference in understanding of the term “women’s health” and low health literacy; and (4) suggested interventions including education and outreach. Conclusion: Interviews with rural Midwestern women revealed needs regarding preconception/interconception health and care and potential ways to raise awareness. These findings can inform strategies to improve rural women’s health and birth outcomes. [ABSTRACT FROM AUTHOR]

Policy PointsAn estimated 700,000 people in the United States have "long COVID," that is, symptoms of COVID‐19 persisting beyond three weeks.COVID‐19 and its long‐term sequelae are strongly influenced by social determinants such as poverty and by structural inequalities such as racism and discrimination.Primary care providers are in a unique position to provide and coordinate care for vulnerable patients with long COVID.Policy measures should include strengthening primary care, optimizing data quality, and addressing the multiple nested domains of inequity. [ABSTRACT FROM AUTHOR]

Background: Health disparities have become apparent since the beginning of the COVID-19 pandemic. When observing racial discrimination in healthcare, self-reported incidences, and perceptions among minority groups in the United States suggest that, the most socioeconomically underrepresented groups will suffer disproportionately in COVID-19 due to synergistic mechanisms. This study reports racially-stratified data regarding the experiences and impacts of different groups availing the healthcare system to identify disparities in outcomes of minority and majority groups in the United States. Methods: Studies were identified utilizing PubMed, Embase, CINAHL Plus, and PsycINFO search engines without date and language restrictions. The following keywords were used: Healthcare, raci*, ethnic*, discriminant, hosti*, harass*, insur*, education, income, psychiat*, COVID-19, incidence, mortality, mechanical ventilation. Statistical analysis was conducted in Review Manager (RevMan V.5.4). Unadjusted Odds Ratios, P -values, and 95% confidence intervals were presented. Results: Discrimination in the United States is evident among racial groups regarding medical care portraying mental risk behaviors as having serious outcomes in the health of minority groups. The perceived health inequity had a low association to the majority group as compared to the minority group (OR = 0.41; 95% CI = 0.22 to 0.78; P =.007), and the association of mental health problems to the Caucasian-American majority group was low (OR = 0.51; 95% CI = 0.45 to 0.58; P <.001). Conclusion: As the pandemic continues into its next stage, efforts should be taken to address the gaps in clinical training and education, and medical practice to avoid the recurring patterns of racial health disparities that become especially prominent in community health emergencies. A standardized tool to assess racial discrimination and inequity will potentially improve pandemic healthcare delivery. [ABSTRACT FROM AUTHOR]

Following the US Civil War, newly freed Black Americans had significantly poorer health than Whites. Founded in 1865, the Freedmen's Bureau offered a range of support (eg, food, health care, shelter, legal aid) to try to improve health among the newly freed. The COVID-19 pandemic has exposed the persistence of racial health inequity in American life. Ethical obligations to address it exist now, just as they did in 1865. [ABSTRACT FROM AUTHOR]

Objectives: The COVID-19 pandemic affected consumers' access to oral health care. This study evaluated factors associated with teledentistry use among US adults from June 2019 through June 2020. Methods: We used data from a nationally representative survey of 3500 consumers. We estimated teledentistry use and adjusted associations with respondents' concerns about the impacts of the pandemic on health and welfare and with their sociodemographic characteristics using Poisson regression models. We also analyzed teledentistry use across 5 teledentistry modalities (email, telephone, text, video conferencing, and mobile application). Results: Overall, 29% of respondents used teledentistry, and 68% of teledentistry users reported doing so for the first time because of the COVID-19 pandemic. First-time teledentistry use was positively associated with a high level of pandemic concerns (relative risk [RR] = 5.02; 95% CI, 3.49-7.20), age 35-44 years (RR = 4.22; 95% CI, 2.89-6.17), and annual household income $100 000-$124 999 (RR = 2.10; 95% CI, 1.55-2.84) and negatively associated with rural residence (RR = 0.68; 95% CI, 0.50-0.94). Having a high level of pandemic concerns (RR = 3.42; 95% CI, 2.30-5.08), young age (age 25-34 years: RR = 5.05; 95% CI, 3.23-7.90), and higher level of education (some college: RR = 1.59; 95% CI, 1.22-2.07) were strongly associated with teledentistry use for all "other" users (ie, existing or first-time use because of reasons unrelated to the pandemic). Most first-time teledentistry users used email (74.2%) and mobile applications (73.9%), whereas "other" teledentistry users used telephone communication (41.3%). Conclusions: Teledentistry use during the pandemic was higher in the general population than among those for whom teledentistry programs were originally designed (eg, low-income, rural populations). Favorable regulatory changes to teledentistry should be expanded to meet patient needs beyond the pandemic. [ABSTRACT FROM AUTHOR]