COVID-19 Vaccine Policy Implementation and Differential Vaccine Uptake Trajectories in Chicago Communities.

BACKGROUND: Since the onset of the COVID-19 pandemic, multiple public health interventions have been implemented to respond to the rapidly evolving pandemic and community needs. This article describes the scope, timing, and impact of coordinated strategies for COVID-19 vaccine uptake in Chicago for the first year of vaccine distribution. METHODS: Using a series of interviews with public health officials and leaders of community-based organizations (CBOs) who participated in the implementation of the citywide COVID-19 vaccine outreach initiatives, we constructed a timeline of vaccine outreach initiatives. The timeline was matched to the vaccine uptake rates to explore the impact of the vaccine outreach initiatives by community area. Finally, we discussed the nature of policy initiatives and the level of vaccine uptake in relation to community characteristics. RESULTS: The Chicago Department of Public Health (CDPH) implemented myriad vaccine outreach strategies, including mass vaccination sites, improved access, and community-level vaccine campaigns. Protect Chicago+ was the primary vaccine outreach effort initiated by the CDPH, which identified 15 highly vulnerable community areas. More than 2.7 million (67%) Chicagoans completed the vaccine regimen by December 2021. Black (51.3%) Chicagoans were considerably less likely to be vaccinated than Asian (77.6%), White (69.8%), and Hispanic (63.6%) Chicago residents. In addition, there were significant spatial differences in the rate of COVID-19 vaccine completion: predominantly White and Hispanic communities, compared with Black communities, had higher rates of vaccine completion. CONCLUSIONS: The community outreach efforts to improve COVID-19 vaccine uptake in Chicago have shown the importance of community-engaged approaches in pandemic responses. Despite citywide efforts to build community infrastructure, Black communities had relatively lower levels of vaccine uptake than other communities. Broader social restructuring to mitigate disinvestment and residential segregation and to ameliorate medical mistrust will be needed to prepare for future pandemics and disasters.

The association between neighborhood conditions and weight loss among older adults living in a large urban city.

To elucidate the role of neighborhood walkability and crime on weight loss, we examined data from older adults residing in Chicago who participated in a randomized controlled trial lifestyle intervention. Controlling for individual demographic characteristics and the intervention assignment, the neighborhood homicide rate was significantly associated with weight change. Participants who resided in neighborhoods above the 50th percentile of homicide rate actually gained weight between pre- and post-intervention. On the other hand, there was no significant relationship between the level of walkability and weight loss. Our findings suggest that the social environment related to neighborhood crime may play a more important role in weight loss than the built environment, such as walkability. Urban characteristics related to walkability, such as sidewalks, may increase physical activity, however, interventions aiming to increase physical activity to promote weight loss will benefit by addressing the neighborhood social environment that determines how people navigate space.

The Effect of Neighborhood Disorganization on Care Engagement Among Children With Chronic Conditions Living in a Large Urban City.

Neighborhood context plays an important role in producing and reproducing current patterns of health disparity. In particular, neighborhood disorganization affects how people engage in health care. We examined the effect of living in highly disorganized neighborhoods on care engagement, using data from the Coordinated Healthcare for Complex Kids (CHECK) program, which is a care delivery model for children with chronic conditions on Medicaid in Chicago. We retrieved demographic data from the US Census Bureau and crime data from the Chicago Police Department to estimate neighborhood-level social disorganization for the CHECK enrollees. A total of 6458 children enrolled in the CHECK between 2014 and 2017 were included in the analysis. Families living in the most disorganized neighborhoods, compared with areas with lower levels of disorganization, were less likely to engage in CHECK. Black families were less likely than Hispanic families to be engaged in the CHECK program. We discuss potential mechanisms through which disorganization affects care engagement. Understanding neighborhood context, including social disorganization, is key to developing more effective comprehensive care models.

Navigated African American breast cancer patients as incidental change agents in their family/friend networks.

BACKGROUND: Patient navigation is an increasingly widespread intervention to address the persistent, severe, and disproportionate breast cancer (BC) burden that African Americans (AA) face. Navigation may have more widespread effects than previously estimated due to patient-driven diffusion of BC information. METHODS: This pilot study examined the network effects of a randomized controlled trial via recruitment of navigated and non-navigated AA BC patients as well as their network members. We estimated study arm differences in patient BC promotion (i.e., number of individuals to whom BC patients promote BC screening) and network BC screening (i.e., % BC screening among network members). RESULTS: Among our sample of 100 AA BC patients, navigated patients promoted BC screening to more individuals than non-navigated patients. BC patients were more likely to promote BC screening to children and individuals with whom they communicated more frequently. Some models further suggested more network BC screening among "navigated" network members relative to "non-navigated" network members. CONCLUSIONS: Navigated AA patients promoted BC screening more widely throughout their networks than non-navigated AA BC patients. There were also suggestive findings regarding increased BC screening among their network members. Our pilot study highlights the potential for social network analysis to improve the precision of intervention effect estimates and to inform future innovations (e.g., integrating navigation and network-based interventions) with multilevel effects on cancer health disparities.

Stigma and cervical cancer prevention: A scoping review of the U.S. literature.

Cervical cancer is preventable through HPV vaccination and screening however, uptake falls below national targets. A scoping review was conducted to describe stigmas related to HPV infection and vaccination and cervical cancer and screening in the US. Results were organized into the domains proposed by Stangl and colleagues' Health Stigma and Discrimination Framework. Common drivers of stigma were fear of social judgement and rejection, self-blame, and shame. Positive facilitators included social norms that provided motivation to receive HPV vaccination and screening. Gender and social norms were notable negative facilitators of stigma. HPV infection and cervical cancer resulted in stigma marking through the belief that both result from incautious behavior-either multiple sexual partners or failing to get screening. Stereotyping and prejudice were stigma practices attributed to HPV infection and cervical cancer through these same behaviors. Stigma experiences related to HPV infection, cervical cancer, and abnormal screening results included altered self-image based on perceived/anticipated stigma, as well as discrimination. This review advances understanding of the multiple dimensions of stigma associated with these outcomes in the US population. Three areas warrant additional consideration. Future studies should 1) assess how stigma dimensions affect uptake of cervical cancer preventions efforts; 2) focus on US women most affected by cervical cancer incidence and mortality to identify potential differences in these dimensions and tailor interventions accordingly; 3) include women from geographic areas of the US with high rates of cervical cancer to adapt interventions that address potential regional variations in resources and need.

Assessment of a novel ophthalmology tele-triage system during the COVID-19 pandemic.

BACKGROUND: In response to the COVID-19 pandemic, a web-based tele-triage system was created to prioritize in-person clinic visits and ensure safety at the University of Illinois at Chicago Department of Ophthalmology and Visual Sciences during a statewide shelter-in-place order. The aim of this study is to evaluate the impact of the tele-triage system on urgent visit volume and explore the characteristics of acute visit requests at a tertiary referral eye center. METHODS: This retrospective study analyzed acute visit requests between April 6, 2020 and June 6, 2020. Descriptive statistics, chi-square tests, ANOVA, and bivariate logistic regression were used to compare variables with a p-value of 0.05. RESULTS: Three hundred fifty-eight surveys were completed. Mean age was 49.7 ± 18.8 years (range 2-91). The majority of requests were determined as urgent (63.0%) or emergent (0.8%). Forty-nine patients had recent eye trauma (13.7%), and the most common reported symptoms were new onset eye pain (25.7%) and photophobia (22.9%). Most patients were self-referred (63.7%), though provider referral was more common in patients with symptoms of new onset lid swelling (p < 0.01), diplopia (p < 0.01), flashing lights (p = 0.02), or droopy eyelid (p < 0.01). Patients presenting with symptom onset within 48 h tended to be younger (45.8 years) versus those with symptom duration of 48 h to 1 week (49.6 years), or more than 1 week (52.6 years; p < 0.01). CONCLUSION: This novel tele-triage system screened out one-third of acute visit requests as non-urgent, which limited in-person visits during the initial shelter-in-place period of the pandemic. Tele-triage systems should be implemented in eye care practices for future emergency preparedness.

Gendered and racialized social expectations, barriers, and delayed breast cancer diagnosis.

BACKGROUND: Black women are more likely to be diagnosed at a later stage of breast cancer in part due to barriers to timely screening mammography, resulting in poorer mortality and survival outcomes. Patient navigation that helps to overcome barriers to the early detection of breast cancer is an effective intervention for reducing breast cancer disparity. However, the ability to recognize and seek help to overcome barriers may be affected by gendered and racialized social expectations of women. METHODS: Data from a randomized controlled trial, the Patient Navigation in Medically Underserved Areas study, were used. The likelihood of obtaining a follow-up screening mammogram was compared between women who identified ≥1 barriers and those who did not. RESULTS: Of the 3754 women who received the Patient Navigation in Medically Underserved Areas navigation intervention, approximately 14% identified ≥ 1 barriers, which led to additional navigator contacts. Consequently, those women who reported barriers were more likely to obtain a subsequent screening mammogram. Black women, women living in poverty, and women with a higher level of distrust were less likely to report barriers. CONCLUSIONS: Minority women living in poverty have always been the source of social support for others. However, gendered and racialized social expectations may affect the ways in which women seek help for their own health needs. A way to improve the effectiveness of navigation would be to recognize how minority women's gender images and expectations could shape how they seek help and support. A report of no barriers does not always translate into no problems. Proactive approaches to identify potential barriers may be beneficial.

Beyond minimum wage: Broader employment policies can significantly affect food insecurity.

Although many have investigated the impacts of minimum wage on a broad array of health outcomes, innovative policies surrounding broader employment policies have largely not been studied. To that end, this paper contributes in three ways. First, it discusses the rise in precarious employment. Then, it turns to the current federal framework of employment policies, namely minimum wage. Finally, it explores what a broader definition of employment policies could include and how future studies could use state, county, and municipal policymaking in this space to investigate ways in which they might contribute to reducing food insecurity and in turn, improve health outcomes.

About 30% of low-income households experienced food insecurity in 2023. Given that food security is strongly tied to employment conditions, there is potential to reduce food insecurity through innovative employment-focused policy changes. Minimum wage is often studied as an indicator of employment quality. However, employment policies now stretch beyond hourly rate, as several jurisdictions have adopted innovative, broader approaches to improving employment. More research is needed to determine whether these broader employment policies, such as secure scheduling, paid leave, and collective bargaining, may mitigate food insecurity.

Racial/Ethnic disparities in exposure to neighborhood violence and lung cancer risk in Chicago.

BACKGROUND: Despite the lower prevalence and frequency of smoking, Black adults are disproportionately affected by lung cancer. Exposure to chronic stress generates heightened immune responses, which creates a cell environment conducive to lung cancer development. Residents in poor and segregated neighborhoods are exposed to increased neighborhood violence, and chronic exposure to violence may have downstream physiological stress responses, which may explain racial disparities in lung cancer in predominantly Black urban communities. METHODS: We utilized retrospective electronic medical records of patients who underwent a screening or diagnostic test for lung cancer at an academic medical center in Chicago to examine the associations between lung cancer diagnosis and individual characteristics (age, gender, race/ethnicity, and smoking status) and neighborhood-level homicide rate. We then used a synthetic population to estimate the neighborhood-level lung cancer risk to understand spatial clusters of increased homicide rates and lung cancer risk. RESULTS: Older age and former/current smoking status were associated with increased odds of lung cancer diagnosis. Hispanic patients were more likely than White patients to be diagnosed with lung cancer, but there was no statistical difference between Black and White patients in lung cancer diagnosis. The odds of being diagnosed with lung cancer were significantly higher for patients living in areas with the third and fourth quartiles of homicide rates compared to the second quartile of homicide rates. Furthermore, significant spatial clusters of increased lung cancer risk and homicide rates were observed on Chicago's South and West sides. CONCLUSIONS: Neighborhood violence was associated with an increased risk of lung cancer. Black residents in Chicago are disproportionately exposed to neighborhood violence, which may partially explain the existing racial disparity in lung cancer. Incorporating neighborhood violence exposure into lung cancer risk models may help identify high-risk individuals who could benefit from lung cancer screening.

Evaluating the Relationship between Neighborhood-Level Social Vulnerability and Patient Adherence to Ophthalmology Appointments.

PURPOSE: To examine the association between neighborhood-level social vulnerability and adherence to scheduled ophthalmology appointments. METHODS: In this retrospective cohort study, records of all patients ≥18 years scheduled for an ophthalmology appointment between September 12, 2020, and February 8, 2021, were reviewed. Primary exposure is neighborhood-level Social Vulnerability Index (SVI) based on the patient's residential location. SVI is a rank score of 15 social factors into four themes (socioeconomic status, household composition/disability, minority status/language, and housing type/transportation), ranging from 0 to 1.0, with higher ranks indicating greater social vulnerability. The overall SVI score and each theme were analyzed separately as the primary exposure of interest in multivariable logistic regression models that controlled for age, sex, appointment status (new or established), race, and distance from clinic. The primary outcome, non-adherence, was defined as missing more than 25% of scheduled appointments. RESULTS: Of 8,322 patients (41% non-Hispanic Black, 24% Hispanic, 22% non-Hispanic White) with scheduled appointments, 28% were non-adherent. Non-adherence was associated with greater social vulnerability (adjusted odds ratio [aOR] per 0.01 increase in overall SVI = 2.46 [95% confidence interval, 1.99, 3.06]) and each SVI theme (socioeconomic status: aOR = 2.38 [1.94, 2.91]; household composition/disability: aOR = = 1.51 [1.26, 1.81]; minority status/language: aOR = 2.03 [1.55, 2.68]; housing type/transportation: aOR = 1.41 [1.16, 1.73]). CONCLUSION: Neighborhood-level social vulnerability is associated with greater risk of non-adherence to scheduled ophthalmology appointments, controlling for individual characteristics. Multi-level intervention strategies that incorporate neighborhood-level vulnerabilities are needed to reduce disparities in access to ophthalmology care.

Bridging the Gap: Engaging Black Men in Lung Cancer Research Through Barbershop Collaboration.

Health disparities persist among Black men, notably in the context of lung cancer and stress-related health outcomes. This study explores these disparities through a community-based participatory research (CBPR) approach, citizen science, and social network theory, leveraging the expertise and trust of Black barbers as community leaders. The purpose is to understand the nuanced connections between stress and lung cancer in this demographic. Engaging 161 Black men across four Chicago neighborhoods, the study successfully collected hair samples and survey data, emphasizing the importance of culturally sensitive recruitment strategies. Findings highlight the effectiveness of the collaboration, showcasing the role of barbershops as community hubs for research. The study concludes by advocating for sustained partnerships with community leaders, emphasizing transparency in research communication, and promoting culturally grounded approaches to address health disparities and enhance research participation among underrepresented populations.

Equity in Cancer and Chronic Disease Prevention through a Multi-Pronged Network Intervention: Works-in-Progress.

The increasing rates of cancer incidence are disproportionately borne by populations that are ineligible for screening and historically marginalized populations. To address this need, our community-centered model seeks to catalyze the widespread diffusion of evidence-based information and resources (e.g., community-based organizations, federally qualified health centers) to reduce the risks of cancer, chronic disease, and other conditions. In this study, we tested whether improving personal health literacy (i.e., confidence in seeking information) and enabling successful information transfer (i.e., intention to share the specific information learned through the program) among community residents could contribute to greater diffusion intention (i.e., number of network members with whom residents plan to share information and resources). The current study used post-intervention surveys, which were administered to Chicago residents who were 18 years or older and had participated in the program. Among the 1499 diverse Chicago residents, improved personal health literacy was associated with greater diffusion intention (ORs = 2.00-2.68, 95% CI [1.27-4.39], p ≤ 0.003). Successful information transfer was associated with greater diffusion, especially for cancer and other chronic disease risk reductions (ORs = 3.43-3.73, 95% CI [1.95-6.68], p < 0.001). The findings highlight the potential gains for health equity through sustainable, scalable, multi-sectoral partnerships.

The Effect of Exposure to Neighborhood Violence on Glucocorticoid Receptor Signaling in Lung Tumors.

Despite lower rates and intensity of smoking, Black men experience a higher incidence of lung cancer compared to white men. The racial disparity in lung cancer is particularly pronounced in Chicago, a highly segregated urban city. Neighborhood conditions, particularly social stress, may play a role in lung tumorigenesis. Preliminary studies indicate that Black men residing in neighborhoods with higher rates of violent crime have significantly higher levels of hair cortisol, an indicator of stress response. To examine the relationship between social stress exposure and gene expression in lung tumors, we investigated glucocorticoid receptor (GR) binding in 15 lung tumor samples in relation to GR target gene expression levels and zip code level residential violent crime rates. Spatial transcriptomics and a version of ChIP sequencing known as CUT&RUN were used. Heatmap of genes, pathway analysis, and motif analysis were conducted at the statistical significance of P < 0.05. GR recruitment to chromatin was correlated with zip code level residential violent crime rate and overall GR binding increased with higher violent crime rates. Our findings suggest that exposure to residential violent crime may influence tumor biology via reprogramming GR recruitment. Prioritizing lung cancer screening in neighborhoods with increased social stress, such as high levels of violent crime, may reduce racial disparities in lung cancer. SIGNIFICANCE: Exposure to neighborhood violent crime is correlated with glucocorticoid signaling and lung tumor gene expression changes associated with increased tumor aggressiveness, suggesting social conditions have downstream biophysical consequences that contribute to lung cancer disparities.

Impact of COVID-19 Pandemic, Social Vulnerability, and Opioid Overdoses in Chicago.

Introduction: This research was undertaken to examine the individual and neighborhood drivers that contributed to increases in opioid overdose deaths during the COVID-19 pandemic. Methods: The incident location and Centers for Disease Control and Prevention Social Vulnerability Index (along with the individual indicators) were then geocoded to 1 of the 77 Chicago Community Areas. Changes in opioid overdose death rates were calculated and compared for each Chicago Community Area using linear regression between 2019 and 2020. Results: Opioid overdose deaths increased by 45% from 2019 to 2020. Chicago Community Areas in the highest 25th percentile of social vulnerability before the pandemic had a 2.8 times higher rate of opioid overdose deaths than Chicago Community Areas in the lowest 25th percentile. The increase in opioid overdose death rate observed from 2019 to 2020 was 10.2 times higher in the most socially vulnerable Chicago Community Areas than in the least vulnerable communities. Chicago Community Areas with the highest degree of social vulnerability had a higher baseline and disproportionate relative increase in opioid overdose death rate compared with the least vulnerable Chicago Community Areas. Conclusions: COVID-19 has revealed the urgent need for policies that better support the social and economic security of disadvantaged communities, particularly for residents who use opioids.

Racial disparities in the pattern of intergenerational neighbourhood mobility.

Neighbourhood context is known to shape one's life chances, but much of neighbourhood disadvantage is passed down from parents to children. The gap in social and economic achievements between Black and White families in the United States may partially be explained by differences in the intergenerational transmission of neighbourhood context. Using census tract socio-economic data, we created a national ranking of US census tracts. We then examined intergenerational neighbourhood mobility using 2828 parent-child pairs from a longitudinal household survey. We found that White children, compared with Black children, were more likely to inherit higher neighbourhood ranks from their parents. Income and education had smaller negative effects on neighbourhood rank for White children than Black children, all other things equal. Black children whose parents were in the bottom 25th percentile neighbourhood rank tended to move up in neighbourhood rank. But by much smaller magnitudes than their White counterparts. Our findings indicate that different patterns of intergenerational neighbourhood mobility between White and Black families may be an important factor for persisting racial disparities in the neighbourhood context.

Qualitative Analysis of Multiple Sources and Dimensions of Stigma Among Older Adults Living With HIV Infection Released From Corrections.

While sources of stigma associated with HIV, incarceration, and aging have been explored separately, the concurrent effects of these multiple sources have been understudied. We conducted in-depth interviews with 48 older adults over 50 years of age with HIV infection who were returning from correctional settings concerning their experiences of stigma. Participants described HIV-related stigma substantially more often than incarceration-related stigma and a greater number of stigma experiences as time passed from release. Anticipated stigma experiences were frequently associated with HIV. Enacted stigma was often related to incarceration. Internalized stigma was associated with both HIV and incarceration. However, participants often described aging as a positive experience of gaining wisdom and control over their life. The findings indicated that multiple sources of stigma affect different dimensions of stigma. Postrelease interventions may benefit from addressing increasing experiences of stigma in the rapidly growing population of older adults living with HIV with a history of incarceration.

Predicting prenatal depression and assessing model bias using machine learning models.

Perinatal depression (PND) is one of the most common medical complications during pregnancy and postpartum period, affecting 10-20% of pregnant individuals. Black and Latina women have higher rates of PND, yet they are less likely to be diagnosed and receive treatment. Machine learning (ML) models based on Electronic Medical Records (EMRs) have been effective in predicting postpartum depression in middle-class White women but have rarely included sufficient proportions of racial and ethnic minorities, which contributed to biases in ML models for minority women. Our goal is to determine whether ML models could serve to predict depression in early pregnancy in racial/ethnic minority women by leveraging EMR data. We extracted EMRs from a hospital in a large urban city that mostly served low-income Black and Hispanic women (N=5,875) in the U.S. Depressive symptom severity was assessed from a self-reported questionnaire, PHQ-9. We investigated multiple ML classifiers, used Shapley Additive Explanations (SHAP) for model interpretation, and determined model prediction bias with two metrics, Disparate Impact, and Equal Opportunity Difference. While ML model (Elastic Net) performance was low (ROCAUC=0.67), we identified well-known factors associated with PND, such as unplanned pregnancy and being single, as well as underexplored factors, such as self-report pain levels, lower levels of prenatal vitamin supplement intake, asthma, carrying a male fetus, and lower platelet levels blood. Our findings showed that despite being based on a sample mostly composed of 75% low-income minority women (54% Black and 27% Latina), the model performance was lower for these communities. In conclusion, ML models based on EMRs could moderately predict depression in early pregnancy, but their performance is biased against low-income minority women.

Examination of provider knowledge, attitudes, and behaviors associated with lung cancer screening among Black men receiving care at a federally qualified health center.

The study's goal was to look at providers' knowledge, attitudes, and behaviors regarding lung cancer screening among Black male smokers served by a federally qualified healthcare center. Participants in the study were interviewed in depth. Participants completed a short (5-10 minute) survey that assessed demographics, training, and attitudes toward lung cancer screening. For quantitative data, descriptive statistics were used, and for qualitative data, deductive thematic analysis was used. This study included ten healthcare professionals, the majority of whom identified as Black (80%) and were trained as advanced practice providers (60%). The majority of providers (90%) have heard of LDCT lung cancer screening; however, participants reported only being "somewhat" familiar with the LDCT eligibility criteria (70%). Despite generally positive attitudes toward LDCT, patient referral rates for screening were low. Barriers included a lack of provider knowledge about screening eligibility, a lack of use of shared decision-making tools, and patient concerns about screening risks. The reasons for the low referral rates varied, but they included a preference to refer patients for smoking cessation rather than screening, low screening completion and follow-up rates among referred patients, and a lower likelihood that Black smokers will meet pack-year requirements for screening. Additionally, providers discussed patient-level factors such as a lack of information, mistrust, and transportation. The study findings add to the body of knowledge about lung cancer knowledge and screening practices among providers in FQHC settings. This data can be used to create health promotion interventions aimed at smoking cessation and lung cancer screening in Black males and other high-risk smokers.

Machine Learning for Digital Scoring of PRMT6 in Immunohistochemical Labeled Lung Cancer.

Lung cancer is the leading cause of cancer death in the U.S. Therefore, it is imperative to identify novel biomarkers for the early detection and progression of lung cancer. PRMT6 is associated with poor lung cancer prognosis. However, analyzing PRMT6 expression manually in large samples is time-consuming posing a significant limitation for processing this biomarker. To overcome this issue, we trained and validated an automated method for scoring PRMT6 in lung cancer tissues, which can then be used as the standard method in future larger cohorts to explore population-level associations between PRMT6 expression and sociodemographic/clinicopathologic characteristics. We evaluated the ability of a trained artificial intelligence (AI) algorithm to reproduce the PRMT6 immunoreactive scores obtained by pathologists. Our findings showed that tissue segmentation to cancer vs. non-cancer tissues was the most critical parameter, which required training and adjustment of the algorithm to prevent scoring non-cancer tissues or ignoring relevant cancer cells. The trained algorithm showed a high concordance with pathologists with a correlation coefficient of 0.88. The inter-rater agreement was significant, with an intraclass correlation of 0.95 and a scale reliability coefficient of 0.96. In conclusion, we successfully optimized a machine learning algorithm for scoring PRMT6 expression in lung cancer that matches the degree of accuracy of scoring by pathologists.