Public Health Data of the People, by the People, for the People: A Public Health of Consequence, June 2023

The author discusses a study by Krieger and colleagues, published within the issue which presents information on the alarming decreases in response rates across six national U.S. surveys in 2020 compared with those in 2019. Topics include people who were more likely to complete surveys than those who did, importance of the application of an equity-focused lens to data collection, and the impact of the COVID-19 pandemic on response rates.

Public Health Practice and Health Equity for Vulnerable Workers: A Public Health of Consequence, May 2023

Structured vulnerabilities that threaten the health of meat- and poultry-packing workers are driven by a complex and complicated host of economic, occupational, social, and health care access-related factors. Recognition of these complexities is a first step. More challenging, yet critical to sustaining a commitment to social justice for these frontline workers, are public health practice initiatives rooted in health equity that work toward eliminating health disparities.In this issue of AJPH, Porter et al. (p. 500) describe implementation of a public health practice initiative aimed at reducing COVID-19 vaccine hesitancy and increasing vaccine uptake among poultry industry workers. This editorial seeks to contextualize this initiative as one investment in a larger constellation of investments that are needed to provide resources and services equally to all members of our society.

Sustaining PrEP Prescriptions at a Safety-Net Hospital in New York City During COVID-19: Lessons Learned.

To understand the impact of COVID-19-related disruptions on PrEP services, we reviewed PrEP prescriptions at NYC Health + Hospitals/Bellevue from July 2019 through July 2021. PrEP prescriptions were examined as PrEP person-equivalents (PrEP PE) in order to account for the variable time of refill duration (i.e., 1-3 months). To assess "PrEP coverage", we calculated PrEP medication possession ratios (MPR) while patients were under study observation. Pre-clinic closure, mean PrEP PE = 244.2 (IQR 189.2, 287.5; median = 252.5) were observed. Across levels of clinic closures, mean PrEP PE = 247.3, (IQR 215.5, 265.4; median = 219.9) during 100% clinic closure, 255.4 (IQR 224, 284.3; median = 249.0) during 80% closure, and 274.6 (IQR 273.0, 281.0; median = 277.2) during 50% closure were observed. Among patients continuously prescribed PrEP pre-COVID-19, the mean MPR mean declined from 83% (IQR 72-100%; median = 100%) to 63% (IQR 35-97%; median = 66%) after the onset of COVID-19. For patients newly initiated on PrEP after the onset of COVID-19, the mean MPR was 73% (IQR 41-100%; median = 100%). Our ability to sustain PrEP provisions, as measured by both PrEP PE and MPR, can likely be attributed to our pre-COVID-19 system for PrEP delivery, which emphasizes navigation, same-day initiation, and primary care integration. In the era of COVID-19 as well as future unforeseen healthcare disruptions, PrEP programs must be robust and flexible in order to sustain PrEP delivery.

Abortion Care Is Health Care: A Public Health of Consequence, September 2022

[...]although poor women saw a 26% decrease, women living at or above 200% of the poverty level saw a 36% decrease in abortions. [...]between 2011 and 2015, conservative state legislators enacted 288 restrictions on women seeking abortion care (e.g., 24-hour waiting periods, mandatory counseling, bans on abortions after the first trimester, and banning medication abortion) as well as on abortion care providers (most commonly referred to as "targeted regulation of abortion providers," or TRAP laws, that mandated a number of unnecessary and onerous burdens on providers;https://bit.ly/3NYKZLM). [...]it is possible that declines in overall fertility were related to the recession, particularly fertility among adolescents,2 women already living in poverty, and women who already had children.3 Second, use of long-acting reversible contraception increased from 6% in 2008 to 12% in 2012.4Third, women residing in Medicaid expansion states had greater access to contraception as part of their insurance coverage than did women in nonexpansion states. [...]expansion of access to comprehensive sexual and reproductive health care by expanding insurance coverage for these services is being proposed in several states.

Food Insecurity, Financial Hardship, and Mental Health Among Multiple Asian American Ethnic Groups: Findings from the 2020 COVID-19 Household Impact Survey.

Background: The COVID-19 pandemic has adversely impacted the financial and mental well-being of U.S. adults, however, Asian American (AA)-specific data are lacking, particularly disaggregated by AA ethnicity. Our objective was to evaluate food insecurity (FI), financial hardship, and mental health among disaggregated AA ethnic groups during the COVID-19 pandemic. Methods: We used data from the COVID-19 Household Impact Survey, a sample of 10,760 U.S. adults weighted to reflect the U.S. population (weighted n: 418,209,893). AA ethnic categories were based on self-report (n=312, 5.1%; weighted n: 21,143,079) and provided as follows: Chinese American, South Asian, Filipino+Vietnamese, and Japanese+Korean. We estimated the prevalence of FI and financial hardship across AA ethnic categories. We estimated the demographic determinants of FI, including financial hardship, among AA adults using multivariable Poisson regression. We calculated the prevalence of mental health symptoms among food-insecure AA adults, as well as among AA adults experiencing both FI and financial hardship. Results: Overall, the prevalence of FI and financial hardship among AA adults was highest among Filipino+Vietnamese adults (52.9-24.5%) and lowest among Japanese+Korean adults (13.9-8.6%). Determinants of FI among AA adults included Filipino+Vietnamese ethnicity (adjusted prevalence ratios [aPR]: 2.81, 95% confidence interval [CI]: 1.49-5.29), being widowed/divorced/separated (aPR: 3.14, 95% CI: 1.37-7.23), high school graduate only (aPR: 3.46, 95% CI: 1.96-6.11), having low income <$30,000 (aPR: 2.54, 95% CI: 1.27-5.06), and living in rural areas (aPR: 7.65, 95% CI: 1.17-50.14). Eighty-one percent and 63% of AA adults with anxiety and hopelessness at least 3-7 days/week, respectively, were food insecure and experiencing financial hardship. Conclusion: Disparities exist in FI and financial hardship among AA adults, particularly Filipino+Vietnamese adults, and are associated with increased self-reporting of feelings of anxiety and hopelessness.

Confronting and Ending Food Insecurity During and Beyond the Pandemic: A Public Health of Consequence, July 2022

[...]we have substantial information across multiple disciplines on the drivers and consequences of food insecurity. According to the US Department of Agriculture's Economic Research Service, food insecurity among US households with children increased from 13.6% in 2019 to 14.8% in 2020, and this increase was greater in communities of color.1 For example, Dubowitz et al. found that low-income African Americans residing in food desert neighborhoods experienced greater increases in food insecurity between 2018 and 2020, from 20.7% to 36.9%, compared with the general population.2 The impact of food insecurity on health care utilization during the pandemic is equally disturbing. [...]supporting local farmers markets that accept produce vouchers will, in addition to increasing access to food banks and mobile pantries for older adults and individuals with limited mobility, enable local communities to meet and sustain local needs in providing healthy produce.

The Future of the Public Health Data Dashboard

[...]a dashboard analyst can easily provide visualizations of epidemiological models that predict disease transmission dynamics based on some set of preidentified metrics-information that is useful to a policymaker or public health official but has less utility to a private citizen trying to determine their individual risk level based on contact with their social networks. [...]we are in an era in which vast amounts of surveillance data are being rapidly collected and quickly integrated in dashboards. For calculating population denominator rates, most dashboards use residential population, but during mass social disturbances, migration is a common feature. Besides rate calculation, there could be closer attention paid to what is the unit of intervention or action. [...]short, mobile-friendly videos and storytelling are powerful paradigms that reach large audiences and can help people

Social Engagement and Mental Health Symptoms Across Asian American Ethnic Groups During the COVID-19 Pandemic.

Background: To examine social engagement and mental health symptoms during the COVID-19 pandemic across Asian American (AA) ethnic groups. Methods: Data from three waves of the nationally representative COVID-19 Household Impact Survey (4/20/2020-6/8/2020) were used to describe social engagement and mental health symptoms during the pandemic. Associations between mental health and social engagement were assessed via multinomial logistic regression. Results: In this sample of 312 AAs (36.9% Chinese American, 30.9% South Asian American, 20.1% Filipino/Vietnamese American, and 12.0% Japanese/Korean American), daily communication with neighbors declined for Chinese, South Asian and Filipino/Vietnamese Americans but increased for Japanese/Korean Americans (P=.012) whereas communication with friends/family increased only for Filipino/Vietnamese, Japanese/Korean and South Asian Americans (P<0.001). Differences in self-reported symptoms of anxiety, depression, loneliness, and hopelessness were observed across AA ethnic groups. In adjusted models, lower social engagement was associated with frequent (3-4 days/week) depressive symptoms during the preceding week (cOR:3.26, 95%CI:1.01-10.5). This association was heightened for Asian men (cOR:14.22, 95%CI:3.62-55.8). Conclusions: Heterogeneity of social engagement and mental health symptoms across AA ethnicities was observed. Understanding associations between social engagement and mental health within different communities is necessary to provide culturally and linguistically appropriate mental health treatment and care.

Ending Homelessness and Advancing Health Equity: A Public Health of Consequence, March 2022

In parallel, pressing questions for public health advocates, policymakers, and community members seeking to end homelessness will include determining which populations to prioritize for intervention and what interventions will yield the most benefit to intervene on this critical driver of health inequity. [...]there are sufficient resources to end homelessness in the United States, communities will struggle with howto allocate limited homeless services. [...]begins the editorial by Shinn and Richard in this issue of AJPH (p. 378), describing, in the absence of necessary resources, which metrics communities can consider employing to determine how homeless services ought to be allocated. Rather, a comprehensive federal housing policy that provides multilevel solutions to ensure long-term housing support is necessary to narrow the racial and sociostructural inequities in homelessness.3 Long-term and sustainable change requires overhauling local eviction laws in states that have highly punitive eviction policies, enacting rent control in urban neighborhoods where housing prices have increased dramatically and far outpaced low- and middleincome wages and increased tenant protections, and significantly expanding housing vouchers as well as greater investment in affordable housing stock to make housing available for individuals and families.

Dental Radiographs for Age Estimation in US Asylum Seekers: Methodological, Ethical, and Health Issues.

Unaccompanied migrant children seeking asylum status in the United States are often forced to undergo dental radiographs, or x-rays, to verify that they are younger than 18 years.The application of third molar dental radiographs is methodologically flawed and should not be employed as a determinant of chronological age. Furthermore, the use of such tests without obtaining informed consent from either the youth or an objective advocate is unethical.Finally, the legal and health consequences of these inappropriately applied tests are severe and jeopardize the safety and security of these vulnerable minors.