Article

COVID-19 Impacts on Families of Color and Families of Children with Asthma

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Abstract

Objective: This cross-sectional study quantified differences in 1) social determinants of health (SDOH) and perceived changes in SDOH during COVID-19 and 2) COVID-19 psychosocial impacts across four groups: 1) non-Hispanic White (NHW) parents of children with asthma, 2) Black, Indigenous, or other People of Color (BIPOC) parents of healthy children, 3) BIPOC parents of children with asthma, and 4) NHW parents of healthy children (referent). The NIMHD Framework was used to identify SDOHs that may change for families during COVID-19. Methods: Parents were recruited via Prolific (N=321) and completed questions about COVID-19 family impacts on employment, income, access to food and healthcare, and psychosocial functioning, including discrimination. It was hypothesized that NHW families of children with asthma and BIPOC families would endorse greater negative outcomes relative to NHW parents of healthy children. Results: BIPOC families experienced greater food insecurity and discrimination relative to NHW parents of healthy children. Compared to the NHW healthy group, COVID-19 resulted in greater parent-reported resource losses for both BIPOC groups and greater reductions in healthcare access for both asthma groups. Children with asthma and BIPOC children had greater distress surrounding COVID-19. BIPOC and NHW parents of children with asthma reported greater worries about resource losses due to COVID-19. Conclusions: The pandemic is widening inequities for BIPOC families, especially for families of children with asthma. These results highlight the need for interventions that address the needs of underserved communities, providing the infrastructure, policies, and supports needed to reduce health inequities during and after COVID-19.

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... Factors associated with having asthma, including SDOH, have posed increased risks for those with asthma during the COVID-19 pandemic, such as medical care disruptions, increased exposure to home-based triggers, and increased anxiety/distress, which may lead to deteriorations in asthma control for some [25,26]. Importantly, parents of children with lung disease are experiencing greater anxiety relative to parents of healthy children during the pandemic [27][28][29] and are specifically experiencing more COVID-19-specific worry. To date, there is scant literature on the intersection of respiratory disease (i.e., asthma) and respiratory virus (i.e., COVID-19) and on how the COVID-19 pandemic is affecting parents with the intersecting identities of being racially marginalized and being a parent of a child with lung disease. ...
... One prior, related paper has examined SDOH and perceived changes in SDOH during COVID-19 among parents of children with asthma and BIPOC parents of children with and without asthma relative to NHW parents of healthy children. Overall, BIPOC parents of children with asthma experienced the most pervasive negative COVID-19 impacts on family resource losses and parent psychosocial responses to COVID-19 relative to parents with fewer minoritized identities [29]. More specifically, BIPOC parents experienced greater discrimination and greater pandemic-related resource losses (i.e., employment loss, income loss, and food insecurity) compared to NHW parents of healthy children. ...
... Parents also reported on several COVID-19 impacts, including how COVID-19 had impacted family access to food (response options ranged from 0 = No to 3 = Severely/Frequently) and access to medical and mental health care (response options ranged from 0 = None to 4 = Severely), and these factors were examined as potential mediators. Parents also completed the Resource Loss Worry subscale [29]; this subscale assessed parental worries about finances/food insecurity during COVID- 19 and was examined as a mediator. This subscale demonstrated good reliability in the current sample (Cronbach's α = 0.87). ...
Article
Objectives: This study investigated whether select social determinants of health and worries about COVID-19 resource losses mediated the relations between four parent groups: [1) non-Hispanic White (NHW) parents of children with asthma; 2) Black, Indigenous, or other Persons of Color (BIPOC) parents of healthy children; 3) BIPOC parents of children with asthma; and 4) NHW parents of healthy children (referent)] and parent anxiety and depression symptoms during COVID-19. Methods: Parents (N = 321) completed online questionnaires about discrimination, anxiety, depression, and COVID-19 impacts on employment/income and access to food and health care. Mediation analyses were conducting using nonparametric bootstrapping procedures. Results: BIPOC parents of children with and without asthma experienced greater anxiety and depression symptoms through greater discrimination compared to NHW parents of healthy children. BIPOC parents of children with asthma experienced greater anxiety symptoms, and both BIPOC groups experienced greater depression symptoms, through greater COVID-19 income losses. NHW parents of children with asthma and both BIPOC groups experienced greater anxiety and depression symptoms through greater worries about COVID-19 resource losses. Conclusions: The suffering of BIPOC parents, especially BIPOC parents of children with asthma, necessitates multi-level COVID-19 responses to address key drivers of health inequities.
... COVID-19 resulted in greater parentreported resource losses and greater reductions in health-care access for Black, indigenous or other ethnic minority groups. 45 This effect was particularly substantial in families of children with asthma. ...
Article
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By the April 12, 2022, the COVID‐19 pandemic had resulted in over half a billion people being infected worldwide. There have been 6.1 million deaths directly due to the infection, but the pandemic has had many more short‐ and long‐term pervasive effects on the physical and mental health of the population. Allergic diseases are among the most prevalent noncommunicable chronic diseases in the pediatric population, and health‐care professionals and researchers were seeking answers since the beginning of pandemic. Children are at lower risk of developing severe COVID‐19 or dying from infection. Allergic diseases are not associated with a higher COVID‐19 severity and mortality, apart from severe/poorly controlled asthma. The pandemic disrupted routine health care, but many mitigation strategies, including but not limited to telemedicine, were successfully implemented to continue delivery of high‐standard care. Although children faced a multitude of pandemic‐related issues, allergic conditions were effectively treated remotely while reduction in air pollution and lack of contact with outdoor allergens resulted in improvement, particularly respiratory allergies. There is no evidence to recommend substantial changes to usual management modalities of allergic conditions in children, including allergen immunotherapy and use of biologicals. Allergic children are not at greater risk of multisystem inflammatory syndrome development, but some associations with Long COVID were reported, although the data are limited, and further research is needed. This statement of the EAACI Section on Pediatrics provides recommendations based on the lessons learnt from the pandemic, as available evidence.
... Applied to the problems rendered visible by COVID-19, intersectionality illuminates social inequities in light of multiple forces of oppression. COVID-19 became the harbinger of several health disparities, including those based on race and class, by shaping access to healthcare (Clawson et al., 2021;Gravlee, 2020) and access to education and career opportunities (Ji & Charles, 2020). For instance, school counselors can attend to the ways that an inadequate infrastructure for technology resources might affect students at the intersection of classism and ableism. ...
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The school counseling profession has an ethical responsibility to provide and advocate for individual students’ career planning and development, while expanding school counselors’ own multicultural and social justice advocacy to become effective culturally competent professionals. Additional literature is needed to identify how school counselors can adapt their career counseling approaches to fit the unique challenges and barriers of historically marginalized students both during and after the global COVID-19 pandemic. We describe how school counselors can use intersectionality theory as a framework for career development with marginalized populations in response to COVID-19 and its impact on the economic decline.
... Behavior problems and psychological distress among young children have increased since the pandemic began (Ehrler et al., 2021;Gadermann et al., 2021;Steimle et al., 2021), and are correlated with cumulative exposure to pandemic-related stressors, such as job loss and family illness . Parents' psychological distress mediates the effects of pandemic-related stressors on child behavior problems (Koehler-Dauner et al., 2021;Marchetti et al., 2020) and the pandemic has had stronger effects on Black, Indigenous, and People of Color (BIPOC) children than White children (Clawson et al., 2021). ...
Article
The COVID-19 pandemic profoundly affected American families and children, including through the closure or change in the nature of their care and school settings. As the pandemic has persisted, many children remain in remote schooling and those attending in-person childcare or school have contended with unpredictable closures. This study investigated the frequency and consequences of disruptions to children's childcare and school arrangements during Fall 2020. The sample is parents who were hourly service-sector workers prior to the pandemic, had a young child between the ages of 3 and 8, and were at least partially responsible for their children's school and/or care in Fall 2020 (N = 676); half of the sample were non-Hispanic Black, 22% were Hispanic, and 18% are non-Hispanic White. Parents were asked to complete 30 days of daily surveys about whether their care and school arrangements went smoothly and as predicted that day, about their mood, parenting behaviors, and children's behavior. Results showed that daily disruptions to care and school were common, with families reporting a disruption on 24% of days. Families with children in exclusively remote schooling experienced more frequent disruption than families with children in in-person care or school. For all families, care or school disruptions were related to worse child behavior, more negative parental mood, and increased likelihood of losing temper and punishment. Within-family mediation suggests that parents' difficulties supporting children's learning, and to a lesser degree their mood and parenting behaviors, partially mediate effects of disruptions on child behavior. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... Employment/income loss, poverty, and a history of household chronic illness during COVID-19 have also demonstrated associations with poorer mental health status for parents and children. 16,[22][23][24] A survey study conducted on children during the lockdown period in India revealed that 73.15% and 51.25% of children had signs of increased irritation and anger, while 18.7% and 17.6% of parents also mentioned the symptoms of depression and anxiety among their children, respectively. ...
Article
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Objective: The restrictions imposed by the coronavirus disease 2019 (COVID-19) pandemic have caused significant changes in people's lives. This study aimed to investigate anxiety levels and changes in health and hygiene behaviors in mothers of children with asthma in early COVID-19 lockdown in Turkey. Materials and Methods: This study was a cross-sectional survey conducted on children with asthma, 6 to 11 years of age, between June 1 and 30, 2020, in Turkey. A sociodemographic data form, health and hygiene behavior form, childhood asthma control test, and state-trait anxiety inventory were administered to the mothers of the children. Results: The asthma group included 123 children (Female: 39.0%) and median age, interquartile range (IQR) [minimum-maximum]: 8.0 (6) [6-12] years; the control group included 88 children (Female: 47.7%) median age, IQR [minimum-maximum]: 8.0 (7) [5-12] years. Increased hygiene behaviors and high compliance with social isolation measures were recorded in the early lockdown, with no difference between the groups. Before the pandemic, the most frequently used cleaning products were general-purpose cleaners. During the early lockdown, however, the most frequently used product was disinfectants and was similar in both groups. In both groups, the rate of using nutritional supplements increased during the pandemic period, but the rate was higher in children with asthma both before and during the early lockdown (P < 0.001). The anxiety levels of the mothers in asthma and control groups were similar. Conclusion: This study is the first in Turkey demonstrating that, in mothers of children with asthma, lifestyle changes related to health and hygiene and anxiety levels are similar to those of other children and their mothers during the early lockdown period of COVID-19 pandemic.
... Although we have not seen the full scope of the pandemic's effects on behavioral health, we have already witnessed negative impacts from social isolation, child care and school closures, grief and loss, and family economic insecurity (1,2). And although children across the globe have borne pandemic distress, in many communities, children of color have been disproportionately burdened (3). ...
... Parents in the present study had CEFIS Exposure and Impact scores comparable to a community sample described by Kazak et al., 2021. Although disparate measures (e.g., Coronavirus Health and Impact Survey; Nikolaidis et al., 2021;COVID-19 Adolescent Symptom and Psychological Experience Questionnaire-Parent;Clawson et al., 2021) make it difficult to compare parents' cumulative COVID-19-related experiences across studies, findings consistently suggest a high level of disruption in the lives of parents and families. In the present study, greater COVID-19 impacts were linked to higher levels of work-life conflict, greater stress when engaging in parent-assisted learning with their children, more feelings of parenting role overload, and elevated reports of anxiety and depression symptoms. ...
Article
Objective The objective of this study was to document the direct impact of the COVID-19 pandemic on parents and families in the United States. Methods Parents’ experiences during the pandemic were examined using an online survey (N = 564) collected during May and June 2020. Results Parents reported experiencing a high frequency of COVID-19-related events (e.g., job loss and health concerns) and impact on their lives. Parents’ experiences with COVID-19, as well as self-reported perceived increase in home labor, experiences with assisting children with remote schooling, and work-life conflict were all significantly associated with higher levels of parental role overload. COVID-19-related events and impact, as well as parental role overload, significantly predicted parents’ anxiety and depression, even after controlling for demographic factors. Conclusions The findings suggest the importance of providing support for parents and families through direct services and public policy changes.
... However, Some factors, such as reduced treatment follow-up, weight gain, and parental anxiety, may affect children with asthma during the COVID-19 pandemic (Ding and Lu, 2020). One study found that children with asthma and their parents experienced more negative emotions than healthy children during the pandemic (Clawson et al., 2021). ...
Article
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Coronavirus SARS-CoV-2 disease (COVID-19) has affected the quality of life of children and parents. Furthermore, the mental health of children with asthma and their care givers may be affected by the anxious conditions of the coronavirus. In this study, the moderating role of coronavirus anxiety in the associations between psychiatric symptoms and quality of life (QL) in children with asthma was investigated. The present study is a cross-sectional study. The sample includes 118 children (53% boys) aged 7 to 14 years with asthma and their mothers (n =118). Also, 56% of the samples had mild asthma, 38% moderate, and 24% severe asthma. The results showed that after adjusting for the role of severity and control of asthma, child and mother psychiatric symptoms predicted 17% (ΔR²=.17) of the variance in QL in children. Coronavirus anxiety in children and mothers as moderating variable explained 15% of the variance QL in children with asthma. Overall, psychiatric symptoms and coronavirus anxiety in mothers and children predicted 27% of the poor QL in children with asthma. In this study, a high correlation was observed between maternal psychiatric symptoms and child psychiatric symptoms. Psychiatric symptoms and coronavirus anxiety in mothers and children play a significant role in the QL of children, especially during the coronavirus pandemic. Therefore, paying more attention to these symptoms can help improve the QL of children with asthma. Also, investigating the long-term effects of these symptoms can be of interest to researchers.
... We created a scoring rubric for the COVID-19 Child Experience Survey (see Table 1; full rubric available in Appendix), as no rubric or psychometric data had been available for the original CASPE parent survey at the time of our study. Nonetheless, our scoring approach was similar to that of other recent studies making use of CASPE questionnaire items (34,35). Item scores were weighted more heavily depending on the severity of the event or experience, as determined via discussion and consensus from all authors. ...
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... 30 Loss of work, food and income insecurity, and family members' illnesses have been associated with poor mental health for the parents and children in households of color. 31,32 Furthermore, when children needed to be quarantined due to a COVID-19 exposure, parents reported regressive behavior in their children. 33 One strategy to reduce the risk of mental health problems was to be outdoors. ...
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Chapter
COVID-19 and associated shutdowns have had numerous, negative, physical and mental health effects on families and children. These effects were disproportionately experienced by groups marginalized prior to the pandemic's onset, including BIPOC families, those living in communities characterized by higher levels of poverty, and those with children with special educational and health needs. Thus, the pandemic has dramatically widening pre-existing social, health, and educational disparities. This chapter reviews this literature, and provides recommendations for future research and policy.
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Although asthma has emerged as a major contributor to disease and disability among US children, the burden of this disease is unevenly distributed within the population. This article provides a brief overview of social-status variables that predict variations in asthma risks and social exposures, such as stress and violence, that are emerging as important risk factors. The central focus of the article is on the distal social variables that have given rise to unhealthy residential environments in which the risk factors for asthma and other diseases are clustered. Effective initiatives for the prevention and treatment of childhood asthma need to address these nonmedical determinants of the prevalence of asthma.
Article
Background: Bronchial asthma has not been adequately assessed in coronavirus disease 2019 (COVID-19). Respiratory allergy is associated with significant reductions in the expression of angiotensin-converting enzyme 2 receptor, which is the entry receptor for COVID-19. Objective: To observe COVID-19 susceptibility in patients with bronchial asthma, analyze the prevalence of asthma in a large cohort of consecutive outpatient subjects who were tested with the RT-PCR assay for COVID-19. Methods: This was a retrospective population-based cross-sectional study using data from a large nationwide health maintenance organization in Israel. All health maintenance organization enrollees who had been tested for COVID-19 from February to June 2020 were included. Differences in demographic and clinical characteristics between the subjects with negative and positive COVID-19 RT-PCR test results and between COVID-19 RT-PCR-positive subjects with and without asthma were analyzed. Results: A total of 37,469 subjects were tested for COVID-19 RT-PCR, and results for 2,266 (6.05%) of them were positive. A significantly higher proportion of smokers was observed in the COVID-19-negative group than in the COVID-19-positive group (4734 [13.45%] vs 103 [4.55%]; P < .001). Asthma was found in 153 (6.75 %) subjects of the COVID-19-positive group and in 3388 (9.62%) subjects of the COVID-19-negative group (P < .001). No significant impact of antileukotrienes, inhaled corticosteroids, and long-acting beta-blockers use was revealed on COVID-19 positivity proportions. Multiple logistic regression analysis adjusted for sex, age, smoking, and comorbidity revealed a negative association of asthma with the likelihood of being positive for COVID-19 (odds ratio, 0.71; 95% CI, 0.58-0.87; P = .001). Conclusions: We observed lower COVID-19 susceptibility in patients with preexisting asthma.
Article
Background: Bronchial asthma has not been adequately assessed in the coronavirus disease 2019 (COVID-19). Respiratory allergy is associated with significant reductions in ACE2 receptors expression, which is the entry receptor for COVID-19. Objective: To observe COVID-19 susceptibility in patients with bronchial asthma, we have analyzed the prevalence of asthma in a large cohort of consecutive outpatient subjects who tested in the RT-PCR assay for COVID-19. Methods: This was a retrospective population-based cross-sectional study utilizing data from a large nation-wide health maintenance organization (HMO) in Israel. All HMO enrollees who had been tested for COVID-19 from February to June 2020 were included. Differences in demographic and clinical characteristics between the subjects with negative and positive COVID-19 RT-PCR tests and between COVID-19 RT-PCR positive subjects with and without asthma were analyzed. Results: A total of 37,469 subjects were tested for COVID-19 RT-PCR and 2,266 (6.05 %) of them were positive. A significantly higher proportion of smokers was observed in the COVID-19 negative group, than in the COVID-19 positive group (4,734 (13.45 %) vs 103 (4.55 %); p<0.001). Asthma was found in 153 (6.75 %) subjects of COVID-19 positive and in 3,388 (9.62 %) subjects of COVID-19 negative group (p<0.001). No significant impact of antileukotrienes, inhaled corticosteroids and long-acting beta-blockers use was revealed on COVID-19 positivity proportions. Multiple logistic regression analysis adjusted for sex, age, smoking, and comorbidity revealed a negative association of asthma with the likelihood of being positive for COVID-19 (OR 0.71 (95% confidence interval, 0.58-0.87); p=0.001). Conclusion: we observed lower COVID-19 susceptibility in patients with pre-existing asthma.
Article
Background: The COVID-19 pandemic has demonstrated significantly worse outcomes for Minority (Black and Hispanic) individuals. Understanding the reasons for COVID-19-related disparities among asthma patients has important public health implications. Objective: To determine factors contributing to health disparities in those with asthma during the COVID-19 pandemic. Methods: An anonymous survey was sent through social media to adult patients with asthma, and a separate survey was sent to physicians who provide asthma care. The patient survey addressed demographic information including socioeconomic status (SES), asthma control, and attitudes/health behaviors during COVID-19. Results: A total of 1171 patients (10.1% Minority individuals) and 225 physicians completed the survey. Minority patients were more likely to have been affected by COVID-19 (e.g., became unemployed, lived in a community with high COVID-19 cases). They had worse asthma control (increased emergency visits for asthma, lower ACT score), were more likely to live in urban areas, and had a lower household income. Initial differences in attitudes and health behaviors disappeared after controlling for baseline demographic features. Institutional racism was demonstrated by findings that Minority individuals were less likely to have a primary care physician, had more trouble affording asthma medications due to COVID-19, were more likely to have lost health insurance due to COVID-19, and that 25% of physicians found it more challenging to care for Black individuals with asthma during COVID-19. Conclusion: Differences in SES and the effects of institutional racism, but not health behaviors, sources of information, or attitudes, are playing a role in disparities seen for asthma patients during COVID-19.
Article
Background Since COVID‐19 pandemic became a serious health concern globally, patients with chronic diseases require close attention with regard to general risks and current individual treatments. We aimed to reveal the general health status of the pediatric asthmatic patients during the pandemic, considering the role of household factors in parental attitudes. Methods We asked 60 asthmatic patients and their parents to respond to a questionnaire, aiming to reveal the current health status of the patients and the general approach of the family to the asthma management during the pandemic. Results A total of 8 patients had had an asthma attack during the outbreak, but there was no confirmed correlation with COVID‐19 infection. Most of the parents had never considered to stop their children's current medications. However, the majority of them reported concerns about failure of the ambulatory care services and almost all saw their children as being at high risk for COVID‐19 infection. There was no significant relationship between these concerns and their psychological statuses (p>0.05). Conclusions The crucial point of asthma management is to keep down both patients’ medical and psychological status that may lead to minimize the effects of the pandemic. Healthcare professionals should also pay attention to household members of the patients that their adaptation period to ‘new normal’of pandemic may directly effect the patients state of health.
Article
Background and objectives: The outbreak of coronavirus disease 2019 has changed American society in ways that are difficult to capture in a timely manner. With this study, we take advantage of daily survey data collected before and after the crisis started to investigate the hypothesis that the crisis has worsened parents' and children's psychological well-being. We also examine the extent of crisis-related hardships and evaluate the hypothesis that the accumulation of hardships will be associated with parent and child psychological well-being. Methods: Daily survey data were collected between February 20 and April 27, 2020, from hourly service workers with a young child (aged 2-7) in a large US city (N = 8222 person-days from 645 individuals). A subsample completed a one-time survey about the effects of the crisis fielded between March 23 and April 26 (subsample n = 561). Results: Ordered probit models revealed that the frequency of parent-reported daily negative mood increased significantly since the start of the crisis. Many families have experienced hardships during the crisis, including job loss, income loss, caregiving burden, and illness. Both parents' and children's well-being in the postcrisis period was strongly associated with the number of crisis-related hardships that the family experienced. Conclusions: Consistent with our hypotheses, in families that have experienced multiple hardships related to the coronavirus disease 2019 crisis, both parents' and children's mental health is worse. As the crisis continues to unfold, pediatricians should screen for mental health, with particular attention to children whose families are especially vulnerable to economic and disease aspects of the crisis.
Article
Background: As the coronavirus disease pandemic spread across the United States and protective measures to mitigate its impact were enacted, parents and children experienced widespread disruptions in daily life. Our objective with this national survey was to determine how the pandemic and mitigation efforts affected the physical and emotional well-being of parents and children in the United States through early June 2020. Methods: In June 2020, we conducted a national survey of parents with children age <18 to measure changes in health status, insurance status, food security, use of public food assistance resources, child care, and use of health care services since the pandemic began. Results: Since March 2020, 27% of parents reported worsening mental health for themselves, and 14% reported worsening behavioral health for their children. The proportion of families with moderate or severe food insecurity increased from 6% before March 2020 to 8% after, employer-sponsored insurance coverage of children decreased from 63% to 60%, and 24% of parents reported a loss of regular child care. Worsening mental health for parents occurred alongside worsening behavioral health for children in nearly 1 in 10 families, among whom 48% reported loss of regular child care, 16% reported change in insurance status, and 11% reported worsening food security. Conclusions: The coronavirus disease pandemic has had a substantial tandem impact on parents and children in the United States. As policy makers consider additional measures to mitigate the health and economic effects of the pandemic, they should consider the unique needs of families with children.
Article
The COVID-19 pandemic has disproportionately affected racial and ethnic minority groups, with high rates of death in African American, Native American, and LatinX communities. While 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.
Article
Background: It is unclear whether asthma may affect susceptibility or severity of the Coronavirus Disease 2019 (COVID-19) in children and how pediatric asthma services worldwide have responded to the pandemic. Objective: To describe the impact of the COVID-19 pandemic on pediatric asthma services and on disease burden in their patients. Methods: An online survey was sent to members of the Pediatric Asthma in Real Life (PeARL) think-tank and the World Allergy Organization Pediatric Asthma Committee. It included questions on service provision, disease burden and on the clinical course of confirmed cases of COVID-19 infection among children with asthma. Results: Ninety-one respondents, caring for an estimated population of >133,000 children with asthma, completed the survey. COVID-19 significantly impacted pediatric asthma services: 39% ceased physical appointments, 47% stopped accepting new patients, 75% limited patients visits. Consultations were almost halved to a median of 20 (IQR: 10-25) patients per week. Virtual clinics and helplines were launched in most centers. Better than expected disease control was reported in 20% (10-40%) of patients, while control was negatively affected in only 10% (7.5-12.5%). Adherence also appeared to increase. Only 15 confirmed cases of COVID-19 were reported among the population; the estimated incidence is not apparently different from the reports of general pediatric cohorts. Conclusion: Children with asthma do not appear to be disproportionately affected by COVID-19. Outcomes may even have improved, possibly through increased adherence and/or reduced exposures. Clinical services have rapidly responded to the pandemic by limiting and replacing physical appointments with virtual encounters.
Article
Background We aimed to evaluate anxiety among children with cystic fibrosis (CF) and their mothers related to the COVID‐19 pandemic. Methods A total of 45 patients with CF and their mothers were enrolled in the study together with 90 age‐matched healthy children and their mothers as a control group. The State and Trait Anxiety Inventory (STAI) was administered by teleconference with children aged 13–18 years old and their mothers. The STAI for children was administered with children aged 9–12 years. Results were compared with age‐matched healthy children and their mothers. The relationship between anxiety scores of children with CF and their mothers was evaluated by comparing with clinical data of children with CF. At the conclusion of the teleconference, mothers were asked whether their anxiety had changed as a result of the interview. Results It was found that healthy children aged 13–18 years had higher state anxiety scores than age‐matched children with CF. Mothers of children with CF had higher trait anxiety scores, especially those of children aged 0–12 years, than mothers of healthy children (p<0.05). For mothers of children with CF, state anxiety scores were higher among those whose children had chronic Pseudomonas infection (p<0.05). Most mothers of children with CF stated that their anxiety decreased following the interview. Conclusion The COVID‐19 pandemic may increase anxiety among mothers of children with CF as well those with healthy children. However, COVID‐19 had no effect on the anxiety of children with CF. Informing parents of children with CF about COVID‐19 by teleconference may decrease anxiety. This article is protected by copyright. All rights reserved.
Article
This qualitative study investigated the personal experiences of police racial bias and brutality among 18 African-American parents, the effect these experiences have had on them, how they discuss such incidents with their children, and which sources of strength the rely on during difficult times. Results revealed that both the participants and some of their children had endured negative encounters with law enforcement, and most of them suffered mental health consequences as a result, including fear, anger, and chronic stress. Most of the participants reported engaging in various forms of preparation for bias, including preparation for interaction with the police. For many, this was in order to ensure their children’s survival. Despite the negative and sometimes traumatic experiences, participants indicated that they found strength primarily in their faith and their families. Implications of these findings are discussed.
Article
Much is being learned about clinical outcomes for adult COVID-19 patients with underlying chronic conditions, however, there is less coverage on how the COVID-19 pandemic impacts the management of chronic medical conditions in children and youth, such as asthma. Asthma is a common chronic medical condition in children that is uniquely susceptible to changes brought upon by COVID-19. Sudden dramatic changes in the environment, medical practice, and medication use have altered the asthma management landscape with potential impacts on asthma outcomes. In this paper, we review how changes in transportation and travel patterns, school attendance, physical activity, and time spent indoors, along with changes in healthcare delivery since the start of the pandemic all play a contributing role in asthma control in children. We review potentially important influences of asthma control in children during the COVID-19 pandemic worthy of further study.
Article
As the coronavirus disease (COVID-19) pandemic spreads throughout the United States, evidence is mounting that racial and ethnic minorities and socioeconomically disadvantaged groups are bearing a disproportionate burden of illness and death. We conducted a retrospective cohort analysis of COVID-19 patients at Sutter Health, a large integrated health care system in northern California, to measure potential disparities. We used Sutter's integrated electronic health record to identify adults with suspected and confirmed COVID-19, and used multivariable logistic regression to assess risk of hospitalization, adjusting for known risk factors, such as race/ethnicity, sex, age, health, and socioeconomic variables. We analyzed 1,052 confirmed cases of COVID-19 from January 1-April 8, 2020. Among our findings, we observed that, compared with non-Hispanic white patients, African Americans had 2.7 times the odds of hospitalization, after adjusting for age, sex, comorbidities, and income. We explore possible explanations for this, including societal factors that either result in barriers to timely access to care or create circumstances in which patients view delaying care as the most sensible option. Our study provides real-world evidence that there are racial and ethnic disparities in the presentation of COVID-19. [Editor's Note: This Fast Track Ahead Of Print article is the accepted version of the peer-reviewed manuscript. The final edited version will appear in an upcoming issue of Health Affairs.].
Article
COVID-19 does not discriminate on the basis of immigration status, and neither should the measures to lessen the impact. Pediatricians can help to mitigate exponential growth of health inequities for CIF during this pandemic. Strategies within and beyond health care systems must incorporate policy and public health approaches that are compassionate, culturally relevant, and equitable.
Article
We introduce the National Institute on Minority Health and Health Disparities (NIMHD) research framework, a product that emerged from the NIMHD science visioning process. The NIMHD research framework is a multilevel, multidomain model that depicts a wide array of health determinants relevant to understanding and addressing minority health and health disparities and promoting health equity. We describe the conceptual underpinnings of the framework and define its components. We also describe how the framework can be used to assess minority health and health disparities research as well as priorities for the future. Finally, we describe how fiscal year 2015 research project grants funded by NIMHD map onto the framework, and we identify gaps and opportunities for future minority health and health disparities research.
Article
Racial trauma, a form of race-based stress, refers to People of Color and Indigenous individuals' (POCI) reactions to dangerous events and real or perceived experiences of racial discrimination. Such experiences may include threats of harm and injury, humiliating and shaming events, and witnessing racial discrimination toward other POCI. Although similar to posttraumatic stress disorder, racial trauma is unique in that it involves ongoing individual and collective injuries due to exposure and reexposure to race-based stress. The articles in this special issue introduce new conceptual approaches, research, and healing models to challenge racial trauma. The authors encourage psychologists to develop culturally informed healing modalities and methodologically sophisticated research and urge the inclusion of public policy interventions in the area of racial trauma.
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This article examines the extent to which racial differences in socio-economic status (SES), social class and acute and chronic indicators of perceived discrimination, as well as general measures of stress can account for black-white differences in self-reported measures of physical and mental health. The observed racial differences in health were markedly reduced when adjusted for education and especially income. However, both perceived discrimination and more traditional measures of stress are related to health and play an incremental role in accounting for differences between the races in health status. These findings underscore the need for research efforts to identify the complex ways in which economic and non-economic forms of discrimination relate to each other and combine with socio-economic position and other risk factors and resources to affect health.
Article
This article examines the extent to which racial differences in socio-economic status (SES), social class and acute and chronic indicators of perceived discrimination, as well as general measures of stress can account for black-white differences in self-reported measures of physical and mental health. The observed racial differences in health were markedly reduced when adjusted for education and especially income. However, both perceived discrimination and more traditional measures of stress are related to health and play an incremental role in accounting for differences between the races in health status. These findings underscore the need for research efforts to identify the complex ways in which economic and non-economic forms of discrimination relate to each other and combine with socio-economic position and other risk factors and resources to affect health. Peer Reviewed http://deepblue.lib.umich.edu/bitstream/2027.42/67159/2/10.1177_135910539700200305.pdf
Article
Population health research on racial discrimination is hampered by a paucity of psychometrically validated instruments that can be feasibly used in large-scale studies. We therefore sought to investigate the validity and reliability of a short self-report instrument, the "Experiences of Discrimination" (EOD) measure, based on a prior instrument used in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Study participants were drawn from a cohort of working class adults, age 25-64, based in the Greater Boston area, Massachusetts (USA). The main study analytic sample included 159 black, 249 Latino, and 208 white participants; the validation study included 98 African American and 110 Latino participants who completed a re-test survey two to four weeks after the initial survey. The main and validation survey instruments included the EOD and several single-item discrimination questions; the validation survey also included the Williams Major and Everyday discrimination measures. Key findings indicated the EOD can be validly and reliably employed. Scale reliability was high, as demonstrated by confirmatory factor analysis, Cronbach's alpha (0.74 or greater), and test-re-test reliability coefficients (0.70). Structural equation modeling demonstrated the EOD had the highest correlation (r=0.79) with an underlying discrimination construct compared to other self-report discrimination measures employed. It was significantly associated with psychological distress and tended to be associated with cigarette smoking among blacks and Latinos, and it was not associated with social desirability in either group. By contrast, single-item measures were notably less reliable and had low correlations with the multi-item measures. These results underscore the need for using validated, multi-item measures of experiences of racial discrimination and suggest the EOD may be one such measure that can be validly employed with working class African Americans and Latino Americans.
Article
Surveys are central for information on asthma prevalence. Recently, the validity of parental reports of pediatric asthma has been questioned. Confidence is examined in the report of asthma for children, obtained in a survey from the adult household member most knowledgeable about household health care (MKA). MKA reports of asthma are compared with pharmacy records of prescriptions beneficial in asthma treatment ("asthma medications") for children 0 to 17 years old in the 1996 Medical Expenditure Panel Survey. "Asthma medications" were filled for 6.5% of children, yet the MKA did not report asthma for 47.3% of them. However, for 61.2% of these children, the MKA reported plausible alternative medical conditions. For 9.0%, diagnosis information was missing. Among children with an "asthma medication," the MKA was less likely to report either asthma or a plausible alternative diagnosis for girls and for children 0 to 5 years of age. Reporting was not statistically different by child race/ethnicity, household income, education level, and MKA English language proficiency. Surveys do not overlook as many children with asthma as previously reported. Among children with "asthma medications," only sex and age appear to be different for children whose MKA reported either asthma or a plausible alternative diagnosis versus those whose MKA did not report either.
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