Purpose of Review COVID-19 is a major concern for the health and wellbeing of individuals worldwide. As COVID-19 cases and deaths continue to increase in the USA, aging Black and Hispanic populations have emerged as especially at-risk for increased exposure to COVID-19 and susceptibility to severe health outcomes. The current review discusses the weathering hypothesis and the influence of social inequality on the identified health disparities. Recent Findings Aging minoritized populations have endured structural and social inequality over the lifecourse. Consequently, these populations experience weathering, a process that results in physiological dysregulation due to stress associated with persistent disadvantage. Through weathering and continued inequity, aging minoritized populations have an increased risk of exposure and poor health outcomes from COVID-19. Summary Current literature and available data suggests that aging minoritized persons experience high rates of COVID-19 morbidity and mortality. The current review hypothesizes and supports that observed disparities are the result of inequalities that especially affect Black and Hispanic populations over the lifecourse. Future efforts to address these disparities should emphasize research that supports governments in identifying at-risk groups, providing accessible COVID-19-related information to those groups, and implementing policy that addresses the structural and social inequities that perpetuate current COVID-19 disparities.
Introduction The American Academy of Pediatrics (AAP) updated its blood pressure (BP) screening guidelines in 2017 to emphasize body weight as a risk factor. We provide contemporary, nationally representative estimates of prevalence of elevated and hypertensive BP among US children and examine sociodemographic prevalence differences, accounting for the influence of weight. Methods We used cross-sectional data from children aged 8 to 17 years (N = 5,971; weighted N = 36,612,323) collected from 2011 through 2018 in 4 biennial cycles of the National Health and Nutrition Examination Survey (NHANES). Children’s BP was categorized as normal, elevated, or hypertensive. Sociodemographic characteristics included were sex, age, race/ethnicity, family income, and education. Log binomial regression, with and without adjustment for weight (dichotomized at the 85th body mass index percentile), determined prevalence estimates and differences for elevated and hypertensive BPs with 95% CIs. Results In NHANES data collected from 2011 through 2018, 7.2% (95% CI, 6.3%–8.3%) of US children had elevated BP, and 3.8% (95% CI, 3.3%–4.5%) had hypertensive BP according to 2017 AAP guidelines. Differences in prevalence of weight-adjusted elevated BP indicated higher prevalence among children aged 16 to 17 years compared with children aged 8 to 9 years (prevalence difference, +6.3%; 95% CI, 3.2%–9.4%), among males compared with females (+4.6%; 95% CI, 2.7%–6.4%), and among non-Latino Black children compared with non-Latino White children (+4.0%; 95% CI, 2.2%–5.8%). Crude hypertensive BP prevalence was highest among children aged 8 to 9 years, male children, and Mexican American children. The only difference remaining after weight adjustment was among children aged 8 to 9 years and 13 to 15 years. Conclusion Elevated BP was most prevalent among US children who were older, male, or non-Latino Black. Factors beyond inequalities in body weight may contribute to disparities in elevated BP.
Vaccine hesitancy is a long-standing public health issue. The present work describes parental perceptions of COVID-19 vaccination for 5- to 11-year-old children, to aid in vaccination efforts. Parents of 5- to 11-year-old children residing in Worcester, Massachusetts, were recruited through community partner outreach to participate in semi-structured focus groups. Focus groups were conducted via Zoom in English (n = 4) and Spanish (n = 3) with a total of 67 parents. Rapid qualitative analysis was used. Most participants were female and of Hispanic ethnicity. Themes included: (1) Trusted sources and influential types of information (e.g. personal COVID-19 vaccine stories from peers and healthcare providers), (2) Motivations for vaccination: health (i.e. protecting children, families, and communities from COVID-19), (3) Motivations for vaccination: social, emotional, and educational (i.e. mitigating related negative effects of COVID-19), (4) Drivers of vaccine hesitancy (e.g. frustration, uncertainty, and confusion), (5) Differentiating vaccine acceptance, hesitancy, and resistance, (6) Needed information. Although this context may be unique to parents of 5- to 11-year-old children from Central Massachusetts, especially those who may be Spanish-speaking, or of Hispanic ethnicity, this work reinforces the need for effective and persistent communication to combat vaccine hesitancy. In describing parents’ perceptions toward COVID-19 vaccination in their 5- to 11-year-old children, we contextualize vaccine hesitancy and highlight opportunities for existing evidence-based communication strategies to increase vaccine confidence and uptake in pediatric populations.
Background: Policy, systems, and environmental (PSE) approaches can sustainably improve healthy eating (HE) and physical activity (PA) but are challenging to implement. Community health improvement plans (CHIPs) represent a strategic opportunity to advance PSEs but have not been adequately researched. The objective of this study was to describe types of HE and PA strategies included in CHIPs and assess strategies designed to facilitate successful PSE-change using an established framework that identifies six key activities to catalyze change.Methods: A content analysis was conducted of 75 CHIP documents containing HE and/or PA PSE strategies, which represented communities that were identified from responses to a national probability sample of US local health departments (<500,000 residents). Each HE/PA PSE strategy was assessed for alignment with six key activities that facilitate PSE-change (identifying and framing the problem, engaging and educating key people, identifying PSE solutions, utilizing available evidence, assessing social and political environment, and building support and political will). Multilevel latent class analyses were conducted to identify classes of CHIPs based on HE/PA PSE strategy alignment with key activities. Analyses were conducted separately for CHIPs containing HE and PA PSE strategies.Results: Two classes of CHIPs with PSE strategies emerged from the HE (n = 40 CHIPs) and PA (n = 43 CHIPs) multilevel latent class analyses. More CHIPs were grouped in Class A (HE: 75%; PA: 79%), which were characterized by PSE strategies that simply identified a PSE solution. Fewer CHIPs were grouped in Class B (HE: 25%; PA: 21%), and these mostly included PSE strategies that comprehensively addressed multiple key activities for PSE-change.Conclusions: Few CHIPs containing PSE strategies addressed multiple key activities for PSE-change. Efforts to enhance collaborations with important decision-makers and community capacity to engage in a range of key activities are warranted.
The Infectious Disease Society of America (IDSA) publishes guidelines regularly for the management of skin and soft tissue infections; however, the extent to which practice patterns follow these guidelines and if this can affect treatment failure rates is unknown. We observed the treatment failure rates from a multicentre retrospective ambulatory cohort of adult emergency department patients treated for a non-purulent skin infection. We used multivariable logistic regression to examine the role of IDSA classification and whether adherence to IDSA guidelines reduced treatment failure. A total of 759 ambulatory patients were included in the cohort with 17.4% failing treatment. Among all patients, 56.0% had received treatments matched to the IDSA guidelines with 29.1% over-treated, and 14.9% under-treated based on the guidelines. After adjustment for age, gender, infection location and medical comorbidities, patients with a moderate infection type had three times increased risk of treatment failure (adjusted risk ratio (aRR) 2.98; 95% confidence interval (CI) 1.15–7.74) and two times increased risk with a severe infection type (aRR 2.27; 95% CI 1.25–4.13) compared with mild infection types. Patients who were under-treated based on IDSA guidelines were over two times more likely to fail treatment (aRR 2.65; 95% CI 1.16–6.05) while over-treatment was not associated with treatment failure. Patients ⩾70 years of age had a 56% increased risk of treatment failure (aRR 1.56; 95% CI 1.04–2.33) compared with those <70 years. Following the IDSA guidelines for non-purulent SSTIs may reduce the treatment failure rates; however, older adults still carry an increased risk of treatment failure.
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